Burning Mouth Syndrome

Question 1

what is burning mouth syndrome

Answer 1

chronic pain disorder affecting oral cavity.
most common site is anterior 2/3 of tongue but can also affect hard palate, lower lip and pharynx

Question 2

discuss the epidemiology of BMS

Answer 2

affects up to 4.5% of general population
increases in both genders with age
most common in post menopausal women

Question 3

discuss the aetiopathogenesis of BMS

Answer 3

exact cause unknown, multiple theories
- neuropathic - evidence of small epithelium fibres undergoing atrophy
endocrinogical - BMS sees tongue epithelium thickness reduced, tongue epithelium thickness maintained by gonadal hormones
psychosocial - anxiety and depression common in BMS patients, reduced neuroprotective steroids produced

Question 4

what investigations may be done when a potential BMS patient presents (4)

Answer 4

investigations to rule out secondary causes
- swab for gram staining (candida)
- patch testing (allergy)
- FBC/ haematinics (deficiencies)
- HbA1c/ thyroid function (endocrine issues).
- autoantibody screen
- psychiatric evaluation

Question 5

what non pharmacological treatment may be offered for BMS patients

Answer 5

CBT
simple advice - suck ice cubes, no acidic/ spicy foods

Question 6

name 3 systemic medications that may be used to treat BMS

Answer 6

clonazepam
amitriptyline
gabapentin

Question 7

clonazepam as BMS treatment
- MOA

Answer 7

agonistic effect on GABA receptors

Question 8

clonazepam as a BMS treatment
- dosage

Answer 8

0.5-2mg at night (sedative effect)

Question 9

clonazepam as a BMS treatment
- side effects

Answer 9

drowsiness, memory issues, depression, dizziness