Burning Mouth Syndrome Case Studies

RULE-OUT OTHER NEUROPATHIC AND IDIOPATHIC CAUSES OF FACIAL PAIN Clinicians involved in the orofacial pain field should not encounter particular difficulties to make a differential diagnoses between PDAP and other neuropathic facial pain conditions, simply relying on the clinical history. Burning mouth syndrome has a characteristic clinical presentation that is easy to differentiate with PDAP (36). Persistent idiopathic facial pain (PIFP) is still an “ill-defined” entity and there is not enough data to consider or not PDAP as a localized form of this condition. The differential diagnosis relies on topographic features as PIFP manifests with poorly localized, diffuse pain on the face, while PDAP is characterized by intra-oral well-localized pain in the dento-alveolar region (17). Trigeminal neuralgia (TN) has a
However, some cases of PDAP may share some features with TN. If PDAP pain is constant without exacerbation, trigeminal neuralgia diagnosis is automatically excluded. In PDAP cases characterized by constant pain with exacerbations, the clinician may be in doubt with a trigeminal neuralgia type II diagnosis (Burchiel classification) (60). Durham et al., from qualitative data derived from PDAP patients interviews (case-series, level of evidence 4), suggest that the clinician should not rely on pain descriptors, as PDAP pain exacerbations may be described as stabbing or electric-like by some patients. Authors highlights two key differences between PDAP and TN that can be helpful in such cases. First, TN attacks usually follow an anatomical line that correspond to the direction of a trigeminal nerve branch, while PDAP pain exacerbations tend to be localized in one spot. Second, TN attacks duration are usually much shorter in duration