Burning mouth syndrome – An ayurvedic approach

Dear Editor, Burning mouth syndrome (BMS) is by burning sensation of the oral mucosa without having specific lesions in the oral cavity. Chronic oral burning pain is the chief complaint of BMS patients with or without altered taste sensation and dry mouth. The nature of the oral mucosal pain in BMS patients is like burning or scalding or annoying or tingling or tender or numb feeling, especially in the tongue, hard palate, and labial mucosa. BMS patients are usually frustrated and absence of pathological lesions in the oral cavity is mandatory for its diagnosis.[1] The chronic burning pain of BMS is often debilitating and has a negative impact on quality of life.[2] Irritability, depression, and decreased sociability are frequently seen in BMS patients. Fatigue, stress, and speech might increase the intraoral burning sensation in BMS patients.[3] The prevalence of BMS ranges from 0.7% to 4.6%.[4] The mean age of BMS is between 55 and 60 years and the ratio between females and males is around 3:1–16:1. Hence, far BMS remains a fascinating and poorly understood condition.[5] BMS is having multifactorial origin and its exact etiopathogenesis is often unknown. There is no definitive cure for BMS. Although there are plenty of treatment methods and medications available, none of them proves to be satisfactory in the management of BMS. BMS seems to have complex etiopathology.[1] Psychogenic, genetic, environmental factors, and dysregulated pain pathways (both central and peripheral) have been postulated in the pathogenesis of BMS. The diagnosis of BMS should be made after excluding all local and systemic causes.[2] BMS is classified into two categories, i.e., primary (idiopathic) and secondary (as a consequence of any local or systemic illness).[4] Laboratory investigations are usually unremarkable in BMS patients.[2] The management of BMS is challenging and its prognosis is poor. Complete remissions are observed in only 3% of the BMS patients within 5 years after the onset.[3] No single drug or procedure has been known to provide complete relief in BMS patients to date. A systematic and interdisciplinary approach is essential to manage BMS patients in a better way.[1] Attempts of treatment are often unsuccessful for BMS patients; hence, they do consult one physician after another. Some patients of BMS may become cancerophobic. To avoid unrealistic expectations, patients should be informed that there is no cure for BMS and its treatment is purely symptomatic.[2] BMS patients are usually depressed, anxious, and tired due to unsuccessful treatments and limited knowledge about their condition.[3] Patients suffering with various chronic and rare diseases may seek the help of Ayurveda (traditional Indian System of Medicine) for sustained and better relief. Diagnosis and management of BMS according to Ayurveda is still unknown and the scientific literature published on this topic is scarce. According to a case report, BMS occurs due to the imbalance of Pitta Dosha (a body humor responsible for digestion, metabolism and temperature) and Ayurvedic treatment proved beneficial.[6] Diseases are classified into two major categories in Ayurveda, i.e., Nija (endogenous) and Agantuja (exogenous); Endogenous or Agantuja diseases are again classified into two types, i.e., Samanyaja (caused by the vitiation of either two or three Doshas, i.e., Vata, Pitta, and Kapha) and Nanatmaja (diseases manifests independently due to the vitiation of any single Dosha).[7] Pittaja Nanatmaja Vikaras (PNVs) are the diseases occur exclusively due to the vitiation of Pitta Dosha (without the involvement or comorbidity of the other Doshas in the manifestation of disease). Although PNVs are said to be innumerable, 40 types of PNVs are listed in various Ayurvedic classical texts.[8]Daha is one among the 40 types of PNVs that indicates generalized burning sensation and it occurs due to the vitiation of Pitta Dosha alone.[9] “Dava” is an independent disease entity characterized by burning sensation (Daha) in oral cavity (Mukha), lips (Oshtha), and palate (Taalu). Dava is one among the 40 types of PNVs and it is first mentioned in an Ayurvedic classical text, “Ashtanga Samgraha.” Vitiation of Pitta Dosha is mandatory for the manifestation of Dava. Etiology, pathogenesis and treatment of Dava are similar to other PNVs.[10]Dava seems to be the most suitable diagnosis for BMS as both of them share similar clinical picture i.e., burning sensation in oral cavity (Mukha Daha), hard palate (Taalu Daha), and lips (Oshtha Daha). Medicines and procedures having the property to pacify Pitta Dosha such as Virechana (therapeutic purgation), Snehana (oil massage), Surabhi Gandha (aroma therapy), Shishira Salila Majjanam (cold water immersion), Geeta Shravanam (music therapy), Ghrita Paana (intake of plain or medicated ghee), Gandusha (holding liquid substances. i.e., herbal decoctions, oils, infusions, fresh juice of herbs, etc., in the mouth), Kavala (gargling with herbal decoctions or infusions or oils, etc.,), and Nasya Karma (nasal administration of oil, ghee, decoction, powder, etc.,) should be implemented in the management of BMS.[7] BMS should be diagnosed with “Dava” according to Ayurveda and the treatment should focus on to pacify Pitta Dosha. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.