Reconsideration of the nomenclature and disease definition of burning mouth syndrome: an international Delphi survey

Abstract

Objectives We sought to determine whether the nomenclature, disease definition, and diagnostic criteria for burning mouth syndrome (BMS) should be revised on the basis of expert agreement using the Delphi method of consensus. Methods An international group of 30 BMS experts was invited to participate (April 2019). The study consisted of 3 iterative survey rounds, and findings were presented and participant feedback obtained in a fourth round. QualtricsXM survey software (Qualtrics, Provo, UT) was used to create an electronic self-administered questionnaire. The first survey included closed-ended and open-ended questions intended to generate suggested changes and gauge each participant s agreement (predefined as 70% in agreement) with the existing International Classification of Diseases, 11th Revision (ICD-11), nomenclature, diagnostic criteria, and disease definition for BMS. Subsequent rounds summarized and presented data from the previous round. Round 2 presented suggested changes and asked if participants agreed or disagreed (dichotomous variable); open-ended questions were for additional changes, comments, and rationales for their selections. Round 3 presented items that met with >50% but Results Thirty screening e-mails were sent to international experts in BMS, and 22 expressed interest in participating. Nineteen experts completed round 1, 17 completed round 2, and 15 completed round 3 for 86%, 89%, and 88% response rates, respectively. Consensus was reached that BMS should not be classified as a syndrome (15 of 17) and that it should be renamed (15 of 19) “burning mouth disorder.” Consensus included that the following should be removed from the diagnostic criteria: (1) emotional distress or functional disability and (2) the number of hours per day that symptoms occur. All other items that reached consensus clarified the disease definition and diagnostic criteria, including delineating the local and systemic causes of oral burning that should be evaluated before diagnosis. Conclusions International consensus among selected experts indicated that the proposed ICD-11 nomenclature, disease definition, and diagnostic criteria can be improved and clarified.