Burning Mouth Syndrome Management

Introduction to BMS Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends that systemic corticosteroids should not be used for burning mouth syndrome (BMS), as there is no evidence supporting their efficacy for this condition, and they carry substantial risks—particularly in older adults with pre-existing risk factors for osteoporosis, diabetes, and hypertension 1

Systemic corticosteroids cause sodium retention and can precipitate or worsen hypertension and heart failure, and induce insulin resistance, increasing risk of diabetes onset and progression, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
The use of systemic corticosteroids increases the risk of cardiovascular disease, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1
Fracture risk increases within 3 months of starting corticosteroids, with greatest bone loss occurring early in treatment, as reported in the journal Gut 3
Systemic corticosteroids are associated with mood disorders, insomnia, psychosis, increased infection risk, peptic ulcers, cataracts, myopathy, and adrenal suppression with prolonged use, according to the American Academy of Otolaryngology-Head and Neck Surgery 1

If systemic corticosteroids are considered necessary for a different oral condition in an elderly patient, precautions should include calcium and vitamin D supplementation, bisphosphonate therapy, proton pump inhibitor for gastrointestinal protection, and pneumocystis jirovecii prophylaxis, as recommended by Praxis Medical Insights 2, 3, 4