Case report:
A 57-year-old female patient presents with good health, without a regular consumption of drugs.
For 6 months, she has been complaining about burning sensation on the tip of the tongue and on palate, lasting all day long and present at night for 2 months.
Besides, the patient has been reporting dysgeusia for 2 months with a perception of a metallic taste that she ascribed to older prosthetic restorations. On physical examination, the patient was in good health condition.
The oral mucosa was intact.There were also 9 crowns in good condition.
In order to exclude other pathologies or possible deficiencies, we applied an oral tampon that was negative to candidiasis, and we demanded hemochrome, serum iron and zinc level that revealed no alteration.
We made a diagnosis of burning mouth syndrome.
Considering the prevalent emotional element, the therapy consisted first in reassuring the patient about the benignity of the clinical condition and, secondly, in administering 5mg Chlordiazepoxide to be taken at night, before going to bed.
During the first examination after 7 days, the patient reported a significant reduction of dysgeusia and of the symptoms of pain.
Fifteen days after the beginning of therapy, the set of symptoms completely disappeared.
Discussion:
Burning Mouth Syndrome is a clinical condition that typically affects women, especially between the fifth and the seventh decade of life. It has to be distinguished from secondary BMS, characterized by favoring clinical conditions like candidiasis, vitamin nutritional deficiencies and diabetes.
The clinical triad is composed of oral burning, dysgeusia and xerostomia.
The pathogenetic processes responsible for this clinical condition are linked to the onset of peripheral neuropathies.
As the motivating factor is still unknown, there is no specific therapy. In fact, there are several therapies in literature: antidepressants, capsaicin, lipoic acid and chlordiazepoxide.
Conclusions: A correct differential diagnosis is crucial, by means of a careful clinical examination, of instrumental investigations, and of a thorough case history that, in most cases, reveals the presence of negative life events.
F. Inchingolo 1-5, A. Palladino1, M. Tatullo 2, M. Marrelli 5 , A.M. Inchingolo 3, F.M. Abenavoli 4, A.L. Valenzano 2, F. Schinco 1, V. Angelini 2, A.D. Inchingolo1, G. Dipalma1-5
1 Department of Odontostomatology and Surgery, University of Bari, Bari, Italy
2 Private Doctor in Dental Sciences
3 Department of Odontostomatology and Surgery, University of Milano, Milano, Italy
4 Department of Otorinolaringoiatry, Hospital ?S. Pietro – Fatebenefratelli?, Rome, Italy
5 Department of Maxillofacial Surgery, Calabrodental Srl, Crotone, Italy