Use of soft intraoral appliance for refractory burning mouth syndrome: an exploratory case series

BACKGROUND: Burning mouth syndrome (BMS) is a chronic oral mucosal pain disorder that significantly impacts patients' quality of life. While pharmacologic treatment is primarily used for patients with BMS, outcomes are limited, and nonpharmacologic adjuvant treatments are necessary in refractory patients. This study aimed to assess the feasibility and potential effectiveness of soft intraoral appliances as an adjunctive therapy for patients with refractory BMS. METHODS: A retrospective chart review of nine female patients diagnosed with primary BMS, all of whom had persistent symptoms despite undergoing conventional pharmacologic treatment, was conducted. Five patients received soft intraoral appliances (appliance group), whereas four declined and continued pharmacologic therapy alone (non-appliance group). The oral symptoms were assessed using a 10-cm visual analog scale. Symptom severity was compared within and between groups over the observation period, and the treatment response was analyzed. RESULTS: The median observation periods were 4 months and 4.5 months in the appliance group and non-appliance group, respectively. Most of the appliance users reported initial discomfort that subsided after adaptation, and no severe adverse events were observed. One patient was able to reduce medication use. Compared with the non-appliance group, the appliance group showed changes in symptom scores, with a tendency toward improvement, particularly in relation to aching, stinging, and the effect of oral complaints on daily life. The response rates for these domains were significantly higher in the appliance group (p < 0.05). CONCLUSION: Soft intraoral appliances may present a feasible adjunctive therapeutic option for selected patients with refractory BMS, particularly those with a limited response to pharmacologic treatments. However, given the small sample size and exploratory design of this case series, these findings should be interpreted as preliminary observations and require confirmation in larger prospective studies.