Burning Mouth Syndrome-A Report of 3 Cases

Burning Mouth Syndrome-A Report of 3 Cases

Mingi Chan-Liao

Dept. of Anesthesia, Jen-Ai Hospital, Tali, Taichung, Taiwan

The burning mouth syndrome(BMS) is a relatively common intraoral disorder affecting women seven times more frequently than men. It is characterized by burning and painful sensations of the mouth in the absence of significant mucosal abnormalities.

The pain is typically reported at the anterior part of the tongue, the anterior hard palate and the lip. We report our recent experience in treating 3 cases of BMS. All were post-menopausal women and treated mainly with a series of stellate ganglion blocks plus antiderpressants except for Case 2 who in addition received low-level laser therapy but in vain.

Typically they had different manifestations and different outcomes after treatment. Case 1 and 2 could be classified(Tab.2) as type 2 (continuous) BMS and Case 3 as type 3 (intermittent) BMS based on diurnal fluctuations of symptoms according to Lamey and Lewis. Following basically similar treatment for 2 weeks~2months, Case 1 had total relief of pain, Case 2 had only partial improvement but Case 3 experienced no improvement at all. BMS with many other confusing synonyms(Tab.1) is a difficult disease for both patients and pain clinicians. Because its etiology and pathophysiology are still unknown, evaluation should be followed in a stepwise fashion and management(Fig.1) focused on correcting suspected causative factors(local, systemic or psychologic). Generally it is believed that psychologic factors predominate in the etiology of BMS. It is unclear whether psychologic factors predispose patients to BMS or whether BMS predisposes them to psychologic disorders but treatment with low-dose antidepressants is always indicated.

Tab.1 Synonyms of Burning Mouth Syndrome

Glossalgian Syndorme

Glossodynia

Glossopyrosis

Stomatodynia

Stomatopyrosis

Oral dysesthesia

Denture sore mouth

Tab.2 Classification of 3 Subtypes of BMS

Type	Other Linked Etiology	Burning Sensation
1	Nutritional deficiencies	Symptom-free on waking
2	Chronic anxiety	Continuous
3	50% emotional instability	50% food allergies, Intermittent

(Lamey and Lewis 1989)

Tab3. Summary of 3 cases with intraoral burning

	Age	Sex	Meno-pause	Signs and Symptoms	Treatment	Outcome	Remarks
Case1	70	F	♀	lIntermittent burning lnormal mucosa	lstellate gl.block (SGB) lantidepressant lbenzodiazepine	Cure	Dramatic Improvement After SGB
Case2	66	F	♀	lInsomnia lXerostomia lDepression lCancerophobia	lstellate gl. Block lantidepressant llow-level laser	Sx unresolved	Patient abandoned further Tx after 2 wks
Case3	58	F	♀	lXerostomia lDepression lHalitosis	lstellate gl. Block lantidepressant lmexiletine	Partial improvement	lDiabetic ldenture