Diseases of nerves

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1. Burning mouth syndrome 2.  Bms is a painful,frustating condition often described as a scalding sensation in tongue,lip palate or throughout the mouth in absence of…
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  • 1. Burning mouth syndrome
  • 2.  Bms is a painful,frustating condition often described as a scalding sensation in tongue,lip palate or throughout the mouth in absence of any visible oral lesions.  Vandar waal described bms to refer only to idiopathic cases in which main symptom are located in oral mucosa with without involvement of any other body parts.  Strong female predilection is found with most of the female patient being menopausal and age of onset being approximately 50 yrs.
  • 3.  Affected pt often are present with multiple oral complications including burning, dryness and change in taste.  In many pt pain is absent during night but occurs to mild or moderate level by middle to late morning.  The burning may progressively increase throughout day, reaches its greatest intensity by late afternoon and into early evening.
  • 4.  Local causes; 1.Damage to nerves that control pain and taste. pain- taste- 2.Dry mouth(xerostomia) 3.Mucosal disorders(geographic tongue,lichen planus) 4.Trauma to oral mucosa(ill fitting dentures) 5.Repetitive oral habits(tongue thrusting)  Medical causes; 1.Vit b12,iron,folate deficiencies 2.medication(ace inhibitors such as captopril) 3.Psychogenic disorders( depression, anxiety) 4.Diabetes mellitus and menopause
  • 5.  Burning sensation may be felt either as a continuous or intermittent discomfort which most frequently affects the tongue and sometimes lips or palate. Onset of symptoms may be sudden or gradual over months and it has been suggested that psychomatic factors are associated with onset of bms. No oral lesions will be detected on examination. Unlike most other oral disorders bms does not interfere with sleeping. Patient may have associated anxiety or depression.  Other symptoms includes; 1.Tingling or numbness on tip of tongue or in mouth 2.Bitter or metallic change in taste 3.Dry or sore mouth
  • 6.  A rewiev of medical history, a thorough oral examination and a general examination may help identify the source of bm. Test may include; 1.Blood test to look for infection,nutritional deficiencies and disorders associated with bms such as diabetes or thyroid problem. 2.Oral swab to check for oral candiasis, allergy test for denture material, certain food or substances that may be the cause
  • 7.  Treatment should be tailored to indiviuals need. Depending on the cause of bms symptom,possible treatment may include; 1.Adjusting or replacing irritating dentures 2.Treating of existing disorders like dm or thyroid prblem 3.Recommending supplements for nutritional deficiencies 4.Treat oral candidiasis 5.Help control pain from nerve damage 6.Relieve anxiety and depression Medications; Use of antidepressants Vitamin and dietary supplements such as alpha lipoic acid analgesic spray or mouthwashes Hormonal replacements or topical estrogen for menopausal female patients
  • 8.  Oral herpes  Chronic ebstien barr viral infection  Pemphigoid  Pemphigus  Squamous cell carcinoma
  • 9. 1.Sip water frequently 2.Suck ice cubes 3.Chew sugarless gums 4.Brush teeth and dentuers with baking soda and water 5.Avoid alcohol and tobacco products.  These self care tips will ease the pain of bms
  • 10. Frey’s syndrome or gustatory sweating
  • 11.  The auriculo temporal syndrome is an unusual phenomena that arises as a result of damage to the auriculo temporal nerve and subsequently reinnervation of sweat glands by parasympathetic salivary fibers.  In this we see sweating on forehead, face, scalp, neck occurring soon after ingesting food.  Some sweating is common after eating hot spicy food but this condition arises as a result of damage to nerve .
  • 12.  The syndrome follows some surgical operations such as removal of parotid tumor or ramus of mandible, or a parotitis of some type that damaged the auriculo temporal nerve.  After a considerable amount of time following surgery, during which the damaged nerve regenerates, the parasympathetic salivary nerve supply develops, innervating sweat glands, which then functions after salivary, gustatory or psychic stimulations.
  • 13.  The patient typically exhibits flushing and sweating of involved side of the face, chiefly in temporal area during eating.  Moreover, this can happen even when the patient thinks or talk about certain foods that causes increased salivation.  Of further interest is the fact that profuse sweating may b evoked by parenteral administration of pilocarpine or eliminated by administration of atropine or by procaine block of the auriculo temporal nerve.
  • 14.  The syndrome is possible complication not only of parotitis, parotid abscess, parotid tumor and ramus resection, but also of mandibular resection of prognathism .  A review of affected patients indicates that all had had the history of the parotid gland excised.
  • 15.  Treatment of the auriculo temporal syndrome by intracranial division of auriculo temporal has been reported to be succesful.  Medication includes oxybutynin chloride, propantheline bromide and clonidine.  Recently some success has been reported using topical application of glycopyrrolate lotion that has to be applied to the skin of forehead and face , sparing the eye and mouth.
  • 16. Dr.S.K.RAJPUROHIT (B.D.S.) RAJASTHAN UNIVERSITY OF HEALTH SCIENE,JAIPUR
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