Understanding Burning Mouth Syndrome: Causes, Symptoms, and Management

Burning Mouth Syndrome (BMS) is a frequently undiagnosed condition characterized by a range of symptoms such as abnormal taste, coated teeth, and feelings of scalding or peeling in the mouth. Often affecting women and menopausal individuals, BMS can lead to frustration, concern, and social impact. This article explores the classical features, different names, affected sites, and timing of BMS, shedding light on a condition that is often misunderstood and overlooked.

• Burning Mouth Syndrome
• Oral Health
• Symptoms
• Management
• Undiagnosed

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1. Burning Mouth Syndrome - a frequently unrecognised condition Dr Tim Poate Consultant in Oral Medicine King s College Hospital The Lister Hospital, Chelsea

2. Causes of a sore mouth Mucosal diseases (Lichen planus) Anaemia Trauma Ulcers Burning Mouth Syndrome Infections (thrush) Drugs Geographic tongue Xerostomia Cancer

3. BMS symptoms Burning Saliva feels different Abnormal taste

4. BMS symptoms 2 Raw Teeth are coated Scalded Peeling Bad breath Mouth feels dirty Feeling of cracks / ulcers Feeling of sandpaper Lumpy

5. Different names for BMS Burning Mouth Syndrome Oral dysaesthesia Burning tongue Glossodynia Stomatodynia

6. Sites affected 77% 33% 31% 25% 13% 12% 10% 6% Tongue Palate Gingiva Lips Mucosa Throat FOM Other

7. BMS classical features Usually women Usually menopausal / post-menopausal Have often had the symptoms for months / years Have often seen many doctors / dentists / specialists Often have been repeatedly told that nothing is wrong May have been given repeated courses of antibiotic or antifungal therapy without benefit

8. BMS classical features Often left thinking that everyone thinks that you are making it up or it is all in the head Often think that there is a serious cause that has not yet been found Often worried that it is due to cancer Often has become a considerable cause of frustration, concern, anger, depression with a considerable impact on mood, social life, relationships and enjoyment of life.

9. BMS - timing Type 1 Pain-free on awakening Burning commences in late morning Increase in severity throughout day Reaches a peak in the evening. Type 2 Continuous symptoms throughout the day Type 3 Intermittent symptoms

10. BMS common associations Stress Depression Other chronic pains Anxiety Irritable bowel Syndrome Chronic fatigue

11. BMS causes Neuropathic Hormonal Psychogenic

12. How common is BMS? 1427 subjects 758 Women 669 Men Age range 20-69 PDH service registers Sweden Examined & interviewed Diagnosed with BMS BMS % 6 Bergdahl, Bergdahl Joral Pathol Med 1999; 28:350-4. 5 5.5 4 3 3.7 2 1.6 1 0 Men Women Total

13. What investigations are typically performed? Saliva test / swab Assess saliva flow rate Exclude raised candida count Blood test Exclude anaemia or haematinic deficiency Others - as indicated to exclude other causes

15. Treatment Discussion & reassurance Symptomatic Drugs Psychological

16. BMS - Treatment Discussion & reassurance Correct diagnosis Reassurance Explanation Correct any abnormal findings (eg candida, iron) Stress reduction Relaxation

17. BMS treatment Discussion & reassurance Symptomatic Drugs Psychological

18. Antidepressant treatment for BMS Low dose Minimal side effects Essential information for BMS patients - Needs to be taken daily for many months May take 2-3 months for effect to begin Not addictive When result achieved, and after maintaining results for several months, may be stopped / reduced / continued

19. Spontaneous remission Burning Mouth Syndrome: a retrospective study investigating spontaneous remission and response to treatments. Sardella al. Oral Diseases (2006)12,152-5. 4% 19% Complete remission 28% Moderate improvement 49% No change Worsening

20. BMS data for patients with over 3 months follow up at KCH 11% 22% Complete resolution >50% improvement 19% <50% improvement 48% No improvement

21. BMS data for patients with over 3 months follow up at KCH 7 6.7 6 5.8 5.7 5 4.3 4 3.7 3 2.8 2 1 0 Initial visit Visit 2 (3 months) Visit 3 (6 months) Visit 4 (12 months) Visit 5 (16 months Visit 6 (21 months)

22. What achieves good results ? Discussion & reassurance Symptomatic treatment Drugs - explanation Psychological therapy - availability

23. Annual BMS Patient Education Day King s College Hospital, London

24. Burning Mouth Syndrome Very distressing condition despite normal appearance of mouth Condition with considerable impact on sufferer and family Sufferers have often gone years undiagnosed despite seeing many healthcare professionals Correct diagnosis and reassurance (especially that cancer has been excluded) is vital Steps to reduce stress and increase relaxation may help Treatment is available Results may take months or even years to achieve Pain often not completely resolved Halving the severity of pain is a good result

25. Summary Increased awareness about Burning Mouth Syndrome in Jersey Consider BMS in patients with symptoms in absence of clinical findings Exclude other causes of a sore mouth - candidosis, anaemia, mucosal disease Reassurance Provide symptomatic treatment Consider associated factors stress, anxiety, depression Consider drug therapy, psychological therapy Consider referral

26. Burning Mouth Syndrome Dr Tim Poate King s College Hospital, London The Lister Hospital, Chelsea t.poate@nhs.net www.oralmedicinelondon.co.uk