GLOSSODYNIA

(BURNING MOUTH SYNDROME)

AN INDEPENDENT CE STUDY COURSE

FOR DENTAL PROFESSIONALS

By
Dr. Javed A. Qazi, BDS, MSc.

File Name: amelogo and usage.eps

As of Date: 04/2004

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ABOUT THE AUTHOR

Dr. Qazi a graduate of Khyber Medical College and received a BDS degree from
University of Peshawar in 1980. In 1982, he was appointed as Lecturer. He obtained
a Master of Science degree in Oral Medicine & Periodontia in 1991 from Khyber
College of Dentistry, Peshawar. He worked as a periodontist at Royal Dental
Hospital; KSA from 2001-2003. Dr. Qazi is active in several national dental
organizations and has written numerous dental journal articles. He maintains a
private practice of generalized & specialized dentistry.
Presently, he is working as Senior Lecturer at Khyber Medical College and been
awarded exemption in Membership in Oral Medicine of Royal College of Surgeons
of Edinburgh, UK (Part 1). He is also an Examiner of BSc in dental technology and
BDS examinations. Dr. Qazi is member of IADR and is actively involved in research
of glossodynia.

© 2006 – ArcMesa Educators, LLC/Dr. Javed A. Qazi

All rights reserved. This CE/CME course,
or any part thereof, may not be duplicated

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or reproduced without the permission of the authors.

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COURSE OBJECTIVES

Upon successful completion of this course, the participant will:

1. Comprehend the local, systemic and psychogenic causes of glossodynia

2. Understand the various symptoms of glossodynia
3. Know the significance of the multiple causes in relation to other possible
chronic diseases

Target Audience
This course was developed to provide an overview of glossodynia for dental professionals.

Accreditation
ArcMesa Educators, LLC is an ADA CERP Recognized Provider
for Dental Continuing Education, an Academy of General
Dentistry Accepted National Sponsor (#90564) for
FAGD/MAGD Credit, a Florida Board of Dentistry Provider (#BP-00246), and a registered provider
with the Dental Board of California (RP 4365).

Credit Designation
By reviewing the course content and completing the post test at the end of this continuing medical
education activity, you are entitled to receive one credit hour if you achieve a score of 70% or greater.
Estimated time to complete this activity is one hour.

Disclosure
It is the policy of ArcMesa Educators, LLC to ensure balance, independence, objectivity, and
scientific rigor in all its educational activities. All faculty/authors are expected to disclose any
relevant financial relationships they may have with commercial interests in relation to this activity.
These relationships, along with the educational content of this program, have been reviewed and
any potential conflicts of interest have been resolved to the satisfaction of ArcMesa Educators.

Dr. Javed Qazi has indicated he has nothing to disclose relative to this activity.

ArcMesa Educators, LLC staff has nothing to disclose relative to this activity.

Date of original release: June 2006 Date of most recent review/approval: N/A
Medium used: Monograph / Internet Expiration Date: June 2009

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TABLE OF CONTENTS

ABOUT THE AUTHOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

COURSE OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii

TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii

COURSE INSTRUCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

ETIOLOGIC FACTORS OF GLOSSODYNIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

LOCAL FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

SYSTEMIC FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

PSYCHOGENIC FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

MULTIPLE ETIOLOGIC FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

COURSE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

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COURSE INSTRUCTIONS

FOR INTERNET AND HOME STUDY PARTICIPANTS!

• Read the course material carefully. Internet participants may study online or print a copy
of the course for off-line study. Start when you are fresh and take your time.

• This course includes an "open book" exam. You may review the text at any time as a learning
aid or to check the accuracy of your responses before submitting your completed exam.

• Be sure to answer each exam question; blanks are counted as incorrect answers.
A minimum score of 70% is required for successful completion of this exam.

• The processing fee for this course entitles only one person to receive a certification of com-
pletion. A history of courses taken and certificates earned can be found in your "Member
History" section of our online program and/or available traditionally by contacting our cus-
tomer services department.

• After successful completion of the course exam, Internet users are returned to their
"Member History" page where you may view and/or print your Certificate of Completion.
Please note that each certificate is uniquely identified with an ArcMesa "Certificate ID
Number". Numbers may be used for certificate validation by various authorized organiza-
tions. Mailed or faxed exams and evaluations are processed within 48 hours of receipt.
Certificates are posted for return by 1st Class U.S. Mail the next day.

• If you fail an on-line exam, you may retest immediately by selecting the "Repurchase Exam"
link found directly across from the course title within your "Member History" page.
Note: Traditional users will be notified by ArcMesa and may retest upon purchasing a
new exam.

• Please complete the brief course evaluation form at the end of the exam. Your responses
and suggestions will allow us to upgrade our procedures and course materials to serve you
more effectively in the future.

PROBLEMS OR QUESTIONS?
If you have any questions about your examination or your Certificate of Completion, please call
ArcMesa at 1-800-597-6372
Your Certificate of Completion will reflect the following data:
Date of completion, name, profession/occupation, license number (if provided), course title,
CE/CME hours awarded, provider name and approval number (if applicable). Internet users receive
an online grade report. Home study users may request a grade report.
Thank you for choosing ArcMesa Educators!

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INTRODUCTION

GLOSSODYNIA, is also known as burning mouth syndrome (BMS), Glossalgia,

Glossopyrosis, Stomatodynia or oral dysphasia. It has been recognized worldwide
and affects 2.6 percent of the general population and more than 1 million people in
the United States.1
Glossodynia is characterized by intra oral pain disorder with burning or altered
sensation in the tongue, gingiva, lips or denture bearing areas. The burning may be
unilateral or bilateral and tends to be relieved by eating or drinking. Other
symptoms commonly associated with this disorder include dry mouth, headache,
sleep disturbances and severe postmenopausal symptoms in women.
Traditionally it has been described as a chronic syndrome without specific organic
etiology and those diagnosed with BMS are often emotionally disturbed
postmenopausal women. Women are particularly affected by the condition; they are
diagnosed with symptoms seven times more frequently than males.
Schoenberg et al reported that the symptoms occur in men as well as in women
and are not necessarily confined to old age.2
Glossodynia can be divided into two types:3
1. With observable alterations of the tongue and
2. Without any observable alterations of the tongue
The common observable signs of BMS are inflamed fungi form papillae, a localized
reddening due to trauma or atrophy of the filiform papillae, localized or generalized
lobulations and generalized redness. These symptoms may alter an individual’s
sense of taste.
In the second type of BMS with no observable alterations of the tongue, there is
no evidence of tissue abnormalities and both the filiform and fungi form papillae of
the tongue are without any atrophic changes.
Although the burning sensations are readily recognizable symptoms, the
underlying cause is always obscure. The clinician must consider various etiological
factors with careful and thorough clinical examination plus laboratory
investigations before diagnosing a case of glossodynia. The purpose of this course
is to present a systemic approach to the differential diagnosis of glossodynia.
Etiologic factors of glossodynia include: local, systemic and psychogenic causes.

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ETIOLOGIC FACTORS OF GLOSSODYNIA

LOCAL FACTORS
• Candidiasis
• Migratory Glossitis
• Lichen Planus
• Trauma
• Oral Cancer
• Denture faults
• Impression surface
• Polished surface
• Occlusal surface
• Denture Plaque
• Residual monomer
• Sensitivity to dental materials
• Radiation therapy (xerostomia)
• Periodontal diseases
• Electro galvanic discharge

CANDIDIASIS
One of the most common causes of glossodynia is candidiasis or moniliasis. It is
caused by candida albican, a fungal organism that exists in the oral cavity as a part
of normal flora. There is a competitive inhibition with other organisms in the oral
flora. The host immune defenses maintain the candida population low numbers.
When there is a disruption of the ecosystem or the host defense mechanism is
lowered, the candida proliferate and as a result candidiasis develops. Candidiasis can
also occur from the prolonged use of antibiotics, corticosteroids and cancer
chemotherapy. Those with debilitating diseases like diabetes mellitus, often have
candidiasis as well. Trauma from ill-fitting dentures along with poor oral hygiene
allows candida organisms to penetrate the oral tissues, thus resulting in candidiasis.
Oral manifestations of candidiasis range from erythema to creamy whiter colonies
that may be associated with angular cheilosis. There is burning sensation of entire
oral mucosa rather than only the tongue. The treatment consists of rinsing the

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LICHEN PLANUS
Lichen Planus is a dermatological disease with oral manifestations. Recent studies
indicate that oral lesions are present without skin lesions in 65% of Lichen Planus
cases. Lichen Planus represents 9% of all oral white lesions and appear in three
forms (as atrophic and bullous subtype):4
• Striated
• Plaque like &
• Erosive
The exact etiology of Lichen Planus is unknown but it is presumed to be an
autoimmune or psychosomatic disease. The predisposing factors for Lichen Planus
are emotional stress, trauma, viral or bacterial infection, hypersensitivity, or drug
therapy.
Oral manifestations of Lichen Planus include: wickhams striae (lacy white
configuration), erosions, ulcers or white plaques (which may or may not be
present). The buccal mucosa is the most common site but the tongue and gingival
area may also be affected. About 50% patients with oral Lichen Planus also have
raised purple, itchy papules with white lacy striae on the skin.5
The symptoms of burning and pain occur most often with erosive Lichen Planus.
The diagnosis is made by a histological examination and biopsy. Local or systemic
corticosteroid therapy is frequently helpful in the acute phase of erosive Lichen
Planus. The incidence of malignant transformation of erosive Lichen Planus varies
from 0% to 10%. Therefore, careful monitoring is recommended, as chronic oral
ulcerative might represent a cofactor in the development of malignancy in certain
people.5

TRAUMA
Low incidence of trauma may be on the list of causes for oral burning. Trauma
may be in the form of physical, chemical or thermal injury. Biopsy and surgical
repair of tongue can also result in Glossodynia.

ORAL CANCER
Glossodynia may be caused by oral cancer, which is normally present on the lateral
borders of the tongue or the oropharynx. The incidence of oral cancer varies in
different parts of the world. In 1980, oral and pharyngeal cancer ranked the sixth
most common form of cancer worldwide. In India, for example, 40% of all cancers
occur in the mouth while in England there is incidence of 2% oral cancer. Binnie et
al reported a rate of 1.9% for oral cancers compared to all cancers in England and

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Wales. Whenever leukoplakia or erythroplakia persist with accompanying burning

symptoms, the biopsy is mandatory.6
The incidence of the oral cavity and oropharynx cancers represent approximately
three percent of all malignancies in men and two percent of all malignancies in
women in the United States. Over 90 percent of these tumors are squamous cell
carcinomas, which arise from the oral mucosal lining. Approximately 2,000
patients a year are diagnosed with oral cancer in New York State alone. Governor
George Pataki has taken a leadership role in the United States by mandating and
funding training for dentists in the prevention and early detection of oral cancer.
Dental surgeons because of its continual association with the oral cavity have the
greatest opportunity to detect early oral cancer and can educate prevention among
their patients. Patients with persistent leukoplakia and accompanying burning
symptoms need to have a biopsy in order to test for oral cancer.

MIGRATORY GLOSSITIS
Migratory Glossitis (Geographic tongue) is an asymptomatic inflammatory
condition that can be painful. A patient with migratory glossitis will often go to the
dentist because of the unusual appearance of the tongue, rather than complaints of
pain.
Migratory Glossitis is a common idiopathic recurring condition, which manifests
as an area of depapillation of the filiform papillae of the tongue with white
hypertrophic borders. The patient may complain of a burning sensation of the
tongue in the depapillated area after eating hot or spicy foods. The treatment is
symptomatic and patient is assured of its benign condition.
The treatment for Migratory Glossitis is given as a symptomatic treatment,
according to each symptom. As there is no helpful therapy, most patients are
relieved to know that the disease is not contagious, life-threatening, and not a sign
of any serious internal problem. In patients who experience pain, analgesics are
prescribed. Patients with a history of anxiety are often prescribed anxiolytic drugs
to relieve their anxious symptoms.

DENTAL CAUSES
A faulty denture design in any three surfaces (Impression, polished or occlusal
surface) may promote the burning sensation due to an increased level of functional
stress to the circum oral or lingual musculature. The presence of dental plaque can
also cause glossodynia.
A patient, who has an allergy to the denture base material such as monomeric
methyl methacrylate, is a potent tissue irritant that can cause glossodynia. The

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allergy is an infrequent cause of burning mouth syndrome because once the denture
design is modified the symptoms are alleviated. Other allergens, which cause
burning mouth syndrome, include propylene glycol, sorbic acid, benzoates and
cinnamon aldehyde.

XEROSTOMIA
Xerostomia is a subjective condition in which there is less than the normal
amount of saliva present in the mouth. The relation between burning and dry
mouth has been recognized since the 1930’s and present literature also provides
statistical support for this inter relationship. Xerostomia may be reversible or
irreversible. The patients with severe xerostomia will often complain of dry, burning
mouth, which can be very painful and interfere with functions.
Xerostomia is normally caused by a local factor, radiation therapy. Ionizing
radiation causes pronounced changes in salivary glands, and the degeneration of
acini. Replacement of resultant fibrous or fatty may be necessary depending on the
effects from the amount of radiation therapy. Saliva substitute and fluoride gel
should be used to reduce the risk caries from radiation therapy.

SYSTEMIC FACTORS
• Climacteric as postmenopausal hypoestrogenism
• Diabetes
• Sjogren’s syndrome (Xerostomia)
• Drug reactions (Xerostomia)
• Deficiency states
• Anemias (Iron, Vitamin B12, Folic Acid deficiencies)
• Lingual artery atherosclerosis
• Rheumatoid arthritis
• Gastric disturbances such as hyperacidity
• Xerostomia
• Hypothyroidism

DIABETES
Diabetes mellitus is the most common of the endocrine disorders. Its prevalence
in Britain is over 1% although 50% of those affected remain undiagnosed. The oral
manifestations of diabetes comprise of painless swelling of the parotid, increased

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amounts of glucose in serous saliva, increased risk of periodontal disease and caries.
Glossodynia may be one of the symptoms of diabetes, which is often associated
with xerostomia and candidiasis. There also may be diabetic neuropathies, which
manifest in the head and neck region contributing glossodynia.
Basker et al reported that diabetes might not be an important etiological factor in
glossodynia as the association between diabetes and burning mouth syndrome is
small. Recently Zegarelli reported that he did not find any case of hyperglycemia
among the 57 patients with burning mouth syndrome.9
The treatment of diabetic glossodynia is achieved by the correct management of
diabetes as directed by the patient’s physician for such treatment. A saliva substitute
and fluoride gel should be used in the cases of xerostomia and the other infections.

SJOGREN’S SYNDROME
Sjogren’s Syndrome is a chronic disease in which the body’s white blood cells
attack the moisture-producing glands causing various symptoms, one being dry
mouth. It is one of the most prevalent autoimmune disorders, striking as many as
four million Americans. Glossodynia may appear early in the course of the disease,
before other symptoms appear. The oral symptoms of Sjogren’s syndrome are due to
xerostomia. The diagnosis is made by histological and hematological examinations
with serologic findings. Although there is no effective treatment, saliva substitute
and fluoride gel should be prescribed for the relief of these oral symptoms.

DRUG REACTIONS (XEROSTOMIA)

Many drugs used to treat a variety of systemic disorders produce varying degrees
of xerostomia, such as pharmacologically induced xerostomia and Iatrogenic
xerostomia. Drugs that are frequently used for long periods of time can cause
prolonged decrease in salivary flow and eventually xerostomia occurs. Short-term
xerostomia itself often does not cause oral discomfort and dental problems rather
the prolonged use of certain drugs that lead to xerostomia may produce oral
discomfort with an increased incidence of caries.
The primary neural control of salivary flow is exerted through the parasympathetic
division of the autonomic nervous system. An increase in cholinergic activity will
increase the salivary flow where as the decrease in nerve activity results in the
decrease of flow. Likewise drugs that alter cholinergic activity either at sites in the
central nervous system or in the periphery will alter salivary flow rate. The most
striking example of the cholinergic drugs on salvation is the profound decrease in
flow seen after administration of cholinergic (muscarinic) blocking drugs such as
atropine propantheline and glycopyrrolate. These drugs block the action of

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acetylcholine, a neurotransmitter, at peripheral muscarinic receptors. Other drugs

such as antihypertensive agents (CLONIDINE) act on the central nervous system to
decrease cholinergic nerve output to peripheral sites such as salivary gland.
Xerostomia can also be caused by opium and its derivatives, bronchodilators
(ephedrine), central nervous system stimulants, Tricyclic anti-depressant
(Imipramine) and diuretics.

NUTRITIONAL DEFICIENCIES (ANEMIAS)

Glossodynia may be one of the symptoms of deficiency states especially iron,
Vitamin B12 and folic acid reported as early as in 1922 by Beal.10
Iron deficiency can cause oral discomfort with glossodynia and angular cheilitis.
There are atrophic changes in the epithelium of any part of oral mucosa, which may
result in non-specific ulceration. These atrophic changes in the oral pharyngeal
mucosa may lead to wide spread soreness and dysphasia. The diagnosis can be made
by estimation of hemoglobin content, serum iron, ferritin level and iron binding
capacity. The treatment is by iron replacement therapy. The recent data indicates
that the burning sensation may also result from the deficiency of vitamin B1 and
B6 also produces greasy dermatitis of the face.
In pernicious anemia, there may be generalized atrophy of the oral mucosa with
ulceration as in iron deficiency anemia. The soreness of tongue is due to atrophic
changes in the lingual papillae termed as “Beefy red tongue“. The tongue often
shows a shiny smooth appearance and may be painful and tender to hot or spicy
foods. Glossodynia is a common symptom. The diagnosis can be made by RBC
morphology and serum vitamin B12 parental therapy.

Complex vitamins
Iron deficiency is not a disease but a sign of disease and associated with
glossodynia. The high incidence of iron deficiency anemia in women often occurs
in the second half of pregnancy due to the increased demand for iron. In
postmenopausal women and adult males, the common cause of iron deficiency is
gastrointestinal bleeding by non-steroidal anti-inflammatory drugs and hook
worms infection.11
Patients suffering from iron deficiency states are also particularly susceptible to
candida albican infection, a skin infection caused by a yeast-like fungus. With this
infection, there is an atrophy of tongue epithelium with resulting disturbance of
underlying nerve that causes taste disturbance and pain in the tongue. This change
in sensitivity of tongue can be of diagnostic value in determining possible vitamin
deficiency states.

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Iron deficiency anemia has insidious onset with gradual fatigue, irritability,
dizziness, palpitation, breathlessness and headache. These changes in metabolism of
oral epithelial cells are due to minor variations in the overall quality of the blood
supply. The changes in the blood supply give rise to abnormalities of cell structure
and keratosis pattern of the oral epithelium resulting in the atrophy and possible
elimination of the filiform papillae of the tongue. The atrophic changes in the
tongue may lead to ulceration and soreness, and in many cases affect the whole oral
mucosa and lead to ulceration.
In a small group of patients, the atrophic changes in the oral and pharyngeal
mucosa may lead to wide spread soreness and dysphasia. This is known as
Plymmer-Vinson syndrome or achlorhydria. The patient may experience angular
cheilitis, thrush and complain of taste disturbance due to atrophy of the tongue
epithelium (from the disturbance of underlying nerve endings).
Folic acid like vitamin B12 is involved with RNA and DNA metabolism. A
deficiency of folic acid may lead to burning mouth angular cheilitis and
glossodynia. The tongue shows varying degrees of papillary atrophy which
progresses until the surface of tongue is smooth and shiny. The diagnosis is done by
RBC morphology and serum folate level. Likewise, niacin deficiency causes
generalized erythema of the oral mucosa along with papillary atrophy. A proper
diagnosis can be made by the measurement of niacin level. It is treated with niacin
and vitamin B-complex vitamins.12

PSYCHOGENIC FACTORS
• Anxiety
• Depression
• A cancer phobia
Psychogenic factors are often implicated as being etiologic in burning mouth
syndrome and are the most frequent factor in many patients. Engman first
recognized the psychogenesis of burning mouth in 1920 that studied eleven
patients suffering from burning mouth syndrome who were mostly women having
the fear of cancer.13
It is reported that Glossodynia is one of classic symptoms of anxiety and
depression precipitated by psychological stress. The specific psychological stress is a
real or threatened loss of love, person, valuable object or bodily function. Chronic
illness of psychosomatic origin can be traced to dental operation, proper fitting
dentures and the failure of the patients to adjust to these procedures. Losing a tooth

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according to an old adage means, “losing a friend” but it also means in the
unconscious loss of strength and virility. Thus the patients suffering from burning
mouth syndrome often associate the onset of symptoms as correlating with a time
several weeks after exodontias, periodontal surgery or extensive restorative dental
treatment.
Ewalt noted that a common complaint in depression is a peculiar taste, stinging or
burning sensation around teeth, gingival or tongue.14 The diagnosis of
psychologically induced glossodynia is established after all local and systemic
factors are excluded by a negative clinical picture, negative laboratory findings and
positive historical data regarding emotional factors. The burning sensation is
confined to tongue but the palate and lips are frequently involved. Pain could be
aggravated by hot and/or spicy foods and relieved by local anesthetics. Main and
Basker claim that 20% patients complaining of burning mouth syndrome have or
do not have anxiety towards a cancer-phobia.15 Browning et al concluded that 44%
of burning mouth patients had an associated psychiatric disorder.16 Recently, Lamb
et al indicated that 60% of burning mouth patients has had psychological factors
and anxiety was most difficult to cure.17
Glossodynia may be symptom of cancer-phobia. Reassuring the patients after a
complete diagnosis is often helpful in relieving the symptoms. The treatment of
psychogenic Glossodynia is anxiolytic/antidepressant drugs or by referring the
patients for psychiatric consultation.

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MULTIPLE ETIOLOGIC FACTORS

Occasionally, some patients are diagnosed with glossodynia from the presence of
multiple etiologic factors. The exact amount of burning sensation from each cause
is unknown but it is evident that more than one can exist in such patients. Zegarelli
reported that multiple etiologic factors for glossodynia exist in 12.3% of the cases in
57 patients he studied with burning mouth syndrome.9
In 1984, a study conducted at the Division of Stomotology at Columbia
Presbyterian Medical Center concluded that out of 57 patients, 7 patients with BMS
had multiple co existent causes (12.5%). Psychogenesis moniliasis was found in 4
of patients, 2 male and 2 female. All four had history of a psychiatric disorder
(depression) and were taking anti depressive therapy with demonstrable xerostomia
and candidiasis. Treatment for these patients included anti fungal and anti
depressant drugs.
In the same study two female patients had psychogenesis and geographic tongue
while one was having geographic tongue and moniliasis. In this case, anti fungal
therapy was given and within 9 days there was 75% improvement. When multiple
causes of glossodynia exist, treatment is provided for each cause.9

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CONCLUSION

A systematic approach to the diagnosis of burning mouth syndrome is suggested

for the successful management of this condition. The following diagnostic protocol
is recommended.

HISTORY
A detailed history for each patient must be taken with reference to his complaint.
The emphasis should be placed on the following points; exact site of burning
sensation, duration, and severity and in case of edentulous patients, any association
with denture must be assessed. The relationship of symptoms with chemotherapy
or dental procedure should be noted. For the denture wearer, specific questioning
about the age of present denture, length of denture wearing experience, association
of symptoms with previous denture, whether denture worn at night, any repair and
relining done. The patient’s prescription or non-prescription drug history should be
taken in order to determine potential systemic factors that can cause xerostomia or
hypersensitivity reactions.

CLINICAL EXAMINATION
Routine extra and intra oral examination should also be performed. Any
abnormality in color texture of oral mucosa particularly at the site of burning must
be noted. When erythema presents its precise relationship to adjacent natural teeth
or dentures, this must be noted. All dentures should be examined with regard to
material, plaque formation and design of impression occlusal or polished surfaces.

SPECIAL LABORATORY INVESTIGATIONS

Every patient should be advised for a complete blood, urine and stool
examination. Patients having xerostomia must have their blood glucose level
checked in order to prevent xerostomia from becoming worse. A smear should be
taken for cytological examination from dorsal surface of tongue for the presence of
candida infection. Whenever necessary, panoramic x-rays and biopsy should be
performed.
If inconclusive results are obtained after all efforts mentioned above, then a
psychiatric consultation should be considered. Whenever diagnosis is confirmed
then appropriate treatment should be given with necessary periodic follow up.

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REFERENCES

1. Grushka M, Sessle BJ. Burning mouth syndrome, a historical review. Clinical

Journal of Pain 1987; 2:245-252.
2. Schoenberg B, Carr AC, Kutscher AH., Zegarelli EN. Chronic idiopathic
orolingual pain: psychogenesis of burning mouth NY state J Med 1971; 71:
1932-7.
3. Glass BJ, Kuhel RF, Langlais RP. Treatment of common orofacial condition.
Dent clinic of N. America 1986; 30: 3, 443-445.
4. Shklar G, Mccarthy PL. The oral manifestations of systemic diseases. Ist Ed
PP 74-75 Boston and London, Butterworths, 1976.
5. Kaplan B and Barnes. Oral Lichen Planus and squamous cell carcinoma: case
report and update of the literature. Arch Otolaryngol. III (8): 543-547, 1985.
6. Fowler CB, Rees TD, Smith BR, Squamous cell carcinoma on the dorsum of
the tongue arinsin in a long standing lesion of erosive Lichen Planus. JADA
1987; 115: 707-709.
7. Binnie WJ, Cawson RA, Hill GB, Soaper AE. Oral Cancer in England and
Wales. A national study of morbidity, mortality, Curability and related
factors. Office of population censuses and surveys studies on medical and
population subjects. No. 23 London, HMSO, 1972.
8. Basker RM, Sturdee DW, Davenport JC. Patients with burning mouth. A
clinical investigation of causative factors including the climacteric and
diabetes. Br Dent J 1978; 145: 9-16.
9. Zegarelli DJ. Burning mouth. An analysis of 57 patient’s oral surg 1984; 58:
34-38.
10. Beal H. Glossopyrosis. Dent Cosmos 1922: 64: 474.
11. Qazi JA. Glossodynia associated with iron deficiency anemia; case report.
Pak Oral and Dental J 1989; 9: 2; 56-59.
12. Gallagher FJ, Baxter DL, Denobile J, Taybos GM. Glossodynia, iron
deficiency anemia and gastrointestinal malignancy report of a case. Oral
surg oral Med oral Path 1988; 65: 1, 130-133.
13. Engman MF. Buring tongue. Arch dermatol syphilol 1920; 6: 137-8.
14. Ewalt J. Somatic manifestations of depression. Hosp. Med 1966; 2:6.
15. Main DMG, Basker Rm. Patients complaining of burning mouth Br Dent J
1983; 154: 206-211.

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16. Browning S, Hislop S, Scully S, Shirlan P. The associated between burning

mouth syndrome and psychological disorders. Oral surg oral Med oral Path
1978; 64, 171-74.
17. Lamb AB, Lamey PJ, Reeve PE. Burning mouth syndrome psychological
disorders. Br Dent J 1988; 165: 256-260.
18. Zegarelli DJ, Schmidt ECZ. Oral fungal infection. Journal of Oral Med 1987;
42: 2, 76-79.
19. Harris M. Psychosomatic disorders of mouth and face. Practioner
1975:214:372-379.
20. Grushka M, Epstein JB, Gorsky M.Burning mouth syndrome. Am Fam
Physician. 2002 Feb 15; 65(4): 615-20. Review.
21. Muzyka BC, De Rossi SS. A review of burning mouth syndrome. Cutis. 1999
Jul; 64(1): 29-35. Review.
22. Savage NW, Boras VV, Barker K.Burning mouth syndrome: clinical
presentation, diagnosis and treatment. Australas J Dermatol. 2006 May;
47(2): 77-81
23. Kugu N, Akyuz G, Dogan O.Burning mouth syndrome and depression: a case
report] Turk Psikiyatri Derg. 2002 Autumn; 13(3): 232-7
24. Neville BW, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin.
2002 Jul-Aug; 52(4): 195-215
25. WHO. World health statistics Annual Geneva. WHO 1967.
26. Tyldesley Wr. Oral Medicine for Dental Practitioner. Brit Dent J 1974, 136:
111.
27. Lamey PJ AB. Prospective study of aetiological factors in burning mouth
syndrome. Brit Dent J 1988; 296: 1243-46
28. Chimenos-Kustner E, Marques-Soares MS.Burning mouth and saliva. Med
Oral. 2002 Jul-Oct; 7(4): 244-53. Review. English, Spanish.
29. Lamey PJ, Lewis MAO. Oral Medicine in practice: Orofacial allergic reactions.
Br Dent J 1990; 168: 59-63
30. Gruskha M., Clinical features of burning mouth syndrome. Oral Surg Oral
Med Oral Path 1987; 62: 30-6
31. Macleod J, Edwards C, Bouchier I. Davidson’s Principles and practice of
Medicine. 15th Ed PP 461-62 ELBS, 1987.
32. Taybos Gm and Terezhalmy GT. Glossodynia: Diagnosis and Treatment. US
Navy MED Sept-Oct 1983; 74: 18-19.

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33. Gilman AG, Goodman LS, Rall TW, Murad F. Goodman and Gilman’s The
Pharmacological Basis of Therapeutics, 7th Ed, PP 135, New York; Macmillan
Publishing Company, 1985.
34. Tyldesley Wr. Oral Medicine, the oral mucosa in generalized disease (2) 1st
ed. PP 133-34 Oxford E I B S, Oxford University Press, 1985.
35. Lamey PJ, Allam BF. Vitamin status of patients with burning mouth
syndrome and the response to replacement therapy. Br Dent J 1986; 160; 81.
36. Vander Pleog HM, vander waal N, Eijkman MAJ, vander waal I.
Psychological aspects of the patients with burning mouth syndrome. Oral
surg 1987; 63: 664-668.
37. Dworkin SF, Burgess JA. Orofacial pain of psychologenic origin. Current
concepts and classification. JADA 1987; 115: 565-571.
38. Kutscher AH, Schoenberg B, Carr AC. Death, grief and dental thanatology as
related to dentistry. JADA 1970; 81: 1373-7.
39. Forabosco A, Negro C. Burning mouth syndrome. Minerva Stomatol. 2003
Dec; 52(11-12): 507-21. Review.
40. Domb GH and Chole RA. The burning mouth and tongue. Ear nose throat J
1981; 60: 310-314
41. Kaaber S, Crames M, Jespen Fl. The role of cadmium as a skin sensitizing
agent n denture and non-denture wearers. Contact Dermatitis 1982, 8: 308-
313
42. Zakrzewska JM, Forssell H, Glenny AM. Interventions for the treatment of
burning mouth syndrome. Cochrane Database Syst Rev. 2005 Jan 25;(1):
CD002779. Review.
43. Hammaren M, Hugoson A. Clinical psychiatric assessment of patients with
burning mouth syndrome resisting oral treatment. Swed Dent J. 1989; 13(3):
77-88.
44. Grushka M. Clinical features of burning mouth syndrome. Oral surg Oral
Med Oral Path 1987; 63: 30-36.
45. Pinto A, Stoopler ET, DeRossi SS, Sollecito TP, Popovic R.Burning mouth
syndrome: a guide for the general practitioner. Gen Dent. 2003 Sep-Oct;
51(5): 458-61
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the dental team. : N Y State Dent J. 2002 Aug-Sep; 68(7): 44-54.

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COURSE EXAMINATION

Traditional Completion: To complete the examination, please circle the appropriate answer for
each question on the “Examination Answer Sheet” provided and return to ArcMesa customer service.

Online Completion: We suggest using this page to prepare for the online examination. If you have
purchased the program, and are ready to complete the online examination, select the “Take Exam” link
located directly across from the program title within your online ArcMesa “Member History” section.

1. Glossodynia has been reported worldwide and affects what percentage of the
general population?
a. 2.6%
b. 5%
c. 10%
d. 25%

2. One of the local causes of glossodynia is:

a. Diabetes
b. Drug reactions
c. Oral Cancer
d. Deficiency states

3. Glossodynia is classified into:

a. Two types
b. Four types
c. Five types
d. Six types

4. The glossodynia and oral symptoms of Sjogren’s syndrome are due to:
a. Bacterial Infection
b. Xerostomia
c. Thermal Injury
d. Salivary Gland enlargement

5. The treatment of diabetic Glossodynia is:

a. Steroid therapy
b. Analgesic drugs
c. Topical application of Betnovet Cream

v
d. Referral to physician for diabetic management

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6. The administration of cholinergic drugs such as atropine, propatheline and

glycopyrrolate effect on salivation is:
a. Increase in salivation
b. Profound decrease in viscosity/flow
c. Stops the salivation
d. Has no effect

7. “Beefy Red tongue” is a symptom of:

a. Iron deficiency anemia
b. Blood loss anemia
c. Pernicious anemia
d. Hereditary Spherocytosis

8. Migratory Glossitis is a benign condition:

True False

9. Oral Lichen Planus is present without lesions in:

a. 25% of cases
b. 65% of cases
c. 75% of cases
d. 100% of cases

10. The psychogenesis of the mouth was first recognized in:

a. 1920
b. 1930
c. 1950
d. 1975

11. Glossodynia may occur in an individual who has a fear of developing

cancer:
True False

12. Losing a tooth according to old age means “Losing an enemy”.

True False

13. Erosive Lichen Planus has symptoms of burning and pain.

True False

14. Candida albican does not exist in the oral cavity as a part of normal flora.

v
True False

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15. The relationship between burning and dry mouth has been recognized since:
a. 1930s
b. 1980s
c. 1990s
d. 2005

16. Common complaint in depression is:

a. Peculiar taste, stinging or burning sensation
b. Xerostomia, candidiasis and altered taste
c. Glossodynia, Xerostomia and excessive salivation
d. Halitosis, burning of mouth & caries

17. Anxiety is not an etiological factor of glossodynia.

True False

18. Glossodynia may be present in postmenopausal women as one of the

systemic causes.
True False

19. A deficiency of folic acid in a glossodynia patient’s diet causes greasy

dermatitis of the face.
True False

20. The primary cause of glossodynia in recent studies is denture defects.

True False

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 ARCMESA EDUCATORS
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Examination Answer Sheet
If completing the exam traditionally, please remove the Examination Answer Sheet and Evaluation page and
return to ArcMesa when completed.
Important Note: Please retain a copy or be sure to mark your answers on the examination page(s) for your own records.

GLOSSODYNIA (BURNING MOUTH SYNDROME)

Use a dark pen or pencil to circle the appropriate answer for each of the questions from the examination.
If you wish to FAX your answer sheet back to ArcMesa, it is best to use a dark pen.

1. (A) (B) (C) (D) 11. True False

2. (A) (B) (C) (D) 12. True False

3. (A) (B) (C) (D) 13. True False

4. (A) (B) (C) (D) 14. True False

5. (A) (B) (C) (D) 15. (A) (B) (C) (D)

6. (A) (B) (C) (D) 16. (A) (B) (C) (D)

7. (A) (B) (C) (D) 17. True False

8. True False 18. True False

9. (A) (B) (C) (D) 19. True False

10. (A) (B) (C) (D) 20. True False

Credit Card Information (For online users completing traditionally):

If you have not yet purchased this course, and would like to complete the course traditionally, Mail or Fax both
the Answer Sheet and Evaluation form with your credit card information to:
ArcMesa Educators, 615 Hope Road, Bldg 1, Eatontown, NJ 07724 or Fax to: 732-380-1104.
ONLINE USERS PLEASE NOTE: Your account will be charged an additional $5.00 processing and grading fee
for traditional completion, and a certificate of completion will be mailed upon receipt of a passing grade.
Method of Payment:
q VISA q Mastercard q American Express q Discover Total Payment: $ _______.____

Card Number: Expiration Date:

Signature: Date:

ArcMesa Educators • 615 Hope Road, Building One, Eatontown, NJ 07724 • Voice: 732-380-1101 Fax: 732-380-1104
 ARCMESA EDUCATORS
www.arcmesa.com

Examination Personal Information and Evaluation Form

Personal Data ( P L E A S E P R I N T C L E A R LY )
THIS Required information for proper certification and individual record retention.

SPACE First Name Last Name

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FOR
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Validation: I certify that I have studied the course materials and have
personally completed the course examination.

Please sign for proper CE/CME certification: ____________________________________________

Course Evaluation
COURSE TITLE: GLOSSODYNIA (BURNING MOUTH SYNDROME)
Please provide us with your candid evaluation so that we can continue to improve these
continuing education materials. We thank you for your comments and appreciate your suggestions
for future courses.
1. After participating in this course do you feel that Comments

A. the learning objectives were met? q Yes q No ____________________________

B. your knowledge has been enhanced? q Yes q No ____________________________

C. your skills have been improved? q Yes q No ____________________________

D. the course was effective in meeting identified needs? q Yes q No ____________________________

E. you are satisfied with the course content? q Yes q No ____________________________

F. the information gained applies to your profession? q Yes q No ____________________________

G. the information gained will assist in improving

your professional performance? q Yes q No ____________________________

2. Your overall rating of this course ("A" being the best): A B C D

3. Please estimate the number of hours spent to complete the course and examination. No. of hrs? ________

Please add any other comments about this course or your suggestions for future courses:
__________________________________________________________________________________________________________
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Mail or fax back to: ArcMesa Educators • 615 Hope Road, Building One, Eatontown, NJ 07724 • Fax: 732-380-1104