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Diagnosis and Treatment of Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a term used to describe a painful intraoral condition that affects the tongue, lips, and oral mucosa. Primary symptoms of BMS include burning, itching, and painful sensations in the absence of significant mucosal abnormalities.1 While burning may occur at other nonoral mucosal sites, it most often occurs in the oral cavity and does not preclude similar symptomology at nonoral sites. This sensation may affect the entire oral cavity or may be limited to certain areas (eg, the tongue or portions of the mucosa). When BMS affects specific areas, a bilateral distribution pattern typically occurs, and the symptoms may last from several months to a year.

Burning mouth syndrome is more commonly diagnosed in women than in men (16:1). Women diagnosed with BMS are, on average, ten years older than men, which demonstrates that its occurrence may be related to an imbalance of the female sex hormones commonly associated with menopause. When BMS patients were compared to non-BMS patients of similar age and gender, it was found that BMS patients reported a significantly higher severity of all menopausal symptoms.

Patients with extended complaints of BMS are also more likely to suffer from depression, which may be a result of the chronic painful sensations encountered with BMS. Although a correlation between both conditions has been noted, there is no indication that BMS is the result of depression. A significant portion of patients with a pyschogenic cause of BMS have a distinct fear of contracting oral cancer, and this fear may be related to the state of hypersensation of the oral tissues.1,2

In addition to oral cancerophobia, BMS may be associated with a variety of factors. These factors can be systemic (eg, diabetes, dry mouth, deficient levels of folic acid, iron vitamins B1, B2, B6, and B12) or local (eg, lip biting, parafunctional habits). While faulty dentures or oral candidiasis occasionally have been reported to cause BMS, the presence of mucosal abnormalities in these instances is not known. By definition, the presence of mucosal abnormalities would eliminate a diagnosis of BMS.

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Patients with BMS can be classified into three groups: Type 1 patients report a persistent, daily burning sensation that progresses in intensity as the day develops; Type 2 patients report a constant burning sensation that is present upon awakening from sleep without increasing intensity; and Type 3 patients report that pain does not follow a specific pattern or occur in the usual intraoral sites.

As the causes of BMS are multifactorial, the approach to treatment of this condition is also multifactorial. In patients with only serum deficiencies, correction of abnormally low levels of B vitamins, iron, or folate will often cause the symptoms of BMS to disappear. In developed nations, however, serum deficiencies are rare due to a varied and fortified diet. Patients suffering from BMS quite often benefit from very low doses of tricyclic antidepressant medications. It is important to note that these agents are used to block neurologic pain and are not given in dosages strong enough to affect psychological conditions.2 The correction of faulty dental prostheses in patients has been reported to reduce BMS symptoms. The patient's awareness and elimination of oral parafunctional habits are also crucial in the reduction of BMS symptoms.

Burning mouth syndrome is a frustrating ailment for both patient and healthcare provider, as many of its symptoms are nonspecific and its causes are multifactorial and poorly understood. Although BMS can be effectively eliminated with proper treatment, healthcare practitioners may wish to refer patients with these symptoms to oral medicine specialists for appropriate treatment.

*Director of Hospital Dentistry, Division of General Dentistry, East Carolina University School of Dental Medicine, Greenville, NC



  1. Lamey PJ, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J 1988;296(6631):1243-1246.
  2. Muzyka BC, DeRossi SS. A review of burning mouth syndrome. Cutis 1999;64(1):29-35.
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