Use of Low-Dose Aripiprazole for Duloxetine-Resistant Burning Mouth Syndrome

Burning mouth syndrome (BMS) is defined as a chronic, idiopathic, burning discomfort or pain in the context of clinically normal mucosa. BMS generally involves the oral mucosa, primarily the tongue, lips, hard palate, alveolar ridges, mouth floor, and cheeks. A burning sensation is the defining characteristic, but this may be accompanied by paraesthesia, xerostomia, and altered taste or smell.1 Prevalence studies show inconsistent results in the general population, ranging between 1% and 40%.2 Women who are post- or perimenopausal have the highest risk for BMS.3 The illness is usually diagnosed by dentists and general practitioners based on history and exclusion of other possible diseases. Patients diagnosed with BMS tend to have more anxiety and depressive symptoms or major depression. Social phobia, specific phobia, panic disorder, as well as neurotic, fearful, and obsessive-compulsive personality disorders have been associated with BMS.4 Despite the evidence of the relationship between BMS and psychiatric disorders, previous studies have not shown strong causality among them.5 One common underlying biological characteristic is low levels of dopamine neurotransmitter in the nigro-striatal pathway, which could be deemed as a potential common risk factor among patients with BMS and other psychiatric disorders, including several personality disorders.3,4 Antidepressants, analgesics, antiepileptics, antifungals, antibacterials, sialagogues, antihistamines, anxiolytics, and antipsychotics, as well as vitamin, mineral, and hormonal replacements have been shown to have beneficial effects in the treatment of patients with BMS.6 This article presents the case of a patient with primary BMS case who had a response after a low dose of aripiprazole was added to current treatment with duloxetine.