Burning mouth syndrome
Burning mouth syndrome is characterised by discomfort or pain of the mouth, with no known medical or dental cause. It is often localised to the tongue and/or lips but can be more widespread and involve all the oral mucosa. It has increasing prevalence in older women, affecting up to one third of postmenopausal women and up to 15% of adults overall.
Focus of the review
Despite being relatively common, burning mouth syndrome is rarely recognised by medical practitioners, and yet it has a significant impact on quality of life. For this update, we have examined the evidence for selected interventions that may be considered to manage the symptoms.
Comments on evidence
Many studies do not provide diagnostic criteria, and it cannot be ascertained whether medical or dental causes for burning mouth were excluded. There is a wide heterogeneity of treatments used, and outcome measures vary, with few providing measures of quality of life, which makes it difficult to compare treatments. The adverse effects of treatments are poorly documented. In some RCTs, there is a high placebo response (one systematic review evaluating the placebo response in studies on treatments for burning mouth syndrome found a positive placebo response in 6 out of 12 RCTs). More attention needs to be paid to this effect when designing trials.
Search and appraisal summary
The update literature search for this overview was carried out from the date of the last search, November 2009, to January 2015. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts 45 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 25 studies and the further review of 20 full publications. Of the 20 full articles evaluated, one systematic review and nine RCTs were added at this update.
Acknowledgement that this condition has a neurophysiological basis and is not purely psychiatric helps patients come to terms with the disorder, especially if they meet fellow sufferers.
Substantive changes at this update
Benzydamine hydrochloride One systematic review added. Categorisation unchanged (unknown effectiveness).
Selective serotonin re-uptake inhibitors New option. One systematic review added. Categorised as 'unknown effectiveness'.
Tricyclic antidepressants New option. One systematic review added. Categorised as 'unknown effectiveness'.
INTRODUCTION: Burning mouth syndrome mainly affects women, particularly after the menopause, when its prevalence may be 18% to 33%. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected treatments for burning mouth syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2015 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 45 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 25 studies and the further review of 20 full publications. Of the 20 full articles evaluated, one systematic review and nine RCTs were added at this update. We performed a GRADE evaluation for five PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for six interventions based on information about the effectiveness and safety of alphalipoic acid, benzodiazepines, benzydamine hydrochloride, cognitive behavioural therapy (CBT), selective serotonin re-uptake inhibitors (SSRIs), and tricyclic antidepressants.