Burning mouth syndrome is defined as a burning pain in the oral cavity or tongue that does not have associated clinical or laboratory abnormalities. The syndrome may coexist with other oral conditions. Frequently, these individuals pass from one health care provider to another in search of a remedy for their pain. Often, there is significant emotional impact on these patients, who are at times suspected of imagining or exaggerating their symptoms.
The condition is seen most often in women, particularly those that are post-menopausal.
Burning mouth pain is often absent during the night but progressively increases throughout the day and into the evening.
Spontaneous partial recovery within six to seven years after onset has been reported in up to two thirds of patients, with recovery often preceded by a change from constant to episodic burning.
Causes of Burning Mouth Syndrome
There has also been no clear consensus on the etiology, pathogenesis or treatment of burning mouth syndrome.
Because of a long-standing difficulty in understanding the pain of burning mouth syndrome and its complex clinical picture, a number of etiologies have been suggested. However, each of these postulated causes explains the pain in only small groups of patients. They include psychological dysfunction, such as anxiety and depression. Hypertension and nutritional disorders have been suggested as possible causes. Some antihypertensive medications have also been implicated, such as ACE inhibitors. Hormonal factors are considered important contributing factors to this disorder. Postmenopausal women display this disorder 3-12 years after the onset of menopause. Dry mouth has also been implicated in this disorder. Candida infections are also purported to cause burning mouth syndrome.
Signs and Symptoms of Burning Mouth Syndrome
The majority of these individuals experience the spontaneous onset of pain within the mouth or tongue. About one third have the symptoms develop in relationship to a dental procedure, recent illness or medication. Regardless of the nature of pain onset, once the oral burning starts, it often persists for many years.
The burning sensation often occurs in more than one oral site, with the anterior two thirds of the tongue, the anterior hard palate and the mucosa of the lower lip most frequently involved.
In many patients with the syndrome, pain is absent during the night but occurs at a mild to moderate level by middle to late morning. The burning may progressively increase throughout the day. Patients often report that the pain interferes with their ability to fall asleep.
Perhaps because of sleep disturbances, constant pain, or both, patients with oral burning pain often have mood changes, including irritability, anxiety and depression. Earlier studies frequently minimized the pain of burning mouth syndrome, but more recent studies have reported that the pain ranges from moderate to severe and is similar in intensity to toothache pain.
Most studies have found that oral burning is frequently accompanied by other symptoms, including dry mouth and altered taste. Alterations in taste occur in as many as two thirds of patients and often include complaints of persistent tastes (bitter, metallic, or both) or changes in the intensity of taste perception.
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