Burning Mouth Syndrome is a syndrome often characterized by a burning feeling in the tongue or other oral locations. Many times, there are no clinical or lab findings to substantiate the pain, but nonetheless, it can cause many unpleasant to severe effects, including burning, dryness and changes in ability to taste.  Its  cause has been associated with many disorders, including chronic anxiety or depression, nutritional deficiencies, type 2 diabetes and changes in salivary function, though never directly linked with them; and direct treatment does not appear to affect the burning mouth syndrome at all. This leaves us wondering, how DO we treat the burning mouth pain that has not been touched by treatment of other disorders?

Recent studies conducted by Miriam Grushka, an associate professor of oral diagnosis at the CWRU School of Dentistry indicate that clonazepam offers signifigant amounts of relief for people suffering from burning oral pain. 43 percent of the patients reported partial to complete relief and were still using the medication. From the 30 participants in the study, Twenty-seven percent found the drug helpful but quit using it due to side effects, usually drowsiness. For the remaining 30 percent, the clonazepam offered no relief.  All in all, 70% of the participants reported pain relief from the clonazepam.

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An open-label, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome.
Grushka M, Epstein J, Mott A.
School of Dentistry, Case Western Reserve University.

OBJECTIVE: Current treatment for burning mouth syndrome is usually directed at correction of detected organic causes or is empiric, and it often involves the use of tricyclic antidepressants. Recently, there has been renewed interest in the use of benzodiazepines for burning mouth syndrome. The present study was designed to assess the effect of clonazepam in burning mouth syndrome. STUDY DESIGN: Thirty patients, each with a chief complaint of mouth burning without oral mucosal lesions, were entered into the study. All patients underwent routine blood screens. Identified abnormalities were corrected, when possible, before clonazepam was prescribed. The starting dose was 0.25 mg daily, with an increase in dose of 0.25 mg on a weekly basis if symptoms continued. RESULTS: The subject population consisted of 29 women and 1 man. All subjects had been symptomatic (average premorbid burning intensity, 7.0 +/- 1.9 on 10-point scale) for 1 month to 12 years (mean, 3.9 +/- 3.4 years; median, 2.75 years), and 16% had had burning for more than 2 years. Three groups of patients were identified: those who experienced partial to complete relief with clonazepam and who were using the medication at the last follow-up (group 1; 43%); those who found the clonazepam helpful but withdrew from the medication because of side effects--usually drowsiness (group 2; 27%); and those who did not benefit from clonazepam (group 3; 30%). Among the 3 groups, age was found to be significantly lower for group 1 than for group 2 but not significantly lower for group 1 than for group 3. Although the difference did not reach significance, the mean dose of clonazepam appeared lower for group 1 patients than for the other 2 patient groups. The number of patients with burning for less than 2 years was larger in group 1 than in the other groups. CONCLUSIONS: The results suggest that clonazepam may be helpful in burning mouth syndrome, inasmuch as 70% of patients (groups 1 and 2) experienced pain reduction with effects at low doses. These findings suggest that the mechanism of action of clonazepam may be specific and separate from the anxiolytic effect of the benzodiazepines and that clonazepam may represent a useful therapy in a subset of patients with burning mouth syndrome.

Source:  PMID: 9830647 [PubMed - indexed for MEDLINE]; Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Nov;86(5):557-61