Unraveling Burning Mouth Syndrome: A Review of Diagnosis and Treatments

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Burning mouth syndrome [BMS] is a chronic and challenging orofacial pain syndrome characterized by a persistent burning sensation in the oral mucosa, in the absence of specific oral lesions. It predominantly affects middle-aged and elderly women, often associated with hormonal changes or psychological disorders. The etiology of BMS remains multifactorial and elusive, leading to unsatisfactory treatment outcomes. This systematic review aims to provide an in-depth analysis of the epidemiology, clinical presentation, classification,
etiopathogenesis, diagnosis, and management of BMS.

Methods:

A comprehensive literature search was conducted using electronic databases, including PubMed, to identify relevant studies published between 2014 and 2023. The keywords used for the search included “burning mouth syndrome,” “diagnosis,” “therapy,” “classification,” “epidemiology,” and “etiopathogenesis.” The retrieved articles were assessed for relevance and quality, and data were extracted and synthesized to provide a comprehensive overview of BMS.

Epidemiology:

The true prevalence of BMS is challenging to establish due to the lack of consistent diagnostic criteria and awareness among healthcare professionals. Reported prevalence rates range from 0.6% to 15%, with a higher incidence among middle-aged and elderly individuals, particularly peri- and post-menopausal women. BMS exhibits a significant female predilection, with a female-to-male ratio ranging from 3:1 to 16:1. The condition is rare in individuals under 30 years of age and has not been reported in children or adolescents.

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Classification and Subtypes:

Various classification systems have been proposed to elucidate the clinical course of BMS. Lamey and Lewis classified BMS based on pain intensity variations over 24 hours, while Scala et al. categorized it into primary/idiopathic and secondary forms. Jääskeläinen proposed a classification with three subgroups based on the level of pathology involved. These classifications provide insights into the heterogeneity of BMS and aid in individualized patient management.

Clinical Features:

BMS is characterized by diverse and variable clinical manifestations, making it challenging to diagnose and manage. Patients commonly present with oral burning pain, altered taste sensation, dry mouth, and other sensory disturbances. The pain is described as burning, tingling, scalding, or numbness, primarily affecting the tongue, followed by other oral mucosal sites. Taste disturbances, particularly bitter or metallic taste, and dry mouth are frequently reported. BMS is often associated with comorbidities such as headaches, TMJ pain, musculoskeletal disorders, and psychiatric conditions.

Etiopathogenesis:

The complex etiology of BMS involves an interplay between neurophysiological mechanisms and psychological factors. Several local, systemic, and psychological factors have been implicated, although many should be considered important in the differential diagnosis of oral burning rather than causative factors for BMS. Theories propose abnormal sensory interactions, small and/or large fiber neuropathy, centrally mediated alterations in nociceptive processing, disturbances in autonomic innervation and oral blood flow, and chronic anxiety or stress as potential etiological factors.

Diagnosis:

Accurate diagnosis of BMS requires a comprehensive approach. A thorough patient history, clinical examination, assessment of psychosocial stressors, objective measurements of salivary flow rates and taste function, neurological imaging and examination, oral cultures, patch tests, gastric reflux studies, and hematological tests may be necessary to rule out local and systemic causes and establish the diagnosis of BMS.

Treatment:

The management of BMS remains challenging, given its multifactorial etiology and varying clinical presentation. A personalized and interdisciplinary approach is crucial for successful patient management. While no definitive cure exists, symptomatic relief can be achieved through a combination of pharmacological and non-pharmacological interventions. Topical treatments such as capsaicin, clonazepam, and topical anesthetics may provide temporary relief. Systemic medications, including antidepressants, anxiolytics, antiepileptics, and analgesics, are prescribed to alleviate pain and improve quality of life. Psychological interventions, such as cognitive-behavioral therapy and relaxation techniques, can be beneficial in managing associated anxiety and depression.

Burning mouth syndrome is a challenging condition that requires an interdisciplinary and systematic approach for accurate diagnosis and effective management. This comprehensive review highlights the epidemiology, clinical features, classification, etiopathogenesis, diagnosis, and therapeutic approaches for BMS. Further research is needed to better understand the underlying mechanisms and develop targeted treatment strategies to improve the quality of life for individuals suffering from BMS.

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