Characterized by burning and painful oral sensations in absence of clinically significant mucosal abnormalities, the
burning mouth syndrome is, despite numerous researches made, basically idiopathic and, consequently, difficult to treat effectively.
Therapy with
tricyclic antidepressants and
benzodiazepines has been proposed, although the exact pathomechanism is not clear. The objective of this study is to define the possible reasons for the efficacy of
benzodiazepines in the treatment of the
burning mouth syndrome. Starting from the report of eight cases successfully treated with
prazepam, the present authors examined the clinical features and the evidence from literature that support the possibility of a role of
neuroinflammation in the pathogenesis of the
burning mouth syndrome. Available data suggest that the nervous system could be crucial in the pathogenesis of the syndrome (altered perception of
pain, disturbance of neural transmission, increased excitability, negative involvement of trigeminal-vascular system), and the present authors' experience
lets them suppose a role for
neuroinflammation. This hypothesis could also explain the positive response to
benzodiazepines in some patients. The important role of
neuroinflammation in dermatologic and oral diseases has been only recently investigated and acknowledged. Further studies on the connection between
neuroinflammation and
burning mouth syndrome could open interesting perspectives in the understanding and management of this difficult clinical condition.