Randomized trials for the treatment of burning mouth syndrome: an evidence‐based review of the literature

Abstract

Burning mouth syndrome (BMS) is defined as a chronic pain condition, characterized symptomatically by a generalized or localized burning sensation in the oral cavity. Various drugs have been used in attempting to treat BMS, but there is insufficient evidence to show the effect of any effective treatment. The aim of this review was to assess the effectiveness of therapies for BMS. Randomized controlled trials (RCTs) enrolling patients with a diagnosis of BMS were identified by searching Pubmed and Scoppus databases. The methodological quality of included studies was assessed on the basis of the method of allocation concealment, blindness of the study, loss of participants, size sample, and outcome concealment. A total of 12 relevant articles were analyzed. Therapies that used capsaicin, alpha-lipoic acid (ALA), and clonazepam were those that showed more reduction in symptoms of BMS. However, many studies of therapeutic interventions in BMS lack consistency in their results, because they use in their methodology, sample and a relatively short time of therapy and often do not provide a follow-up of patients treated. Thus, future studies are required to establish the treatment for patients suffering from this chronic and painful syndrome.

Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

“…On the other hand, professional contact and welcoming also show positive result in light of the patient emotional component. This correlations were reported in the literature 16,24 , and considering the primary BMS subtypes 9 and that the neuropathic pain may be associated to BMS may be a mixture of peripheric or central 26 , the proposed ideal therapy must be individual 27 . However, new studies are needed in order to define better treatment protocols.…”

“…In an attempt to minimize the adverse effects, the use of topical clonazepan was evaluated, with reduction of 70% in the burning sensation 15 . However, the study performed by Moraes et al 16 observed that even in topical form, some patients reported side effects, such as drowsiness, xerostomia, and increased burning sensation in the mouth in some cases.…”

Burning Mouth Syndrome

“…Indeed, the binding of capsaicin inactivates the neuronal responses to heat. 58 Prolonged exposure to capsaicin has been shown to deplete TRPV1 in peripheral tissues, thus contributing to the long-term desensitization of nociceptors and a reduction in the burning sensation. 58 Then, activation of TRPV1 can induce persistent depolarization of the nerve terminals, causing a decrease in their ability to generate and propagate action potentials.…”

“…58 Prolonged exposure to capsaicin has been shown to deplete TRPV1 in peripheral tissues, thus contributing to the long-term desensitization of nociceptors and a reduction in the burning sensation. 58 Then, activation of TRPV1 can induce persistent depolarization of the nerve terminals, causing a decrease in their ability to generate and propagate action potentials. 57,59 In addition, expression of TRPV1 in various brain regions has been established, and capsaicin results in an increase in the excitatory glutamatergic synaptic transmission in the nucleus tractus solitarius, locus coeruleus, dopaminergic neurons of the substantia nigra, and the preoptic hypothalamic neurons.…”

“…50 These findings reinforce the hypothesis that both central and peripheral neural mechanisms are involved in BMS. 58 Although it may be argued that clonazepam efficacy is due to anxiolysis, such a conclusion seems unwarranted because neither maximal effect nor compliance for clonazepam seemed to be dose related; instead, both were observed at the lower dose range (0.5 mg/d). 50 Hens et al 60 Regarding GABAergic treatment, White et al 61 reported that gabapentin (300 mg 3 times per day) decreased the burning sensation by 71% on VAS in a 67-year-old woman suffering from BMS.…”