A systematic review of randomized trials for the treatment of burning mouth syndrome.
Burning mouth syndrome (BMS) is characterized by burning of the oral mucosa in the absence of underlying dental or medical causes. The results of previous systematic reviews have generally been equivocal. However, findings for most interventions are based on searches of 5-10years ago. This study therefore updates previous searches of randomized controlled trials (RCTs) for pain as assessed by Visual Analogue Scales (VAS). Secondary outcomes included quality of life, mood, taste and salivary flow.



A search of MEDLINE and Embase up to 2016.



24 RCTs were identified. Meta-analyses were impossible because of wide variations in study method and quality. The commonest interventions were alpha-lipoic acid (ALA) (8 comparisons), capsaicin or an analogue (4 comparisons), clonazepam (3 comparisons) and psychotherapy (2 comparisons). ALA and capsaicin led to significantly greater improvements in VAS (4 studies each), as did clonazepam (all 3 studies), at up to two month follow-up. However, capsaicin led to prominent dyspepsia. Psychotherapy significantly improved outcomes in one study at two and 12month follow-up. Catauma and tongue-protectors also showed promise (one study each). There were no significant differences in any of the secondary outcomes except in the one study of tongue protectors.



At least in some studies and for some outcomes, ALA, clonazepam, capsaicin and psychotherapy may show modest benefit in the first two months. However, these conclusions are limited by generally short follow-up periods, high study variability and low participant numbers. Further RCTs with follow-up of at least 12months are indicated.
School of Medicine, The University of Queensland, Woolloongabba, Australia; Griffith Health Institute, Gold Coast, Queensland, Australia; Department of Psychiatry, Dalhousie University, Halifax, Canada; Department Community Health and Epidemiology, Dalhousie University, Halifax, Canada. Electronic address: s.kisely@uq.edu.au.
Steve
S
Kisely
School of Medicine, The University of Queensland, Woolloongabba, Australia; Department of Psychiatry, Royal Melbourne Hospital, 300 Grattan St, Parkville, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Malcolm
M
Forbes
School of Medicine, James Cook University, Queensland, Australia.
Emily
E
Sawyer
Rural Clinical School, The University of Queensland, Toowoomba, Australia.
Emma
E
Black
School of Dentistry, The University of Queensland, Herston, Queensland, Australia.
Ratilal
R
Lalloo
D002054:Burning Mouth Syndrome / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D002211:Capsaicin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D059408:Pain Management / Q000379:methods / Q000523:psychology; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods / Q000523:psychology; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D008063:Thioctic Acid / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D008063:Thioctic Acid; D002211:Capsaicin
Burning mouth syndrome; Medically unexplained symptoms; Randomized controlled trials; Somatic symptom disorder; Stomatodynia; Therapy