There are patients and situations that present themselves to the office that I think are good topics to bring up and this is one of them. I had an 82 year old patient come in for a consultation for a lower partial denture. During her examination I noted that her mouth was dry and the soft tissues of the mouth looked like there was something wrong. She had sores in the cheeks and her tongue was whitish. During exams we always look for signs of cancer or other pathology so these areas looked very suspicious so I referred her to an oral surgeon for a better diagnosis and to rule out cancer.
She was put on a mouthwash that helps with fungal infections and helps to relieve the pain by providing some numbing to the soft tissues. She was then referred back to her physician where any systemic disorder was ruled out. She was diagnosed with burning mouth syndrome or had a fungal infection. Fungal infections (thrush) can take place in the mouth or even in vaginal areas of women if they have been on long term antibiotics accompanied with a dry mouth (usually from multiple medication use).
I would like to list some information about this from 2 articles published in the June 2012 Michigan Dental Association Journal.
What are some of the characteristics of burning mouth syndrome?
Typical symptoms
It is usually a sudden onset of oral burning sensation that can have a significant negative impact on the quality of life and can have the pain similar to a toothache. It is most common in women in their 50s through 70s and is between 1%-5% of the general population. Generally the patients are unaware of the oral burning during sleep or waking with the sensations gradually increasing to peak intensity in the late afternoon and early evening. The onset can be related to an event such as a recent dental appointment or administration of a new medication or other personal event. The tongue is usually the most affected followed by the lips and roof of the mouth (palate).
Burning Mouth Syndrome is very difficult to recognize and diagnose because it is usually a diagnosis of exclusion. In other words, it is considered this if other systemic diseases or oral diseases are ruled out. It is usually necessary for the patient to have blood tests or other laboratory tests to rule out diabetes, allergies, depression, nutritional imbalances, neuropathy, and hormonal imbalances due to menopause. Those who have a lack of saliva function (dry mouth) usually brought on by medications or Sjogen’s syndrome are also a factor in this burning mouth syndrome. Many individuals with oral burning have had more nonspecific health complaints and more severe menopausal symptoms than healthy controls. So in other words those who are healthy are not as affected by this compared with unhealthy women. There is a common consensus that this is a neuropathic disease since taste can also be altered. The nerves that give sensation to the mouth, taste to the tongue, etc. can be affected. This means that the pain may be coming from the nerve near the surface of the affected areas such as the tongue, lips and palate. This is why you will notice therapies that have to do with the psyche of the patient. This means that the wellbeing of the patient may affect the sensitivity of the nerves near the surface.
Treatment
This Syndrome is currently being researched and there is not a single medication or therapy used to effectively treat the pain. There are many therapies that have been tested and studies done and yet there are so many questions unanswered to address this mysterious problem.
Most of the medications used are in the form of a rinse. This delivery system usually gets absorbed into the body through the largely vascular nature of the mouth and tongue. This also gives the most affected area a chance to be exposed directly by the medication. The following prescription medications are listed:
- Clonazepam- This is in the family of medication such as valium and is used to reduce anxiety.
- Lidocaine- This is a topical anesthetic used to numb the area to provide pain relief.
- Capsaicin cream-This is an analgesic and is found in icy/hot.
- Doxepin cream-This is an antidepressant
- Nystatin rinse-This is an antifungal which helps with thrush.
There are many more systemic medications that are used to treat this elusive problem so when being treated would expect the affected patient to go through a number of medication combinations with the hope of finding the right one for them.
Therapy for depression and counseling has been helpful which helps relieve anxiety is a great place to start since this is beneficial for the entire person.
As you can see this is difficult to diagnose because of the elusive nature of the problem and difficult to treat because of the many different routes of therapy but it is important for the affected patient to know that they aren’t crazy and this real pain. Many times if a desperate patient who has chronic pain goes from doctor to doctor without adequate help for their problem they begin to think they are making up their pain. The truth is they are in pain and over time chronic pain can affect the person’s psyche and attitude. This cycle of pain and depression must be broken and this is why psychotherapy can play a part in complete treatment. Pain clinics that treat chronic pain are equipped to take care of and understand the needs of a chronic pain patient.
If you have questions or comments please call us at (586)247-3500 or email at drantolak@thegentledentist.com
The Gentle Dentist Located in Macomb County, Michigan- Burning Mouth Syndrome