- Burning mouth syndrome (BMS) can leave patients in daily pain for years
- Cause is unknown, but it could be the way signals are sent to the brain
- Lasers could work by triggering natural painkillers in body and hormones
- Same lasers are used in treatment of musculoskeletal problems
Medical lasers used to treat joint pain are the latest weapon in the battle against a debilitating condition that causes patients to feel as if they have scalded their mouth.
The laser procedure is proving more effective than conventional medication used to treat the mystery condition known as burning mouth syndrome (BMS), according to new research.
Experts believe lasers may work by triggering the release of natural painkilling compounds in the body, and hormones.
The pain of BMS is commonly described by sufferers as burning, scalding or tingling.
The discomfort can be in the lips or tongue or more widespread in the mouth. Other symptoms include dry mouth, numbness or an altered sense of taste. Some find the symptoms increase with talking or when eating hot or spicy foods, and some switch to bland diets to avoid these triggers.
“BMS is a difficult condition to treat,” says Ms. Tara Renton, professor of oral surgery at King’s College London, which is providing the laser treatment for its patients for the first time.
Patients live with constant daily pain that can last years. The cause is not known, although there may be changes in the way the mouth sends warmth, cold and taste signals to the brain, resulting in neuropathic or nerve pain.
“There is no cure, and patients often exist on bland diets of milk and porridge to minimise their discomfort,” says Prof. Renton.
The condition is also difficult to diagnose because there are no special tests and the mouth looks normal. Investigations must be undertaken to exclude medical problems including Vitamin B and D and zinc deficiencies and neurological conditions.
Diagnostic difficulty is one reason why the estimates on the prevalence of the condition vary widely, but women are up to 20 times more likely to be diagnosed than men, especially around the time of menopause.
Low-dose antidepressants, anti-seizure medication and cognitive behavioural therapy are effective in some patients. However, in the new study, dental surgeons used low-level laser therapy and compared it to an anti-seizure drug.
The same medical-grade lasers, which emit a low-energy beam that does not cause significant heating of the tissues, are used in the treatment of musculoskeletal problems, including tendon damage and frozen shoulders.
The trial involved 33 patients, half of whom were given the drug, and the remainder treated with a hand-held laser. The beam of light was held 2mm from the painful areas in the mouth, and fired for ten seconds at each target. Each patient had ten treatment sessions over a five-week period.
After three weeks of treatment, pain scores in the laser group were almost half those of patients prescribed the tablet. Three months after the treatment, the laser patients were still reporting pain relief. None of those who had the laser therapy suffered side effects, compared to one in three who had the drug and complained of dizziness, fever, headache and lack of appetite.
Prof. Renton says: “It seems to work, but we are not sure of the mechanisms involved. Burning mouth syndrome was thought to be a psychological problem, but increasing evidence indicates it is likely to be more complex.
“We see changes in oral nerve fibres and differences between patients and healthy people and some research has also shown the tolerance of pain in BMS patients is significantly reduced.
“But the question remains as to whether this is due to changes within the peripheral or central nervous system. If laser therapy proves to be effective, it may give us clues as to the mechanism involved in BMS.” – Roger Dobson for The Mail