VALENCIA, SPAIN – Sucking on a clonazepam tablet for 3 minutes after every meal effectively reduced pain, paresthesia, dry mouth, and altered sense of taste in patients with burning mouth syndrome in a retrospective study.
Seventy-two patients who met International Headache Society criteria for burning mouth syndrome were instructed to place a 1-mg tablet of clonazepam in their mouths after each meal and suck on it for 3 minutes, holding their saliva in the painful areas of the mouth all the while without swallowing. After the 3 minutes were up, the dregs of the tablet and the saliva were to be spit out, Dr. Maialen Mendizabal reported at the International Headache Congress.
Controlled trials previously have shown orally ingested clonazepam to be effective in patients with burning mouth syndrome. Sucked clonazepam provides the advantages of a topical therapy, added Dr. Mendizabal of the University of the Basque Country, Bilbao, Spain.
Pain was assessed via the validated Brief Pain Inventory at baseline, 2 months, and 6 months, as were the sensory disturbances and other symptoms that are often featured prominently in patients with burning mouth syndrome.
At 2 months, 31% of patients reported a greater than 50% reduction from baseline in pain scores, and an additional 10% had a 30%-50% reduction in pain. At 6 months, 39% of patients reported a greater than 50% reduction in pain, and 8% had a 30%-50% decrease.
Fifteen patients (20%) were completely asymptomatic at 6 months. An additional three patients were pain free but continued to experience dry mouth or other symptoms associated with burning mouth syndrome, she reported at the meeting sponsored by the International Headache Society and the American Headache Society.
Dry mouth and altered taste showed a particularly favorable response to topical clonazepam. Two-thirds of subjects had an altered sense of taste at baseline, one-third after 2 months of clonazepam sucking, and none at 6 months. Likewise, two-thirds of patients reported dry mouth at baseline, 47% at 2 months, and just 13% at 6 months.
Although this retrospective, uncontrolled study certainly can’t be considered the final word, the results are sufficiently encouraging to warrant a randomized trial, Dr. Mendizabal said.
The International Headache Society diagnostic criteria for burning mouth syndrome require the presence of pain in the mouth on a daily basis and persisting for most of the day, normal appearing oral mucosa, and exclusion of other local and systemic diseases.
Burning mouth syndrome is mainly a disorder of postmenopausal women. In this study, the mean age of the population was 63 years, and 82% were female.
Dr. Mendizabal reported having no financial conflicts regarding this study, which was conducted free of commercial support.