Burning Mouth Syndrome -
Part 2 - Dr.Gazala Danish . United Arab Emirates
Neutritis Isn't Neuralgia,
It's Different .-
Lewiston Daily Sun - Sep 16, 1970
The July issue continues with the Best of Papers of the past 5 years
with Dr.Gazala Danish's Review article on Burning Mouth Syndrome. I
have linked the Original Issue published in the Feb 2009 Issue. For
the Editorial of the nest issue MARCH
2009 , I received a lot of appreciative mails from "dentists" as
well as " non dentists" who read it .
Hope you enjoyed the
series. From September We will be back with new papers for yet
another journey with all of you as we expand our wings on FaceBook !
International Association for Study of Pain
defines glossodynia as burning pain in the tongue, which most often
involves the tip and lateral borders of glossal mucosa. Palate, lips
and sometimes other buccal mucosa and is often associated with odd
taste, dry mouth, uncomfortable bite or denture intolerance.
Burning sensation can be seen with a number of inflammatory and
ulcerative conditions of the oral mucosa, but the term “Burning
Mouth Syndrome” is reserved to a condition where there is oral
burning with no detectable cause. There are no mucosal lesions or no
known neurological disorders to explain the symptoms and there are
no characteristic laboratory findings.
The causes of burning sensation in the mouth are multifactorial and
divided into three groups; local, systemic and psychogenic.
Local factors :
The onset of symptoms, as reported by patients related to previous
dental treatment, may be as high as 65%. Conversely Nater et al.
found it was not possible to correlate any signs that implicated
dentures as a local etiologic agent. Gorsky et al. provided similar
conclusions, corroborating that denture difficulties are an
uncertain cause in the development of burning mouth syndrome.
Mucosal diseases like geographic tongue or benign migratory
Mucosal allergic reactions to allergens like methyl methacrylate
monomer, nickle sulfate, cobalt chloride and mercury. Chemicals
commonly found in denture materials were evaluated through
epicutaneous patch testing in 53 patients who wore dentures by
Kaaber et al. In this study 23% of the patients demonstrated an
allergic reaction to the substance in denture and the allergy was
determined the cause for burning sensation.
Oral allergies to food containing sorbic acid (a preservative found
in foods, ointments and creams), cinnamic aldehyde (a flavoring
agent in foods and dentifrices), nicotinic acid (used as a
rubefacient in toothpaste) and propylene glycol (a food additive)
have been reported.
A case where peanut sensitivity was a cause of burning mouth has
been reported by Burnett et al. using the serum of 10 peanut
allergic subjects, Burnett et al. identified 16 IgE-binding proteins
in a raw peanut extract and 7 IgE-binding proteins in a roasted
peanut extract by crossed radioimmunoelectrophoresis.
Dysfunction and parafunction of the stomatognathic. Parafunctional
activities resulting in excessive occlusal or denture wear has been
shown in up to 61% of studied patients with burning mouth syndrome.
Parafunctional activity of lip licking, lip sucking, lip pressure
and mouth breathing are noted in patients with perioral symptoms.
Quantity and quality
Oral salivary quantity and quality have been investigated as
causative factors in burning mouth syndrome. Irregularities in
saliva metabolites as protein, potassium and phosphate
concentrations between patients with burning mouth syndrome and
control patients have been suggested as causative factors.
systemic disease and pharmacotherapeutic agents have been shown to
diminish salivary flow rates and may be associated with increased
incidences of burning mouth syndrome symptoms.
Burning mouth symptoms may reflect a neuropathic condition possibly
involving the central or peripheral nervous system or both. Nerve
injury or dysfunction resulting from oral, facial or systemic trauma
from medical conditions might be the cause of burning sensations.
The constant burning may indicate a tonic efflux from nociceptive
primary afferents to the brain. This may be evident in inflammatory
conditions or regional nerve trauma (neuroma). Excitatory afferent
input could evoke a burning sensation with limited sensory changes
such as touch or thermal perception. Hence, the use of topical local
anesthetic in the burning oro-facial region did not interrupt the