It often may be difficult to identify local or systemic factors that may mimic BMS.17 Patients often complain of oral burning with various stomatological disorders such as Oral Lichen Planus (OLP), mucous membrane pemphigoid, traumatic ulcers, recurrent aphthous stomatitis, oral herpes simplex infection, candidosis, benign or malignant neoplasms, ill-fitting dentures, orthodontic appliances, contact allergic reactions to dental restorative materials, partial and complete denture materials, dental hygiene products (toothpastes, mouthrinses, gels, etc.), allergy to foods, wines, sweets, mints, chewing gum, traumatogenic oral parafunctional habits and many others. Other less common oral neurological conditions such as persistent idiopathic facial pain, atypical odontalgia, idiopathic facial arthromyalgias or traumatic intraoral nerve injuries may require consultation with a neurologist.17 Xerostomia is a very common complaint in individuals with BMS. It is difficult to determine whether the dryness is a contributing etiologic factor or a secondary BMS factor possibly associated with psychological factors such as stress, anxiety or depression initiated by prolonged chronic disease.49-52 In a recent study by Acharya, et al. the researchers reported a strong association with BMS, skin diseases and xerostomia. The BMS group of patients had more allergies and complained of dry mouth issues.64 Additionally, medications often used to treat BMS are usually among those drugs reported to cause xerostomia as an adverse side effect. Xerostomia is also a common adverse side effect of various medications often used by older individuals for control of systemic diseases or disorders. Clinical experiences indicate dry mouth may significantly influence the subtle tongue discomfort often associated with BMS in patients who develop tongue thrust habits. It is certainly possible that xerostomia may partially explain the common BMS complaint of altered taste sensation such as a bitter or metallic taste. Taste alteration was also discussed in recent data from Jääskeläinen. The author distinguishes between Central Nervous System BMS and Peripheral BMS. The Peripheral type may respond positively to lidocaine blocks and topical clonazepam and capsaicin.65
An investigation of the possible local causes of intraoral burning sensations should be conducted and every effort made to eliminate potential contributing factors prior to defining the patient’s complaint as BMS.