Burning Mouth Syndrome (BMS) is a complex condition characterized by a burning sensation in the mouth without an identifiable cause. While the exact cause of BMS remains unknown, it is believed to be a form of neuropathic pain, indicating abnormal functioning of nerve fibers in the mouth.
BMS is thought to arise from the abnormal stimulation and excitation of nerves responsible for pain perception in the mouth. This leads to the transmission of pain signals even in the absence of any apparent painful stimulus.
While the exact factors contributing to BMS are not fully understood, several potential factors have been identified.
Primary vs. Secondary Burning Mouth Syndrome
Burning Mouth Syndrome (BMS) is classified into two main types: primary BMS and secondary BMS.
Primary BMS:
Primary BMS refers to cases where the burning sensation in the mouth is the main symptom, and there is no underlying identifiable cause or oral health abnormality.
The exact cause of primary BMS is still not well understood, and it is considered a diagnosis of exclusion, meaning other potential causes must be ruled out.
Some theories suggest that it may be related to dysfunction in the nerves responsible for pain and taste sensation in the mouth. Hormonal imbalances, psychological factors, and changes in the oral microbiome have also been proposed as possible contributing factors.
Contributing Factors to primary BMS
1. Adverse Life Events
Stressful life events, such as the loss of a job or the death of a family member or spouse, have been suggested as potential contributing factors to BMS.
2. Psychiatric Disorders
Conditions like anxiety, depression, and post-traumatic stress disorder (PTSD) have been linked to BMS. The relationship between these conditions and BMS is complex and requires further research.
3. Blood Dyscrasias
Blood dyscrasias refer to abnormalities or disorders of the blood, such as anemia or deficiencies in certain blood components. These conditions may impact the overall health and function of the oral tissues, potentially leading to symptoms associated with BMS.
4. Allergic or Inflammatory Disorders
Allergic reactions or inflammatory disorders affecting the oral tissues can contribute to the development of BMS. Inflammation in the mouth can disrupt the normal functioning of nerve fibers and contribute to neuropathic pain sensations.
Secondary BMS
Secondary BMS occurs when the burning sensation in the mouth is caused by an underlying medical condition or a specific triggering factor. Several factors can contribute to secondary BMS.
Contributing Factors to secondary BMS
a. Oral Conditions
Oral conditions such as oral candidiasis (yeast infection), oral lichen planus (immune-related disorder), Xerostomia (dry mouth), or geographic tongue (benign inflammatory condition) can cause secondary BMS.
b. Gastroesophageal reflux disease (GERD) or acid reflux
Situations where stomach acid flows back into the esophagus can sometimes result in the reflux of gastric acid into the mouth. This acid exposure can irritate the oral tissues and contribute to the symptoms of BMS in some individuals.
c. Nutritional Deficiencies
Deficiencies in certain nutrients, particularly vitamin B12, iron, zinc, and folate, have been associated with BMS. Addressing these deficiencies through supplementation or dietary changes may alleviate symptoms.
d. Medications
Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors, oral diabetic medications, and some psychiatric medications, have been linked to BMS as a side effect. In some cases, adjusting the medication dosage or switching to an alternative medication can help manage symptoms.
e. Hormonal Changes
Hormonal changes, particularly during menopause, have been associated with an increased risk of developing BMS. Fluctuations in hormone levels may contribute to the development or exacerbation of symptoms.
f. Systemic Conditions
Underlying systemic conditions like diabetes, thyroid disorders, autoimmune diseases (e.g., Sjögren’s syndrome), and gastrointestinal reflux disease (GERD) can contribute to secondary BMS.
g. TMJ Problems
Temporomandibular joint (TMJ) disorders, which affect the jaw joint, have been associated with BMS in some cases.
h. Chronic Fatigue Syndrome and Fibromyalgia
BMS has been reported to coexist with chronic fatigue syndrome and fibromyalgia, although the nature of this association is still being studied.
i. Dentures and Infections
BMS is not directly caused by wearing dentures or infections. However, wearing dentures can sometimes exacerbate the burning sensation in the mouth.
Associated Symptoms of BMS
BMS is often accompanied by various other symptoms reported by patients. These may include:
- Headaches
- Fatigue
- Shoulder and back pain
- Irritable bowel syndrome
- Burning sensations in the skin or genital area
- Panic attacks
- Palpitations
- Tinnitus (ringing in the ears)
Management of BMS
Since the exact cause of BMS is unknown and the condition is multifaceted, its management can be challenging. Hormone replacement therapy (HRT), which is a commonly sought treatment, has generally shown limited effectiveness in managing BMS symptoms in post-menopausal women.
The distinction between primary and secondary BMS is essential for determining the appropriate treatment approach. Diagnosing BMS involves a thorough evaluation of the patient’s medical history, a physical examination, and ruling out other potential causes through various tests and assessments.
Treatment approaches for BMS that have helped to reduce the severity of symptoms usually involve a multidisciplinary approach with a combination of medications targeting neuropathic pain (e.g., painkillers, tricyclic antidepressants, anticonvulsants), saliva replacement products, addressing underlying psychological factors (e.g., anxiety, depression), managing associated symptoms, and exploring lifestyle modifications.
Final thoughts
It’s important for individuals experiencing symptoms of BMS to seek evaluation and guidance from healthcare professionals or specialists experienced in managing this condition. They can provide a comprehensive assessment, diagnose BMS, and develop an individualized treatment plan to alleviate symptoms and improve overall quality of life.
