Use of data-driven criteria may improve the diagnosis of burning mouth syndrome (BMS) compared with existing frameworks, international researchers say.
The team assessed the performance of four existing classification systems with criteria for diagnosing BMS: the International Classification of Headache Disorders (ICHD-3), the International Classification of Diseases (ICD-11), the International Classification of orofacial pain (ICOP-1) and the World Congress of Oral Medicine (WCOM).
They found that none of the current diagnostic criteria accurately identified patients with BMS while excluding those with oral mucosal pain (OMP).
In particular, many clinically diagnosed BMS patients showed measurable sensory abnormalities, indicating that ICHD-3’s requirement for normal somatosensory function risks excluding true cases and could substantially reduce diagnostic accuracy.
In addition, ICD-11 criteria require the presence of significant emotional distress or functional impairment, but these constructs are not operationally defined and so their measurement depends on questionnaires and self-reported limitations, potentially reducing diagnostic sensitivity.
The team evaluated 76 patients referred for burning oral pain and two control groups, one with 31 patients with temporomandibular disorders and 30 participants who were pain free.
Among the burning oral pain cohort, 34 were diagnosed with BMS according to the reference standard, 37 were diagnosed with various OMP conditions, and five were diagnosed with neuropathic pain (NP).
Patients were given a clinical examination to assess oral mucosa colour and morphology, the presence of lesions, erosions or ulcerations, moisture level and tongue characteristics, as well as salivary glands and general dental status.
Based on the results of the study, the researchers developed optimised diagnostics criteria for BMS within the ICOP framework, which showed the highest sensitivity (94.1%) while maintaining acceptable specificity (78.6%).
When constructing the new criteria, the researchers allowed for a more flexible, data-driven framework that prioritised distinguishing BMS from other oral mucosal pain conditions.
Patients who would have been excluded under ICHD-3 and ICD-11 criteria, including those presenting with oral lesions or somatosensory abnormalities, were instead eligible for subclassification within the BMS spectrum, marking a shift towards a phenotype-based rather than exclusionary diagnostic approach.
The researchers also widened the descriptions of pain for BMS beyond burning pain alone to include discomfort and dysesthesia, to better capture clinically relevant symptom presentations.
In addition, the requirement for persistent symptoms (typically pain for at least six hours a day) improved discriminatory performance, the team noted.
“Current and commonly used diagnostic criteria show limited accuracy, generally achieving either acceptable sensitivity or acceptable specificity – but not both,” the researchers wrote.
“This study provides the first data-driven proposal for modified diagnostic criteria for BMS, offering a foundation for improving future versions of ICHD and ICOP.”
The study is published in Cephalalgia [link here].