Burning mouth syndrome (BMS) is a disorder localized continuously and exclusively, or predominantly, to the oral cavity. The central symptom is a discomfort described as pain and/or burning, with a continuous pattern throughout the day and a tendency to increase during the second half of the day.
The symptom may affect the tongue, the lining of the cheeks, the gums, the lips, or the entire oral cavity. Other sensory disturbances may also occur in the buccal, oral, and more generally facial region, along with alterations in taste and salivation, particularly dry mouth.
Treatment is generally assessed over the same time frame used for other somatoform disorders or mood and anxiety disorders with somatic symptoms, usually one to three months.
- Paroxetine. Other drugs in the same class (SSRIs) have also been tried, with less clear results.
- Amisulpride. One study indicates a sustained effect in female patients.
- Clonazepam. Results are not unequivocal, but the proportion of patients achieving a complete response is relatively high.
- Alpha-lipoic acid and gabapentin. Ineffective when used alone.
This is a disorder with a high rate of partial but non-lasting improvement, which is often referred to as the “placebo effect.” A rapid response is not necessarily destined to disappear over time; unfortunately, however, several months are needed to establish whether the observed effect—which may be genuine and directly related to the medication—remains satisfactory.
Because dry mouth may also be present, some medications are used less frequently or at lower doses in order to avoid causing dryness as a side effect, which would obviously be counterproductive. It should nevertheless be remembered that the relationship between dryness and pain/burning is far from clear, and that conditions in which a definite relationship exists, such as Sjögren’s syndrome, do not fall within this diagnosis.