175 Burning Mouth Syndrome Equivalent to Restless Leg Syndrome

Abstract

Study Objective: Stuginski-Barbosa reported apatient with Burning Mouth Syndrome (BMS), whosesymptoms were transiently improved with tongue movement, postulated to be an oral equivalent of restless legsyndrome (RLS) (Stuginski-Barbosa, 2008).METHODS: Four Case Studies are described.RESULTS: Case 1: A 35 year old pathological left handedwoman presented with one-year history of burning andstinging sensations on the sides of the tongue and lipswithout any known precipitant. It is reduced with chewinggum and eating. For the last few months she noticed tonguemovement reduced the burning sensation. Two to threeseconds of tongue movement alleviated the burning from3/10 to 0/10 in intensity, which persists for one minuteafter cessation of tongue movement.Case 2: A 57 year old right handed female, three yearsprior to presentation, had multiple teeth extractions.Four months later, she perceived a rough sensation of hertongue, which has gradually changed to a burningsensation which has persisted since then. The burningis 10/10 in severity and constant. Chewing 24 pieces ofgum a day reduces the pain. Movement of the tongueincluding anterior-posterior protrusion and retraction,side to side movements without contacting surroundingoral mucosa, converted pain from 9/10 to 5/10, whichlasted approximately 1 minute.Case 3: Eight years prior to presentation, this 60 year oldwoman developed BMS, after dental extraction. The paininvolves the tongue (right and center of palate) accompanied by a gritty sandpaper-like sensation. The burningis a level 5/10 in intensity and progressively worsensthroughout the day. Burning mouth pain is made lessintense with chewing gum and using dental wax. Baselineburning mouth severity is at level 5/10 however, withprotrusion, retraction, and side-to-side movement of thetongue, the intensity dropped to 3/10.Case 4: Three years prior to presentation, a 59 year oldfemale patient suffered severe allergies with onset ofburning mouth and absent taste. The burning is in themiddle of her tongue, rarely, her palate, but never on herlips. Severity is 2/10 and is worse in the morning, withdrinking red wine, and hot drinks. It is better with colddrinks and ice cream. Movement of her tongue side-to-sideeliminates the burning severity from 2/10 to 0/10, lastingone minute.CONCLUSION: Like the patients described by Stuginski &Barbosa 2008, these four patients showed reduced painin response to tongue kinesia (Stuginski-Barbosa, 2008).Their mandibulation of gum as an analgesic maneuvermay have been due, not to the taste of the gum, butrather to the associated tongue movement that mastication induces. Through moving, large nerve fibers ofproprioception are stimulated, which may act throughthe Gate Controlled Theory of Pain of Melzac and Wall,to reduce unrestricted small nerve fiber discharge, thusinhibiting pain. Query regarding movement or gumchewing inhibition of BMS is warranted.