Burning Mouth Syndrome (BMS) is a relatively unknown and commonly misunderstood syndrome within the medical world. It is characterised by an intense burning sensation in the mouth and tongue and it most prevalent amongst postmenopausal women. In fact, 95% of BMS sufferers are postmenopausal women. If it is found it premenopausal women or in men the pain will often be a result of a serious underlying medical condition.
Diagnosing BMS can be tricky and it requires a lot of differential diagnosing. Traditional treatments have failed for a number of reasons. For example, if a sufferer presents to a GP the traditional diagnosis would involve prescribing a short course of antifungals. This fails, as BMS doesn’t result in the presentation of candida. The patient then returns and is referred to an eye, mouth and throat specialists, dermatologists and gastroenterologists.
If the patient decides to see a dentist the dentist may feel the irritation is the result of a denture or filling that has come loose. Unfortunately, this can often exacerbate the issue and increase the discomfort of the patient.
The problem with these traditional treatments is that they don’t involve a comprehensive enough diagnosis process. A proper diagnosis process should run as follows:
- Proper Understanding of How the Tongue and Mucosa Function – The mouth is a harsh environment and the filiform and fungiform pillipae that sit on the dorsal surface of the tongue are forced to constantly regenerate themselves. When these pillipae are in the process of regenerating the tongue will generally be redder and more sensitive. Any deficiencies make this process more difficult and slow down the regeneration process.The tongue is also covered by lymphoid tissue that has the highest metabolic rate and turnover rate of any cell in the body meaning the tongue and the mouth are in a constant process of breakdown, change and regeneration.
- Oral Exam – A proper oral exam will take into account that the tongue and mouth may look normal even though the patient is experiencing pain and swelling. It will also understand that localised lesions are more likely to be a result of trauma or mucosal pathology than BMS.
- Structural Medical History – BMS is most likely secondary to systemic issues and hematologic, nutritional, dermatologic, endocrine and psychogenic investigations should be made before a treatment plan is decided on.
Hematologic: A complete picture blood test should be conducted focusing on vitamin B12, zinc, magnesium and fasted serum iron. In 10% of cases a blood test will provide the answer. Iron deficiency is the most common cause so before an iron supplement is prescribed it’s important that bloody bowel cancer and other more serious cases of iron deficiency are ruled out.
Nutritional: BMS caused by a nutritional problem will be rare in Australia, expect in the case of vegans and recently arrived migrants and refugees. However, quality of food isn’t the only cause of nutritional problems so malabsorbtion and bowel disorders do need to be checked for.
Dermatologic: A skin history should be performed and all lesions should be biopsied and for histopathology and immunofluorescence. Remember, lesions are not BMS so it’s important not to disregard any irregularities as mere irritations.
Endocrine: Although BMS is most prevalent amongst postmenopausal females it is not a hormonal condition and the increase or cessation of hormone replacement therapy can either worsen or help with BMS. Hyperthyroidism, however, should be checked for and eliminated before the diagnosis continues.
Psychogenesis: People suffering from BMS will often be worried about having cancer. Patient history such as smoking, alcohol consumption and anaemia should be checked for. Patients also need be reassured that their BMS is not contagious and they can behave as they always would around their family and loved ones. Antidepressants may help with the anxiety and pain that BMS causes but it can also exacerbate the problem as antidepressants can often dry out the mouth.
Historically the success rate for treating BMS has been low. If you suffer from BMS or you are a medical professional it’s important you liaise or refer your patient to a BMS specialist such as maxillofacial or oral surgeon. New developments have linked BMS to nerve endings and the anti-epileptic drug Clonazepam has been used to successfully treat 80% of cases.
This from of treatment should only ever be used a last resort as BMS is rarely a stand-alone condition. Once a structured medical history has been undertaken and all possible serious diseases investigated and eliminated this form of treatment is a fantastic option for sufferers but it can never be used in place of an exhaustive medical investigation.
Please contact us if you have questions about Burning Mouth Syndrome or if you would like to book an appointment with a specialist in Melbourne.