Burning mouth syndrome is characterized by chronic burning and pain in the mouth . This pain can affect the tongue, gums, lips, inside of the cheeks, palate, or extend throughout the entire oral cavity.
The pain can be intense, like a burning sensation in the mouth. However, the cause of the symptoms often cannot be identified , which makes treatment very difficult.
What is burning mouth syndrome?
Burning mouth syndrome is a disorder characterized by generalized oral burning, in the absence of obvious local lesions or systemic pathological changes.
The incidence of the disease is higher from age 50 onwards and in women.
The causes of the disease are still unclear, but some neuropathological disorders that may predispose individuals to developing it have recently been identified. These include degeneration of the oral peripheral trigeminal fibers , impaired taste perception mechanisms, and loss of central inhibitory mechanisms for pain control.
Burning mouth syndrome is frequently observed in association with psychosomatic disorders , impaired salivary gland function (with qualitative and quantitative changes in saliva), and changes in estrogenic status (as occurs in the postmenopausal period ).
Epidemiology
The syndrome affects 3% of the population (around 1,5 million in Italy), mainly women , and begins in late adulthood , between the ages of 50 and 70.
Causes of burning mouth
In the case of primary syndrome, the symptoms appear to be related to the sensory and taste nerves (possible neuropathic basis of burning mouth syndrome, with altered excitability in the trigeminal nociceptive pathway at the level of the central and/or peripheral nervous system).
In the secondary syndrome, on the other hand, the symptoms are linked to one or more of the pathologies responsible for the syndrome:
- xerostomia by drugs or pathologies such as S. by Sjogren;
- oral mycoses;
- lichen planus of the oral cavity;
- geographic tongue;
- psychological factors such as anxiety, depression, pathophobia;
- nutritional deficiencies zinc, iron, folate, thiamine, riboflavin, pyridoxine, cobalamin deficiency;
- dental prostheses for tension of the muscles and tissues of the mouth and for irritation due to any incompatibility with the materials;
- neurological damage of nerves related to tongue taste and pain control, allergies or reactions to foods, flavors, additives;
- gastroesophageal reflux with gastric acid rising into the oral cavity;
- medications, especially some antihypertensives (ACE inhibitors);
- bruxism;
- endocrine or hormonal imbalances such as diabetes, hypothyroidism, menopause;
- oral irritation due to incongruous habits such as excessive brushing of the tongue, excessive use of mouthwashes, abuse of acidic and alcoholic beverages
If it is not possible to establish a specific local and/or systemic organic cause, treatment is symptomatic and consists of prescribing drugs intended to reduce chronic pain (e.g., amitriptyline , carbamazepine , clonazepam and trazodone ) and, possibly, psychological support for forms on a psychosomatic basis.
To reduce the discomfort associated with burning mouth syndrome, it is recommended to frequently sip water , keep the mucous membranes moist, and avoid irritants (such as spicy or very hot foods , alcohol-based mouthwashes , lemon juice , and carbonated beverages ).
Factors riesgo
The primary form usually begins spontaneously , without triggering factors, although researchers highlight some factors that may increase the risk of developing the syndrome:
- be a "supertaster", that is, subjects with a genetic predisposition to perceive more flavors due to a greater number of taste buds in language;
- upper respiratory tract infections;
- previous dental procedures;
- medicines;
- traumatic life events;
- stress;
- drugs
Clinical manifestations, symptoms and signs of burning mouth syndrome
Symptoms of burning mouth include:
- loss of taste (ageusia);
- taste changes with a metallic or bitter taste (dysgeusia);
- dry mouth;
- increased thirst;
- oral pain that progresses throughout the day;
- tingling, numbness in the mouth or on the tip of the tongue;
- burning in the tongue, gums, lips, inside of the cheeks, palate.
Pain has different patterns; it can be:
- daily, not very intense at first but getting worse during the day;
- continuous beginning in the morning and persisting unchanged throughout the day;
- irregular that presents phases of total absence, even for a few days.
Whatever the pattern of symptoms, the symptoms often last for years before the correct diagnosis is made and appropriate treatment is started.
Laboratory Investigations: Pathology Diagnostic Procedures
There are no tests to determine if a person has this syndrome or what triggers the mouth pain. The role of the physician and dentist is to rule out the underlying conditions responsible for the secondary syndrome. The tests to be performed are:
- complete blood chemistry routine, including thyroid function, nutritional factor dosage, and immune function;
- culture examination of the oral cavity, looking for viral, bacterial and fungal infections;
- allergy testing in case of history of exposure to allergens;
- salivation measurement to check for reduced saliva flow;
- psychological evaluation application of tests of anxiety, depression, other mental pathologies;
if indicated,
- pH-metry (or impedance) to document any episode of gastroesophageal reflux.
endoscopic radiology images
If necessary, ultrasound, computed tomography, MRI are used.
burning mouth therapy
There is no guaranteed way to treat the syndrome, and there is a lack of firm evidence regarding the most commonly used methods. Since the choice of therapy depends on both the signs and symptoms, as well as the presence of any underlying conditions, it is important to identify the exact trigger, if one exists. If the cause is not identified, treatment is empirical.
General dietary hygiene measures
Avoid tobacco, foods with mint or cinnamon, too spicy foods, acidic foods such as tomatoes, oranges, coffee, vary toothpastes, reduce excessive stress.
Drugs of choice in burning mouth syndrome
The medication options are:
- Clonazepam an antiepileptic drug.
- Alpha lipoic acid, a powerful antioxidant produced naturally by the body.
- Antifungals for candidiasis.
- Antidepressants like the SSRIs;
- Topiramate, which acts at different levels of neuronal transmission, blocking sodium and calcium channels, increasing GABA concentration and decreasing the function of postsynaptic glutamate.
- Resorts B vitamins (although in reality the true vitamin deficiencies are only malabsorptive patients).
- Cognitive behavior therapy.
- Capsaicin-based products.
Burning Mouth Syndrome Complications
They can be the causes or be related to the pain:
- sleep disorders;
- irritability;
- depression;
- anxiety;
- hearing disorders;
- reduced socialization.