Pharmacoresistant burning mouth syndrome: clinical patterns and treatment efficacy

Abstract

Introduction. Burning mouth syndrome is a form of idiopathic orofacial pain, characterized by a persistent intraoral burning sensation or dysesthesia, in the absence of obvious causative lesions. The management of this condition remains difficult, due to the heterogeneity of the mechanisms involved, the variable therapeutic response and the significant impact on the quality of life. Aim: To describe the clinical and therapeutic profile of patients with burning mouth syndrome with poor pharmacological response (pharmacoresistance). Materials and methods: The study had an observational, descriptive, case series design, and included 20 patients with burning mouth syndrome. The duration of treatment, drug classes used, reported adverse reactions, percentage of pain reduction under pharmacotherapy, VAS scores and OHIP-14 score were analyzed. Absolute and relative frequencies were calculated for categorical variables, and mean and standard deviation, median, interquartile range, and minimum and maximum values were reported for numerical variables. Results. The group presented multiple drug class use, with benzodiazepines being administered to 95% of patients, antidepressants to 85%, and topical treatments to 70%. Treatment duration was 56.4 ± 13.8 months, with a median of 59 months. Pain reduction under pharmacotherapy was modest, with a mean of 25.8 ± 4.4%, and residual pain intensity remained high, with a mean VAS score of 5.92 ± 0.37. For OHIP-14, available in 19 patients, the mean score was 28.8 ± 5.2. Tinnitus and vertigo were among the most frequently reported adverse reactions. Conclusions. The patients included in the study presented a profile characterized by long-term treatment, polypharmacotherapy, modest pain relief, persistence of pain symptoms, and significant impairment of oral quality of life. This picture reflects a limited therapeutic response and supports the need for a multimodal, individualized approach, with the integration of functional assessment and therapeutic tolerability.