The Clinical Syndrome
Burning mouth syndrome is an infrequent but serious cause of oral pain. Although mouth pain has many causes with readily demonstrable pathological conditions, such as herpes simplex infections and aphthous ulcers, burning mouth syndrome is the diagnosis given to patients who complain of mouth and tongue pain in the presence of a completely normal physical examination. Therefore burning mouth syndrome is by definition a diagnosis of exclusion. Included in the diagnosis of burning mouth syndrome are the clinical syndromes of burning tongue syndrome, glossalgia, glossodynia, stomatodynia, and oral dysesthesia syndrome. Affecting females 7 to 8 times more frequently than men, burning mouth syndrome is a disease of the fifth decade and beyond. The pain of burning mouth syndrome is characterized as a burning, hot, or scalded sensation of the mouth and tongue that may be accompanied by tingling. Most commonly the anterior two-thirds of the tongue, palate, gingiva of the upper and lower alveolar region, and lips are involved, with the sublingual region less commonly affected. The exact pathophysiology responsible for burning mouth syndrome remains elusive, and the putative causes in most cases are multifactorial. Underlying nutritional disorders, psychiatric illness, allergic stomatitis, xerostomia, diabetes mellitus, menopause, and other endocrinopathies are often identified in patients with burning mouth syndrome, even though the oral examination is completely negative. Magnetic resonance imaging (MRI) and functional MRI has identified altered structure and function of the hippocampus and medial prefrontal cortex in some patients with burning mouth syndrome.
The Clinical Syndrome
Burning mouth syndrome is an infrequent but serious cause of oral pain. Although mouth pain has many causes with readily demonstrable pathological conditions, such as herpes simplex infections and aphthous ulcers, burning mouth syndrome is the diagnosis given to patients who complain of mouth and tongue pain in the presence of a completely normal physical examination. Therefore burning mouth syndrome is by definition a diagnosis of exclusion. Included in the diagnosis of burning mouth syndrome are the clinical syndromes of burning tongue syndrome, glossalgia, glossodynia, stomatodynia, and oral dysesthesia syndrome. Affecting females 7 to 8 times more frequently than men, burning mouth syndrome is a disease of the fifth decade and beyond. The pain of burning mouth syndrome is characterized as a burning, hot, or scalded sensation of the mouth and tongue that may be accompanied by tingling. Most commonly the anterior two-thirds of the tongue, palate, gingiva of the upper and lower alveolar region, and lips are involved, with the sublingual region less commonly affected. The exact pathophysiology responsible for burning mouth syndrome remains elusive, and the putative causes in most cases are multifactorial. Underlying nutritional disorders, psychiatric illness, allergic stomatitis, xerostomia, diabetes mellitus, menopause, and other endocrinopathies are often identified in patients with burning mouth syndrome, even though the oral examination is completely negative. Magnetic resonance imaging (MRI) and functional MRI has identified altered structure and function of the hippocampus and medial prefrontal cortex in some patients with burning mouth syndrome.
Signs and Symptoms
The hallmark of burning mouth syndrome is mouth and tongue burning pain in the absence of clinically demonstrable oral pathology. Depressive affect or a phobic preoccupation with occult cancer is often present, as is xerostomia. The classic oral findings of nutritional deficiencies such as iron and zinc deficiency, pernicious anemia, and vitamin B complex deficiency may be absent in patients with burning mouth syndrome and must be confirmed with appropriate laboratory testing. The clinician should observe the patient closely for abnormal tongue and mouth movements, such as bruxism, tongue thrusting, and repetitive running of the tongue against the teeth, because these are suggestive of behavioral abnormalities that may contribute to the patient’s pain symptomatology ( Fig. 17.1 ).
Testing
No specific test exists for burning mouth syndrome, and a presumptive diagnosis can be made only if (1) the clinical examination is normal and (2) a workup for all underlying pathological findings fails to identify a specific cause for the patient’s pain symptomatology. A suggested workup based on the experience at the Mayo Clinic is outlined in Table 17.1 and should always include laboratory testing for vitamin deficiencies and diabetes and a culture for Candida infection.
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