Burning mouth syndrome — ORE Part 1 MCQ

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HardOral Medicine and Oral PathologyBurning mouth syndromeORE Part 1

A 61-year-old woman has bilateral burning of the anterior tongue for nine months. The mucosa appears normal, oral swabs are negative, and haematinics, glucose and thyroid tests are normal. Symptoms worsen during the day and improve while eating. What is the most likely diagnosis?

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Correct answer: C — Burning mouth syndrome

Burning mouth syndrome is the correct answer. The patient presents with classic diagnostic features: bilateral burning of anterior tongue with normal-appearing mucosa, exclusion of infection (negative swabs), nutritional deficiency, and metabolic disorder. The diurnal symptom pattern—worsening during the day and improving with eating—reflects the neuropathic basis of BMS and is not explained by erythematous candidosis (only 16–21% of BMS patients have candida; requires visible erythema and positive culture), herpes simplex (requires vesicles/ulcers; swabs negative), squamous cell carcinoma (presents with visible lesions), or ANUG (acute ulceration with necrosis). BMS diagnosis is one of exclusion based on a thorough history and examination showing normal mucosa.

Reference: Clinical Utility of Quantitative Parameters of Salivary Gland Scintigraphy for Diagnosing Burning Mouth Syndrome, 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9497528/; Burning mouth syndrome: a review on diagnosis and treatment, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316128/