Burning mouth syndrome (BMS) is a common, complex, chronic disorder of unknown etiology that affects more than one million people, predominantly women of post-menopausal age. BMS causes constant pain in the mouth as if your mouth has been scalded with hot water. It affects the entire oral cavity including the tongue, lips, inside of the cheeks and the roof of your mouth. Te most common form is called primary or idiopathic BMS when there is no underlying medical cause of the symptoms; no oral lesions or
apparent damage to the oral cavity. It is called secondary BMS when there is an underlying medical condition. These conditions include, but are not limited to: dry mouth; thrush; nutritional deficiencies (lack of iron, zinc and B-vitamins); use of dentures; nerve damage; and reflux of stomach acids. Left untreated, patients develop irritability, depression, and difficulty sleeping and eating.

There are several different patterns for the clinical presentation of the disease. Some patients feel burning all the time, some have severe symptoms only in the morning and others have symptoms go away briefly to return again. BMS does not cause any significant physical changes to your tongue or mouth.

Standard treatment options include benzodiazepines, tricyclic antidepressants and anticonvulsants. Alpha-lipoic acid has been used to treat BMS. There may be a neuropathic component in BMS that releases toxic free radicals in the presence of stress situations.

Alpha-lipoic acid is an antioxidant that is able to reduce free radicals and increase levels of intracellular Glutathione. Hormone therapy, particularly estrogen, has helped patients with symptoms of BMS.

Compounding Suggestions:

• Salicylic Acid Mouthwash
• Salicylic Acid Mouthwash with Capsaicin
• Troche – Capsicum

Patients also benefit from lifestyle changes such as drinking more fluids to keep the mouth hydrated, avoiding tobacco products and limiting spicy, hot foods. It also is recommended to avoid acidic drinks such as coffee, orange juice and carbonated soft drinks. BMS is a painful and frustrating disease, but as compounders, we have a great opportunity to help our patients with compounds that are effective and easy to prepare.

REFERENCES
Rivinius C. Burning mouth syndrome: Identification, diagnosis, and treatment. J Am Acad Nurse Pract. 2009 Aug;21(8):423-9.
Burning mouth syndrome.
Curr Pain Headache Rep. 2008 Aug;12(4):279-84. Mayoclinic.com
Burning Mouth Syndrome
By Jane Jones, RPh, PCCA Pharmacy Consultant