Burning Mouth Syndrome: Treatment Options Reviewed

Twenty three RTC's were included in the review to determine the efficacy of interventions against placebo
Twenty three RTC's were included in the review to determine the efficacy of interventions against placebo

Study authors concluded there was insufficient evidence to either support or refute the use of any interventions in managing burning mouth syndrome (BMS)

BMS refers to oral mucosal pain such as burning pain or discomfort in the tongue, lips, or entire oral cavity without a known cause. A Cochrane database systematic review of randomized controlled trials was conducted to determine the safety and efficacy of any intervention against placebo for symptomatic relief and changes in quality of life (QoL), taste, and feeling of dryness in patients with BMS. 

The primary outcomes were symptom relief (pain/burning) and change in QoL. Secondary outcomes included changes in taste, feeling of dryness, and adverse effects. Data were analyzed as either short-term (up to 3 months) or long-term (3–6 months).  

Twenty-three randomized controlled trials (n=1,121) were included for the review. BMS interventions included antidepressants, antipsychoticsanticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies, and topical treatments. The quality of evidence for efficacy was very low for all interventions and outcomes. 

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For short-term relief of BMS, authors cited very low quality evidence of benefit from electromagnetic radiation (1 study), topical benzodiazpeines (2 studies), physical barrriers (1 study), and anticonvulsants (1 study). 

Insufficient/contradictory data was found regarding the efficacy of antidepressants, cholinergics, systemic benzodiazpeines, dietary supplements or topical treatments. No randomized controlled trials involved psychological therapies for short-term symptom relief. 

For long-term relief of BMS, authors cited very low quality evidence of benefit from psychological therapies (1 study), capsaicin oral rinse (topical treatment) (1 study), and topical benzodiazepines (1 study). There was no evidence of a difference for dietary supplements vs. lactoperoxidase oral rinse. No randomized controlled trials involving  antidepressants, anticonvulsants, cholinergics, electromagnetic radiation or physical barriers evaluated long-term symptom relief.

Authors further concluded very low quality evidence for short-term change in QoL; none evaluated for long-term effect. Electromagnetic radiation proved beneficial in 1 study but findings were inconclusive for antidepressants, benzodiazepines, dietary supplements, and physical barriers. 

Regarding side effects, there was very low quality evidence that antidepressants increase dizziness and drowsiness, and that alpha lipoic acid increases headache and gastrointestinal (GI) complaints. Insufficient/contradictory evidence were found regarding adverse events for anticonvulsants or benzodiazepines. 

Overall, the findings call for a need to discover effective treatment approaches for patients with BMS. More studies are needed with better methodology and standardized outcomes to determine which treatments are effective. Future studies should investigate treatments used for other neuropathic pain conditions and psychological therapies in the treatment of BMS.

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