Burning Mouth Syndrome: a Diagnostic Challenge

Abstract Objectives To characterize the diagnostic process that patients with burning mouth syndrome (BMS) undergo, and to identify the potential pitfalls encountered in the work-up and management of BMS. Study Design A retrospective chart review of BMS patients seen at the Oral Medicine clinic at Brigham and Women's Hospital was conducted from January 2014 to April 2017. Abstracted data focused on the period from onset of symptoms to the referral to the Oral Medicine clinic for definitive diagnosis, and included providers consulted, symptom characteristics, diagnostic tests performed, provisional diagnoses and treatments offered. Results 102 patients (86.3% female) were included, with a median age of 60 years. The median time from onset of symptoms to Oral Medicine referral was 12 months (range: 4-370). Patients saw a median of three providers (range: 1-7); 30.4% had undergone a diagnostic test, 63.7% had been given a provisional diagnosis, and 78.4% had received treatment. Candidiasis was the most common misdiagnosis (25.5%), and antifungal medication was the most frequently prescribed therapy (27.5%). Conclusions Patients with BMS experience delay in diagnosis and management despite seeking and receiving professional care. Many undergo unnecessary tests and tend to be misdiagnosed or receive no diagnosis at all. Even those correctly diagnosed with BMS often receive inappropriate or ineffective treatment.