Burning Mouth Syndrome — ORE Part 1 MCQ

Correct answer: B — Burning mouth syndrome

The answer is B: Burning mouth syndrome. This case exemplifies Type 1 primary BMS—a neuropathic pain disorder characterised by burning sensation of normal-appearing oral mucosa in the absence of identifiable organic cause. The temporal pattern (absent on waking, progressive during day) is pathognomonic for Type 1 BMS. The post-menopausal female with normal examination and normal investigations (excluding nutritional deficiency, candidiasis, and systemic disease) meets diagnostic criteria. Distractors fail because: B (glossopharyngeal neuralgia) and C (trigeminal neuralgia) present as sharp, lancinating pain with triggers (swallowing, touch), not continuous burning. D (candidal glossitis) requires visible mucosal lesions absent here. E (vitamin B12 deficiency) is excluded by normal blood tests. BMS diagnosis depends on clinical features and exclusion of secondary causes—precisely what the normal investigations accomplish.

Reference: University College London Hospitals NHS Foundation Trust. Burning Mouth Syndrome. https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/burning-mouth-syndrome; Bedfordshire Hospitals NHS Trust. Burning Mouth Syndrome. https://www.bedfordshirehospitals.nhs.uk/patient-information-leaflets/burning-mouth-syndrome/; Zakrzewska JM, et al. Burning mouth syndrome: a review of etiology, diagnosis, and management. Journal of Oral and Maxillofacial Surgery. 2019. https://pubmed.ncbi.nlm.nih.gov/30875303/