Burning Mouth Syndrome: Topical Treatment Options

Background

Burning mouth syndrome is a chronic condition characterized by a burning or dysesthetic sensation of the oral mucosa in the absence of identifiable mucosal lesions. Management is largely pharmacologic and extrapolated from neuropathic pain treatment paradigms, given the working hypothesis that BMS involves a neuropathic mechanism (Patton et al., 2007; Zakrzewska and Buchanan, 2016).

Topical Clonazepam

Topical clonazepam, administered as a dissolving troche or oral rinse, has been evaluated in randomized controlled trials for BMS and is among the better-supported topical interventions in the reviewed literature (Patton et al., 2007; Zakrzewska and Buchanan, 2016). Reported use involves localized application to the oral mucosa rather than systemic absorption, which may account for a differing side-effect profile compared with oral benzodiazepine administration.

Capsaicin Cream

Capsaicin, applied topically, has been described as an option for BMS based on its action on transient receptor potential channels involved in nociceptive signaling. Per the current library sources, evidence for capsaicin in BMS consists of expert opinion and anecdotal or small case-level reports rather than double-blind RCT data (Patton et al., 2007; Zakrzewska and Buchanan, 2016).

Systemic Pregabalin

Pregabalin, administered orally at reported doses of 50–150 mg/day, is referenced as an expert-opinion-based option for BMS (Patton et al., 2007; Zakrzewska and Buchanan, 2016). The current library sources explicitly note that this use has not been evaluated in double-blind RCTs. This entry pertains to systemic (oral) administration only.

Topical Pregabalin: Evidence Gap

the research reviewed for this article contains no study evaluating topical pregabalin for BMS — no real-world cohort, controlled trial, or case series. This absence reflects the scope of the reviewed reference set (Patton et al., 2007; Zakrzewska and Buchanan, 2016) and should not be interpreted as a statement that topical pregabalin is unstudied in the broader published literature. Clinicians or researchers with access to a specific study on topical pregabalin in BMS should have that source reviewed directly and cited accordingly before any claims are incorporated into patient-facing or referral materials.

Clinical Considerations

Selection among topical and systemic agents for BMS should account for the relative strength of supporting evidence, patient-specific factors (comorbidities, concurrent medications, tolerance of local versus systemic exposure), and the absence of a single agent with robust, replicated RCT support across the full range of therapies discussed. Treatment decisions remain the responsibility of the evaluating clinician.

References

• Patton LL, Siegel MA, Benoliel R, De Laat A. Management of burning mouth syndrome: systematic review and management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007.
• Zakrzewska JM, Buchanan JAG. Burning mouth syndrome. BMJ Clin Evid. 2016.