Burning Mouth Syndrome: Aetiopathogenesis and Management

Question-and-answer flashcards covering definition, epidemiology, classification, aetiopathogenesis, clinical features, investigations, treatment, and prognosis of Burning Mouth Syndrome.

What is the hallmark clinical feature that defines Burning Mouth Syndrome (BMS)?

A chronic oral burning sensation in the absence of any clinically observable mucosal lesions or organic oral disease.

Which population is most commonly affected by BMS?

Middle-aged to elderly women, especially in the peri- and post-menopausal period.

List three common synonyms for Burning Mouth Syndrome.

Glossopyrosis, stomatodynia, oral dysesthesia (also sore tongue, stomatopyrosis).

How is BMS classified on the basis of aetiology?

Primary BMS (no identifiable local/systemic cause) and Secondary BMS (burning due to an underlying local or systemic disorder).

Name three example conditions that can cause secondary BMS.

Hyposalivation, oral infections (e.g., candidiasis), autoimmune mucosal diseases like lichen planus (others: nutritional deficiencies, allergies, reflux, endocrine disorders).

How is BMS classified by diurnal symptom pattern?

Type 1: symptom-free on waking, worsens through the day (35%); Type 2: continuous daytime pain, none at night (55%); Type 3: intermittent symptoms with pain-free days (10%).

With which systemic issues is Type 1 BMS most often linked?

Nutritional deficiencies and diabetes mellitus.

Which psychological condition is commonly associated with Type 2 BMS?

Chronic anxiety.

What is the female-to-male ratio reported for BMS prevalence?

Women are affected approximately 2.5 – 7 times more often than men.

State the mean age of onset for BMS.

Around 61 years (range 27 – 87 years).

Name four broad categories implicated in the multifactorial aetiology of BMS.

Neuropsychiatric, endocrine, immunologic/allergic, nutritional (also infectious and iatrogenic/ drug-associated).

What proportion of BMS patients exhibit depression or anxiety?

More than 50 percent, with depression predominating.

Which hormonal changes are observed in peri/post-menopausal women with BMS?

Lower estradiol levels and higher follicle-stimulating hormone (FSH) levels compared with healthy controls.

Briefly describe the neurosteroid hypothesis in BMS pathogenesis.

Menopausal decline in neuroprotective gonadal/adrenal steroids decreases neuroactive steroids, leading to degeneration of small oral nerve fibers and brain areas processing oral sensations.

Give three common dietary or dental allergens linked to BMS.

Cinnamon, sorbic acid, and dental metals such as cobalt or mercury (others: propylene glycol, benzoic acid).

Which vitamin deficiencies have been associated with BMS?

B-complex vitamins (B1, B2, B6, B12) and folic acid; zinc deficiency has also been implicated.

Which oral infection is most frequently linked with BMS and often improves after antifungal therapy?

Candidiasis.

Name two antihypertensive drug classes reported to induce BMS.

ACE inhibitors and angiotensin receptor blockers (ARBs).

What percentage of BMS cases are thought to involve peripheral small-fiber neuropathy?

Approximately 50 – 60 percent.

List three fundamental Scala diagnostic criteria for BMS.

1) Daily, bilateral, deep burning of oral mucosa; 2) Duration ≥ 4–6 months; 3) Constant or increasing intensity during the day without sleep disturbance (others: no symptom worsening with eating).

Which three oral sites are most commonly affected in BMS?

Tongue, palate, and lower lip (buccal mucosa and floor of mouth rarely affected).

What subjective oral complaints accompany burning pain in roughly two-thirds of BMS patients?

Dysgeusia (taste changes) and xerostomia (dry mouth).

Name two parafunctional habits frequently observed in BMS sufferers.

Bruxism (tooth grinding/clenching) and tongue thrusting (also lip/cheek biting, lip licking).

List four key laboratory or chair-side investigations helpful in BMS evaluation.

Hematological tests for nutritional deficiencies, fasting blood glucose, autoimmune markers (e.g., ANA, SSA), and patch testing for contact allergies (others: sialometry, oral cultures).

What is the primary therapeutic approach for secondary BMS?

Identify and treat the underlying local or systemic cause (e.g., manage candidiasis, correct deficiencies, withdraw offending drugs).

Name four pharmacologic or non-pharmacologic modalities trialed in primary BMS management.

Alpha-lipoic acid, clonazepam lozenges, topical/systemic capsaicin, cognitive behavioral therapy (others: gabapentin, antidepressants, biofeedback, tongue protectors).

What daily dose and duration of alpha-lipoic acid has shown benefit in BMS?

600 mg per day for two months.

Which medication combo reduced BMS symptoms in 70 % of patients compared with 15 % with placebo?

Gabapentin 300 mg daily plus alpha-lipoic acid 600 mg daily.

How are clonazepam lozenges used for BMS?

1-mg tablet dissolved in the mouth for 3 minutes and expectorated, three times daily; helpful in predominantly peripheral BMS.

What was the reported improvement rate with systemic 0.25 % capsaicin capsules thrice daily in severe BMS?

About 93 % improvement at 1 month (noting 32 % gastric side-effects).

Which three antidepressants each showed ~70 % symptom relief after 8 weeks in BMS trials?

Paroxetine (20 mg/day), sertraline (50 mg/day), and amisulpride (50 mg/day).

How successful was cognitive behavioral therapy (12–15 weeks) for BMS in follow-up studies?

Significant symptom reduction in all treated patients; ~27 % remained symptom-free at 6-month follow-up vs 0 % in placebo group.

Describe the natural course of BMS without therapy over at least 18 months.

~10 % spontaneous remission, 26 % moderate improvement, 37 % no change, 26 % symptom worsening.

Overall, what proportion of treated BMS patients experience effective relief according to long-term studies?

Roughly 29 % show effective improvement, 56 % no change, and 15 % worsening despite therapy.