Interventions for the Treatment of Burning Mouth Syndrome: A Systematic Review

Aims: To carry out a systematic review of previous studies to determine the effectiveness of any intervention vs placebo for relief of symptoms and improvement in quality of life of patients with burning mouth syndrome (BMS) and to assess the quality of the studies. Methods: Electronic databases, conference proceedings, and bibliographies of identified publications were searched (up to September 2001) to identify relevant literature, irrespective of lan-guage of publication. Randomized controlled trials and controlled clinical trials of interventions used for the treatment of BMS in comparison to a placebo were included. The primary outcome was relief of burning/discomfort. The screening of studies, validity assessment, and data extraction were undertaken independently and in duplicate. Since statistical pooling of data was inappropri-ate, a qualitative assessment was undertaken. Results: Seven trials, evaluating antidepressants, cognitive behavioral therapy, anal-gesics, hormone replacement therapy, and vitamin complexes, met the inclusion criteria. None of the trials was able to provide con-clusive evidence of effectiveness. However, cognitive behavioral therapy may be beneficial in reducing the intensity of the symp-toms. Conclusion: Given that the research evidence is, as yet, unable to provide clear, conclusive evidence of an effective inter-vention, clinicians need to provide support and understanding when dealing with BMS sufferers. Psychological interventions that help patients to cope with symptoms may be of some use, but promising and new approaches to treatment still need to be evalu-ated in good-quality randomized controlled trials.

burning mouth syndrome; randomized controlled trials; systematic review

1. Zakrzewska JM, Hamlyn PJ. Facial pain. In: Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff M (eds). Epidemiology of Pain. Seattle: IASP Press, 1999:177–202.

2. Bergdahl J, Anneroth G. Burning mouth syndrome: Literature review and model for research and management. J Oral Pathol Med 1993;22:433–438.

3. Bergdahl M, Bergdahl J. Burning mouth syndrome: Prevalence and associated factors. J Oral Pathol Med 1999;28:350–354.

4. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115–121.

5. Tammiala-Salonen T, Hiidenkarii T, Parvinen T. Burning mouth in a Finnish adult population. Comm Dent Oral Epidemiol 1993;21:350–354.

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

7. Grushka M, Sessle BJ. Burning mouth syndrome. Dent Clin North Am 1991;35:171–184.

8. Eli I, Baht R, Littner MM, Kleinhauz M. Detection of psychopathologic trends in glossodynia patients. Psychosom Med 1994;56:389–394.

9. Grushka M, Sessle BJ, Howley TP. Psychophysical assessment of tactile pain, pain and thermal sensory functions in burning mouth syndrome. Pain 1987;28:169–184.

10. Svensson P, Bjerring P, Arendt-Nielsen L, Kaaber S. Sensory and pain thresholds to orofacial argon laser stimulation in patients with chronic burning mouth syndrome. Clin J Pain 1993;9:207–215.

11. Jääskeläinen SK, Forssell H, Tenovuo O. Abnormalities of the blink reflex in burning mouth syndrome. Pain 1997; 3:455–460.

12. Forssell H, Jääskeläinen S, Tenovuo O, Hinkka S. Sensory dysfunction in burning mouth syndrome. Pain 2002;99: 41–47.

13. Bartoshuk LM, Grushka M, Duffy VB, Fast K, Lucchina L, Prutkin JSD. Burning mouth syndrome:Damage to CN VII and pain phantoms in CN V. Chem Senses 1999;24: 609.

14. Buchanan J, Zakrzewska JM. Burning mouth syndrome. Clin Evid 2002;7:1239–1243.

15. Clarke M, Oxman AD (eds), editors. Cochrane Reviewers Handbook 4.2.0 [updated March 2003]. Available at www.cochrane.dk/cochrane/handbook/handbook.htm.

16. Bergdahl J, Anneroth G, Perris H. Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: A controlled study. J Oral Pathol Med 1995;24: 213–215.

17. Loldrup D, Langemark M, Hansen HJ, Olesen J, Bech P. Clomipramine and mianserin in chronic idiopathic pain syndrome. A placebo controlled study. Psychopharma-cology 1989;99:1–7.

18. Sardella A, Uglietti D, Demarosi F, Lodi G, Bez C, Carrassi A. Benzydamine hydrochloride oral rinses in management of burning mouth syndrome. A clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:683–686.

19. Femiano F, Gombos F, Scully C, Busciolano M, De Luca P. Burning mouth syndrome (BMS): Controlled open trial of the efficacy of alphalipoic acid (thioctic acid) on symptomatology. Oral Dis 2000;6:274–277.

20. Tammiala-Salonen T, Forssell H. Trazodone in burning mouth pain: A placebo-controlled, double-blind study. J Orofac Pain 1999;13:83–88.

21. Bogetto F, Bonatto Revello R, Ferro G, Maina G, Ravizza L. Psychopharmacological treatment of burning mouth syndrome (BMS). A study on a sample of 121 patients. Minerva Psichiatr 1999;40:1–10.

22. Pisanty S, Rafaely B, Polishuk W. The effect of steroid hormones on buccal mucosa of menopausal women. Oral Surg Oral Med Oral Pathol 1975;40:346–353.

23. Juni P, Altman DG, Egger M. Assessing the quality of randomised controlled trials. In: Egger M, Davey Smith G, Altman DG (eds). Systematic Reviews in Healthcare. Meta-analysis in Context. London: BMJ Publishing Group, 2001: 87–108.

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

25. Juni P, Witschi A. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 1999;282:1054–1060.

26. Farrar J, Portenoy RK, Berlin JA, Kinman JL, Strom BL. Defining the clinically important differences in pain out-come measures. Pain 2000;88:287–294.

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

28. Jääskeläinen SK, Rinne JO, Forssell H, et al. Role of the dopaminergic system in chronic pain—a fluorodopapet study. Pain 2001;90:257–260.

29. Woolf CJ, Bennett GJ, Doherty M, et al. Towards a mech-anism-based classification of pain? Pain 1998;77:227–229.

30. Grushka M, Epstein J, Mott A. An openlabel, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:557–561.

31. Woda A, Navez ML, Picard P, Gremeau C, Pichard-Leandri E. A possible therapeutic solution for stomatodynia (burning mouth syndrome). J Orofac Pain 1998;12: 272–278.