Impact of Criteria-Based Diagnosis of Burning Mouth Syndrome on Treatment Outcome

Aims: Burning mouth syndrome (BMS) primarily affects postmenopausal women and is often difficult to treat successfully. Treatment outcomes have been problematic because of failure to distinguish between patients with BMS and patients presenting with oral burning (OB) resulting from other clinical abnormalities. The purpose of this study was to determine characteristics that might uniquely identify BMS patients from patients with OB and to determine whether proper classification influences treatment outcome. Methods: The clinical sample consisted of 69 patients (83% female) with an average age of 62 years, pain duration of 2.45 years, and visual analog scale pain rating of 49 mm (rated from 0 to 100 mm). All patients underwent a clinical exam and completed the Multidimensional Pain Inventory and Symptom Checklist 90–Revised. Results: There were no differences between the BMS and OB groups with respect to age, pain duration, pain intensity, life interference, and levels of psychologic distress. Patients with OB demonstrated more clinical abnormalities than BMS patients. Hyposalivation and greater use of prescription medications, most notably hormone replacement therapy, were more common in the OB group compared with the BMS group. When treatment was provided that corrected an identifiable abnormality, significantly more OB than BMS patients reported greater than 50% relief from baseline pain rating. Conclusion: These data indicate that while BMS and OB groups may initially present with similar clinical and psychosocial features, they are distinguishable with careful diagnosis that often enables successful management of symptoms for each group.

burning mouth syndrome; classification; treatment outcome; psychological distress

1. Harris M. Psychosomatic disorders of the mouth and face. Practitioner 1975;214:372–379.

2. Van der Waal I. The Burning Mouth Syndrome. Copenhagen: Munskgaard, 1990.

3. Zakrzewska JM. The burning mouth syndrome remains an enigma. Pain 1995;62:253–257.

4. Basker RM, Sturdee DW, Davenport JD. Patients with burning mouths. A clinical investigation of causative factors, including the climacteric and diabetes. Br Dent J 1978;145:9–16.

5. Grushka M. Clinical features of burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:30–36.

6. Ship JA, Grushka M, Lipton JA, Mott AE, Sessle BJ, Dionne RA. Burning mouth syndrome: An update. J Am Dent Assoc 1995;126:842–853.

7. Tourne LP, Fricton JR. Burning mouth syndrome. Critical review and proposed clinical management. Oral Surg Oral Med Oral Pathol 1992;74:158–167.

8. Samaranayake LP, Lamb AB, Lamey PJ, MacFarlane TW. Oral carriage of Candida species and coliforms in patients with burning mouth syndrome. J Oral Pathol Med 1989;18:233–235.

9. Lamey PJ, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J 1988;296:1243–1246.

10. Zegarelli DJ. Burning mouth: An analysis of 57 patients. Oral Surg Oral Med Oral Pathol 1984;58:34–38.

11. Gorsky M, Silverman S, Chinn H. Burning mouth syndrome: A review of 98 cases. J Oral Med 1987;42:7–9.

12. Bergdahl M. Salivary flow and oral complaints in adult dental patients. Community Dent Oral Epidemiol 2000;28:59–66.

13. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:191–197.

14. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345–356.

15. Derogatis LR. Symptom Checklist 90-R. Minneapolis, MN: National Computer Systems, 1991.

16. Langlais RP, Miller CS. Appendix II. In: Color Atlas of Common Oral Diseases, ed 2. Baltimore: Williams & Wilkins, 1998:152–158.

17. SPSS. Statistical Package for the Social Sciences (Version 8.0). Chicago: SPSS, 1997.

18. Grushka M, Epstein J, Mott A. An open-label, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome. Oral Surg Oral Med Oral Pathol1998;86:557–561.

19. Carlson CR, Miller CS, Reid KI. Psychosocial profiles of patients with burning mouth syndrome. J Orofac Pain 2000;14:59–64.

20. Browning S, Hislop S, Scully C, Shirlaw P. The association between burning mouth syndrome and psychosocial disorders. Oral Surg Oral Med Oral Pathol 1987;64:171–174.

21. Grushka M, Sessle BJ, Miller R. Pain and personality profiles in burning mouth syndrome. Pain 1987;28:155–167.

22. Zilli C, Brooke RI, Lau CL. Screening for psychiatric illness in patients with oral dysesthesia by means of the General Health Questionnaire–Twenty-Eight Item Version (GHQ-28) and the Irritability, Depression and Anxiety Scale (IDA). Oral Surg Oral Med Oral Pathol 1989;67:384–389.