Several years ago, Lamy and Lewis classified BMS into 3 types based on the pattern of pain that the patient experienced. Type I BMS features no significant disruption of sleep, no pain on waking but gradual onset and increase in burning sensation throughout the day. In their study, about 35% of BMS patients had this type and it was linked to systemic diseases, nutritional deficiencies or vitamin deficiencies. They believed that type 1 patients were likely to experience improvement with treatment. Type 2 BMS features essentially unremitting pain that disrupts sleep and persists throughout the day. Fifty-five percent of patients fell into this category and it is more likely related to psychological disorders. Type 3 BMS is characterized by intermittent burning pain throughout the day and occasional pain-free days. Only about 10% of patients fell into this category, which they believe represents an allergic reaction. Pain usually peaks in the early afternoon or evening, but it can be constant and severe enough to cause one to waken during the night.23,58 Others who adhere to Scala’s concept of primary and secondary BMS addressed neuropathic pain subgroups in primary BMS. Group 1 had peripheral small-diameter fiber neuropathy (50-65%), group 2 had subclinical lingual, mandibular or trigeminal neuropathies (20-25%), while group 3 had central pain hypofunction (20-40%).56,61 Jaaskelainen classifies this as a Central Type and a Peripheral Type. With the peripheral type responding to Capsaicin and topical Clonazepam.65
In classic BMS (primary BMS), the pain is usually bilateral and symmetrical on the anterior two-thirds of the tongue. In others the tongue dorsum and posterior lateral borders are involved followed by the anterior hard palate, the labial mucosa and other sites, e.g., (floor of the mouth, soft palate, oropharynx and rarely the buccal mucosa).18 Burning of the lips as a single entity has been described featuring a thinned labial mucosa and inactive minor labial salivary glands.5
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