Burning mouth syndrome is characterized by a persistent burning pain in the mouth without any visible abnormalities. It mainly affects middle-aged or older women and the pain is typically described as burning. No organic cause can be found and the pain has no aggravating or relieving factors. Treatment is difficult but antidepressants and cognitive behavioral therapy appear to help many patients by addressing the associated anxiety and depression.

1. Burning mouth syndrome
Dr. Ishfaq Ahmad
BDS,BCS,MCPS,MS

2. Features
Middle-aged or older women are mainly affected
No visible abnormality or evidence of organic disease
No haematological abnormality
No candidal or bacterial infection
Pain typically described as ‘burning’
Persistent and unremitting soreness without aggravating or relieving
factors, often of months or years duration; no response to
analgesics

3. Features
Bizarre patterns of pain radiation inconsistent with neurological or
vascular anatomy
Sometimes, bitter or metallic taste associated
Associated depression, anxiety or stressful life situation
Obsession with symptoms may rule the patient’s life
Constant search for reassurance and treatment by different
practitioners
Occasionally, dramatic improvement with antidepressive treatment

4. Features
• More than 80%, are female and older than 50 years.
• Symptoms may affect the whole mouth, or only the tongue may be sore.
• The floor of mouth is characteristically not involved.
• The pain is typically described as burning, sometimes as tingling or
‘raw’, and the sensation is persistent, unremitting and usually of long
duration.
• It is bilateral and has no aggravating or relieving factors.
• Accompanied by a metallic, bitter or unpleasant taste
• Sensation of dryness despite normal salivary flow.
• Spicy foods and flavoured toothpastes often aggravate the symptoms.

5. CLASSIFICATION
BMS has been subdivided into three general types, with TYPE 2
being the most common and TYPE 3 being the least common
Type 1: symptoms not present upon waking, and then increases throughout
the day
Type 2: symptoms upon waking and through the day
Type 3: no regular pattern of symptoms

6. Diseases that must be excluded as possible
causes of burning mouth symptoms
• • All visible mucosal disease
• • Erythema migrans
• • Candidal infection
• • Iron deficiency anaemia or subclinical deficiency
• • Vitamin B12 and folate deficiency
• • Xerostomia
• • Menopausal symptoms
• • Gastro-oesophageal reflux

7. Diseases that must be excluded as possible
causes of burning mouth symptoms
• • Diabetic neuropathy
• • Hypothyroidism
• • Dental, dentifrice or food irritants
• • Multiple sclerosis
• • Drugs
• • Angiotensin converting enzyme inhibitors
• • Angiotensin receptor blockers
• • Antiretrovirals nevirapine and efavirenz
• • Antiepileptic topiramate

8. Association
There is a close association with anxiety, depression and other
diseases with a psychogenic component but whether these are
causative or secondary to the pain is unresolved.

9. Treatment
• Treatment is difficult.
• Reassurance and explanation to provide a realistic patient expectation is
essential.
• Antidepressants appear to help most patients
• Cognitive behaviour therapy
• Anxiolytics
• Topical capsaicin
• Hormone replacement therapy
• Topical analgesics
• Pentoxifylline
• Fluorocitrate
• Follow up for monitoring and support is required.

10. At A Glance