You’ve probably have heard of PMS, but what about BMS? Burning Mouth Syndrome (BMS) is a little-known condition that affects some 1.3 million Americans. It most commonly affects the tongue, although the problem can occur in any part of the oral area.
BMS typically occurs with no precipitating factors, although some patients report their symptoms began following a dental procedure or recent respiratory infection. The main symptom is a burning sensation in the mouth that feels as if one had just scalded their tongue on hot coffee. The pain is usually not present on awakening but starts by late morning and becomes most severe in the evening, making falling asleep difficult. Patients can become depressed and anxious from the chronic pain. No relief is noted with the use of over-the-counter analgesics. Some patients have been known to have a spontaneous partial recovery 6 to 7 years after onset.
What causes BMS?
What could be the cause of such an unusual condition? There are many suggested possibilities but no single answer. Most sufferers are postmenopausal women, which has led some to believe hormonal changes cause the problem. However, BMS is also seen in men and some younger patients. Possible causes include the following:
- Allergies (food or drug)
- Cranial nerve injury
- Drug reaction
- Gastroesophageal reflux disease (GERD)
- Hormonal imbalances
- Oral thrush
- Medications such as angiotensin-converting enzyme (ACE) inhibitors
- Neuropathy to nerves that control taste and pain to the tongue
- Nutritional/vitamin deficiencies (especially B vitamins)
- Poor fitting dentures or poor dental work
- Poor oral habits/bruxism, excessive brushing of tongue, overuse of mouthwash
- Sjogren’s syndrome
- Thyroid dysfunction
- Xerostomia (dry mouth)
How is BMS diagnosed?
Diagnosis of BMS is difficult because no specific test exists for the condition. Patients are frequently shuttled from one doctor to another in an attempt to find a diagnosis, cause, or treatment. Other medical problems should be ruled out first: blood work to rule out anemia, endocrine problems, infection or nutritional deficiencies; an oral swab to check for thrush; an MRI of the brain to check for any organic cause; allergy testing; and oral culture or biopsy to check for infection or thrush. If no underlying condition is identified, a diagnosis of BMS is made.
How is BMS treated?
Treatment is based on the patient’s symptoms. Because another stimulus in the mouth may mask the pain, patients use various strategies to gain relief. These include eating, sipping water, sucking on ice, brushing teeth, using mouth freshening strips, applying an oral numbing agent to the affected area, and using other oral care drops and rinses on the market. Usually the most effective action is chewing sugar-free gum. Unfortunately, these tactics offer only temporary relief of the pain.
Medical and nursing plans of care should fit the individual’s needs depending on the cause of the BMS, including adjusting ill fitting dentures, providing vitamin B supplements to correct deficiencies, switching medications, treating oral thrush, relieving anxiety and depression, controlling pain from nerve damage, and treating existing disorders like diabetes. Benzodiazepines (clonazepam), tricyclic antidepressants or anticonvulsants (gabapentin) may be effective. Topical capsaicin has been tried as a desensitizing agent but is not tolerable to all patients.
What is it like to have BMS?
I have suffered from this chronic condition for 18 months. I went through the various labs, physicians, tests and drugs and have found for me, the answer is a combination of clonazepam and duloxetine. My pain has gone from a daily rating of 7-8 to a 0-3 since being on these medications. Most days my pain is a zero but I have found certain triggers that will cause it to flare up: orange juice, salty foods, and even some sweet foods will cause a flare. I have also found that stress seems to make BMS more noticeable. My arsenal of items to help the pain has decreased to carrying gum and breath strips, and most days I do not need either of them.
BMS is a distressing disease and requires persistence of the medical profession to continue to strive to find answers for those suffering with it.
Debra S. Fischio is a staff nurse at Union Hospital in Dover, Ohio, on the surgical telemetry unit.
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