Several years ago I was doing some research on manual therapy and skin dysfunction. In my literature searches I came across a couple of articles written by Shannon Campbell (now Trotter), an osteopathic physician with a specialty in dermatology. As I read one of her articles, one of the conditions described was Burning Mouth Syndrome (BMS). I had never heard of BMS before and it stuck with me.
Not even one month later, a massage therapist that I know asked me if I had ever heard of BMS or treated someone with it. She had a patient who had been suffering with this syndrome for a year or more. I acknowledged that I was aware of it, but had never treated anyone with the condition before. I offered her client a complimentary treatment to assess the possible benefit of manual therapy for the condition, and for her in particular.
Burning Mouth Syndrome is described as unremitting, burning pain in the mouth for greater than 4 – 6 months, often accompanied by xerostomia (dry mouth), and dysgeusia (altered taste). It is most often affects middle-aged women and is characterized as intractable, drastically affecting the quality of life of the individual. Its etiology is not understood, although neurological, hormonal, and psychological factors are listed as possible contributors. There are no definitive treatments or pharmacological options that consistently improve the condition. (See these articles for more information: http://www.ncbi.nlm.nih.gov/pubmed/22612823 and http://www.ncbi.nlm.nih.gov/pubmed/23645183.)
A manual medicine treatment is described in Shannon Campbell’s article and I called her up to ask about her experience with it. She explained that her professor of osteopathy had treated it on several occasions.
Here’s an excerpt from her article:
“Research in the last decade has suggested there is an underlying autonomic nerve disorder of the oral cavity in patients with BMS due to dysfunction of the sensory trigeminal nervous system. This evidence is supported by the presence of neuropathic symptoms, including pain, dysgeusia, and xerostomia. It has also been suggested that BMS results from a reduction in salivary output if the etiology of BMS were proven to be of trigeminal nerve origin, cranial osteopathic manipulation to normalize neural function might be beneficial.”
So, with nothing to lose but time, I proceeded to treat this patient as described in the literature. Now, if I had stopped at this time and considered that there are no double blind, randomized, clinical trials with over 100 subjects validating the treatment, then this patient may still have BMS. But, armed with hope, orthopedic manual therapy training and an understanding of neurophysiologic states, I proceeded.
Reasoning through her case, I realized that a heightened neurophysiological state in the trigeminal nerve could be contributed to by mechanical dysfunction in the upper cervical spine, suprahyoid area, and temporomandibular joints and muscles. I also followed the recommendation to perform a sphenopalantine ganglion release.
After an initial assessment and one treatment, her xerostomia (dry mouth) was significantly reduced. After four subsequent visits, she had significantly reduced pain, however, it was not fully alleviated.
At this point, I recommended traditional Chinese acupuncture to her, to hopefully further reduce the heightened neurophysiological state. Three acupuncture visits later, all of her symptoms were completely alleviated.
Interestingly, she continued with acupuncture once a month, but I did not hear from her until six months later. Her symptoms had returned. After three OMPT visits, all of her symptoms were completely alleviated again. She continued with one acupuncture and one OMPT treatment each month after that, which prevented further episodes.
Just remember, with new or novel cases, make no guarantees. But also don’t give up before you try. There are so many possibilities for benefits of OMPT in conditions that have not been researched yet…
Join us for one of our progressive fall manual therapy courses focused on clinical reasoning, including Cervical Spine, Upper Extremity, Lumbopelvic Spine, Manual Therapy and Pregnancy, Advanced Spinal Manipulation and more.
-Rebecca Lowe, PT, COMT, FAAOMPT
Rebecca began coursework in 1994 with the North American Institute of Orthopaedic Manual Therapy, was certified in 1999, and fellowship trained by 2006. She owns Manual Therapy of Nashville, is a NAIOMT CFI. She is very thankful for the framework that NAIOMT provided her right after graduating from PT school. Her advice, don’t just learn techniques, learn when to use them. And, look at the whole person. She recently published a book for her patients (and therapists) called Restoring Hope in Chronic Pain: A Whole Person Perspective from an Orthopedic Manual Physical Therapist.
One thought on “Burning Mouth Syndrome: A Case Study”
That’s just awesome! I mean who doesn’t do “sphenopalantine ganglion releases” consistently??!! Well done Rebecca!