Retrospective Evaluation of the Topical Use of 1% Amitriptyline in Patients with Burning Mouth Syndrome

Objective: The aim of this study was to explore the clinical response and tolerability of topical 1% amitriptyline in patients with burning mouth syndrome in a real-world clinical setting. Methodology: A retrospective observational study was conducted through a review of the clinical histories of patients diagnosed with burning mouth syndrome, treated at the Dental Clinic of the Morales Meseguer Hospital (Murcia, Spain). All the patients were treated with topical amitriptyline for a period of four weeks. The following parameters were evaluated at the start of the treatment and at the end of the four weeks: pain or mouth burning, through the visual analog scale (VAS); anxiety and depression, with the Hospital Anxiety and Depression (HAD) scale; sleepiness, with the Epworth Sleepiness Scale (ESS); sensation of dry mouth (VAS) and basal sialometry for the objective measurement of salivary flow. Results: Of the 32 patients that were initially included, 27 were ultimately analyzed. After 4 weeks of treatment with 1% topical amitriptyline, a significant improvement was observed in mouth pain or burning, measured with the VAS, with a decrease in the median of 7.5 (IQR 6-9) to 5 (IQR 5-7) (p < 0.001). Likewise, significant improvements were recorded in the anxiety (HAD-A) and depression (HAD-D) scores, with significant reductions after the treatment (p = 0.019 and p = 0.009, respectively). No statistically significant differences were observed in the subjective sensation of dry mouth (VAS) (p = 0.054) or in the total production of saliva (p = 0.477). Conclusions: Treatment with 1% topical amitriptyline for four weeks was associated with a reduction in pain and emotional distress in patients with burning mouth syndrome, with very few reported adverse effects. As an exploratory retrospective study with a limited sample size reflecting real-world clinical practice, these findings suggest that 1% topical amitriptyline may represent a useful therapeutic option in the management of burning mouth syndrome. However, the results should be interpreted with caution, and further prospective controlled studies are needed to confirm these findings.