JADA 145(1) http://jada.ada.org January 2014 19

COMMENTARIES

would develop in the late morning, gradually increase in severity during the day and reach peak intensity by evening. But in patients with OSMF alone, the burning sensation occurs only aft er eating something and is not continuous in nature.

All three patients gave a history of altered taste sensation, which again is one of the characteristic features of BMS. Subjective dryness of the mouth is a feature of BMS, but not all BMS patients have a history of dry mouth. Th us, these fi ndings are not very helpful in diagnosing BMS or OSMF.

Hence, in such cases, the only reliable factor is taking a detailed case history. Although careful history taking will help in suspecting BMS in OSMF, it can become diffi cult when BMS is mild and intermittent in na-ture, such as a Lamey and Lamb4 type 3 classifi cation. With this experience in mind, the other two cases were diagnosed at the fi rst visit.

According to our observation, OSMF patients rarely disclose the history of psychological stress as a reason for starting a betel quid-chewing habit. Since one of the major etiological factors for BMS is psychological stress, the existence of these two lesions together is justifi ed. However, none of the three patients mentioned a history of any psycho-logical stress.

A similar situation of complicated BMS can happen with candidal infection, xerostomia, oral galva-nism, parafunctional habits such as tongue thrusting, psychological and neurological disturbances, diabetes mellitus, menopause, side eff ects of drug therapy, vitamin B12 defi ciency, iron defi ciency and paraneoplastic syndromes, all of which are known to cause oral burning.1

To conclude, we recommend proper detailed history taking in such patients to avoid underdiagnosis.

Dr. Sachin C. Sarode, BDS, MDSProfessor

Dr. Gargi S. Sarode, BDS, MDSAssociate Professor

Department of Oral Pathology and Microbiology

Dr. D. Y. Patil Dental College and Hospital

Pune, MaharashtraIndia

1. Balasubramaniam R, Klasser GD, Delcanho R. Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma. Aust Dent J 2009;54(4):293-299.

2. Sarode SC, Sarode GS, Karmarkar S, Tupkari JV. A new classification for potentially malignant disorders of the oral cavity (published online ahead of print June 28, 2011). Oral Oncol 2011;47(9):920-921. doi:10.1016/ju.oraloncology.2011.06.005.

3. Sarode SC, Sarode GS. Burning sensation in oral submucous fibrosis and its possible association with mucin secreted by affected minor salivary glands (published online ahead of print Jan. 28, 2013). Oral Oncol 2013;49(4):e16-e17. doi:10.1016/j.oraloncology.2013.01.004.

4. Lamey PJ, Lamb AB. Prospective study of aetio-logical factors in burning mouth syndrome. Br Med J (Clin Res Ed) 1988;296(6631):1243-1246.

Authors’ response: We appreci-ate the interest that Drs. Sachin C. Sarode and Gargi S. Sarode have shown with their response to our article. We agree with their classifi -cation and criteria for distinguish-ing between primary/idiopathic/essential burning mouth syndrome (BMS), in which there is a lack of evidence of any other disease, and secondary/complicated BMS, in which an oral burning sensation is identifi ed secondary to other clinical abnormalities or systemic condi-tions. Th is is the defi nition identifi ed by the survey of program directors in our article.

We are thankful that they have shared three interesting case reports of patients with oral submucous fi brosis concomitantly experiencing BMS. Once again, their case reports highlight the necessity to diff erenti-ate BMS from oral burning sensa-tions.1 We also share their concern with the need for all health care practitioners to take a detailed his-tory and perform a comprehensive examination prior to establishing a defi nitive diagnosis and, ultimately, designing a patient-specifi c treat-ment plan. By so doing, practitioners may avoid providing an incomplete

or incorrect diagnosis accompanied by a well-intentioned treatment plan that is, unfortunately, inappropriate or misdirected.2

It would be very helpful for the practitioners who treat BMS and to the patients with this enigmatic condition if there was a standardized process developed for the diagnosis and treatment of this condition. Our article hopefully will provide baseline data from a group of expe-rienced clinicians in the fi elds of oral medicine and orofacial pain to ignite this process on both a national and international level.

Gary D. Klasser, DMD, Cert. Orofacial Pain

Associate ProfessorDivision of Diagnostic Sciences

School of DentistryLouisiana State University

Health Sciences CenterNew Orleans

Andres Pinto, DMD, MPH, FDS RCS(Edin)

Associate ProfessorUniversity Hospitals Case Medical

Center and Department of Oral

and Maxillofacial Medicine and Diagnostic Sciences

School of Dental MedicineCase Western Reserve University

Cleveland

Joel Epstein, DMD, MSD, Dip ABOM, FRCD(C),

FDS RCS(Edin)Director

Oral Medicine and Adjunct Professor

Division of Otolaryngology and Head and Neck Surgery

City of HopeDuarte, Calif.

1. Balasubramaniam R, Klasser GD, Delcanho R. Separating oral burning from burning mouth syn-drome: unravelling a diagnostic enigma. Aust Dent J 2009;54(4):293-299.

2. Klasser GD, Epstein JB, Villines D, Utsman R. Burning mouth syndrome: a challenge for dental practitioners and patients. Gen Dent 2011;59(3):210-220.

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