Isaäc van der Waal - Burning Mouth Disease: A Guide to Diagnosis and Management

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Burning mouth disease (BMD), also referred to as burning mouth syndrome, is an enigmatic disease for both the patient and the clinician. When the disease is not recognized as such, the patient may become exposed to a wide variety of redundant treatments, including dental and surgical procedures.

This monograph is intended for use by all dental and medical healthcare providers who are involved in the diagnosis and management of patients suffering from BMD and BMD-like symptoms. The text is largely based on the literature from the past decades and, above all, on personal experience with a vast number of BMD patients who have been referred to the Department of Oral and Maxillofacial Surgery/Oral Medicine/Oral Pathology of the VU Vrije Universiteit medical centre/ACTA, Amsterdam, The Netherlands. Admittedly, having always worked in a secondary/tertiary healthcare setting, and not in a primary healthcare setting, my knowledge and experience may be somewhat biased. The text is science-based but practice-oriented, the focus being on the clinical aspects.

If feasible, management of BMD patients should be arranged in a multidisciplinary setting, taking advantage of the experience of each participating healthcare provider. By following a step-by-step approach, as outlined in this monograph, an apparently unbearable disease will for many, if not most, patients become a more or less acceptable one to live with.

I am grateful to dr. J. A. Carpay, neurologist in The Netherlands, for his valuable comments on the chapters on neurological aspects and psychogenic aspects. Finally, I would like to thank Springer Nature for their pleasant and efficient collaboration during the realization of this monograph.

Burning mouth disease (BMD) is a rare but serious, chronic disease. Patients suffering from BMD may consult not only their dentist or family doctor but also various medical specialists, such as the otolaryngologist, the oral and maxillofacial surgeon, the dermatologist and the neurologist. First-line healthcare providers often do not recognize the symptoms associated with it. As a result BMD patients may undergo unnecessary diagnostic tests and treatments for their complaints, varying from drug prescriptions, extractions of teeth to psychiatric treatment.

In this chapter attention will be paid to the various definitions and terminologies that have been used in the literature. Furthermore, several classifications of BMD will be discussed.

In the absence of an identifiable cause, the terms glossodynia or glossalgia have been used in the past to describe a painful tongue, and the term glossopyrosis to describe a burning sensation in the tongue. When just discomfort is experienced, the term lingual dysaesthesia has been used. Likewise, for burning sensations elsewhere in the oral cavity, with or without involvement of the tongue, the terms stomatodynia, stomatopyrosis, and oral dysaesthesia have been used. Other terminologies to describe BMD are hot tongue syndrome, and scalded mouth syndrome. Some authors prefer the term burning mouth condition [].

Denture-wearing patients may occasionally complain of a burning or itching sensation limited to the mucosa underneath the upper denture, without clinical signs of inflammation. This condition is referred to as denture sore mouth (DSM). In most instances the removal of the dentures does not result in the disappearance of the symptoms. In fact, DSM can be considered a subtype of BMD.

According to some authors, BMD, atypical odontalgia (unexplained toothache in one or more adjacent teeth), atypical facial pain and oral dysaesthesia may occur sequentially or simultaneously in the same patient and may be associated with facial arthromyalgia in which the temporomandibular joint or its musculature is involved []. Personally, I have never encountered patients with such sequential events, but this may be due to an insufficient follow-up period or referral bias.

In the present text, the term burning mouth disease (BMD) will be used, irrespective of the specific oral subsite of the complaints and irrespective of the presence of any accompanying oral complaints, such as dry mouth, taste disturbance and/or smell disorder. The term BM-Disease is probably better understood by patients than BM-Disorder or BM-Syndrome.

The use of burning in the terminology may be confusing for those patients in whom the complaints do not so much consist of burning but, instead, of itching, tingling or bizarre sensations, such as a sandpaper sensation. In that case, the patient should be properly informed about the terminology.