Orofacial Pain

A Guide for the Headache Physician

Martina K. Shephard, BDent(Hons), MBBS(Hons), FRACDS; E. Anne MacGregor, MD, FFSRH; Joanna M. Zakrzewska, MD, FDSRCS, FFPMRCA


Headache. 2014;54(1):22-39. 

In This Article

Burning Mouth Syndrome

Burning mouth syndrome describes a collection of symptoms affecting the oral cavity, including a "burning" or painful sensation, often with an associated alteration in taste sensation and an altered perception of the quality and quantity of saliva. The symptoms are most commonly localized to the tongue.[29,30] On clinical examination, the oral mucosa appears entirely normal. The area of abnormal sensation does not typically follow anatomic boundaries, is usually bilateral, and is continuously present. Patients may describe their symptoms as "discomfort" rather than pain. One patient described their symptoms as a "Prickly feeling like an injection wearing off," and when choosing photographic images as representative of their symptom, many choose images of fire.[31] Other causes of oral burning sensations such as hematinic deficiencies, diabetes, other systemic diseases, and oral infections should be ruled out. The condition is most common in perimenopausal or postmenopausal females, and is strongly associated with psychological comorbidities such as anxiety and depression.[32] Patients often report that their symptoms are worsened during periods of psychological stress. The etiology of the condition is unclear, although recent studies have suggested the presence of a small-fiber sensory neuropathy, thus suggesting it is a form of neuropathic pain,[33,34] but others propose a steroid dysregulation mechanism.[35] The condition can be difficult to manage, and a variety of RCTs have been reported, which include drug therapies and cognitive behavior therapy.[36–38] Research on this condition is difficult to conduct in part due to its rarity and a lack of animal models; however, studies are being undertaken that indicate evidence of central changes on functional magnetic resonance imaging (MRI), thus supporting the hypothesis that there are definite neurophysiological elements to this condition, rather than it being a psychosomatic condition as has been previously suggested.