Management of burning mouth syndrome

Abstract

In this review, we discuss some practical strategies that can be useful for clinicians in the interdisciplinary and individualised management of patients with burning mouth syndrome. Burning mouth syndrome (stomatodynia, glossodynia) is a chronic, idiopathic pain syndrome accompanied by a sensation of pain or burning, scalding, pinching, numbness or stinging without clinical changes in oral cavity mucosa in the absence of abnormalities in additional tests. In addition to the above symptoms, burning mouth syndrome is characterised by a sensation of oral dryness (xerostomia), distortion of the sense of taste (dysgeusia), and food hypersensitivity. Patients may further report mood swings, anxiety, insomnia, personality disorder, chronic fatigue, headache or carcinophobia. Burning mouth syndrome has a clear predisposition to perimenopausal females, and significantly affects not only the quality of life of patients but also that of their families. The aetiopathogenesis of the disease is not fully understood, and treatment predominantly focuses on symptomatic relief. Topical therapies involve benzydamine, clonazepam, capsaicin, lidocaine, lactoperoxidase, and sucralfate. Antidepressants, antiepileptics, atypical neuroleptics, and benzodiazepines have been used in systemic pharmacological management of burning mouth syndrome. Burning mouth syndrome therapy should be a combination of pharmacological and neuromodulating effects with psychological support for both patients and their families. The therapeutic strategy should be highly personalised, interdisciplinary, and holistic.