BURNING MOUTH SYNDROME PPT.pptx

BURNING MOUTH SYNDROME BY DR. KIRAN KUMAR, NAVODAYA DENTAL COLLEGE, RAICHUR

1. Dr Kiran Kumar K R Professor Dept of Oral Medicine & Radiology Navodaya Dental College

2. BURNING MOUTH SYNDROME Your information

3. Introduction Burning Mouth Syndrome (BMS) is a Chronic Orofacial Burning Pain condition. Usually in the absence of clinical and laboratory findings that affects many adults worldwide.

4. Is a variant of an atypical facial pain and Is usually described as a steady, continuous, though variable, typical superficial somatic pain.

5. Synonyms BMS Glossodynia , Glossopyrosis , Stomatopyrosis , Or Oral Dysesthesia

6. Epidemiology Prevalent In Postmenopausal Women. In and about 10-40% of postmenopausal women presents with these symtoms . BMS was found in 3.9% of persons. However, Maresky et al. found the number of patients with BMS to be 35%

7. Etiology Etiologic factors are divided into two categories. 1. Local factors 2. Systemic factors

8. LOCAL FACTORS------ The possible local causes include Denture allergy, Galvanic current, Mechanical irritation, Parafunctional habits, Salivary dysfunction ( xerostomia ), Taste disturbances,

9. Ulcerative or erosive lesions, Gingivitis, Periodontitis , Candidiasis , Geographic tongue, and Peripheral nerve disease.

10. SYSTEMIC CONDITIONS-- --- Burning pain may be associated with systemic conditions such as Anemias , Nutritional disorders, Hematological disorders, Immunologic abnormalities, Diabetes mellitus, Psychiatric and psychological disorders,

11. Central nervous system disorders, Neoplasms , Polyglandular failure syndrome, Sjogren’s syndrome, Systemic lupus erythematosus , primary biliary cirrhosis and Autoimmune hemolytic anemia, and Menopause (Hormonal changes)

12. Clinical feature: Mainly affects middle-aged/old women with hormonal changes Middle-aged and elderly subjects with an age range from 38 to 78 years ( Basker et al., 1978 ). Acc. to Van der Waal, Occurrence below the age of 30 is rare . 7/10/2021

13. The female-to-male ratio is about 7:1 ( Bergdahl and Bergdahl, 1999 ). Tip of the tongue is the most common site 71% Lips 50%, lateral border of the tongue 46%, palate 46% 7/10/2021

14. Management 7/10/2021 Template copyright 2005 www.brainybetty.com 14

15. Topical Systemic Cognitive behavioral therapy Initially, it is important to provide patients with information on the nature of their condition and give reassurance.

16. Topical Topical Lidocaine (anesthetic) -Viscous gel 2% -5 ml qid . -Rinse for two minutes and expectorate.

17. Oral rinse of Bzd HCL 0.15% , -used 3 times a day for 4 weeks -for each mouth wash, 15 mL, used for 1 min. Clonazepam 0.5-1mg, 3times/day Let tablet dissolve and hold fluid in mouth in area of most intense burning for three minutes, then spit.

18. Capsaicin - 0.025%, 3–4 times/day -Hot pepper and water -Rinse mouth with 1 teaspoon of a 1:2 dilution (or higher) of hot pepper and water; increase strength of capsaicin as tolerated to a maximum of 1:1 dilution. 7/10/2021

19. Systemic Medications Tricyclic antidepressants: Amitriptyline ( Elavil ) Nortriptyline ( Pamelor ) - 10 to 150 mg per day -10 mg at bedtime -Increase dosage by 10 mg every 4 to 7 days until oral burning is relieved or side effects occur 7/10/2021

20. Duloxetine -serotonin, norepinephrine reuptake inhibitor -60 mg qd -Start with 30 mg for one week then increase to 60 mg

21. Atypical anti-psychotic agent Trazodone 100 mg cap. of Trazodone in the evening for the first 4 days, & after this, the medication , increased to two 100 mg cap. Amisulpride -50 mg tablets up to three times per day. - Maximum dose not to exceed 400 mg/d 7/10/2021

22. Systemic levosulpiride 100 mg/daily for 8 weeks. Olanzapine - 5 mg/day 7/10/2021

23. Anticonvulsants   Gabapentin ( Neurontin )  -300 to 1,600 mg per day -100 mg at bedtime; -increase dosage by 100 mg every 4 to 7 days until oral burning is relieved or side effects occur. -as dosage increases, medication is taken in three divided doses. Pregabalin 100 mg tid 7/10/2021

24. Benzodiazepines Clonazepam ( Klonopin ) -0.25 to 2 mg per day -0.25 mg at bedtime; - increase dosage by 0.25 mg every 4 to 7 days until oral burning is relieved or side effects occur. 7/10/2021

25. Others: Capsaicin: as 0.25% capsules t.i.d . for 4 weeks