13.11 Burning mouth syndrome (BMS)

Identification: Female patient, 65 years old, with persistent oral burning for 8 months.

History of Present Illness: Symptoms: Location: Tongue (70% – tip and lateral borders) Lower lip (30%) Characteristics: Continuous burning (5-7/10 VAS) Worsens throughout the day (maximum at night) Temporary relief with cold foods Associated Symptoms: Subjective xerostomia (normal salivation on examination) Dysgeusia (metallic taste) No visible mucosal lesions

Relevant History: Postmenopausal for 12 years Anxiety controlled with SSRI (sertraline 50mg/day) No nutritional deficiencies or diabetes

Physical Examination: Oral Assessment: Intact mucosa, no erythema or ulcerations Tongue with preserved filiform papillae Normal oral Schirmer test (>15mm/5min) Sensory Assessment: Hyperesthesia to pinprick on tongue Normal taste threshold (tested with sucrose/citric acid) General Neurological Examination: No other sensory deficits

Complementary Exams: Hemogram and Biochemistry: Normal iron, ferritin, vitamin B12, folate, and HbA1c Allergen Test: Negative for metal sensitization (nickel, cobalt) Lingual Mucosa Biopsy: Reduction of intraepithelial nerve fibers (immunohistochemistry with PGP 9.5)