Oral cenesthopathy superimposed on burning mouth syndrome treated with aripiprazole: A case report with a phenomenological overview.

Background: Burning mouth syndrome (BMS) is an idiopathic condition that presents with chronic pain and/or burning sensations in the oral structures. The syndrome mostly affects elderly women with hormonal changes and/or with a diagnosis of comorbid psychiatric disorder. In some rare conditions, the clinical appearance of BMS may also overlap with oral cenestopathy (OC), which is defined in the literature as a special form of delusional disorder of somatic type. Patients with OC may complain about abnormal experiences such as melting, feeling of stickiness, as well as extremely strange feelings of wires, metal coils, etc being present in their mouths.

Case Presentation: We present an elderly woman whose ongoing symptoms of BMS (burning in the mouth and tongue, taste alterations etc) were, over time, superimposed by cenesthopatic delusions that her gums had melted, and her palate had totally dissolved. We believe that the case is clinically striking and demonstrative for the understanding of complex nosology of BMS and OC, given that (a) the patient exhibited a relatively rare example of overlapping BMS and OS symptoms, which both are not sufficiently recognised by clinicians, (b) OC symptoms have disappeared with low-dose aripiprazole and psychoeducation-based cognitive therapy, which resulted in significant improvement in the patient's quality of life.

Conclusion: Clinicians are required to be aware of BMS and OC, two syndromes with multifactorial aetiology and highly heterogeneous presentation, in order to determine the most appropriate treatment options from a multidisciplinary perspective, as well as to avoid unnecessary medical interventions.