Introduction

Burning discomfort in the oral cavity is a common complaint associated with many local or systemic disorders. Intraoral factors may include mechanical factors such as tongue thrusting, subtle trauma to the cheeks, lips or tongue resulting from bruxing or other parafunctional habits. Ill-fitting dentures may be a common source of oral burning discomfort. Bacterial, viral or fungal intraoral infections often induce oral burning as can contact with mouthrinses, toothpastes, mints, chewing gum or candies, dental restorations, or dentures to which an individual is allergic.12 Many individuals with oral burning complaints prove to have significant reduction in their salivary output, which may predispose them to oral infections and an increased tendency to traumatize oral soft tissues.49-52 Endocrine disorders (diabetes, thyroid diseases), autoimmune diseases (lupus erythematosus, Sjogren’s syndrome) and esophageal reflux are associated with decreased salivary flow and burning oral discomfort as are nutritional deficiencies (vitamin B12, folic acid, zinc and others). It is of utmost importance to identify and manage these conditions when a patient presents with oral burning discomfort.27,37 However, between 0.6% to 15% of older patients may present with oral burning despite the absence of these exclusion factors, and this is currently classified as burning mouth syndrome (BMS). This condition may be most perplexing for the patient and for the dental practitioner since there is no visible evidence of the existence and cause of the condition. Psychological problems, such as emotional stress, anxiety, depression, cancer phobia or psychosocial disorders, are commonly noted in association with oral burning as are hormonal deficiency in post-menopausal women and neurological abnormalities. Often patients have visited multiple medical and dental offices in an effort to identify the cause of their burning pain.31,39 They may have been given a variety of unsuccessful treatments, which increased their sense of frustration and concern. As a result, fear of oral cancer is quite common in this patient group.28

Three primary causes have been identified as possible contributors of BMS: (1) neurologic, (2) psychogenic or (3) hormonal. This course gives the participant a working knowledge of the key factors related to BMS and the psychological components, possible etiologies, pathogenesis, treatment protocol, as well as patient education related to BMS.