Which drugs may be etiologic factors in burning mouth syndrome (BMS)?

Answer

Various cases of drug-associated burning mouth syndrome (BMS) have been reported. ACE inhibitors and angiotensin receptor blockers are perhaps the most commonly noted in case reports.^{[39, 40, 41]}This may be the product of an inflammatory reaction generated by increases in bradykinin (similar to the mechanism by which angioedema may result). The mechanism as it relates to burning mouth symptoms has not been determined, but kallikrein, a molecule active in the kinin pathway, may be increased in the saliva of burning mouth syndrome (BMS) patients, resulting in increased inflammation.^[16]

Other drugs that have been reported are the antiretrovirals nevirapine and efavirenz.^{[42, 43]}No clear mechanism has been proposed. L-thyroxines have also been implicated in burning mouth syndrome (BMS), although whether the medication itself or the underlying hypothyroidism is the cause is unclear.^[44]Topirimate, a common treatment for trigeminal neuralgia, has been reported to cause BMS-like symptoms.^[18]

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Media Gallery

A 29-year-old female presents with tongue irritation. A diagnosis of benign migratory glossitis (geographic tongue) is made by the appearance. The portions of the tongue with atrophic filiform papilla are symptomatic to acidic foods.
A 60-year-old male with a 2-week history of tongue and mouth burning. The lateral tongue was positive for C. albicans fungus inflammation. The black arrow identifies a white tongue lesion. The patient was treated with oral clotrimazole.
A 63-year-old female presents with tongue discomfort lasting 6 months. She had a right tongue squamous cell carcinoma that extended to the regional lymphatics. She was treated with combined modality therapy.
A 55-year-old female with tongue burning for 15 months. The history for cancer risk factors was negative. Examination failed to reveal any systemic or local causes. Diagnosis of burning mouth syndrome (BMS) was made, and the patient received no medical treatment except for serial examinations.

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Author

Vincent D Eusterman, MD, DDS Assistant Professor, Director, Department of Otolaryngology-Head and Neck Surgery, Denver Health Medical Center

Vincent D Eusterman, MD, DDS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Dental Association, American Head and Neck Society, American Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Katharine G Meddles, MD Pediatric Neurologist, UCSF Benioff Children's Hospital Oakland

Katharine G Meddles, MD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.

Additional Contributors

B Viswanatha, DO, MBBS, PhD, MS, FACS, FRCS(Glasg) Professor of Otolaryngology (ENT), Sri Venkateshwara ENT Institute, Victoria Hospital, Bangalore Medical College and Research Institute, India

B Viswanatha, DO, MBBS, PhD, MS, FACS, FRCS(Glasg) is a member of the following medical societies: Association of Otolaryngologists of India, Indian Medical Association, Indian Society of Otology

Disclosure: Nothing to disclose.

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