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Burning Mouth Syndrome — ORE Part 1 MCQ

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ModerateOral MedicineBurning Mouth SyndromeORE Part 1

A 58-year-old post-menopausal woman reports a 6-month burning sensation affecting her tongue and anterior oral mucosa. There is no visible mucosal abnormality. Blood tests, oral swabs and an incisional biopsy have excluded haematinic deficiency, infection and mucosal disease. What is the most appropriate management?

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Correct answer: D — Explain the diagnosis, offer CBT and consider low-dose amitriptyline

This is primary burning mouth syndrome: persistent oral burning with a normal mucosa after relevant causes, including infection and deficiency, have been excluded. Management should validate the symptom, explain that serious oral disease has been excluded, and use symptom-directed chronic pain strategies. UK oral-medicine services describe benefit from psychological pain management, including CBT, and may use low-dose tricyclic antidepressants such as amitriptyline for neuropathic pain. Nystatin is inappropriate without candidiasis; corticosteroid mouthwash is for inflammatory mucosal disease, which is absent. Repeat biopsy is unnecessary after an adequate negative assessment without new red flags. Vitamin B12 should be replaced only when deficiency is demonstrated, not empirically at high dose.

Reference: University College London Hospitals NHS Foundation Trust. Burning mouth syndrome, updated 26 May 2026. https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/burning-mouth-syndrome