Evaluation of the efficacy of treatment modalities in burning mouth syndrome-A systematic review.

Objectives: Burning mouth syndrome (BMS) is a medical entity characterised by a spontaneous sensation of burning, numbness or pain of the oral mucosa in the absence of clinical symptoms. The goal of this systematic review was to assess the efficacy of various current treatments for BMS.

Methods: The literature search used the following inclusion criteria: randomised controlled trials (RCTs) which compared one or more treatment strategies for patients with primary/idiopathic BMS with a placebo group describing all types of interventions. The primary and secondary outcome measures included: relief of pain/burning sensations, changes in psychosocial factors and feeling of sensation of dryness. A computer and manual search was performed in Pubmed, Web of Science and Cochrane Library up to 5 November 2019 and updated on 28 June 2020. The risk of bias was measured with the Cochrane Collaboration tool.

Results: Thirty RCTs which included 727 study participants and 589 controls were identified. The following interventions were introduced: dietary supplements, anticonvulsants, benzodiazepines, antidepressants, analgesics, topical agents, electromagnetic radiation or induction, physical barriers and psychological therapies. The most successful therapeutic outcomes were observed for clonazepam tested in 3 RCTs, where significant pain reduction appeared after both topical and systemic application. Evident pain reduction was also reported for tongue protectors and capsaicin in 2 separate studies.

Discussion: Short follow-up periods, low numbers of participants, variability of the metrics used in the evaluation of the results and heterogeneous study design were the main limitations of the reviewed studies. Based on our analysis, clonazepam appears to be the most effective treatment option for BMS.