Treatment

Current treatment for BMS is usually either empiric or directed at correcting detected organic causes. It often involves the use of tricyclic antidepressants, which have been used for many years to treat depression.15

Recently, there has been renewed interest in the use of benzodi-azepines (anticonvulsants) for burning mouth syndrome. One study assessed the effect of clonazepam (a benzodiazepine approved by the Food and Drug Administration to treat seizures and panic disorder) on burning mouth syndrome in clients with a chief complaint of mouth burning without oral mucosal lesions or evident pathology.16 Clonazepam (commonly known as Klonopin) was approved by the Food and Drug Administration (FDA) in 1975. It is also one of the top 200 drugs prescribed in the United States, and is used to treat conditions such as epilepsy and Lennox-Gastaut syndrome (a severe form of epilepsy).

A pilot study by Grushka et al. suggests that clonazepam may be helpful in treating BMS, as 70% of the subjects experienced pain reduction with low doses of the drug. 17 This included 43% of participants who achieved total or partial relief, and 27% who achieved relief but withdrew from the study because of the side effect of drowsiness.16

BMS and the resulting stomatodynia (pain in the mouth) are difficult for both clients and clinicians. In the past, clients have often been offered poorly effective treatment for pain. This has prompted studies, such as one by Woda, to investigate therapeutic agents for pain relief. The study examined the local application of clonazepam (0.5 or 1.0 mg two or three times daily) in clients who suffered from idio-pathic stomatodynia. The conclusion was that clonazepam was a possible therapeutic solution for stomatodynia resulting from BMS.17 The antidepressant trazodone was evaluated in another study in the treatment of chronic burning mouth pain. An eight-week parallel placebo- controlled, double-blind trial was conducted, but trazodone failed to relieve burning mouth pain.18

Since BMS is an oral pain disorder of uncertain origin, it has been proposed that central or peripheral pain mechanisms may play a role in the oral burning. One study tested the effect of a topical anesthetic (dyclonine HCl) on clients’ intensity ratings for oral burning, taste dysgeusia (impairment), and the taste of two chemical stimuli (1.0 M NaCl and 1.0 M sucrose). The anesthetic reduced the perceptual intensity of both chemicals in most of the study clients post-anesthesia, suggesting BMS dysgeusia is related to the activation of peripheral taste mechanisms. It also implies that BMS oral burning may be a disorder of peripheral pain pathways in some clients.20

For clients with no identified causative factor, antifungal, nutritional, and estrogen replacement therapy can be initiated. If these fail, long-term therapy with anti-depressants, benzodiazepines, and clonazepam can be considered. Topical capsaicin and laser therapy have been reported to be beneficial in a few clients.22

According to one researcher, BMS is a common condition.21 Its management is successful in about 70% of cases if a structured protocol based on scientific evidence is adopted. Specialist advice must be sought in some cases, but many clients can be successfully treated in the primary care environment.

Dental hygiene interventions may include instruction in proper oral hygiene, saliva-stimulating agents such as pilocarpine HCI, saliva substitutes, or dietary recommendations, depending on the severity of the salivary dysfunction. Treatment may include antifungal therapy if candidiasis is diagnosed. In severely distressed clients, local or systemic corticosteroids may be indicated. Life style changes, such as refraining from tobacco and alcohol use, should be initiated. Avoiding toothpastes containing sodium lauryl sulfate may also be considered. Research shows that future treatment might include agents with combined antibacterial and anti-inflammatory actions, such as triclosan, which show promising effects in clients with oral mucosal diseases secondary to salivary hypofunction.13