Mar 232010

Burning mouth syndrome (BMS, stomatodynia), also referred to as glossopyrosis or glossodynia (when the burning occurs on the tongue only), is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. BMS occurs most often among women especially after menopause and is often accompanied by xerostomia (dry mouth) and taste disturbances. The dorsal tongue, palate, lips and gingival tissues, individually or in combination, are the most common sites involved. Bilateral or unilateral oral burning pain has been found to be associated with jaw pain or uncontrollable tightness, taste changes, subjective dry mouth, geographic and fissured tongue, painful teeth, headache, neck and shoulder pain, difficulty speaking, nausea, gagging and swallowing difficulties. BMS has been reported to follow dental treatment, antibiotic usage and a severe upper respiratory infection. Pain is constant, progressively increases over the day, and usually decreases during eating. The lack of pathology to account for the pain can be frustrating. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes, taste alterations, and changes in salivary function and dry mouth.

Recent studies have pointed to dysfunction of several cranial nerves as a possible cause of burning mouth syndrome. Recently, a neuropathological basis has been proposed; therefore, BMS may be regarded as an oral dysesthesia or painful neuropathy. Therapy for BMS may include the use of centrally acting medications for neuropathic pain, such as low doses of tricyclic antidepressants, benzodiazepines or anticonvulsants such as gabapentin. Topical medications, including clonidine, may be considered for application to local sites.

A combination of oral medications for the management of BMS (clonazepam, gabapentin, baclofen, and lamotrigine) significantly decreased pain in 38 of 45 patients. These results suggest that BMS may be treated with lower doses of a combination of medications rather than higher doses of a single medication, which may help to limit adverse effects such as drowsiness or dizziness.

Clonazepam is a benzodiazepine used either topically or in low doses orally, which appears to have excellent efficacy in the relief of the symptoms related to BMS. It is hypothesised that clonazepam acts locally to disrupt the mechanism(s) underlying stomatodynia. A double-blind, randomized, multicenter parallel group study evaluated the efficacy of topical use of clonazepam. Forty-eight patients (4 men and 44 women, aged 65+/-2.1 years) were included, of whom 41 completed the study. The patients were instructed to suck a tablet of either clonazepam 1 mg or placebo and hold their saliva near the painful sites in the mouth without swallowing for 3 minutes and then to expectorate. This protocol was repeated three times a day for 14 days. The intensity was evaluated by a 11-point numerical scale before the first administration and then after 14 days. Two weeks after the beginning of treatment, the decrease in pain scores was 2.4+/-0.6 and 0.6+/-0.4 in the clonazepam and placebo group, respectively. The formulation for a mouth rinse containing clonazepam 1mg /5ml has been reported, and may be easier to use.

Emerging evidence supports the effectiveness of the antioxidant alpha lipoic acid (ALA, thioctic acid). Alpha lipoic acid is able to increase the levels of intracellular glutathione and eliminate free radicals. A double-blind study compared the use of alpha lipoic acid versus placebo for two months in 60 patients with constant BMS, in whom there was no laboratory evidence of deficiencies in iron, vitamins or thyroid function and no hyperglycemia. Following treatment with alpha lipoic acid 600 mg orally daily, there was a significant symptomatic improvement compared with placebo. This improvement was maintained in over 70% of patients at the 1 year follow-up. Another study showed that patients with BMS who had previously been treated with benzodiazepines responded poorly to therapy with alpha lipoic acid compared with those who had not received benzodiazepines.

For references, more information, or to discuss a particular problem, please contact Canada’s 2005 “Compounding Pharmacist of the Year” Marvin Malamed, B.Sc.Pharm., at Haber’s Pharmacy, 416-656-9800, or visit haberspharmacy.com.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S39.e1-13
J Eur Acad Dermatol Venereol. 2004 Nov;18(6):676-8
J Oral Pathol Med. 2002 May;31(5):267-9
Adv Otorhinolaryngol. 2006, 63:278–287
Int J Pharm Compounding July/Aug 2005, 9(4):310
Pain 2004 Mar;108(1-2):51-7
Pain Med. 2000 Mar;1(1):97-100

Topical therapies such as a mouth rinse, lozenge, or muco-adhesive paste offer the advantage of direct application to the affected site and a lower incidence of side effects. Contact Haber’s Pharmacy to discuss formulations which will meet the specific needs of each patient.

9 Responses to “Burning Mouth Syndrome: Clinical Presentation and Therapy”

  1. Jenzing Says:

    Great…

    love your blog, http://www.bloggen.be/jessiea/ ,Thanks again….



  2. Cenzing Says:

    Great…

    love your blog, http://blog.bodybuilding.com/ishars/ ,Thanks again….



  3. Hehmer Says:

    Great One…

    I must say, its worth it! My link, http://candice.weblogplaza.com/,thanks haha…



  4. ctilde Says:

    Great One…

    I must say, its worth it! My link, http://www.freeblog.com.br/cinderella/,thanks haha…



  5. Frederic Says:

    really…

    Fat women and girls always worried because of their ugly shaped bodies. http://www.protectiamediului.org/bnhjtfrra/ , but they can not wear these outwears…



  6. Pterker Says:

    Great One…

    I must say, its worth it! My link, http://misuperblog.com/christina,thanks haha…



  7. sander Says:

    very helpful…

    I preferred to thank you for this good article. http://promdressq.beeplog.com/blog.pl?blogid=214133&o=entry&a=add I by all odds liked every little bit of it…



  8. Benzing Says:

    very helpful…

    I preferred to thank you for this good article. http://lychtb.mylivepage.com/blog/1958/12062 I by all odds liked every little bit of it…



  9. Richelle Says:

    quality post…

    I have spent a bit of time going through your posts! http://lililian.blinkweb.com/elegant-evening-dress-blog.html,i had a good read….



Leave a Reply

preload