Burning Mouth Syndrome: A Mouthful of Burning Issues (Case Study #6)

Burning Mouth Syndrome: A Mouthful of Burning Issues (Case Study #6)

A Glimpse of Burning Mouth Syndrome: A Mouth on Fire

Mdm S who is in her 60s had visited a periodontist – a gum specialist – for burning pain in her mouth. Unable to detect any obvious anomaly, he then referred her to me for a consultation.

 

The pain affected both sides of her palate and tongue. She described it as ‘intense, persistent and burning’. It lasted throughout her waking hours. Strangely, the pain would disappear during sleep, and did not disturb her rest.

Inconclusive Clinical Tests Despite Severe Pain

Clinical examination indeed showed that there were no obvious problems with her teeth, gums and other oral soft tissues. Her head and neck muscles, and other peri-oral soft tissues appeared normal. X-rays revealed no abnormalities of the jaw bones or surrounding bony structures. Yet, she was in intense pain.

Subsequent Findings & Management at Our Clinic

I carried out a salivary flow test on Mdm S at our clinic, which revealed that her salivary flow was borderline low.

 

Subsequent blood tests that I sent her for revealed abnormally high levels of auto-antibody called ANA (anti-nuclear antibody). This can signify the presence of an underlying autoimmune disorder or other possible diseases.

 

After more related tests, we found that she had a hormonal problem that contributed to her oral pain.

 

We began a co-management treatment regimen between an endocrinologist and myself. Apart from hormonal replacement, she received topical medications which significantly reduced her pain.

What is Burning Mouth Syndrome?

Burning Mouth Syndrome (BMS), as experienced by Mdm S, presents as chronic pain in the mouth. The sensations felt by the patient are described as ‘burning’, even ‘scalding hot’. It can also present as numbness, an alteration or loss of taste, or dry mouth.

 

The pain may be widespread in the mouth, or affect areas such as the lips, gums, cheeks, palate and especially the tongue.

Subtypes and Root Causes of Burning Mouth Syndrome

Burning Mouth Syndrome that occurs on its own without an underlying medical condition is known as Primary BMS, or idiopathic BMS.

 

Whilst the cause of Burning Mouth Syndrome is yet unknown, experts believe that the pain is caused by damage to the nerves that control pain and taste. It is thus classified as a form of neuropathic pain.

 

Secondary BMS is the result of an underlying local or systemic condition. Treating the root cause usually helps to alleviate the patient’s pain.

 

Further investigations need to be done to determine the medical condition(s). Some common causes include:

 

  • Hormonal changes (e.g. menopause)
  • Endocrine disorders (e.g. diabetes or hypothyroidism)
  • Dry mouth / Xerostomia as a result of treatments or chronic illnesses (e.g. Sjögren’s Syndrome or radiotherapy)
  • Medications (particularly those that lower blood pressure)
  • Nutritional deficiencies in iron, zinc and various types of vitamin B
  • Oral infections (e.g. yeast infection, oral lichen planus or geographic tongue)
  • Acid reflux or GERD
  • Food allergies
  • Allergies to materials used in dental products (usually metals)
  • Oral habits (e.g. bruxism / teeth grinding)
  • And even psychological factors (e.g. stress)

Who Gets Burning Mouth Syndrome?

Burning Mouth Syndrome is a rare condition. According to The American Academy of Oral Medicine (AAOM):

“BMS affects around 2% of the population with women being up to seven times more likely to be diagnosed than men.”

Patients are mostly post or peri-menopausal women over 50, although Burning Mouth Syndrome can affect anyone including men.

How is Burning Mouth Syndrome Diagnosed, and Who Treats It?

As Burning Mouth Syndrome is an invisible illness, it can be difficult to diagnose. The tests done to determine if a patient is suffering from Burning Mouth Syndrome are in correlation to the possible root causes that are listed above.

 

Burning Mouth Syndrome should be diagnosed by a specialist, which includes an Oral Medicine and/or an Orofacial Pain specialist.

 

Timely referral is crucial, so that effective management of the pain can be started. Half to two-thirds of patients with Burning Mouth Syndrome will experience some improvement in their pain levels within a few weeks to a few months of treatment. Some patients’ pain may even subside without any other issues.

What This Case Study Shows

This case study highlights the need to investigate pain beyond the oral cavity, although the primary complaint is from there.

 

Burning Mouth Syndrome manifests as burning pain in the mouth, yet the root cause runs deeper. Treatment and pain management also varies widely, depending on what the true nature of the problem is.

How Nourish Dental & TMJ Care Can Help

Here at Nourish Dental & TMJ Care we specialise in diagnosing and treating orofacial pain, TMD, pain and sleep disorders. You can find out more about Dr. Eric Chionh and our dental practice on our About Page.