Why is it difficult to diagnose «burning mouth syndrome»?
M.I. Koreshkina
LLC “AVA-PETER”, Saint Petersburg
Burning mouth syndrome is a chronic, refractory orofacial syndrome characterized by the presence of a burning sensation on the oral mucosa in the absence of specific damage. Most commonly found in women in a climacteric period or menopause. According to various international studies, prevalence of burning mouth syndrome varies from 0.6 to 15%. An etiology of burning mouth syndrome involves the interaction of neurophysiological mechanisms and psychological factors. Most often, patients describe the pain as stinging, burning, tingling, irritation, soreness and numbness of the oral mucosa, a change in sensitivity. Neuropathic mechanisms of burning mouth syndrome can be divided into possible subtypes: peripheral neuropathy (50–60%), subclinical trigeminal neuropathy (20–25%) and central dopaminergic hypofunction of the basal ganglia (20 to 40% of cases). More than 40% of patients report about improvement in response to the drug administration in neuropathic pain. Thus, despite the existing problems in the classification, lack of knowledge on the pathophysiology of burning mouth syndrome — diagnostic criteria of the disease and various treatment options have already been developed and are ready for use in daily practice. The introduction of new questionnaires and treatment algorithms will make it possible to detect this complex pathology more often and successfully treat it.
Key words: burning mouth syndrome, neuropathic pain, questionnaire for the diagnosis of facial pain.
For citation: Koreshkina M.I. Why is it difficult to diagnose «burning mouth syndrome»? // RMJ. Medical Review. 2018. № 9. P. 10–13.
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2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition // Cephalalgia. 2018. Vol. 38 (1). P. 1–211.
3. Ettlin D.A., Sommer I., Brönnimann B. et al. Design, construction, and technical implementation of a web-based interdisciplinary symptom evaluation (WISE) — a heuristic proposal for orofacial pain and temporomandibular disorders // J Headache Pain. 2016. Vol. 17 (1). P. 77.
4. Scala A., Checchi L., Montevecchi M.A. et al. Update on burning mouth syndrome: Overview and patient management // Crit Rev Oral Biol Med. 2003. Vol. 14. P. 275–291.
5. Sun A., Wu K.M., Wang Y.P. et al. Burning mouth syndrome: A review and update // J Oral Pathol Med. 2013. Vol. 42. P. 649–655.
6. Grushka M. Clinical features of burning mouth syndrome// Oral Surg Oral Med Oral Pathol. 1987. Vol. 63. P. 30–36.
7. Bartoshuk L.M., Snyder D.J., Grushka M. et al. Taste damage: Previously unsuspected consequences // Chem Senses. 2005. Vol. 30 (Suppl 1). P. 218–219.
8. Forssell H., Jääskeläinen S., Tenovuo O., Hinkka S. Sensory dysfunction in burning mouth syndrome // Pain. 2002. Vol. 99. P. 41–47.
9. Lauria G., Majorana A., Borgna M. et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome // Pain. 2005. Vol. 115. P. 332–337.
10. Heckmann S.M., Heckmann J.G., HiIz M.J. et al. Oral mucosal blood flow in patients with burning mouth syndrome // Pain. 2001. Vol. 90. P. 281–286.
11. Klasser G.D., Fischer D.J., Epstein J.B. Burning mouth syndrome: recognition, understanding, and management // Oral Maxillofac Surg Clin North Am. 2008. Vol. 20. P. 255–271.
12. Aggarwal A., Panat S.R. Burning mouth syndrome: A diagnostic and therapeutic dilemma // J Clin Exp Dent. 2012. Vol. 4 (3). P. 180–185.
13. Scala A., Checchi L., Montevecchi M. et al. Update on burning mouth syndrome: overview and patient management // Crit Rev Oral Biol Med. 2003. Vol. 14. P. 275–291.
14. Granot M., Nagler R.M. Association between regional idiopathic neuropathy and salivary involvement as the possible mechanism for oral sensory complaints // Pain. 2005. Vol. 6. P. 581–587.
15. Albuquerque R.J., De Leeuw R., Carlson C.R. et al. Cerebral activation during thermal stimulation of patients who have burning mouth disorder: An fMRI study // Pain. 2006. Vol. 122. P. 223–234.
16. Schiavone V., Adamo D., Ventrella G. Anxiety, depression, and pain in burning mouth syndrome: First chicken or egg? // Headache. 2012. Vol. 52. P. 1019–1025.
17. Finnerup N.B., Attal N., Haroutounian S. et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis // Lancet Neurol. 2015. Vol. 14. P. 162–173.
18. Jaaskelainen SK, Woda A. Burning mouth syndrome // Cephalalgia. 2017. Vol. 37 (7). P. 627–647.
19. Dvorkin R.H., O’Connor A.B., Audette J. et al. Recommendation management of neuropathic pain: an over view and literature update // Mayo Clin Proc. 2010. Vol. 85 (Suppl. 3). P. S3–S14.
20. Finnerup N.B., Attal N., Haroutounian S. et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis // Lancet Neurol. 2015. Vol. 14 (2). P. 162–173.
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