Targeting the Endocannabinoid System in Burning Mouth Syndrome: A Case Report on CBD-Dominant Cannabis Oil

Burning Mouth Syndrome (BMS) is a chronic orofacial pain disorder characterized by burning sensations of the oral mucosa without evident causative lesions. Current treatment options often provide limited relief, highlighting the need for alternative therapeutic approaches. Recent evidence suggests that dysregulation of the endocannabinoid system plays a role in BMS patho- physiology, with altered expression of cannabinoid receptors in oral mucosa. We present a case of a 62-year-old postmenopausal female with a 3-year history of BMS refractory to conventional treatments including topical clonazepam, gabapentin, and alpha-lipoic acid. The patient was treated with CBD-dominant cannabis oil (20:1 CBD:THC ratio), starting at 5 mg CBD twice daily and titrated to 15mg CBD twice daily over 4 weeks. After 8 weeks of treatment, the patient reported a reduction in burning sensation from NRS 8/10 to 4/10, with concurrent improvement in xerostomia and taste alterations. Pain relief was maintained at 6-month follow-up with stable dosing and no significant adverse effects. This case suggests that CBD-dominant cannabis preparations may offer a promising therapeutic option for BMS through modulation of the endo- cannabinoid system.