Diagnosis and management of burning mouth syndrome

If burning mouth syndrome is suspected, the initial work-up is extensive and requires a detailed clinical history, including a dental, medical and medication history. Because burning mouth syndrome is a diagnosis of exclusion, other causes of the patient’s symptoms must be ruled out, such as:

local causes (eg mucocutaneous conditions, fungal infections, rough dental surfaces)
systemic causes
hypersensitivity in patients who feel the problem is prosthesis-related (hypersensitivity can be identified with skin patch testing, but this is rarely required)
drugs (eg drugs that cause sensory neuropathy, taste aberrations or salivary gland hypofunction).

Some practitioners use questionnaires to assess the impact of symptoms on the patient’s mood and quality of life.

The management of burning mouth syndrome is complex. The most important component of management is helping the patient to understand the condition (ie that burning mouth syndrome is a chronic neuropathic pain syndrome, irrespective of the likely initial triggers). Some patients may improve with discussion and counselling alone.

Note: The most important component of managing burning mouth syndrome is helping the patient to understand the condition.

Other management strategies for burning mouth syndrome include:

lifestyle changes to modify a patient’s response to external stressors (eg relaxation therapy, time management, exercise, community group participation)
pharmacological management—topical or systemic use of psychotropic drugs (eg tricyclic antidepressants, antiepileptic drugs, clonazepam).

Pharmacological management is the treatment chosen by most patients and requires specialist referral.