diease

Burning Mouth Syndome


OVERVIEW OF Burning Mouth Syndome :

Burning mouth syndrome (BMS) is a condition that causes a sensation of the burning feel in your mouth. The sensation can be strated anywhere in the oral cavity and it might spreads to the surrounding regions inside the mouth. Common areas  include  roof of your mouth, tongue, and lips. This condition can become a chronic, everyday problem, or it may occur periodically.


EPIDEMIOLOGY :

it is common among the women and the age group is above 50 years of age.


CAUSES :

Candida infection

Denture wearers

Xerostomia

Parafunctional habit such as tongue thrusting,lip biting and nail biting

Nutritional deficiency disordes such as iron deficiency anaemia,  vitamin deficiency

Hormonal changes during menopause , pregnancy

Thyroid and parathyroid deficiency deficiency

Chordae typamni dysfuction


PATHOPHYSIOLOGY :

In the pathogenesis of burning mouth syndrome central and peripheral neuropathies plays an vital role. The psychological role might also cause the disesase.

The lingual mucosa exhibits  a reduced number of small diameter of nerve fibers. These nerve fibers shows the upward regulation of the nerve fibers and receptors activity resulting in the burning mouth syndrome.

TRPV1 channels are mostly found in nociceptive terminals of peripheral Aδ and C fibres but also centrally in the dorsal root and trigeminal ganglia. They respond to chemical irritants including the chilli pepper ingredient capsaicin . P2X3 ion channel receptors are expressed by a subpopulation of small-diameter primary nociceptors in the trigeminal nervous system and when activated by adenosine triphosphate (ATP) they can evoke a sensation of burning pain.

It also has been suggested that the downward regulation of the central dopaminergic pathways might also tends to show the effects of burning mouth syndrome.  The persistent peripheral neuropathy causes spontaneous excitation of the neurons

There may also be a decrease in the functional activity of the GABA-mediated pain-inhibitory interneuron circuits in the dorsal horn of the spinal cord which under physiological circumstances inhibit the glutamate/NMDA-mediated central sensitization, possibly contributing to the neuropathic pain of BMS.

Thus, central sensitization characterised by structural and functional neural plasticity results in increased excitability and increased tonic activity of central nociceptive neurons, playing an important role in the pathogenesis of BMS . However, surprisingly, despite the possible roles of central sensitization and of psychogenic factors such as anxiety or depression in BMS neuropathic pain, it appears that, in persons with BMS, the co-occurrence of other chronic neuropathic pain disorders (central sensitivity syndromes) including fibromyalgia, atypical facial pain, trigeminal neuralgia, temporomandibular joint pain, back pain, and vulvodynia is rare. This suggests that the neural pathogenic mechanisms of BMS are distinct, probably localised somewhere in the trigeminal nerve pathway 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Glossodynia- burning sensation the tongue(glosso-tongue)

Glossopyrosis

Stomatodynia-burning sensation of the mouth(stomato-mouth)

Stomatopyrosis

Scalding feel

Tingling feel in the mouth

Altered taste sensation

Psychological thoughts


DIAGNOSTIC :

Diagnosis of burning mouth syndrome:

 The following is the SCALA criteria which aids in the diagnosis of Burning Mouth Syndrome in 2003:

Fundamental criteria:

1)Daily deep burning sensation is present in the mouth

2)Pain of atleast 4-6 months

3)And constant increase in the intensity of the pain

4)Characteristic symptoms might get subsides or decrease in the tingling sensation is felt on ingeation of the after the food or drinking water.

Additional criteria:

5)  no interference with the sleep

6) T he occurrence of other oral symptoms sucha dysgeusia with xerostomia

7) sensory changes or chemosensory alterations

8)psychopathological change or mood alterations that translates the patients personality disorder.

 

Other lab diagnosis:

Fungal culture for the isolation of candidal organisms from the tongue

Complete blood count

Serum ferritin concentration

Serum Iron concentration

Iron binding capacity

Circulating levels of vit b12, zinc

Glycaemia- that is the increase in the blood glucose level

Sialometry

Allergic epicutaneous test

Test for the levels of serum estradiol levels in women

 


TREATMENT AND PROGNOSIS :

Acute cases:

Topical:

A) Capsaicin gel 0.025%

B) Alpha lipoic acid as mouthrinse

Systemic:

Multivitamins-B 12 ,methylcobalamine and folic acid.

Chronic cases:

Systemic:

  1. Amitryptiline 25mg (b.i.d) for 15 days.
  2. Gabapentin 300mg(t.i.d)
  3. Alprazolam 0.25mg(b.i.d)
  4. Clonazepam 2mg (o.d) for 15 days
  5. Nortriptyline 25 mg (o.d) for more than 3 months

 

Sialologues:( drugs increasing the salivary flow)

Pilocarpine ,  carvemeline

 


PROGNOSIS :

One half to two thirds of the patient on therapeutic period might show good prognosis within a week or month.


PREVENTION :

  • Suck on small ice chips throughout the day to lessen the burning sensation.
  • Drink or sip cold liquids throughout the day to relieve mouth pain. Some people experience relief after drinking.
  • Avoid acidic foods, like citrus fruits.
  • Avoid food and drinks that worsen or trigger the burning sensation. Limit your consumption of hot beverages and spicy foods. Monitor your symptoms after smoking or consuming alcohol. Both actions can worsen BMS. Keep in mind that medications containing alcohol can also worsen symptoms.
  • Change your toothpaste. If burning worsens after brushing your teeth, switch to a toothpaste specifically for people with mouth sensitivities, or use baking soda as a toothpaste or mouth rinse. Dissolve a spoonful of baking soda in lukewarm water and rinse your mouth to neutralize acid and cool the burning sensation.
  • Stay active and practice relaxation techniques to reduce stress, like yoga, exercise, and meditation .


Recovery Period :

But for the people who shows the symptoms more than 6-7 years shows the stage as a manageable level

Patient who experience very good control after medicine are at recovery stage

 


Medicines used in the Treatment :

  1. Amitryptiline 25mg (b.i.d) for 15 days.
  2. Gabapentin 300mg(t.i.d)
  3. Alprazolam 0.25mg(b.i.d)
  4. Clonazepam 2mg (o.d) for 15 days
  5. Nortriptyline 25 mg (o.d) for more than 3 months
  6. Pilocarpine

  7.  carvemeline


REFERENCE :

Burkitt’s book of Oral medicine

Ongole book of oral medicine

https://www.nidcr.nih.gov/health-info/burning-mouth

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316128/

 Rodriguez-de Rivera-Campillo E, López-López J. Evaluation of the response to treatment and clinical evolution in patients with burning mouth syndrome. Med Oral Patol Oral Cir Bucal. 2013;18(3):e403–e410. [PMC free article] [PubMed] [Google Scholar