Burning mouth syndrome

By definition, BMS has no signs. Sometimes affected persons will attribute the symptoms to sores in the mouth, but these are in fact normal anatomic structures (e.g. lingual papillae, varices). Symptoms of BMS are variable, but the typical clinical picture is given below, considered according to the Socrates pain assessment method (see table). If clinical signs are visible, then another explanation for the burning sensation may be present. Erythema (redness) and edema (swelling) of papillae on the tip of the tongue may be a sign that the tongue is being habitually pressed against the teeth. The number and size of filiform papillae may be reduced. If the tongue is very red and smooth, then there is likely a local or systemic cause (e.g. erythematous candidiasis, anemia). ==Causes==

Theories In about 50% of cases of burning mouth sensation no identifiable cause is apparent; As most people with BMS are postmenopausal women, one theory of the cause of BMS is of estrogen or progesterone deficit, but a strong statistical correlation has not been demonstrated. and some consider BMS a psychosomatic illness, Apart from BMS itself, a full list of causes of an oral burning sensation is given below: • Deficiency of iron, folic acid or various B vitamins (glossitis e.g. due to anemia), or zinc • Neuropathy, e.g. following damage to the chorda tympani nerve. • Hypothyroidism. • Medications ("scalded mouth syndrome", unrelated to BMS) – protease inhibitors and angiotensin-converting-enzyme inhibitors (e.g. captopril). • Type 2 diabetes • Fissured tongue. ==Diagnosis==

BMS is a diagnosis of exclusion, i.e. all other explanations for the symptoms are ruled out before the diagnosis is made. There are no clinically useful investigations that would help to support a diagnosis of BMS Classification A burning sensation in the mouth may be primary (i.e. burning mouth syndrome) or secondary to systemic or local factors. However this contradicts the accepted definition of BMS which specifies that no cause can be identified. "Secondary BMS" could therefore be considered a misnomer. BMS is an example of dysesthesia, or a distortion of sensation. More recently, BMS has been described as one of the 4 recognizable symptom complexes of chronic facial pain, along with atypical facial pain, temporomandibular joint dysfunction and atypical odontalgia. BMS has been subdivided into three general types, with type two being the most common and type three being the least common. Types one and two have unremitting symptoms, whereas type three may show remitting symptoms. • Type 1 – Symptoms not present upon waking, and then increase throughout the day • Type 2 – Symptoms upon waking and through the day • Type 3 – No regular pattern of symptoms Sometimes those terms specific to the tongue (e.g. glossodynia) are reserved for when the burning sensation is located only on the tongue. ==Treatment==

If a cause can be identified for a burning sensation in the mouth, then treatment of this underlying factor is recommended. If symptom persist despite treatment a diagnosis of BMS is confirmed. Other treatments which have been used include atypical antipsychotics, histamine receptor antagonists, and dopamine agonists. Supplementation with vitamin complexes and cognitive behavioral therapy may be helpful in the management of burning mouth syndrome. ==Prognosis==

BMS is benign (importantly, it is not a symptom of oral cancer), but as a cause of chronic pain which is poorly controlled, it can detriment quality of life, and may become a fixation which cannot be ignored, thus interfering with work and other daily activities. Two thirds of people with BMS have a spontaneous partial recovery six to seven years after the initial onset, but in others the condition is permanent. Recovery is often preceded by a change in the character of the symptom from constant to intermittent. No clinical factors predicting recovery have been noted. If there is an identifiable cause for the burning sensation, then psychological dysfunctions such as anxiety and depression often disappear if the symptom is successfully treated. ==Epidemiology==

BMS is fairly uncommon worldwide, affecting up to five individuals per 100,000 general population. Some report a female to male ratio of as much as 33 to 1. Males and younger individuals of both sexes are sometimes affected. Asian and Native American people have considerably higher risk of BMS. ==Notable cases==

Sheila Chandra, a British singer of Indian heritage, retired due to this condition. ==References==