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Burning Mouth Syndrome

Drg. Rochman Mujayanto


Fakultas Kedokteran Gigi
Universitas Islam Sultan Agung Semarang
Pendahuluan
 Burning Mouth Syndrome (BMS)
merupakan kondisi rasa sakit dalam mulut
yang konik, biasanya disertai dengan rasa
terbakar atau panas pada lidah, bibir,
dan mukosa tanpa adanya kelainan
patologik.
 Etiologi BMS belum diketahui, tetapi ada
beberapa faktor predisposisi
Sinonim
 Stomatopirosis
 Glossopirosis
 Stomatodinia
 Glossodinia
 Sore mouth
 Sore tongue
 Disesthesia oral
Classification
 BMS Type 1: is defined as absence of
symptoms on awakening, with gradual
increase in symptoms as day progresses.
 BMS Type 2: describes the burning as
present day and night.
 BMS Type 3: patients are characterized as
those withdays of remission which follows
no specific pattern.
Symptoms
 Pain and burning in oral mucosa,
 xerostomia (dry mouth),
 dysgeusia (taste alteration)
Etiological Factors
1. Local Factors
2. Systemic Factors
3. Psychogenic Factors
4. Neurogenic Factors
1. Local Factors
 Salivary Dysfunction : elevated salivary
viscosity may result in thin and discontinuous
salivary film covering the oral mucosa that
triggers the sensation of dry mouth
 Taste Disturbances : The damage to chorda
tympani or taste buds releases the inhibition in
the glossopharyngeal nerve (so phantom
taste) or trigeminal nerve (touch and pain
changes).
 Ulcerative and Erosive Lesions
 Oral conditions: Lichen planus,
geographic tongue
 Oral habits: Tongue thrusting, bruxism
 Excessive mouth irritation: Overbrushing,
overuse of mouth washes, overingestion
of acidic drinks.
2. Systemic Factors
 Hormonal Changes  Menopouse woman
 Diabetes Mellitus : prolonged exposure to
glucose can lead to deterioration of nerve
endings. Poor circulation is also the adverse
effect of diabetes and thereby lowers the
pain threshold as these factor can easily
disrupt functions at the ends of v2 or v3
branches of trigeminal nerve.
 Viral Infection
 Gastroesophageal reflux disease (GRED)
 Anaemias, Nutritional and Hematological
Disorders.
 Hypothyroidism  manifest with aguesia or
dysguesia. Thyroid hormone is essential for
maturation of taste buds. In hypothyroidism, there
is a decreased level of T3, T4 and TSH level is
increased.
 Drugs : angiotensin-converting enzyme (ACE)
inhibitors and angiotensin receptor blockers
(ARBs), anticoagulants, antiretrovirals (efevirenz),
anticholinergics
3.Psychogenic Factors
 Several studies have suggested that
patients with BMS have depression, mood
and anxiety disorders.
 Stress leads to production of free radicals
and increased cortisol levels which can
degrade ordinary T 3 to form reverse T3
that has action opposite to that of T 3
required for taste function
4. Neurogenic Factors.
 dysfunctionof various cranial nerves
associated with taste sensation as
possible cause of BMS
Diagnosis
 History taking is the key to diagnosis of
BMS.
 Normal laboratory findings are found in
BMS patients.
 Alternate causes of oral burning pain
should be ruled out before a diagnosis of
BMS is entertained.
Clinical Features
 Unexplained, usually persistent burning
sensation or pain of the oral soft tissues.
 The diagnostic criteria for BMS are that
pain episodes must occur continuously
for at least 4-6 months.
 Commonly affects the tongue presenting
as glossodynia (painful tongue) and
glossopyrosis (burning tongue).
 Altered taste sensation such as bitter or
metallic taste
 Oral mucosa appears apparently normal
without any visible changes.
 Xerostomia
 Geographic and fissured tongue
 Painful teeth, jaw and temporomadibular
joint
 Loss of a comfortable jaw position and
uncontrollable jaw tightness
 Headache, neck and shoulder pain
 Increased parafunctional activity
 Difficulty in speaking, nausea, gagging
and dysphagia
 Multiple mood and emotional
disturbance
Investigation
 Blood tests: Complete blood cell count,
glucose level, thyroid function, nutritional
factors and immune function
 Oral cultures: For bacterial, viral and
fungal infections
 To check allergy to certain foods,
additives or even denture materials.
 Sialometric analysis to measure and
check salivary flow.
 Psychological questionnaires: To check
symptoms of depression, anxiety, etc.
 Gastric reflux tests: To determine GERD.
 Biopsy of tongue or oral mucosa.
Treatment and Management
 Thegoal of treating BMS is to first identify
the underlying etiology, then to try to
reduce or eliminate the etiology
 Many patients with BMS show reduction or
disappearance of symptoms during meals
or when chewing gum or confectionary is
used. So the following measures may be
taken :
 Sip water frequently
 Chew sugarless gum
 Symptoms of BMS can be reduced and
also prevented from becoming worse by :
 Avoidance of tobacco products
 Avoidance of products with cinnamon or
mint
 Avoidance of spicy and hot foods
 Avoidance of acidic foods and liquids
 Using different brands of toothpastes
 Take steps to reduce excessive stress