I have a perplexing case study for which I have been able to offer little help to this patient. I hope there is someone out there who knows about this condition or who can direct me to someone who does.
She is a 66 y.o. white female who presented with cc of, "I've got a
burning sensation on my lips. I've had it for 20 years. I have gone to
many different dermatologists, physicians and ENT's who have given me some creams to put on my
lips, it hasn't helped and now my entire mouth is burning."
She stated that her palate, gums, lips and tongue burned and it would
come and go. It gets a little worse as the day wears on. Her latest
episode of it occurred after she brushed her teeth using Sensodyne
toothpaste. Clinical exam showed no obvious reddening of the soft tissue
areas. Pt. is taking several medications. They include: Ativan for
depression; hydrochlorothiazide 12.5 mg for hypertension and Benazepril
(ACE inhibitor for hypertension), Imipramine 50 mg for depression, and 81
mg asiprin for prophylactic arteriovascularity, and hydrocodone for back
pain(2 yrs, possibly addicted to Lortab).
Burning Mouth Syndrome came to mind for me as top on the differential,
but what is causing it? The patient swears that it all started after she got her braces on when she was about 46. "they poked into my lips, which created sores and they've been burning ever since."
I suggested taking her off the ACE inhibitor. They have been shown to increase the incidence of BMS. I also suggested drinking plenty of fluids and using Biotene mouthwash and toothpaste instead of the alcohol containing mouthwash that she has been using everyday. The Bioten exacerbated the burning sensation. She used it for two days and could not take the pain so she quit using it.
What else can be done?
Thank you in advance for the help,
I agree with you the diagnosis of burning mouth syndrome.Quote: The etiology of burning mouth syndromeis varied and often difficult to decipher clinically.The symptoms of pain and burning appear to be the result of one of many causes. Factors cited as having possible etiologic significance include:
1. Microorganisms--- especially fungi (C. albicans ) and possibly bacteria ( staphylococci, streprococci, anaerobes )
2. Xerostomia associated with Sjogren's syndrome, anxiety, and drugs.Drug classes associated with Xerostomia: Anticholinergics, Antidepressants, Antihistamines, Antihypertensives, Antihypoglycemics,Antiparkisonians, Beta-blockers, Diuretics, Nsaid.
3. Nutritional deficiencies associated primarily with B vitamin complex or iron, and possibly Zinc
4.Anemias, namely pernicious anemia and iron deficiency anemia
5.Hormone imblance, especially hypoestrogenemia associated with postmenopausal changes
6.Neurologic abnormalities,such as depression, cancerphobia, and other psychogenic problems.
8.Mechanical trauma, such as an oral habits or chronic denture irritation
9. Idiopathic causes
Oral pathology, clinical pathologic correlations, written by Regezi and Sciubba, saunders, 3rd edition,page 139
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