Burning Mouth Syndrome — ORE Part 1 MCQ

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HardOral MedicineBurning Mouth SyndromeORE Part 1

A 55-year-old woman presents with persistent oral dysaesthesia affecting the tip of her tongue and lower lip. She has a history of anxiety and depression. All clinical examination and investigations are normal. Vitamin B12 and folate are normal. MRI brain is normal. What is the most likely diagnosis?

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Correct answer: B — Burning mouth syndrome

Burning mouth syndrome (BMS) is the most likely diagnosis. BMS is a chronic neuropathic orofacial pain condition characterised by intraoral dysaesthesia, altered taste, and burning sensation occurring daily for >2 hours daily over >3 months, without identifiable causative lesions and with normal clinical examination and investigations. This case meets diagnostic criteria: dysaesthesia and taste disturbance, normal intraoral examination, normal blood tests (ruling out nutritional deficiencies), and age/sex profile consistent with BMS epidemiology. Psychosocial comorbidities (anxiety, depression) frequently coexist with BMS. Trigeminal neuropathy would show objective sensory deficits on formal examination; MS would be excluded by normal MRI brain; vitamin deficiency is ruled out by normal B12 and folate; SCC would present with visible mucosal changes and is not associated with BMS. The diagnosis is fundamentally one of exclusion followed by recognition of the characteristic symptom complex.

Reference: Bedfordshire Hospitals NHS Trust. Burning Mouth Syndrome patient information, https://www.bedfordshirehospitals.nhs.uk/patient-information-leaflets/burning-mouth-syndrome/ (2024); ICOP 2020 diagnostic criteria in Adamo D et al. Burning Mouth Syndrome: An Overview. Int J Environ Res Public Health. 2022;20(1):682.