Burning Mouth Syndrome
Burning mouth syndrome (BMS) is defined as burning
sensation in the mouth without any observable abnormalities.
Many people with BMS also describe oral dryness; some of
these people with oral dryness have findings consistent with
Sjogren's syndrome (a condition that classically causes
dryness of the eyes and mouth). Because of this association
we screen all of our BMS patients for Sjogren's and other
conditions manifested by oral dryness.
Burning mouth patients, including those with Sjogren's,
sometimes have an oral candidal (thrush) infection that is
not readily apparent on examination. Because the treatment
is benign (Nystatin vaginal troches slowly dissolved in the
mouth, one troche four times a day), we recommend a two week
treatment for possible candidiasis. (We use vaginal troches
because there is no sugar in them and patients with dry
mouth are prone to more cavities in their teeth if they use
a sugar-containing troche). If the oral burning improves, we
treat for an additional 6 weeks. Some patients require a
full three months of treatment to eradicate the infection,
especially if their mouths are dry. During treatment, it is
important to disinfect any dentures simultaneously so that
the infection is not reintroduced into the mouth. Your
dentist will provide you with disinfectant recommendations
for your dentures. Your doctor can obtain an oral candidal
culture prior to treatment with Nystatin, but our
recommendation is to treat regardless of culture results
because we have seen improvement even when cultures are
negative.
In addition to the above, we screen for nutritional
deficiencies (B1, B2, B6, B12, folic acid and iron) and
diabetes mellitus in all patients, because some of our
patients have low vitamin and/or mineral test results, and
elevated serum glucoses. Both nutritional deficiencies and
diabetes have been reported to be associated with oral
burning in other studies.
Lastly, if evaluation to this point is unrevealing, we
suggest an MRI scan of the head, to make certain that there
is nothing in the brain causing the burning sensations. For
example it is possible that a small "stroke" in a specific
area can cause oral burning symptoms.
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