Ch01: burning mouth disorder

BURNING MOUTH
DISORDER
Multiple conditions have been implicated in the causation of burning mouth dis-order. Current literature favors neurogenic, vascular, and psychogenic etiologies.
However, other conditions, such as xerostomia, candidosis, referred pain fromthe tongue musculature, chronic infections, reflux of gastric acid, medications,blood dyscrasias, nutritional deficiencies, hormonal imbalances, and allergic andinflammatory disorders, need to be considered.
Burning mouth disorder is characterized by the absence of clinical sig To reduce discomfort by addressing possible etiologic factors.
It is of the utmost importance to reassure the patient that this disorder is notinfectious or contagious and does not progress to a premalignant or malignantcondition.
On the basis of history, physical evaluation, and specific laboratory studies, ruleout all possible organic etiologies. Minimal blood studies should include CBC FIGURE 1-1
Normal appearance of the
2 Treatment of Common Oral Conditions
and differential, fasting glucose, iron, ferritin, folic acid and vitamin B , and a thyroid profile (thyroid-stimulating hormone, triiodothyronine, thyroxine).
Rx: Diphenhydramine (Children’s Benadryl) elix 12.5 mg/5 mL (OTC).
Disp: 1 btl.
Sig: Rinse with 1 tsp (5 mL) for 2 minutes before each meal and swallow.
Children’s Benadryl is alcohol free.
When the burning mouth is considered psychogenic or idiopathic, tricyclic anti-depressants or benzodiazepines in low doses exhibit the properties of analgesiaand sedation and are frequently successful in reducing or eliminating the symp-toms after several weeks or months. The dosage is adjusted according to patientreaction and clinical symptomatology. The following five systemic therapies forburning mouth disorder may be best managed by appropriate specialist or thepatient’s physician due to the protected nature of this therapy.
Rx: Clonazepam (Klonopin) tabs 0.5 mg.
Disp: 100 tabs.
Sig: Take half to one tab three times daily and then adjust the dose after
3-day intervals. The patient should not be titrated to a dosage of greater
than 2.0 mg daily.
Rx: Amitriptyline (Elavil) tabs 25 mg.
Disp: 50 tabs.
Sig: Take 1 tab at bedtime for 1 week and then 2 tabs hs. Increase to 3 tabs
hs after 2 weeks and maintain at that dosage or titrate as appropriate.
Rx: Chlordiazepoxide (Librium) tabs 5 mg.
Disp: 50 tabs.
Sig: Take 1 or 2 tabs three times daily.
Rx: Alprazolam (Xanax) tabs 0.25 mg.
Disp: 50 tabs.
Sig: Take 1 tab three times daily.
Rx: Diazepam (Valium) tabs 2 mg.
Disp: 50 tabs.
Sig: Take 1 or 2 tabs three times daily. The dosage should be adjusted
according to the individual response of the patient. Anticipated side
effects are dry mouth and morning drowsiness.
The rationale for the use of tricyclic antidepressant medications and other psy-chotropic drugs should be thoroughly explained to the patient, and the patient’s Burning Mouth Disorder 3
physician should be made aware of the therapy. These medications have a poten-tial for addiction and dependency.
Rx: Tabasco sauce (capsaicin) (OTC).
Disp: 1 btl.
Sig: Place one part Tabasco sauce in 2 to 4 parts of water. Rinse with 1 tsp
(5 mL) for 1 min four times daily and expectorate.
Rx: Capsaicin (Zostrix) crm 0.025% (OTC).
Disp: 1 tube.
Sig: Apply sparingly to affected site(s) four times daily. Wash hands after
each application and do not use near the eyes.
Topical capsaicin may serve to improve the burning sensation in some individu-als. As with topical capsaicin, an increase in discomfort for a 2- to 3-week periodshould be anticipated.
Gorsky M, Silverman S Jr, Chinn H. Clinical characteristics and management outcome in the burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1991;72:192–5.
Grushka M, Epstein J, Mott P. An open-label, dose escalation pilot study of the effect of clon- azepam in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod1998;86:557–61.
Lamey PJ. Burning mouth syndrome. Dermatol Clin 1996;14:339–54.
Lamey PJ, Lamb AB. Lip component of burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1994;78:590–3.
Ship JA, Grushka M, Lipton JA, et al. Burning mouth syndrome: an update. J Am Dent Assoc

Clinician's Guide: Treatment of Common Oral Conditions-Sixth Edition

American Academy of Oral Medicine

Ch04: Cheilitis/Cheilosis (Actinic, Solar)

Ch05: Cheilitis/Cheilosis (Angular)

Ch08: Geographic Tongue (Benign Migratory Glossitis, Erythema Migrans)

Ch10: Herpetic Gingivostomatitis (Primary Herpes)

Ch11: Herpes Simplex Recurrent (Orofacial)

Ch14: Management of Patients Receiving Antineoplastic Agents and Radiation Therapy

Ch15: Pemphigus Vulgaris and Mucous Membrane Pemphigoid

Ch16: Recurrent Aphthous Stomatitis

Ch17: Taste and Smell Disorders (Chemosensory Disorders)

Ch18: Xerostomia (Reduced Salivary Flow and Dry Mouth)

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