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Burning mouth syndrome (BMS) is characterized by a burning sensation in the mouth and/or tongue. It is often accompanied by dry mouth and/or a bitter or metallic taste in the mouth. In some cases, this condition may be associated with vitamin B12 deficiency, oral yeast infection (candida albicans), or irritation from dentures (dental prosthetics). The burning sensation may be aggravated by hot, spicy foods but is not caused by them.
The pain of burning mouth syndrome is usually felt in the front and rear of the mouth (oropharynx). The pain may be accompanied by taste phantoms; that is, taste sensations that occur in the absence of stimuli. The patient will report dryness of the mouth or a bitter taste when there is nothing present to generate the response.
The pain comes on in the morning and progresses during the day, reaching a peak usually in the late afternoon. It may be sufficiently severe to be compared to the pain of a toothache. Although the pain may subside during the rest of the day, it may still be sufficient to interfere with sleep.
The pain of BMS may be relieved by eating, and is typically localized in one or more sites in the mouth, including the first two-thirds of the tongue, the forward part of the upper palate (anterior hard palate), and/or the soft tissue of the lower lip. Taste phantoms such as dry mouth (xerostomia) and/or disturbances of taste such as persistent bitterness or metallic tastes are not uncommon.
Burning mouth and/or tongue syndrome may be the first symptoms of vitamin B12 deficiency. In addition to vitamin B12 deficiency, the symptoms may be attributed to a Candida albicans infection or irritation from dentures.
The cause of burning mouth and/or burning tongue syndrome is unknown when it cannot be attributed to vitamin B12 deficiency, candida infection or another cause mentioned above. None of the attempts to explain the causes of BMS has, as yet, been able to explain the course of the disorder, the symptoms, or the spontaneous remissions that occur in about 50% of cases.
Some of the causes (etiology) proposed for BMS include: nutritional deficiencies, e.g. vitamin B12; major depression; an increase in taste sensation for unexplained reasons; menopause, since 90% of affected women are postmenopausal, and an injury or disorder of a facial nerve, (trigeminal nerve neuropathy).
Burning mouth syndrome may be precipitated by yeast infections. These infections are treatable with certain oral antifungals such as nystatin, and/or clotrimazole. Yeast is present in the mouth of all healthy people, but in burning mouth syndrome it may grow faster than the normal bacteria that ordinarily keep yeast in check. Some of the reasons that may cause yeast to grow more rapidly than usually is the case are other underlying disorders (e.g., Sjogren's syndrome), wearing dentures at night (particularly upper dentures), not cleaning dentures properly, or use of antibiotics that kill normal bacteria, permitting yeast to grow.
BMS is more common in women than in men by a ratio of about 7:1. Women past the onset of menopause are more commonly affected by burning mouth syndrome. The disorder often tends to affect denture wearers. When vitamin B12 deficiency is identified, it is important to treat it promptly. The disorder is estimated to affect more than one million persons in the USA.
Symptoms of the following disorders may be similar to those of burning mouth syndrome. Comparisons may be useful for a differential diagnosis:
Glossitis is an acute or chronic inflammation of the tongue. Geographic tongue, also known as "benign migratory glossitis" is characterized by denuded smooth areas which may be painful. Symptoms of this disorder include a slick, glossy or glazed tongue. (For more information, choose "geographic tongue" as your search term in the Rare Disease Database.)
Vitamin B12 deficiency is characterized by an abnormally low level of this vitamin in the blood. The disorder can be caused either by a poor diet, or inadequate absorption (e.g., pernicious anemia or bowel surgery) or utilization of B12. Changes in the blood and central nervous system may occur. A burning sensation in the mouth is one of the first symptoms of bitamin B12 deficiency. Injection of this vitamin usually cures the disorder if the underlying cause is also being corrected. Since excess amounts of vitamin B12 are stored in the liver for a long period of time, onset of burning mouth syndrome may be gradual with other symptoms following much later. (For more information, choose "vitamin B12 deficiency" as your search term in the Rare Disease Database.)
Because there are no visible abnormalities to be found or seen in the mouth, diagnosis of BMS is difficult.
The strategy of treatment is twofold: treating the potential causes (of the differential diagnosis), and treating the pain.
Antifungal agents are used to treat the thrush (oral candidiasis), and estrogen replacement has been used for the treatment of menopause. Recent concerns about the use of estrogen replacement must be kept in mind by both the patient and the doctor. Vitamin B deficiency is commonly treated by supplements, and dry mouth may be treated with preparations that increase saliva production.
Medications designed to reduce pain, or the perception of pain, include amitriptyline (Elavil) at bedtime, clonazepam (Klonopin) at bedtime, gabapentin (Neurontin) at bedtime.
If patients prove to be allergic to substances in their dentures, another set should be made from other materials. When allergies to other substances cause this disorder, conventional treatment for allergy is recommended if contact with the substance cannot be avoided.
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FROM THE INTERNET
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Report last updated: 2008/03/18 00:00:00 GMT+0