EdenteV2, Istex, Corpus, bibRecord, 007A27

Burning mouth syndrome: A review of etiologies

Identifieur interne : 007A27 ( Istex/Corpus ); précédent : 007A26; suivant : 007A28

Burning mouth syndrome: A review of etiologies

Auteurs : Roman M. Cibirka ; Steven K. Nelson ; Carol A. Lefebvre

Source :

The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1997.

RBID : ISTEX:F6F5CA608462AA34363E8FB892C2E7F23C9A1327

English descriptors

KwdEn :
- Allergy, Candida species, Causative factor, Causative factors, Contact dermatitis, Continuous symptoms, Dent, Dent assoc, Dent clin, Dentistry, Denture, Electronic evaluation, Etiologic, Etiologic factors, Geographic tongue, Grushka, Histologic distance, Infectious agents, Iron deficiency anemia, Lamey, Medical conditions, Mercury allergy, Mouth symptoms, Mouth syndrome, Mucosal diseases, Normal mucosa, Nose throat, Oral cavity, Oral galvanism, Oral manifestations, Oral pathol, Oral rehabilitation, Oral surg, Oral symptoms, Osseous regeneration, Other types, Painful sensations, Parafunctional activity, Pathol, Personality characteristics, Prosthet dent, Prosthetic dentistry, Psychogenic, Psychogenic factors, Psychologic, Removal forces, Sorbic acid, Strange tastes, Surg, Symptom, Syndrome, Systemic factors.
Teeft :
- Allergy, Candida species, Causative factor, Causative factors, Contact dermatitis, Continuous symptoms, Dent, Dent assoc, Dent clin, Dentistry, Denture, Electronic evaluation, Etiologic, Etiologic factors, Geographic tongue, Grushka, Histologic distance, Infectious agents, Iron deficiency anemia, Lamey, Medical conditions, Mercury allergy, Mouth symptoms, Mouth syndrome, Mucosal diseases, Normal mucosa, Nose throat, Oral cavity, Oral galvanism, Oral manifestations, Oral pathol, Oral rehabilitation, Oral surg, Oral symptoms, Osseous regeneration, Other types, Painful sensations, Parafunctional activity, Pathol, Personality characteristics, Prosthet dent, Prosthetic dentistry, Psychogenic, Psychogenic factors, Psychologic, Removal forces, Sorbic acid, Strange tastes, Surg, Symptom, Syndrome, Systemic factors.

Abstract

Abstract: Statement of problem. Dental practitioners occasionally have patients present clinically with a history or chief complaint of burning and painful sensations in the oral cavity. Often the patient demonstrates clinically normal mucosa, which can make formulating a diagnosis challenging. This scenario, has been referred to as burning mouth syndrome, a multifactorial syndrome. Purpose. The purpose of this article is to present a review of etiologic factors and clinical implications related to the condition of burning mouth syndrome. (J Prosthet Dent 1997;78:93-7.)

Url:

https://api.istex.fr/document/F6F5CA608462AA34363E8FB892C2E7F23C9A1327/fulltext/pdf

DOI: 10.1016/S0022-3913(97)70089-1

Links to Exploration step

ISTEX:F6F5CA608462AA34363E8FB892C2E7F23C9A1327

Le document en format XML

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<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para><ce:bold>Statement of problem.</ce:bold>
 Dental practitioners occasionally have patients present clinically with a history or chief complaint of burning and painful sensations in the oral cavity. Often the patient demonstrates clinically normal mucosa, which can make formulating a diagnosis challenging. This scenario, has been referred to as burning mouth syndrome, a multifactorial syndrome.</ce:simple-para>
<ce:simple-para><ce:bold>Purpose.</ce:bold>
 The purpose of this article is to present a review of etiologic factors and clinical implications related to the condition of burning mouth syndrome. (J Prosthet Dent 1997;78:93-7.)</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
<body><ce:sections><ce:para><ce:display><ce:textbox><ce:textbox-body><ce:sections><ce:para><ce:bold><ce:italic>The condition of burning mouth syndrome appears to have a multifactoral, indeterminate cause. The literature defines various etiologic factors, although they often are contradictory. In the presence of normal mucosa and oral pain, the clinician must be discerning in developing a diagnosis and defining an etiologic basis for the patient's discomfort. Psychogenic factors of depression and anxiety seem to be the most common attributes of patients afflicted with this syndrome. Although specific local and systemic conditions may be important etiologic agents for certain patients, no general correlations may be made for all patients with burning mouth syndrome.</ce:italic>
</ce:bold>
</ce:para>
</ce:sections>
</ce:textbox-body>
</ce:textbox>
</ce:display>
</ce:para>
<ce:para>A syndrome, by definition, is characterized by an aggregate of signs or symptoms demonstrating a clinical picture of disease. Burning mouth syndrome is typically characterized by burning and painful sensations in an oral cavity demonstrating clinically normal mucosa.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 This provides substantiation for the term <ce:italic>burning mouth syndrome</ce:italic>
 (BMS).</ce:para>
<ce:para>More than one million adults in the United States are affected by BMS.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 In a patient population studied by Basker et al.,<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
 prevalence of BMS was cited as 2.6% overall, with 4.2% women and only 0.8% men experiencing symptoms. A higher prevalence (>0.8%) among male subjects, not exceeding the percentages in female subjects, has been reported.<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup>
</ce:cross-ref>
 The greatest frequency of symptoms for the patients studied was in the age range of 40 to 49 years (15.7%). The finding that BMS is most frequently found in women beyond middle age has been reported in several studies.<ce:cross-refs refid="bib1 bib5 bib6"><ce:sup>1,5,6</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>Symptoms of BMS may vary from slight to severe, although they will generally be described as “a burning feeling.” Basker et al.<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
 categorized BMS into mild, moderate, and severe grades. Moderate BMS was most frequently seen, followed by the severe and mild forms. In addition, intermittent symptoms were more common than continuous symptoms, and these symptoms may vary throughout the day. Lamey and Lewis<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup>
</ce:cross-ref>
 have suggested classifying BMS into three patterns, type 1, 2, and 3. Type 1 includes symptom-free waking, with sensations developing in the morning and progressively increasing to severe by evening. Type 2 involves continuous symptoms throughout the day; whereas, type 3 includes intermittent symptom-free periods throughout the day. Nonpsychologic causative factors, such as nutritional deficiencies, have been linked to type 1, chronic anxiety to type 2, and food allergy to type 3.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 A wide variation in duration of the syndrome has been described by Browning et al.,<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup>
</ce:cross-ref>
 ranging from 3 months to 12 years with an average duration of 3 years and 4 months. The burning sensations are frequently quantified with linear visual analog scales.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 General body complaints, in addition to discomfort from the oral cavity, are described by many patients with BMS. Other oral complaints may include xerostomia and dysgeusia.<ce:cross-ref refid="bib9"><ce:sup>9</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Burning can occur at many sites within or surrounding the oral cavity. One of the most commonly affected sites is the tongue, particularly the tip and anterior two-thirds.<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup>
</ce:cross-ref>
 The next most commonly affected sites are the hard palate, lip (the mucosal portion), and alveolar ridges (in denture patients), in descending order. Burning of the buccal mucosa, oropharynx, and floor of mouth have also been reported.<ce:cross-refs refid="bib11 bib12"><ce:sup>11,12</ce:sup>
</ce:cross-refs>
 The purpose of this article is to review the etiologic factors associated with BMS.</ce:para>
<ce:section><ce:section-title>REVIEW OF ETIOLOGIES</ce:section-title>
<ce:para>The cause of BMS is considered multifactoral and may be divided into three groups: local, systemic, and psychogenic.<ce:cross-refs refid="bib3 bib8"><ce:sup>3,8</ce:sup>
</ce:cross-refs>
 A Medline search was completed for the literature database (1965 through 1996) used in this review.</ce:para>
</ce:section>
<ce:section><ce:section-title>LOCAL FACTORS</ce:section-title>
<ce:para>Local factors associated with BMS include, but are not limited to, dental treatment, mucosal diseases, fungal infections, bacterial invasion, allergies, temporomandibular joint dysfunctions, and salivary gland abnormalities.<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:section><ce:section-title>Dental treatment</ce:section-title>
<ce:para>The onset of symptoms, as reported by patients related to previous dental treatment, may be as high as 65%.<ce:cross-ref refid="bib13"><ce:sup>13</ce:sup>
</ce:cross-ref>
 Various denture problems have been reported as local etiologic factors.<ce:cross-refs refid="bib1 bib14"><ce:sup>1,14</ce:sup>
</ce:cross-refs>
 Conversely, Nater et al.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup>
</ce:cross-ref>
 found it was not possible to correlate any signs that implicated dentures as a local etiologic agent. Gorsky et al.<ce:cross-ref refid="bib5"><ce:sup>5</ce:sup>
</ce:cross-ref>
 provided similar conclusions, corroborating that denture difficulties are an uncertain cause in the development of BMS.</ce:para>
</ce:section>
<ce:section><ce:section-title>Infectious agents</ce:section-title>
<ce:para>Oral infectious agents have been cited as etiologic factors. Candidiasis has been the most frequently identified infectious agent.<ce:cross-refs refid="bib5 bib6 bib16 bib17"><ce:sup>5,6,16,17</ce:sup>
</ce:cross-refs>
 Although, Nater et al.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup>
</ce:cross-ref>
 considered candidiasis to be of minor importance, the intraoral prevalence of <ce:italic>Candida</ce:italic>
 species and coliforms (<ce:italic>Enterobacter</ce:italic>
 and <ce:italic>Klebsiella</ce:italic>
) has been found to be higher in patients with BMS than those without symptoms.<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup>
</ce:cross-ref>
 Fusospirochetal mucosal infection of oral mucosa was identified in six patients who complained of BMS by Katz et al.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Mucosal diseases as geographic tongue, or benign migratory mucositis, have been found in association with BMS by Gorsky et al.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup>
</ce:cross-ref>
 In this literature, 15% of patients with BMS also demonstrated geographic tongue.</ce:para>
</ce:section>
<ce:section><ce:section-title>Allergic reactions</ce:section-title>
<ce:para>Mucosal allergic reactions have been reported in the development of BMS by patients.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 Relevant allergens include methyl methacrylate monomer, nickel sulfate, cobalt chloride, and mercury.<ce:cross-refs refid="bib20 bib21 bib22 bib23 bib24 bib25"><ce:sup>20-25</ce:sup>
</ce:cross-refs>
 Mercury allergy was cited as a causative factor in a case report describing BMS.<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup>
</ce:cross-ref>
 Chemicals commonly found in denture materials were evaluated through epicutaneous patch testing in 53 patients who wore dentures by Kaaber et al.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup>
</ce:cross-ref>
 In this study, 23% of the patients demonstrated an allergic reaction to the substances in dentures and the allergy was determined the cause of BMS. Contact allergy to denture base chemical constituents has also been reported in up to 27% of patients with BMS studied.<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Oral allergies to food and correlation to syndrome-like symptoms has been noted in the literature.<ce:cross-ref refid="bib26"><ce:sup>26</ce:sup>
</ce:cross-ref>
 The response seemed to affect patients with other types of allergies, usually pollens. Symptoms to ingested allergens including 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.<ce:cross-refs refid="bib21 bib22 bib23"><ce:sup>21-23</ce:sup>
</ce:cross-refs>
 The aforementioned studies suggest that burning pain and diffuse erythema of the contacted mucosa may be associated with allergic reactions to materials, whereas intermittent burning of the oral cavity may be associated with a food-related allergy.</ce:para>
</ce:section>
<ce:section><ce:section-title>Dysfunction and parafunction</ce:section-title>
<ce:para>Dysfunction and parafunction of the stomatognathic system have been documented as frequent causative factors in BMS.<ce:cross-refs refid="bib1 bib27"><ce:sup>1,27</ce:sup>
</ce:cross-refs>
 Parafunctional activities resulting in excessive occlusal or denture wear has been shown in up to 61% of studied patients with BMS.<ce:cross-ref refid="bib28"><ce:sup>28</ce:sup>
</ce:cross-ref>
 Lamey and Lamb<ce:cross-ref refid="bib29"><ce:sup>29</ce:sup>
</ce:cross-ref>
 have described a lip component to the BMS symptoms. They reported the lips as the third most common site affected. Parafunctional activity of lip licking, lip sucking, lip pressure, and mouth breathing were noted in patients with perioral symptoms.</ce:para>
</ce:section>
<ce:section><ce:section-title>Quantity and quality of saliva</ce:section-title>
<ce:para>Oral salivary quantity and quality have been investigated as causative factors in BMS. In one study,<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 34% of 150 patients evaluated demonstrated inadequate saliva or oral dryness. Irregularities in saliva metabolites as protein, potassium, and phosphate concentrations between patients with BMS and control patients have been suggested as causative factors.<ce:cross-ref refid="bib30"><ce:sup>30</ce:sup>
</ce:cross-ref>
 Unbalanced metabolite concentrations of protein, potassium, and phosphate in saliva have also been identified in patients with idiopathic glossodynia.<ce:cross-ref refid="bib30"><ce:sup>30</ce:sup>
</ce:cross-ref>
 Radiation therapy, systemic disease, and pharmacotherapuetic agents have been shown to diminish salivary flow rates and may be associated with increased incidences of BMS symptoms.<ce:cross-refs refid="bib14 bib30 bib31"><ce:sup>14,30,31</ce:sup>
</ce:cross-refs>
 Total salivary protein concentrations in female subjects demonstrating BMS have been shown to be reduced, although flow rates were not diminished indicating symptoms are not associated with a decrease in the lubricating and protecting properties of saliva.<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
</ce:para>
</ce:section>
<ce:section><ce:section-title>Neural mechanisms</ce:section-title>
<ce:para>It has been reported that BMS 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 in BMS.<ce:cross-ref refid="bib50"><ce:sup>50</ce:sup>
</ce:cross-ref>
 The constant burning in BMS may indicate a tonic efflux from nocioceptive 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 orofacial region did not interrupt the burning pattern, suggestive of peripheral nerve abnormalities.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 Peripheral neuroplastic changes can induce alterations in the central nocioceptive neurons that leads to increased excitability and occasional tonic activity. Therefore central neuroplastic changes may play a role in BMS symptoms.</ce:para>
</ce:section>
</ce:section>
<ce:section><ce:section-title>SYSTEMIC FACTORS</ce:section-title>
<ce:para>Systemic factors have been shown to influence the prevalence and severity of BMS symptoms experienced by patients. Deficiency diseases, hormonal and immunologic disturbances, and pharmacotherapuetic side effects have been implicated in producing BMS symptoms. In a number of studies, iron deficiency anemia was the most frequently diagnosed disease entity producing BMS.<ce:cross-refs refid="bib7 bib16 bib33"><ce:sup>7,16,33</ce:sup>
</ce:cross-refs>
 Numerous authors have reported BMS symptoms without a defined cause in patients who show abnormally low levels of vitamin B12 in their blood sera.<ce:cross-refs refid="bib14 bib34 bib35"><ce:sup>14,34,35</ce:sup>
</ce:cross-refs>
 In contrast, Field et al.<ce:cross-ref refid="bib36"><ce:sup>36</ce:sup>
</ce:cross-ref>
 retrospectively examined patients with a deficiency in vitamin B12 and the manifestation of oral BMS symptoms. No direct evidence could be found to correlate vitamin B12 deficiency with the consistently found oral symptoms of BMS.</ce:para>
<ce:para>Other vitamin deficiency-related BMS symptoms have been noted in the literature. A significant portion of patients studied had vitamin B1, B2, and/or B6 deficiencies.<ce:cross-ref refid="bib37"><ce:sup>37</ce:sup>
</ce:cross-ref>
 Jacobs and Cavill<ce:cross-ref refid="bib33"><ce:sup>33</ce:sup>
</ce:cross-ref>
 considered vitamin B6 a prime etiologic factor in BMS. Folic acid deficiency was also noted as a causative factor by Main and Basker.<ce:cross-ref refid="bib14"><ce:sup>14</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>In addition to vitamin-related deficiencies, menopausal factors have been associated with BMS symptoms.<ce:cross-refs refid="bib3 bib14"><ce:sup>3,14</ce:sup>
</ce:cross-refs>
 Climacteric problems and oral disturbances were found to be correlated in patients demonstrating BMS symptoms by Basker et al.<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup>
</ce:cross-ref>
 In this study, perimenopausal and postmenopausal women demonstrating estrogen deficits were diagnosed with oral symptoms of burning alone (43%), strange tastes (27%), and both burning and strange tastes (30%). Diabetes mellitus has also been attributed as a possible etiologic factor in 10% of patients with BMS.<ce:cross-refs refid="bib1 bib3"><ce:sup>1,3</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>Grushka et al.<ce:cross-ref refid="bib39"><ce:sup>39</ce:sup>
</ce:cross-ref>
 found nearly 50% of patients with BMS were found to have some clinically evident immunologically mediated disease. Antinuclear, antibody, and rheumatoid factor imbalances were noted. HIV and AIDS afflictions have also been correlated with BMS. Xerostomia has also been reported as a frequent symptom in patients with immunologic disorders and has been associated with the diagnosis of BMS.</ce:para>
</ce:section>
<ce:section><ce:section-title>PSYCHOGENIC FACTORS</ce:section-title>
<ce:para>After deficiency disorders, depression has been noted as the next most frequent etiologic factor.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup>
</ce:cross-ref>
 Browning et al.<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup>
</ce:cross-ref>
 found that 44% of patients with BMS demonstrated a psychiatric diagnosis, of which depression and generalized anxiety were the two most common diagnoses.<ce:cross-ref refid="bib40"><ce:sup>40</ce:sup>
</ce:cross-ref>
 A complex spectrum of social and psychologic disturbances were found in patients with BMS with linked diagnoses. Psychologic and psychosocial factors play a significant role in facial and orofacial pain disorders.<ce:cross-ref refid="bib41"><ce:sup>41</ce:sup>
</ce:cross-ref>
 Atypical facial pain disorders appear to be linked to stress and chronic personal trouble.<ce:cross-ref refid="bib42"><ce:sup>42</ce:sup>
</ce:cross-ref>
 Psychogenic factors have been considered a common etiologic factor in patients with BMS.<ce:cross-refs refid="bib5 bib43"><ce:sup>5,43</ce:sup>
</ce:cross-refs>
 Lamb et al.<ce:cross-ref refid="bib43"><ce:sup>43</ce:sup>
</ce:cross-ref>
 noted 50% of patients with BMS had psychogenic etiologic factors. The BMS patient personality profile was one of indecision, yet these patients favor their own decisions. These patients were adverse to change and timid, yet responsive to firm advice and professional reassurance. Patient descriptions have ranged from kind and sensitive to hostile and aggressive from psychotherapeutic interviews.<ce:cross-ref refid="bib44"><ce:sup>44</ce:sup>
</ce:cross-ref>
 Emotional factors are clearly important in patients with BMS. In a study of 70 patients, Hampf et al.<ce:cross-ref refid="bib45"><ce:sup>45</ce:sup>
</ce:cross-ref>
 found that 92% presented with some form of mental disorder. Psychosomatic processes have been described in association with patients with BMS.<ce:cross-ref refid="bib46"><ce:sup>46</ce:sup>
</ce:cross-ref>
 Resistant patients with BMS demonstrated significant fatigue and heightened concerns of physical health. The patients examined reported episodic vertigo and depression with tendencies for palpitations and/or indigestion.</ce:para>
<ce:para>Grushka et al.<ce:cross-ref refid="bib47"><ce:sup>47</ce:sup>
</ce:cross-ref>
 reported the personality characteristics of patients with BMS were similar to other patients with chronic pain symptoms. Patients with BMS tended to be more depressed, angry, doubting, apprehensive, and introverted as a direct result of the pain experience. The pain of BMS has been attributed to the manifestation of exogenous or reactive depression caused by the external stress of desolation or anxiety. Furthermore, Lamey and Lamb<ce:cross-ref refid="bib48"><ce:sup>48</ce:sup>
</ce:cross-ref>
 emphasized anxiety, depression, and cancerophobia as contributing to BMS symptoms. Four psychologic tests applied to 184 patients with BMS found symptoms of anxiety, depression, and neurotic tendencies, although the authors did not strongly correlate psychologic factors in the development of BMS. These studies have indicated that 52% to 81% of patients with BMS demonstrate clinical signs of depression surpassing the frequencies of mental disorders found in patients with other types of chronic pain.</ce:para>
<ce:para>Psychologic stress in connection with separation or death may be associated with BMS. Cancerophobia and anxiety have been documented as etiologic factors,<ce:cross-refs refid="bib14 bib17"><ce:sup>14,17</ce:sup>
</ce:cross-refs>
 although authors have grouped patients with BMS symptoms in a general diagnostic category of hypochondria. Hampf et al.<ce:cross-ref refid="bib49"><ce:sup>49</ce:sup>
</ce:cross-ref>
 described patients with oral galvanism as often having a background of psychosocial distress initiated in childhood. It was reported that this affliction creates the need for somatizing disorders. He also suggested the importance of showing an increased humane attitude toward these patient's psychosocial problems by the medical professional community.</ce:para>
</ce:section>
<ce:section><ce:section-title>OTHER ETIOLOGIC FACTORS</ce:section-title>
<ce:para>Many alternative causes have been proposed for the burning mouth symptoms experienced by patients, inclusive of inflamed lymphoid tissue within the lingual foliate papillae, temporal or giant cell arteritis, myeloblastic syndrome, reflux esophagitis, acoustic nerve neuroma, and referred myofascial pain. However, no direct causal relationship to these factors has been supported.<ce:cross-refs refid="bib2 bib5"><ce:sup>2,5</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
<ce:section><ce:section-title>SUMMARY</ce:section-title>
<ce:para>The multiple etiologic factors for diagnosis of BMS presents a challenging scenario for the dental clinician. Generally, the normal appearing mucosa, coupled with variable symptoms of oral pain, offers a formidable task for definitive diagnosis. Identification of the etiologic group, local, systemic, or psychogenic, will provide initial direction toward a diagnostic and treatment course. Dental or infectious origins may require intervention by the clinician. Advisement and control of parafunctional activity, identification of salivary imbalances, prosthesis adjustment, or pharmacotherapuetic management may be indicated. Pharmacotherapuetics may empirically be used to achieve resolve for infectious agents or provide palliation of symptoms. Symptomatic relief may be achieved by rinsing with Benadryl elixir (Parke-Davis, Morris Plains, N.J.) (12.5 mg/5 ml), 1 teaspoonful for 2 minutes before meals and swallowing; or, a suspension of 30 ml Mycostatin (Apothecon, Princeton, N.J.) (100,000 units/ml), 50 ml hydrocortisone (10 mg/5 ml), 60 ml tetracycline (125 mg/5 ml) and 120 ml Benadryl elixir (12.5 mg/5 ml), 1 teaspoon orally four times per day and expectorate.<ce:cross-ref refid="bib51"><ce:sup>51</ce:sup>
</ce:cross-ref>
 Allergic testing of materials, foods, or additives may be supportive in diagnosis and management. Evaluation by an oral pathologist may be helpful. Occasionally, otolaryngology and gastroenterology consultation may assist diagnosis of pharyngeal, esophageal, or reflux-related causes and provide medical care.</ce:para>
<ce:para>Systemic factors usually require medical assistance for correlation of imbalances to the oral symptoms described. Familiarization of the physician to documented correlations of oral symptoms to medical conditions may be necessary. Blood sera analysis, immunologic, or endocrine assessment may be required. Psychogenic etiologies offer complex spectrums of psychologic, psychosocial, and personal disorders. Neurologic consultation or psychologic support may be helpful in diagnosis and care of the patient with BMS.</ce:para>
</ce:section>
</ce:sections>
</body>
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</sb:authors>
<sb:title><sb:maintitle>Clinical pharmacology in dental practice</sb:maintitle>
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<sb:date>1983</sb:date>
<sb:publisher><sb:name>CV Mosby</sb:name>
<sb:location>St Louis</sb:location>
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<name type="personal"><namePart type="given">Roman M.</namePart>
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<affiliation>School of Dentistry, Medical College of Georgia Augusta, Georgia</affiliation>
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<name type="personal"><namePart type="given">Steven K.</namePart>
<namePart type="family">Nelson</namePart>
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<affiliation>School of Dentistry, Medical College of Georgia Augusta, Georgia</affiliation>
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<name type="personal"><namePart type="given">Carol A.</namePart>
<namePart type="family">Lefebvre</namePart>
<namePart type="termsOfAddress">DDS, MS</namePart>
<affiliation>School of Dentistry, Medical College of Georgia Augusta, Georgia</affiliation>
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<abstract lang="en">Abstract: Statement of problem. Dental practitioners occasionally have patients present clinically with a history or chief complaint of burning and painful sensations in the oral cavity. Often the patient demonstrates clinically normal mucosa, which can make formulating a diagnosis challenging. This scenario, has been referred to as burning mouth syndrome, a multifactorial syndrome. Purpose. The purpose of this article is to present a review of etiologic factors and clinical implications related to the condition of burning mouth syndrome. (J Prosthet Dent 1997;78:93-7.)</abstract>
<note>aAssistant Professor, Department of Oral Rehabilitation.</note>
<note>bAssociate Professor, Department of Oral Rehabilitation.</note>
<note>Reprint requests to: Dr. Roman M. Cibirka Dept. of Oral Rehabilitation School of Dentistry Medical College of Georgia Augusta, GA 30912-1260</note>
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<identifier type="ISSN">0022-3913</identifier>
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Burning mouth syndrome: A review of etiologies

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