This document outlines the diagnostic procedure and management of burning mouth syndrome (BMS). It begins with the symptoms of BMS and differentiates between primary and secondary BMS. A diagnostic algorithm is presented which involves examining the patient's medical history and conducting oral exams to rule out other conditions. If no causative factors are found, a diagnosis of primary BMS is made. Treatment options are then discussed, including topical medications, systemic drugs, and cognitive behavioral therapy to manage pain and symptoms in primary BMS cases. Secondary BMS may be treated by addressing any identified underlying causes.

1. 1

2. 2

3. 3

4. 4

5. A. Oral
mucosa
pain
B.
Dysgeusia
C.
Xerostomia
5

6. 6

7. 7

8. ONSET
8

9. 9

10. 10

11. 11

12. 12

13. 13

14. 14

15. 15

16. Local factor
Psychological
factor
Systemic
factor
x Y?
neuropathic changes
central sympathetic
Sensitization alteration of abnormal
segmental inhibitory activity
control
Peripheral ectopic
Sensitization activity
BMS
Primary BMS Secondary
BMS
16

17. Pain in the
mouth
present
daily
persisting
for most of
the day.
Oral
Mucosa is
of normal
appearance.
Local and
systemic
diseases
have been
excluded.
17

18. (I) Algorithm for BMS
Diagnosis
(II) Management of Oral Complications
(a) Anamnesis
Oral Burning or Pain-like
(bilateral) (unremitting)
(>6months)
(b) Oral Mucosal
Examintion
(c) Initial Diagnosis
BMS
Changes
in the
ORAL MUCOSA
Haematological
exams biopsy
DIAGNOSIS
of the specific
condition
Treatment
of the
specific
condition
Still
pain
Complicated
BMS
Relief of
the
condition
Relief
of the
pain
NO
BMS!
Pain
objective
evaluation
Microbiological
oral culture
Epicutaneous
patch test
Dental
examination
(-)
(+)
18

19. Information for patients & psychological
support
Causative therapy in “secondary BMS”
Supportive care in “primary BMS” : the
control of pain and associated symptoms
Periodic follow-up
19

20. 20

21. BMS
Diagnostic Procedure
Dental/ Denture
Examination
Taste/
Perception
Evaluation
Sialometry/
Sialochemistry
Nutritional
Status
Blood Glucose
Level
Estrogen/
Progesterone
Levels
Parafunctional
habits
Dysgesuia/
Sensory
Disorder
Salivary
gland
disorder
Nutritional
Deficiencies
Diabetes
Melitus
Menopausal
Disorders
Final Diagnosis
Secondary BMS
Primary
BMS
Psychological
Assesment
yes
no
no no
no no
no
yes
yes
yes
yes yes
yes
no
Psychological
disorders
21

22. Oral thrush
medication
Vitamin-B
suppliments
Cognitive
behavioral
therapy
Specific oral
rinses or
mouthwashes
Certain
anti-depressants
Anti
convulsant
drugs
22

23. Medication Topical
Administraion
Dosage
Drug Systemic
Administration
Dosage
Capsaicin 3-4 times/day Chlordeizepoxide 15-30 mg/day
Clonazepam 0.5 mg/day Clonazepam 0.25-3 mg/day
Diazepam 2-30 mg/day
Amisulpride 50 mg/day
Sertraline 50-100 mg/day
23

24. 24

25. 25

26. 


26

27. References
….
 Critical Reviews in Oral Biology &
Medicine, Update on Burning
Mouth Syndrome: Overview and
Patient Management; A. Scala, L.
Checchi, M. Montevecchi, I. Marini
and M.A. Giamberardino
 Burning Mouth Syndrome:
Recognition, Understanding, and
Management, Gary D. Klasser,
DMD,*, Dena J. Fischer, DDS,
MSD, MSa, Joel B. Epstein, DMD,
MSD, FRCD(C), FCDS(BC), FDS
RCSEdina,b
 Drug-induced burning mouth
syndrome: a new etiological
diagnosis; César Salort Llorca ,
María Paz Mínguez Serra ,
Francisco Javier Silvestre
27

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