Dr Mandeep Kaur
Burning mouth disease (BMD) is a rare, chronic disease of unknown origin. It is not a life-threatening disease. Patients suffering from BMD may consult not only their dentist or family doctor but also various medical specialists, such as the otolaryngologist, the dermatologist and the neurologist.
First-line healthcare providers often do not recognize the symptoms associated with it and patients may undergo unnecessary diagnostic tests and treatments for their complaints.
Instead of burning, some BMD patients describe their symptoms as prickling, itching, tingling or bizarre sensations, such as a sandpaper sensation. Some patients may also report a “draining” or “crawling” sensation in the mouth. The onset of BMS is usually gradual with no known precipitating factor or event. The symptoms of BMD are almost always daily present over a period of months or years, without periods of remission. The often associated complaints of a dry mouth or taste and smell disorders do so together with the burning or dysaesthetic sensations right from the start. In many BMD patients, the symptoms are not present on waking but arise and increase in severity as the day progresses, without preventing the patient from falling asleep. In some patients the symptoms are continuously present, day and night. Apparently, a few patients may have symptom-free days or may have symptoms at unusual sites such as the floor of the mouth and buccal mucosa.
Spicy or acidic food/liquids or alcoholic beverages, stress and tiredness often intensify the burning sensation. Achlorhydria, gastritis, allergy, deficiency of vitamin B12, Iron deficiency anemia, zinc deficiency, hormonal disorders, side effect of few medications, celiac disease, oropharyngeal reflux, diabetes mellitus, cancerphobia, candidiasis, lichen planus, salivary gland disorder, nocturnal polyuria may be associated with BMD. Other contributing factors are menopause, adverse life events, psychiatric disorders, TMJ problems, chronic fatigue syndrome and fibromyalgia. Patients also often report other symptoms such as headache, fatigue, shoulder pain, back pain, irritable bowel syndrome, burning of the skin or genital area, panic attacks, palpitations and ringing in the ears. There is, indeed, growing evidence that BMD should be regarded as a chronic neuropathic pain that may be associated with but not caused by psychogenic disorders, such as anxiety and depression. Burning mouth disease is most likely based on an altered function of the nerves. Tip of the tongue, Lateral borders of the tongue, dorsum of the tongue, lips, cheek mucosa, Palate, throat, upper and lower denture-bearing tissue are the common sites.
Treatment
There is no cure for BMS. Some, if not most, of the discomfort can be alleviated using a variety of medications, many of which are used to treat anxiety, depression, and other neurologic disorders although at lower doses. The medications help to reduce the activity of nerve fibers. Since many patients also have difficulty sleeping the medications may help you to sleep and rest better, and feel less anxious. Medications such as clonazeapam, lidocaine, alpha lipoic acid, topical capsaicin, mouth rinses, chewing gums, vitamin supplements, female hormone replacement are recommended. Non-pharmacologic helpful approaches in addition to the medications include stress management/reduction, meditation, yoga, exercise, psychotherapy and cognitive behavioral therapy. If stress, anxiety/depression is contributing to BMS, regular use of these techniques or regular counseling may help to reduce symptoms and keep drug dosages low. With any therapy for BMS, it may take several weeks or even months before maximum benefits are achieved.
You can do a few things that may help your symptoms as well:
* Avoid acidic foods like tomatoes and orange and citrus juices
* Avoid alcohol, including mouthwashes with alcohol
* Avoid cinnamon and mint
* Avoid spicy foods
* Avoid tobacco
* Drink lot of fluids
* Suck on crushed ice
* Give herbs a chance such as aloe vera, honey, lavender
(The author is Assistant Professor Dept of Oral Pathology & Microbiology Indira Gandhi Govt Dental College, Jammu)
Follow our WhatsApp channel
