Psychosomatic consideration to the burning mouth syndrome

Burning mouth syndrome (BMS) represents a clinical condition of burning pain over the tongue and/or lips without abnormalities in the oral cavity examination. BMS can involve the whole oral cavity with the distress being described as ‘discomfort’, ‘tender’, ‘annoying’ or ‘burning pain’ accompanied with dryness, oral paresthesia and altered taste. Variety in the affected region and sensation make the terms diverse in the published work, including: glossodynia, glossopyrosis, and oral dysesthesia.1 Here, we report one case to highlight clinical wisdom. A 62-year-old woman visited the psychiatric clinic for insomnia. She was robust until 6 months ago, when she suffered from burning mouth pain. She had visited different professionals, including the dentist, the neurologist, the oral pathologist, and the ear–nose–throat doctors. All the examinations, including oral pathology, were normal but the pain persisted. She was then recommended to visit a psychiatrist. In the mental status examination, dysthymic mood, decreased interest and poor appetite were noted. Further interview presented her severe anxiety about salivary gland tumor – a hypochondriacal idea. Considering the symptoms, low-dose antipsychotics (quetiapine 12.5 mg/day) and antidepressants (duloxetine 30 mg/day) were prescribed. Three months later, her depression and sleep improved. Also, the hypochondriacal ideation and the anxiety were relieved partially. Although the burning mouth sensation did not disappear, her quality of life enhanced remarkably. With no conclusively identified cause, BMS predominantly affects women with increasing prevalence with age and following menopause.2 Besides the oral discomfort, psychiatric comorbidity is another focus worth noticing. Studies had reported BMS to have anxiety, depression and increased tendency for somatization as well as several other psychiatric features when measured by the Symptom Checklist-90 questionnaire.3 Evidence suggested that BMS is often chronic, with only 50% of patients spontaneously remitting within 6–7 years.4 Thus, BMS may exacerbate one's long-term quality of life, making the treatment important. A recent Cochrane review had categorized the management into six types: antidepressants, cognitive behavioral therapy, analgesics, hormone therapy, anticonvulsants and α-lipoic acid.5 Considering the high incidence of psychiatric features, it seemed that the psychiatric interventions for BMS were under-estimated with only few randomized control trials focusing on treating BMS with psychotropic agents. In our opinion, BMS may include the disturbance of both the physiological and psychological systems. Anxiety, depression, pain disorder, hypochondriasis as well as delusional disorder should be considered for BMS. Thus, when clinicians see BMS patients, besides arranging a detailed physical examination, the psychological aspects should also be considered and psychiatric consultation may be needed. In this way, there will be a more comprehensive consideration for BMS. There are no potential conflicts of interest and no financial support, including drug stores, for any authors. There is also no grant support for this report. At the same time, we have no special circumstances, vested interests, or sources of funding to disclose.