Epidemiology

It is difficult to confirm BMS epidemiological data because of a lack of universally accepted diagnostic criteria.18,29 Various international studies suggest the syndrome may affect between 0.6% to 15% of the population, but the prevalence may be considerably higher in middle-aged and elderly individuals with a significant female predilection and a higher rate found in peri- and post-menopausal women. However, the prevalence increases markedly with age in both sexes.53

The disorder may last for months or years, often without a definitive diagnosis, and it may have a profound effect on the patient’s perceived quality of life. The patient may complain of burning pain in the tongue, hard palate, other mucosal sites and even combinations of oral sites. Often the oral burning, pain, numbness, scalding, tingling, puritic sensations or changes in taste, force the patient to search for answers and assume the problem is best treated by a general dentist.

Thoppay et al. states there is often no differentiation between BMS and oral burning.4,39 Since the variations of symptoms occur and each patient reports very subjective complaints, the diagnostic process becomes even more complicated. Thoppay also points out the methodology of research is varied with many studies using subjective surveys and others reporting documented clinical findings.39 These factors complicate the clear consensus, and these stated problems have added to the variation of reported statistics and treatment modality.31

See Table 1 for more information on classifications. The disorder may last for months or years, often without a definitive diagnosis, and it may have a profound effect on the patient’s perceived quality of life. The patient may complain of burning, pain in the tongue, hard palate, other mucosal sites and even combinations of oral sites.

Table 1. Primary and Secondary BMS.56

Primary:
  • Considered a diagnosis of exclusion of other entities.
  • Characterized by burning sensations of the oral and perioral tissues.
  • Absence of relevant clinical or psychological abnormalities.
  • A neuropathological cause is likely.
Secondary:
  • Characterized by clinical abnormalities such as mechanical and chemical irritants.
  • Allergic contact-environmental, foods and oral products.
  • Possible parafunctional habits such as bruxism, clenching and tongue placement causing a frictional reaction.
  • Fungal, bacterial or viral infections such as Candida and Helicobacter pyloriinfection on the tongue surface.
  • Systemic problems such as mucosal disease states, e.g., lichen planus and stomatitis.
  • Candida infection.
  • Psychological conditions.
  • Hormonal imbalance.
  • Vitamin B deficiency, folate, iron or zinc deficiency.