From Journal Of Prosthetic Dentistry; Volume- 78, 1997, 93- 97.

Roman M. Cibirka, DDS,MS; Steven K. Nelson,DMD; Carol A.

Definition of BMSBurning mouth syndrome is typically characterized by burning and painful sensation in oral cavity demonstrating clinically

normal mucosa.

Prevalence> one Million adults in US are affected.

4.2% women0.8% men

Several studies reveal that BMS is most frequently found in women beyond middle age.

ClassificationBasker et al categorized BMS into-

MILDMODERATESEVERE

Moderate>severe>mild

Lamey and Lewis classificationTYPE I- Symptom free waking, with sensation developing in the morning and progressively increasing to severe by evening.

TYPE II- Continuous symptoms throughout day.

TYPE III- Intermittent symptoms free periods throughout the day.

Discomfort zonesBurning sensation

can occur at many sites within oral cavity.

Most commonly affected sites is TONGUE, particularly TIP and ant two-thirds.

Next most common site is HARD PALATE, LIP , ALVEOLAR RIDGES (in denture wearer patients).

Burning has also been reported in BUCCAL MUSOSA, OROPHARYNX, and FLOOR OF MOUTH.

ETIOLOGYBMS is multi factorial and may be divided into three groups-

local factorsSystemicpsychogenic

Local factors Dental treatmentMucosal diseasesFungal infectionsAllergiesSalivary gland disorders

Dental treatmentOnset of symptoms as reported by patients related to previous dental treatment may be as high as 65%.

Infectious agents

Oral infectious agents have been cited as a factor.

Candida is most commonly identified.

Along with enterobacter and klebsiella also identified.

Mucosal diseases as geographic tongue or benign migratory mucositis has been associated with BMS

Allergic reactionsMucosal allergic reactions have reported in the development of BMS.

Relevant allergens includeMethyl methacrlate monomer

Nickel sulfateCobalt chlorideMercury

Contact allergy to denture base chemical constituents has also been reported in upto 27% of BMS.

Some potent food allergens are-Sorbic acid (preservative found in foods)Cinnamic aldehyde ( a flavouring agent)Nicotinic acid ( in toothpaste)Propylene glycol ( food additive)

Dysfunction and parafunctionParafunctional activities resulting in excessive occlusal or denture wear.

Lip has been reported as 3rd most common site.

Parafunctional activity of lip sucking, lip licking, and mouth breathing were noted in pateints of BMS.

Quality and quantity of salivaIrregularity in salivary metabolites

as protein, potassium and phosphate concentration in between patients with BMS and control patients have been suggested as causative factor.

Radiation therapy , systemic disease and pharmacotherapuetic agents have been shown to diminish salivary flow rates and may be associated with BMS syndrome.

NEURAL MECHANISMSBMS symptoms may reflect a

neuropathic condition possibly involving the central or peripheral nervous system, or both.

Nerve injury or dysfunction resulting from oral, facial, or systemic trauma from medical conditions might be the cause of burning sensations in BMS.

Systemic factorsSystemic factors have been shown

to influence the prevalence and severity of BMS symptoms experienced by patients.

Some of them are-Deficiency diseasesHormonalImmonological disturbancesSide effects of drugs

Numerous authors have reported abnormally low levels of vit. B12 in BMS patients.

Iron deficiency anemia was the most frequently diagnosed disease entity producing BMS.

In addition to vitamin deficiencies menopausal factors have been associated with BMS.

Immunological disorders - HIV and AIDS afflictions have also been correlated with BMS.

Psychogenic factorsAfter deficiency disorders, depression has

been noted as the next most frequent etiological factor.

The BMS patient personality profile was one of indecision, yet these patients favour their own decisions. These patients were adverse to change and timid , yet responsive to firm advise and professional reassurance.

The pain of BMS has been attributed to the manifestation of exogenous or reactive depression caused by the external stress of desolation or anxiety.

Cancerophobia and anxiety have been documented as etiological factors.

OTHER ETIOLOGICAL FACTORS

Inflamed lymphoid tissue within the lingual foliate papillae

Temporal or giant cell arteritisMyeloblastic syndromeReflux esophagitisAcoustic nerve neuroma, and Referred myofascial pain.

TreatmentAdvisement and control of parafunctional activity, identification of salivary imbalances, prosthesis adjustment or pharmacotherapuetic management may be indicated.

Symptomatic relief may be achieved by-

Benadryl elixir (12.5mg/5ml), 1 tea spoon before and after meals and expectorate.

Suspension of 30ml Mycostatin50 ml hydrocortisone( 10mg/5ml)

60ml tetracycline (125mg/5ml)

ConclusionThe multiple etiologic factors for

diagnosis of BMS presents a challenging scenario for dental clinicians.

Generally normal appearing mucosa , coupled with variable symptoms of oral pain, offers a formidable task for definitive diagnosis.

Identification of the etiologic group,local, systemic, or psychogenic, will provide initial direction toward a diagnostic and treatment course.