OBJECTIVE: Current treatment for burning mouth syndrome is usually directed at 
correction of detected organic causes or is empiric, and it often involves the 
use of tricyclic antidepressants. Recently, there has been renewed interest in 
the use of benzodiazepines for burning mouth syndrome. The present study was 
designed to assess the effect of clonazepam in burning mouth syndrome.
STUDY DESIGN: Thirty patients, each with a chief complaint of mouth burning 
without oral mucosal lesions, were entered into the study. All patients 
underwent routine blood screens. Identified abnormalities were corrected, when 
possible, before clonazepam was prescribed. The starting dose was 0.25 mg daily, 
with an increase in dose of 0.25 mg on a weekly basis if symptoms continued.
RESULTS: The subject population consisted of 29 women and 1 man. All subjects 
had been symptomatic (average premorbid burning intensity, 7.0 +/- 1.9 on 
10-point scale) for 1 month to 12 years (mean, 3.9 +/- 3.4 years; median, 2.75 
years), and 16% had had burning for more than 2 years. Three groups of patients 
were identified: those who experienced partial to complete relief with 
clonazepam and who were using the medication at the last follow-up (group 1; 
43%); those who found the clonazepam helpful but withdrew from the medication 
because of side effects--usually drowsiness (group 2; 27%); and those who did 
not benefit from clonazepam (group 3; 30%). Among the 3 groups, age was found to 
be significantly lower for group 1 than for group 2 but not significantly lower 
for group 1 than for group 3. Although the difference did not reach 
significance, the mean dose of clonazepam appeared lower for group 1 patients 
than for the other 2 patient groups. The number of patients with burning for 
less than 2 years was larger in group 1 than in the other groups.
CONCLUSIONS: The results suggest that clonazepam may be helpful in burning mouth 
syndrome, inasmuch as 70% of patients (groups 1 and 2) experienced pain 
reduction with effects at low doses. These findings suggest that the mechanism 
of action of clonazepam may be specific and separate from the anxiolytic effect 
of the benzodiazepines and that clonazepam may represent a useful therapy in a 
subset of patients with burning mouth syndrome. Double-blind, placebo-controlled 
trials are warranted.