Advertisement

EPMA Journal

pp 1–11 | Cite as

Oral burning: local and systemic connection for a patient-centric approach

  • Jaisri Thoppay
  • Bhavik DesaiEmail author
Review
  • 21 Downloads

Abstract

Burning symptoms in the oral cavity are caused by a range of systemic and local factors, in addition to the neuropathic pain disorder burning mouth syndrome (BMS). Patients may state oral burning as a standalone symptom or may report as a secondary symptom in association with other factors, most commonly with oral dryness, oral mucosal lesions, or certain systemic conditions. There is a level of uncertainty in the presentation of this condition which creates a diagnostic challenge from both the patient’s perspective and the practitioner evaluating these individuals. The diagnoses are complicated due to the lack of a clear definition of BMS and clinical guidelines to distinguish BMS from other conditions that are responsible for oral burning symptoms. A clinician should be able to differentiate oral burning from burning mouth syndrome. This integrative review discusses on local and systemic etiologies of oral burning based on current evidence that needs to be excluded for a diagnosis of BMS. It also provides an algorithm for diagnostic workup and therapeutic management to medical providers for patients experiencing oral burning symptoms. This comprehensive system provides a systematic stepwise workup in diagnosing and managing patients presenting with a complaint of oral burning that optimally meets a predictive, preventive, and personalized medicine (PPPM) approach.

Keywords

Oral burning Burning mouth Xerostomia Predictive preventive personalized medicine 

Notes

Compliance with ethical standards

Conflicts of interest

The submitted documents represent original work that has not been published previously. The manuscript is not currently submitted for publication elsewhere. All authors have read and approved the manuscript. We also report no conflicts of interest.

References

  1. 1.
    Perier JM, Boucher Y. History of burning mouth syndrome (1800-1950): a review. Oral Dis. 2018.Google Scholar
  2. 2.
    Coculescu EC, Tovaru S, Coculescu BI. Epidemiological and etiological aspects of burning mouth syndrome. J Med Life. 2014;7(3):305–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Salerno C, di Stasio D, Petruzzi M, Lauritano D, Gentile E, Guida A, et al. An overview of burning mouth syndrome. Front Biosci (Elite Ed). 2016;8:213–8.Google Scholar
  4. 4.
    Kohorst JJ, Bruce AJ, Torgerson RR, Schenck LA, Davis MDP. A population-based study of the incidence of burning mouth syndrome. Mayo Clin Proc. 2014;89(11):1545–52.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Honda M, Iida T, Kamiyama H, Masuda M, Kawara M, Svensson P, et al. Mechanical sensitivity and psychological factors in patients with burning mouth syndrome. Clin Oral Investig. 2018.  https://doi.org/10.1007/s00784-018-2488-9.
  6. 6.
    Lamey PJ, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J (Clin Res Ed). 1988;296(6631):1243–6.CrossRefGoogle Scholar
  7. 7.
    Netto FO, et al. Risk factors in burning mouth syndrome: a case-control study based on patient records. Clin Oral Investig. 2011;15(4):571–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Dembert ML, Faust HS. Pizza palate. J Am Dent Assoc. 1984;109(2):138–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Benoliel R, Zadik Y, Eliav E, Sharav Y. Peripheral painful traumatic trigeminal neuropathy: clinical features in 91 cases and proposal of novel diagnostic criteria. J Orofac Pain. 2012;26(1):49–58.PubMedGoogle Scholar
  10. 10.
    Corsalini M, di Venere D, Pettini F, Lauritano D, Petruzzi M. Temporomandibular disorders in burning mouth syndrome patients: an observational study. Int J Med Sci. 2013;10(12):1784–9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Cowan GM, Lockey RF. Oral manifestations of allergic, infectious, and immune-mediated disease. J Allergy Clin Immunol Pract. 2014;2(6):686–96.PubMedCrossRefGoogle Scholar
  12. 12.
    Silverman S. Mucosal lesions in older adults. J Am Dent Assoc. 2007;138:S41–6.CrossRefGoogle Scholar
  13. 13.
    Vellappally S. Burning mouth syndrome: a review of the etiopathologic factors and management. J Contemp Dent Pract. 2016;17(2):171–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Ching V, Grushka M, Darling M, Su N. Increased prevalence of geographic tongue in burning mouth complaints: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(4):444–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Poon R, Su N, Ching V, Darling M, Grushka M. Reduction in unstimulated salivary flow rate in burning mouth syndrome. Br Dent J. 2014;217(7):E14.PubMedCrossRefGoogle Scholar
  16. 16.
    Cibirka RM, Nelson SK, Lefebvre CA. Burning mouth syndrome: a review of etiologies. J Prosthet Dent. 1997;78(1):93–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Navazesh M, Kumar SK. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc. 2008;139(Suppl):35s–40s.PubMedCrossRefGoogle Scholar
  18. 18.
    Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent. 2001;85(2):162–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Kunin A, Polivka J, Moiseeva N, Golubnitschaja O. “Dry mouth” and “Flammer” syndromes-neglected risks in adolescents and new concepts by predictive, preventive and personalised approach. EPMA J. 2018;9(3):307–17.PubMedCrossRefGoogle Scholar
  20. 20.
    Bhattacharyya S, Helfgott SM. Neurologic complications of systemic lupus erythematosus, sjogren syndrome, and rheumatoid arthritis. Semin Neurol. 2014;34(4):425–36.PubMedCrossRefGoogle Scholar
  21. 21.
    Napenas JJ, Rouleau TS. Oral complications of Sjogren’s syndrome. Oral Maxillofac Surg Clin North Am. 2014;26(1):55–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Glazar I, et al. Oral sensorial complaints, salivary flow rate and mucosal lesions in the institutionalized elderly. J Oral Rehabil. 2010;37(2):93–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Renton T. Burning mouth syndrome. Rev Pain. 2011;5(4):12–7.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Vucicevic-Boras V, Topic B, Cekic-Arambasin A, Zadro R, Stavljenic-Rukavina A. Lack of association between burning mouth syndrome and hematinic deficiencies. Eur J Med Res. 2001;6(9):409–12.PubMedGoogle Scholar
  25. 25.
    Morr Verenzuela CS, Davis MDP, Bruce AJ, Torgerson RR. Burning mouth syndrome: results of screening tests for vitamin and mineral deficiencies, thyroid hormone, and glucose levels—experience at Mayo Clinic over a decade. Int J Dermatol. 2017;56(9):952–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Femiano F, Lanza A, Buonaiuto C, Gombos F, Nunziata M, Cuccurullo L, et al. Burning mouth syndrome and burning mouth in hypothyroidism: proposal for a diagnostic and therapeutic protocol. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(1):e22–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Ship JA. Diabetes and oral health: an overview. J Am Dent Assoc, 2003. 134 Spec No: 4s–10s.Google Scholar
  28. 28.
    Forabosco A, Criscuolo M, Coukos G, Uccelli E, Weinstein R, Spinato S, et al. Efficacy of hormone replacement therapy in postmenopausal women with oral discomfort. Oral Surg Oral Med Oral Pathol. 1992;73(5):570–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Tarkkila L, Linna M, Tiitinen A, Lindqvist C, Meurman JH. Oral symptoms at menopause—the role of hormone replacement therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(3):276–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Femiano F, Lanza A, Buonaiuto C, Gombos F, Rullo R, Festa V, et al. Oral manifestations of adverse drug reactions: guidelines. J Eur Acad Dermatol Venereol. 2008;22(6):681–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Douglass R, Heckman G. Drug-related taste disturbance: a contributing factor in geriatric syndromes. Can Fam Physician. 2010;56(11):1142–7.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Silvestre FJ, Silvestre-Rangil J, Lopez-Jornet P. Burning mouth syndrome: a review and update. Rev Neurol. 2015;60(10):457–63.PubMedGoogle Scholar
  33. 33.
    Fortin I, Fortin B, Lambert L, Clavel S, Alizadeh M, Filion EJ, et al. Xerostomia in patients treated for oropharyngeal carcinoma: comparing linear accelerator-based intensity-modulated radiation therapy with helical tomotherapy. Head Neck. 2014;36(9):1343–8.PubMedGoogle Scholar
  34. 34.
    Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2015;11:45–51.PubMedGoogle Scholar
  35. 35.
    Watanabe M, Nakatani E, Yoshikawa H, Kanno T, Nariai Y, Yoshino A, et al. Oral soft tissue disorders are associated with gastroesophageal reflux disease: retrospective study. BMC Gastroenterol. 2017;17(1):92.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Adler I, Denninghoff VC, Alvarez MI, Avagnina A, Yoshida R, Elsner B. Helicobacter pylori associated with glossitis and halitosis. Helicobacter. 2005;10(4):312–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Albilia JB, Lam DK, Clokie CM, Sándor GK. Systemic lupus erythematosus: a review for dentists. J Can Dent Assoc. 2007;73(9):823–8.PubMedGoogle Scholar
  38. 38.
    Carrington J, Getter L, Brown RS. Diabetic neuropathy masquerading as glossodynia. J Am Dent Assoc. 2001;132(11):1549–51.PubMedCrossRefGoogle Scholar
  39. 39.
    Rhodus NL, Fricton J, Carlson P, Messner R. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol. 2003;30(8):1841–5.PubMedGoogle Scholar
  40. 40.
    Koszewicz M, Mendak M, Konopka T, Koziorowska-Gawron E, Budrewicz S. The characteristics of autonomic nervous system disorders in burning mouth syndrome and Parkinson disease. J Orofac Pain. 2012;26(4):315–20.PubMedGoogle Scholar
  41. 41.
    Clark GT, Ram S. Orofacial movement disorders. Oral Maxillofac Surg Clin North Am. 2016;28(3):397–407.PubMedCrossRefGoogle Scholar
  42. 42.
    Ritchie A, Kramer JM. Recent advances in the etiology and treatment of burning mouth syndrome. J Dent Res. 2018;97(11):1193–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Adamo D, Sardella A, Varoni E, Lajolo C, Biasotto M, Ottaviani G, et al. The association between burning mouth syndrome and sleep disturbance: a case-control multicentre study. Oral Dis. 2018;24(4):638–49.PubMedCrossRefGoogle Scholar
  44. 44.
    Lopez-Jornet P, Lucero-Berdugo M, Castillo-Felipe C, Zamora Lavella C, Ferrandez-Pujante A, Pons-Fuster A. Assessment of self-reported sleep disturbance and psychological status in patients with burning mouth syndrome. J Eur Acad Dermatol Venereol. 2015;29(7):1285–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Klasser GD, Pinto A, Czyscon JM, Cramer CK, Epstein J. Defining and diagnosing burning mouth syndrome: perceptions of directors of North American postgraduate oral medicine and orofacial pain programs. J Am Dent Assoc. 2013;144(10):1135–42.PubMedCrossRefGoogle Scholar
  46. 46.
    The International Classification of Headache Disorders: 2nd edition. Cephalalgia, 2004. 24 Suppl 1: p. 9–160.Google Scholar
  47. 47.
    Gremeau-Richard C, et al. Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial. Pain. 2010;149(1):27–32.PubMedCrossRefGoogle Scholar
  48. 48.
    Lauria G, Majorana A, Borgna M, Lombardi R, Penza P, Padovani A, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain. 2005;115(3):332–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Yilmaz Z, Renton T, Yiangou Y, Zakrzewska J, Chessell IP, Bountra C, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. J Clin Neurosci. 2007;14(9):864–71.PubMedCrossRefGoogle Scholar
  50. 50.
    Coculescu EC, et al. Burning mouth syndrome: controversial place as a symptom of oro-dental pathology. J Med Life. 2015;8(Spec Issue):34–7.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Javali MA. Burning mouth syndrome: an enigmatic disorder. Kathmandu Univ Med J (KUMJ). 2013;11(42):175–8.Google Scholar
  52. 52.
    Nasri-Heir C, Zagury JG, Thomas D, Ananthan S. Burning mouth syndrome: current concepts. J Indian Prosthodont Soc. 2015;15(4):300–7.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Bartoshuk LM, et al. Taste damage: previously unsuspected consequences. Chem Senses. 2005;30(Suppl 1):i218–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Jaaskelainen SK. Pathophysiology of primary burning mouth syndrome. Clin Neurophysiol. 2012;123(1):71–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Sigal MJ, Mock D. Symptomatic benign migratory glossitis: report of two cases and literature review. Pediatr Dent. 1992;14(6):392–6.PubMedGoogle Scholar
  56. 56.
    Aravindhan R, Vidyalakshmi S, Kumar MS, Satheesh C, Balasubramanium AM, Prasad VS. Burning mouth syndrome: a review on its diagnostic and therapeutic approach. J Pharm Bioallied Sci. 2014;6(Suppl 1):S21–5.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Thoppay JR, De Rossi SS, Ciarrocca KN. Burning mouth syndrome. Dent Clin N Am. 2013;57(3):497–512.PubMedCrossRefGoogle Scholar
  58. 58.
    Patton LL, et al. Management of burning mouth syndrome: systematic review and management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(Suppl):S39.e1–13.Google Scholar
  59. 59.
    Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64(5):773–86.PubMedGoogle Scholar
  60. 60.
    Gustin SM, Burke LA, Peck CC, Murray GM, Henderson LA. Pain and personality: do individuals with different forms of chronic pain exhibit a mutual personality? Pain Pract. 2016;16(4):486–94.PubMedCrossRefGoogle Scholar
  61. 61.
    Kim MJ, Kho HS. Understanding of burning mouth syndrome based on psychological aspects. Chin J Dent Res. 2018;21(1):9–19.PubMedGoogle Scholar
  62. 62.
    Klasser GD, Grushka M, Su N. Burning mouth syndrome. Oral Maxillofac Surg Clin North Am. 2016;28(3):381–96.PubMedCrossRefGoogle Scholar
  63. 63.
    Imura H, Shimada M, Yamazaki Y, Sugimoto K. Characteristic changes of saliva and taste in burning mouth syndrome patients. J Oral Pathol Med. 2016;45(3):231–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Spadari F, Venesia P, Azzi L, Veronesi G, Costantino D, Croveri F, et al. Low basal salivary flow and burning mouth syndrome: new evidence in this enigmatic pathology. J Oral Pathol Med. 2015;44(3):229–33.PubMedCrossRefGoogle Scholar
  65. 65.
    Mignogna MD, et al. The diagnosis of burning mouth syndrome represents a challenge for clinicians. J Orofac Pain. 2005;19(2):168–73.PubMedGoogle Scholar
  66. 66.
    Pinto A, Khalaf M, Miller CS. The practice of oral medicine in the United States in the twenty-first century: an update. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(4):408–15.PubMedCrossRefGoogle Scholar
  67. 67.
    Shinoda M, Takeda M, Honda K, Maruno M, Katagiri A, Satoh-Kuriwada S, et al. Involvement of peripheral artemin signaling in tongue pain: possible mechanism in burning mouth syndrome. Pain. 2015;156(12):2528–37.PubMedCrossRefGoogle Scholar
  68. 68.
    Varoni EM, Lo Faro A, Lodi G, Carrassi A, Iriti M, Sardella A. Melatonin treatment in patients with burning mouth syndrome: a triple-blind, placebo-controlled, crossover randomized clinical trial. J Oral Facial Pain Headache. 2018;32(2):178–88.PubMedCrossRefGoogle Scholar
  69. 69.
    Miziara I, Chagury A, Vargas C, Freitas L, Mahmoud A. Therapeutic options in idiopathic burning mouth syndrome: literature review. Int Arch Otorhinolaryngol. 2015;19(1):86–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Matsuoka H, Chiba I, Sakano Y, Toyofuku A, Abiko Y. Cognitive behavioral therapy for psychosomatic problems in dental settings. Biopsychosoc Med. 2017;11:18.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© European Association for Predictive, Preventive and Personalised Medicine (EPMA) 2019

Authors and Affiliations

  1. 1.Oral Medicine, Orofacial Pain and Geriatric ProgramsVirginia Commonwealth UniversityRichmondUSA
  2. 2.Oral Health and Diagnostic Sciences, Oral Medicine SectionDental College of Georgia at Augusta UniversityAugustaUSA

Personalised recommendations