Burning Mouth Syndrome: Recognition, Understanding, and Management

Other Secondary Headaches: Odontogenic Pain and Other Painful Orofacial Conditions

This article discusses extremely common odontogenic pain conditions, which may occasionally present to the neurology clinic mimicking headache, and other uncommon orofacial pain conditions, which may do the same. Typical presentations, investigative strategies, and management are discussed, as well as highlighting key diagnostic criteria and the importance of involving oral or dental specialists where diagnostic uncertainty exists.

Amitriptyline effectiveness in burning mouth syndrome: An in-depth case series analysis

OBJECTIVES

To assess the effectiveness of amitriptyline (AMT), and to identify the determinants of the treatment's effectiveness in patients diagnosed with burning mouth syndrome (BMS).

BACKGROUND

Treatment of BMS is challenging and no established treatment protocol is available. AMT may be an important treatment option, cout not all patients benefit from this drug. Studies assessing factors related to treatment response are valuable in improving decision-making.

MATERIALS AND METHODS

This case series study examined the medical records of all patients diagnosed with BMS at an oral medicine unit in a university hospital from 2008 to 2022. The patients were divided into responders to AMT and non-responders to AMT. Data on demographic information, comorbidities, medications, types of symptoms and oral subsites affected were collected. Descriptive and bivariate analyses were conducted to assess the association between the independent variables and the outcome, using the Chi-squared test (P < .05).

RESULTS

Three hundred and fourty-nine patients reported a burning mouth sensation, 50 of them (14.3%) being diagnosed with primary BMS. Of these, 35 were treated with AMT, and 26 (74.2%) responded significantly to AMT. All males responded to AMT, whereas only 67.9% of females responded. The mean dose of AMT among responders was 29.8 ± 12.3 mg, with most patients achieving a response with 25 mg (61.5% of patients), followed by 50 mg (23%). The concomitant use of an anticonvulsant resulted in non-response.

CONCLUSIONS

AMT may be effective in BMS management for most patients.

Oxidative stress-mediated proapoptosis signaling: A novel theory on the mechanism underlying the pathogenesis of burning mouth syndrome

BACKGROUND

Burning mouth syndrome (BMS) is a chronic oral pain disorder characterized by a generalized burning sensation in the oral mucosa without apparent medical or dental causes. Despite various hypotheses proposed to explain BMS pathogenesis, a clear understanding of the cellular-level events and associated histologic and molecular findings is lacking. Advancing our understanding of BMS pathogenesis could facilitate the development of more targeted therapeutic interventions.

TYPES OF STUDIES REVIEWED

The authors conducted an extensive literature search and review of cellular mechanisms, focusing on evidence-based data that support a comprehensive hypothesis for BMS pathogenesis. The authors explored novel and detailed mechanisms that may account for the characteristic features of BMS.

RESULTS

The authors proposed that BMS symptoms arise from the uncontrolled activation of proapoptotic transmembrane calcium permeable channels expressed in intraoral mucosal nerve fibers. Elevated levels of reactive oxygen species or dysfunctional antiapoptosis pathways may lead to uncontrolled oxidative stress-mediated apoptosis signaling, resulting in upregulation of transmembrane transient receptor potential vanilloid type 1 and P2X 3 calcium channels in nociceptive fibers. Activation of these channels can cause nerve terminal depolarization, leading to generation of action potentials that are centrally interpreted as pain.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The authors present a novel hypothesis for BMS pathogenesis, highlighting the role of proapoptotic transmembrane calcium permeable channels and oxidative stress-mediated apoptosis signaling in the development of BMS symptoms. Understanding these underlying mechanisms could provide new insights into the development of targeted therapeutic interventions for BMS. Additional research is warranted to validate this hypothesis and explore potential avenues for effective management of BMS.

Therapeutic effects of clonazepam in patients with burning mouth syndrome and various symptoms or psychological conditions

Burning mouth syndrome (BMS) is frequently accompanied by dysgeusia and xerostomia. Clonazepam has been widely prescribed and is effective, but it is unclear whether clonazepam also affects the symptoms that accompany BMS, or whether such symptoms affect treatment outcomes. Here, we investigated the therapeutic outcomes in BMS patients with various symptoms or comorbidities. We retrospectively reviewed 41 patients diagnosed with BMS between June 2010 and June 2021 at a single institution. Patients were instructed to take clonazepam for 6 weeks. Before the first dose, burning pain intensity was measured using a visual analog scale (VAS); the unstimulated salivary flow rate (USFR), psychologic characteristics, site(s) of pain, and any taste disturbance were evaluated. Burning pain intensity was measured again after 6 weeks. Thirty-one of the 41 patents (75.7%) exhibited a depressed mood, whereas more than 67.8% of the patients exhibited anxiety. Subjective xerostomia was reported by ten patients (24.3%). The mean salivary flow rate was 0.69 mL/min and hyposalivation (an unstimulated salivary flow rate ≤ 0.5 mL/min) was apparent in ten patients (24.3%). Dysgeusia was present in 20 patients (48.7%); a bitter taste (n = 15, 75%) was reported by the largest proportion of patients. Patients who reported a bitter taste responded best in terms of burning pain reduction after 6 weeks (n = 4, 26.6%). Overall, 32 patients (78%) reported decreased oral burning pain after clonazepam (mean VAS score changed from 6.56 to 5.34) use. Patients who reported taste disturbances exhibited a significantly greater decrease in burning pain, compared with other patients (mean VAS score changed from 6.41 to 4.58) (p = 0.02). Clonazepam significantly improved burning pain in BMS patients who had taste disturbances.

The efficacy of alpha-lipoic acid in the management of burning mouth syndrome: An updated systematic review of randomized controlled clinical trials

Background and Aims

Burning mouth syndrome (BMS) causes burning or uncomfortable feelings in the oral cavity without any obvious injuries. This condition's etiopathogenesis is still unknown, consequently, BMS management is very challenging. Alpha-lipoic acid (ALA) is a naturally occurring potent bioactive compound that has been found to be useful in the management of BMS in many studies. Therefore, we conducted a comprehensive systematic review to investigate the usefulness of ALA in the management of BMS based on randomized controlled trials (RCTs).

Methods

Different electronic databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar, were extensively searched to find relevant studies.

Results

This study included nine RCTs that matched the inclusion criteria. In most studies, ALA was given at a dose of 600-800 mg/day, with up to two months of follow-up. The majority of studies (six out of nine studies) indicated that ALA was more effective in BMS patients than in the placebo-controlled group.

Conclusions

This comprehensive systematic review provides evidence of the positive outcomes of the treatment of BMS with ALA. However, more research might be needed before ALA can be considered the first-line therapy for BMS.

Relationship of Depression, Anxiety, and Bipolar Disease with Burning Mouth Syndrome: A Nationwide Cohort Study

Burning mouth syndrome (BMS) is a chronic, painful condition of the oral mucosa. Although the pathogenesis remains unclear, psychological and neuroendocrine factors are considered the major contributors. Few longitudinal studies have investigated the effects of psychological factors on the occurrence of BMS. Therefore, we evaluated the risk of BMS in patients with affective disorders using a nationwide population-based cohort dataset. We identified patients with depression, anxiety, and bipolar disorder and then selected comparison participants using the 1:4 propensity score-matching method. We investigated the incidence of BMS events during the follow-up period using survival analysis, the log-rank test, and Cox proportional hazards regression models. After adjusting for other contributing conditions, the adjusted hazard ratio (HR) for developing BMS was 3.37 (95% confidence interval [CI]: 1.67-6.80) for depression and 5.09 (95% CI: 2.19-11.80) for anxiety; however, bipolar disorder showed no significant risk. Specifically, female patients with depression and anxiety had an increased risk of BMS. Moreover, patients with anxiety showed an increased adjusted HR of BMS events during the first 4 years after diagnosis, whereas patients with depression did not. In conclusion, depression and anxiety disorders are significantly associated with the risk of BMS. Additionally, female patients showed a significantly higher risk of BMS than male patients, and anxiety showed increased BMS events earlier than depression. Therefore, clinicians should consider the risk of BMS when treating patients with depression or anxiety.

Response to Treatment with Melatonin and Clonazepam versus Placebo in Patients with Burning Mouth Syndrome

Objective: to evaluate the efficacy of melatonin and clonazepam versus placebo in patients with burning mouth syndrome (BMS). Methods: a prospective double-blind study was carried out in patients with BMS and randomized to three groups: melatonin (1 mg once a day), clonazepam (0.5 mg/twice a day), or a placebo once a day, for 8 weeks. The clinical changes were evaluated, including xerostomia, the Oral Health Impact Profile 14 (OHIP-14) score, Pittsburg Sleep Quality Index, and the Hospital Anxiety and Depression Scale (HADS). Oxygen saturation and heart rate were recorded, with an analysis of salivary biomarkers in the forms of oxytocin, ferritin, adenosine deaminase (ADA), total proteins, and alpha-amylase. Results: a total of 64 patients were analyzed. A significant decrease in burning sensation was recorded with melatonin (7.8 ± 1.54 pre-treatment, 5.78 ± 2.54 post-treatment; p < 0.001) and clonazepam (8.75 ± 1.2 pre-treatment, 5.5 ± 3.6 post-treatment (p < 0.01). With regard to quality of life (OHIP-14), significant improvements were observed before and after the administration of melatonin (p < 0.001) and clonazepam (p = 0.001). On the other hand, with regard to the changes in salivary biomarkers following treatment, negative correlations were found between oxytocin and drainage (r = −0.410; p = 0.009) and between the HADS-D score and ferritin (r = −0.312; p = 0.05). While salivary amylase showed positive correlation with heart rate (r = 0.346; p = 0.029) and oxygen saturation (r = 0.419; p = 0.007). Conclusions: melatonin and clonazepam were shown to be effective at reducing the burning sensation and improving quality of life. Both drugs were found to be safe, with no major adverse effects in patients with BMS. Melatonin may be regarded as an alternative treatment for patients with BMS, though further studies are needed to confirm its effectiveness.

Topical clonazepam for burning mouth syndrome: Is it efficacious in patients with anxiety or depression?

BACKGROUND

Burning mouth syndrome (BMS) is a chronic disorder characterised by pain in the oral cavity without clinically evident causative lesions. The aetiology of this condition is poorly understood, and treatment can be challenging.

METHOD

A retrospective review of the medical records of 82 patients with BMS was performed. Data on demographics, BMS associated symptoms, symptoms' intensity score (NRS: 0-10) and response to treatment with topical clonazepam were extracted from clinical notes based on a standardised clinical questionnaire. Differences in the symptoms' intensity score between patients with or without concomitant anxiety/depression or systemic psychogenic medication use were analysed using the Wilcoxon signed rank test.

RESULTS

Among the entire cohort, the median symptoms' intensity score at baseline was 4.5 and 3.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI). Among the subjects with anxiety/depression and those who were prescribed systemic psychogenic medications, the median symptoms' intensity score at baseline was 5.0 and 3.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI). Among those without anxiety/depression, the symptoms' intensity score at baseline was 4.0 and 2.0 at first follow-up, a statistically significant improvement (p < .05; 95% CI). The median symptoms' intensity score for those who were not on any psychogenic medications at baseline was 4.0 and 2.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI).

CONCLUSIONS

Clinicians are encouraged to prescribe topical clonazepam for BMS regardless of concomitant use of systemic psychogenic medications or comorbid mood disorders as it is an efficacious management approach in the presence or absence of these potentially complicating factors.

Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta-analysis

OBJECTIVES

To evaluate the worldwide prevalence and epidemiology profile of burning mouth syndrome.

MATERIAL AND METHODS

A systematic review and meta-analysis was conducted. Search strategies were performed in PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database for studies published before January 31, 2021, for the prevalence of burning mouth syndrome.

RESULTS

Eighteen articles were included. The overall pooled prevalence of burning mouth syndrome was 1.73% (95% CI = 0.176-0.351, n = 26,632) in general population, and 7.72% (95% CI = 0.434-0.691, n = 86,591) in clinical patients. The subgroup analysis by continent showed that among the population-based studies the prevalence in Asia (1.05%) lower than in Europe (5.58%) and North America (1.10%). The subgroup analysis by gender showed the prevalence of female (1.15%) was higher than male (0.38%) in general population. The subgroup analysis by age showed the prevalence was higher for people over 50 (3.31%) than under 50 (1.92%).

CONCLUSIONS

The pooled prevalence of burning mouth syndrome was relatively high in both general population and clinical patients, varies in different regions with the highest prevalence in Europe, and females over 50 years were the most susceptible group. More epidemiological surveys on the prevalence of burning mouth syndrome are needed.

Effectiveness of photobiomodulation in the treatment of primary burning mouth syndrome-a systematic review and meta-analysis

To evaluate the effectiveness of photobiomodulation (PBM) on primary burning mouth syndrome (pBMS). We searched Chinese and English studies published before February 10, 2020. The databases used include PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang Database, and China National Knowledge Infrastructure (CNKI). Randomized controlled clinical trials (RCTs) that used the PBM to treat pBMS and reported specific treatment outcomes were considered for inclusion. We eventually included 12 RCTs, and 574 samples were included in these studies. The primary outcomes investigated were pain reduction and life quality improvement. A meta-analysis performed on 9 groups in 5 trials showed that PBM was effective in reducing pain compared with placebo (MD - 1.86, 95% CI - 2.59 to - 1.13, Z = 4.99, P < 0.00001). Meta-analysis was also performed on 7 groups in 4 trials and showed that PBM was effective in improving life quality compared with placebo (MD - 3.43, 95% CI - 5.11 to - 1.75, Z = 4.00, P < 0.0001). Qualitative analysis of the included RCTs found that PBM might also play a role in the decrease of TNF-α and IL-6 in saliva. Three studies that compared PBM with medications were evaluated by descriptive analysis. None of the treatment-related adverse event was reported. Up to date, PBM appears to have an effect on pain reduction and life quality improvement in pBMS patients. However, more evidence is still required to warrant its efficacy and safety in treating pBMS.

Salivary Cortisol Levels and Burning Symptoms in Patients with Burning Mouth Syndrome before and after Low Level Laser Therapy: a Double Blind Controlled Randomized Clinical Trial

Objectives

Burning mouth syndrome (BMS) is a disorder which is described as burning sensation of the oral mucosa without pathological changes. Most of the patients have some underlying stressful conditions. Stress induces an increase in secretion of different endocrine glands resulting in higher levels of glucocorticoids. One of the options for treatment of BMS includes low level laser therapy (LLLT). The aim of this research was to determine salivary cortisol levels and intensity of burning symptoms in BMS patients before and after LLLT.

Materials and Methods

Twenty-three participants were allocated by randomization in two groups: 12 patients in the study group and 11 patients in the placebo group. Cortisol levels in all patients were analyzed from the sample of saliva collected without stimulation. In both groups, the LLLT was performed once a day for ten consecutive days (excluding weekend) with Ga-Al-As light-emitting diode type of laser, with a wavelength of 685nm. In the control group, LLLT was done with inactive laser probe which was only emitting audio signal. The intensity of burning symptoms was measured by a visual analogue scale (VAS). The VAS and unstimulated saliva were measured at baseline and on the last day of the LLLT. A quantitative analysis of saliva was performed using competitive commercial ELISA-kit.

Results

VAS scores and salivary cortisol levels were significantly lower in both groups after LLLT.

Conclusions

LLLT can be useful in patients with BMS for reducing burning symptoms and salivary cortisol level. Future studies on a larger number of patients should clarify whether the positive results are an outcome of laser effectiveness or of placebo effect.

The fifth cranial nerve in headaches

The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.

Salivary Biomarkers and Their Correlation with Pain and Stress in Patients with Burning Mouth Syndrome

Objective: To evaluate a panel of salivary analytes involving biomarkers of inflammation, stress, immune system and antioxidant status in patients with burning mouth syndrome (BMS) and to study their relationship with clinical variables. Materials and Methods: A total of 51 patients with BMS and 31 controls were consecutively enrolled in the study, with the recording of oral habits, the severity of pain using a visual analogue scale (VAS), the Hospital Anxiety and Depression (HAD) score and the Oral Health Impact Profile-14 (OHIP14) score. Resting whole saliva was collected with the drainage technique, followed by the measurement of 11 biomarkers. Results: The salivary flow was higher in patients with BMS. Among all the biomarkers studied, significantly higher levels of alpha-amylase, immunoglobulin A (IgA), and macrophage inflammatory protein-4 (MIP4) and lower levels of uric acid and ferric reducing activity of plasma (FRAP) were observed in the saliva of patients with BMS as compared to the controls (p < 0.05 in all cases). Positive correlations were found between pain, oral quality of life and anxiety scores and salivary biomarkers. Conclusions: BMS is associated with changes in salivary biomarkers of inflammation, oxidative stress and stress, being related to the degree of pain and anxiety.

Neuropathic Pain and Burning Mouth Syndrome: An Overview and Current Update

Burning mouth syndrome/glossodynia and trigeminal neuropathic conditions can have serious negative impact on a patient's overall quality of life. These conditions are often hard to diagnose and even harder to fully treat and manage, but it is important for dentists/oral and maxillofacial surgeons to be aware of these conditions and modalities of their treatment. Often the only method for arriving at the proper diagnosis is for patients to undergo traditional approaches for treatment of presenting signs and symptoms, and it is the unexpected failure of interventional therapies that leads ultimately to a proper diagnosis.

Evaluation of the effectiveness of crocin isolated from saffron in treatment of burning mouth syndrome: A randomized controlled trial

OBJECTIVE

Burning mouth syndrome (BMS) is a debilitating disorder with few limited treatment modalities. Because of the proven association between BMS symptoms, and depression and anxiety, treatment modalities that alleviate the two latter etiologic factors can be clinically effective. Thus, owing to the antidepressant and potential analgesic effects of crocin (as an active constituent of saffron), the present study was performed to compare the effect of crocin and citalopram (as control) on BMS symptoms and depression/anxiety in patients with BMS.

MATERIALS AND METHODS

The present double-blind randomized clinical trial was carried out on BMS patients. Patients were randomly divided into citalopram (n=21) and crocin (n=26) groups and treated for 11 weeks. BMS symptoms (based on Visual Analysis Scale (VAS)), as well as anxiety and depression (based on Hamilton questionnaire) were evaluated at baseline and during the treatment period. Mann-Whitney, Chi-Square test, Independent t-test, Friedman, and Spearman correlation were employed for statistical analysis.

RESULTS

Our findings showed a significant effect for crocin on the severity of BMS symptoms, anxiety and depression in BMS patients.

CONCLUSION

Crocin can be considered for treatment of BMS subjects with concurrent anxiety and/or depression.

[Burning mouth syndrome]

A case-report of burning mouth syndrome is presented. A 27-year-old man complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. All symptoms appeared after suffering a cold and had a wave-like course during self-medication with antibiotics. The pain has continued for 8 months. Diagnoses of atypical facial pain, glossodynia or secondary facial pain (craniomandibular dysfunction) were made. The effect of treatment in the hospital (carbamazepine, amitriptyline, haloperidol, phenozepam) was not achieved. A microbial test showed a higher number of pathogenic microbes. The final diagnosis was secondary facial pain (burning mouth syndrome) with concomitant lesions of the oral mucosa (Staphylococcus aureus, Candida sp.). The patient received a combined therapy with the pronounced positive effect.

Low-level laser therapy in patients with Burning Mouth Syndrome: A double-blind, randomized, controlled clinical trial

Background

Evaluate the effect of LLLT in the treatment of burning mouth syndrome (BMS).

Material and Methods

Twenty-one BMS patients were randomly assigned to two groups: 12 in the laser group (LG) and 9 in the control group (CG). Patients in the LG underwent 2-week sessions of LLLT for 4 weeks. The spot tip area of this tool is 0.088cm2, semi-conductor GaAlAs, with a wavelength of 808nm ±5nm (infrared), 200 mW output power, 1.97W/cm2 of power density, 3 J energy per point and application time 15 seconds per point. LLLT was applied punctually, in continuous emissions, on each of the sites where there was a symptom. Symptoms were evaluated with a visual analogue scale (VAS) and patient psychological profiles were assessed using the Hospital Anxiety-Depression Scale. No side effects were recorded. Statistical analysis was carried out via ANOVA and logistic regression analysis.

Results

The initial VAS score mean was 8.9 for the LG and 8.3 for the CG (p >0.05). After the eighth session the VAS score was 5.5 and 5.8 respectively, and at two months it was 4.7 and 5.1 respectively. Improvement variables were established by dichotomizing the pain scales. We obtained levels of significance for the improvement variable for the LG at the two-month follow-up (p=0.0038) and for the univariate analysis of the treatment. The improvement was marginally significant in the multivariant analysis of: dry mouth, dysgeusia, pain and the treatment (p=0.0538).

Conclusions

LLLT may be an alternative treatment for the relief of oral burning in patients with BMS. Key words:Burning mouth syndrome, oral pain, laser dentistry, laser therapy, low intensity laser therapy.

Burning mouth syndrome in postmenopausal women with self-reported sleep problems

OBJECTIVE

The aim of this study was to investigate possible relationships among hematologic factors, psychological dimensions, the presence of self-reported sleep problems, and clinical characteristics in patients with burning mouth syndrome (BMS).

METHODS

Twenty-five postmenopausal female patients with primary BMS (aged 55.2 ± 9.6 years) were included. All participants underwent clinical and psychological evaluations and blood sampling. The patients were subdivided according to the absence or presence of the self-reported sleep problems.

RESULTS

Pain intensity of BMS patients with sleep problems was significantly higher than those without sleep problems, and the severity of oral complaints was correlated with the presence of depression, anxiety, hostility, phobia, and psychosis. Estradiol levels were significantly lower, and FSH and LH levels were higher in BMS patients with sleep problems than those without sleep problems.

DISCUSSION

BMS patients with sleep problems may suffer inharmonious psychoneuroendocrinological interactions that might worsen oral BMS symptoms.

Oral surgery II: Part 5. Chronic orofacial pain

Chronic orofacial pain syndromes represent a diagnostic challenge for any practitioner. Patients are frequently misdiagnosed or attribute their pain to a prior event such as a dental procedure, ENT problem or facial trauma. Psychiatric symptoms of depression and anxiety are prevalent in this population and compound the diagnostic conundrum. Treatment is less effective than in other pain syndromes and thus often requires a multidisciplinary approach to address the many facets of these conditions.

Neuropathic Pain in Patients with Burning Mouth Syndrome Evaluated Using painDETECT

Objective

This study set out to identify the neuropathic component of pain experienced by burning mouth syndrome (BMS) patients evaluated using painDETECT, a diagnostic tool that could easily be introduced into clinical practice.

Materials and Methods

This study included 64 patients (33 BMS and 31 suffering nociceptive pain). Each completed the painDETECT neuropathic pain questionnaire, the Hospital Anxiety and Depression Scale, and pain intensity was also measured using a visual analogue scale (VAS).

Results

Pain among BMS patients (evaluated by VAS) was 6.1 ± 1.9, and 4.3 ± 1.7 among nociceptive patients ( P  < 0.001). PainDETECT obtained total scores ≥ 19 in 21% of BMS patients, indicating the presence of neuropathic pain. When painDETECT pain descriptors were analyzed comparing the BMS group with nociceptive pain subjects, statistically significant differences were found for burning sensation ( P  < 0.010), prickling ( P  < 0.001), electric shock-like sensation ( P  = 0.046), thermal sensation ( P  < 0.001), and numbness ( P  = 0.002). Logistic regression analysis found that VAS scoring was the strongest determinant predicting neuropathic pain.

Conclusion

The present study suggests that almost a third of BMS patients present neuropathic pain, which is strongly associated with the intensity of pain measured using VAS. These data could provide the basis for further research.

A successful approach to conrol burning mouth syndrome using matricaria recutita and cognitive therapy

The burning mouth syndrome (BMS) has no specific clinical and laboratory signs. Its etiology is yet to be elucidated, but it is considered to be affected by multifactorial, psychological, and local and systemic factors. This condition is considered of great morbidity, and the main complaint of patients maybe associated with xerostomia, thirst, and altered taste. The present study aims to report two cases of BMS and to evaluate the outcome of cognitive therapy (CT) plus phytotherapy in the control of BMS. The patients were female, Caucasian, and aged between 58 and 69 years. The most BMS-affected anatomical parts were the lips and the tongue. In the clinical approach, oral and systemic evaluation, and disease management with CT plus chamomile tea were done. The patients were reassured, and their response to therapy one year after was found to be excellent despite few exacerbations in periods of great emotional stress. Thus, we conclude that psychological treatment is vital in the management of BMS, as CT, along with Matricaria recutita phytotherapy, displayed excellent results in the control of BMS. Key words:Anxiety, chamomile tea, xerostomia, psychosomatic.

Clinical characterization of women with burning mouth syndrome in a case-control study

OBJECTIVE

Burning mouth syndrome (BMS) is a chronic orofacial pain disorder that is defined by a burning sensation in the oral mucosa. The aim of this study was to investigate the underlying factors, clinical characteristics and self-reported oral and general health factors associated with BMS.

MATERIAL AND METHODS

Fifty-six women with BMS (mean age: 67.7) and their age-matched controls were included in the study. A general questionnaire, an OHRQL index and BMS-specific questionnaires were used. Each subject underwent an oral examination.

RESULTS

The mean severity of the BMS symptoms (VAS, 0-100) was 66.2 (SD 19.7). Overall, 45% of the patients reported taste disturbances. More of the patients than the controls rated their general health, oral health and life situation as 'less satisfactory'. The patients also reported more frequently on-going medications, diseases/disorders, xerostomia, allergy and skin diseases. Except for more bruxofacets among the patients, there were no significant differences regarding signs of parafunction. In a multiple logistic regression analysis, xerostomia and skin diseases showed the strongest prediction for BMS and no significant effect was found for medication, allergy or bruxofacets.

CONCLUSIONS

Skin diseases and xerostomia but not parafunction were strongly associated with BMS. Our findings provide the basis for additional studies to elucidate the causal factors of BMS.

A pragmatic evidence-based clinical management algorithm for burning mouth syndrome

Background

Burning mouth syndrome is a poorly understood disease process with no current standard of treatment. The goal of this article is to provide an evidence-based, practical, clinical algorithm as a guideline for the treatment of burning mouth syndrome.

Material and Methods

Using available evidence and clinical experience, a multi-step management algorithm was developed. A retrospective cohort study was then performed, following STROBE statement guidelines, comparing outcomes of patients who were managed using the algorithm and those who were managed without.

Results

Forty-seven patients were included in the study, with 21 (45%) managed using the algorithm and 26 (55%) managed without. The mean age overall was 60.4 ±16.5 years, and most patients (39, 83%) were female. Cohorts showed no statistical difference in age, sex, overall follow-up time, dysgeusia, geographic tongue, or psychiatric disorder; xerostomia, however, was significantly different, skewed toward the algorithm group. Significantly more non-algorithm patients did not continue care (69% vs. 29%, p=0.001). The odds ratio of not continuing care for the non-algorithm group compared to the algorithm group was 5.6 [1.6, 19.8]. Improvement in pain was significantly more likely in the algorithm group (p=0.001), with an odds ratio of 27.5 [3.1, 242.0].

Conclusions

We present a basic clinical management algorithm for burning mouth syndrome which may increase the likelihood of pain improvement and patient follow-up.

Key words:Burning mouth syndrome, burning tongue, glossodynia, oral pain, oral burning, therapy, treatment.

Evaluating Burning Mouth Syndrome as a Comorbidity of Atypical Odontalgia: The Impact on Pain Experiences

OBJECTIVE

This study aimed (1) to investigate the differences in clinical characteristics of patients between 2 groups, those who have atypical odontalgia (AO) only and those who have AO with burning mouth syndrome (BMS), and (2) to assess the influence of psychiatric comorbidity factors on patients' experiences.

METHOD

Medical records and psychiatric referral forms of patients visiting the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between 2013 and 2016 were reviewed. The final sample included 2 groups of 355 patients: those who have AO only (n = 272) and those who have AO with BMS (AO-BMS; n = 83). Clinicodemographic variables (gender, age, comorbid psychiatric disorders, and history of headache or sleep disturbances) and pain variables (duration of illness, pain intensity, and severity of accompanying depression) were collected. Initial pain assessment was done using the Short-Form McGill Pain Questionnaire, and depressive state was determined using the Zung Self-Rating Depression Scale.

RESULTS

The average age, female ratio, and sleep disturbance prevalence in the AO-only group were significantly lower than those in AO-BMS group. AO-BMS patients rated overall pain score and present pain intensity significantly higher than did the AO-only patients (P = 0.033 and P = 0.034, respectively), emphasizing sharp (P = 0.049), hot-burning (P = 0.000), and splitting (P = 0.003) characteristics of pain. Patients having comorbid psychiatric disorders had a higher proportion of sleep disturbance in both groups and a higher proportion of depressive state in the AO-only group.

CONCLUSIONS

AO-BMS patients have different epidemiological characteristics, sleep quality, and pain experiences compared to AO-only patients. The presence of psychiatric comorbidities in both groups may exacerbate sleep quality. We suggest that BMS as a comorbid oral disorder in AO patients contributes to a more intensively painful experience.

Burning mouth syndrome: a systematic review of treatments

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri- and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized controlled trials. Eight studies examined alpha-lipoic acid (ALA), three clonazepam, three psychotherapy, and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea, and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.

Oral Symptoms and Mucosal Lesions in Patients with Diabetes Mellitus Type 2

Background: Good glycoregulation at patients with diabetes mellitus is essential for prevention of many complications, including those in oral cavity. Results of numerous studies indicate that xerostomia and neurosensory oral disorders are present in type 2 diabetics. A review of the literature shows contradictory results about prevalence of oral mucosal lesions in diabetics. The aim of this study was to evaluate the presence of xerostomia, neurosensory disorders and mucosal lesions in oral cavity of type 2 diabetics.

Material and Methods: This study involved 90 adults, 60 with type 2 diabetes and 30 healthy subjects, aged 45-65 years. With regard to value of HbA1c level diabetics were divided into two groups: 30 subjects with satisfactory glycoregulation (HbA1c<9%) and 30 subjects with poor glycoregulation (HbA1c≥9%). All patients recruited into the study completed a questionnaire that included their demographic, medical and oral health data. Clinical examination of the oral mucosa was performed by a single examiner.

Results: In relation to the presence of xerostomia and dysgeusia between satisfactory controlled diabetics and healthy subjects a significant difference was observed (p<0.05). Compared with healthy subjects, poor controlled diabetics had significantly higher presence of xerostomia (p<0.001) and neurosensory disoders (p<0.05). A higher prevalence of oral mucosal lesions was found in poor controlled diabetics, but significant difference between groups was not observed (p>0.05). A significant positive correlation was revealed between smoking and glossodynia as well as smoking and glossopyrosis (p>0.05).

Conclusion: Glycemic control level seems to influence the susceptibility of type 2 diabetics to xerostomia and neurosensory disorders. Less clear is whether diabetes are corellated to oral mucosal lesions.

Burning Mouth Syndrome: A Review of the Etiopathologic Factors and Management

Burning mouth syndrome (BMS) is characterized by pain in the mouth with or with no inflammatory signs and no specific lesions. Synonyms found in literature include glossodynia, oral dysesthesia, glossopyrosis, glossalgia, stomatopyrosis, and stomatodynia. Burning mouth syndrome generally presents as a triad: Mouth pain, alteration in taste, and altered salivation, in the absence of visible mucosal lesions in the mouth. The syndrome generally manifests spontaneously, and the discomfort is typically of a continuous nature but increases in intensity during evening and at night. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. The differential diagnosis requires the exclusion of oral mucosal lesions or blood test alterations that can produce burning mouth sensation. Management is always based on the etiological agents involved. If burning persists after local or systemic conditions are treated, then treatment is aimed at controlling neuropathic symptoms. Treatment of BMS is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. The aim of this review was to discuss several aspects of BMS, update current knowledge, and provide guidelines for patient management.

Individual oral symptoms in burning mouth syndrome may be associated differentially with depression and anxiety

BACKGROUND

Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms.

OBJECTIVE

In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms.

METHODS

Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised).

RESULTS

Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores.

CONCLUSION

Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

Burning mouth syndrome

Burning mouth syndrome (BMS) is a complex disorder that is characterized by warm or burning sensation in the oral mucosa without changes on physical examination. It occurs more commonly in middle-aged and elderly women and often affects the tip of the tongue, lateral borders, lips, hard and soft palate. This condition is probably of multi-factorial origin, often idiopathic, and its etiopathogensis is unknown. BMS can be classified into two clinical forms namely primary and secondary BMS. As a result, a multidisciplinary approach is required for better control of the symptoms. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.

Traditional Japanese herbal medicines for treatment of odontopathy

This article highlights several refractory oral diseases, such as stomatitis, burning mouth syndrome (BMS), glossalgia, atypical facial pain (AFP), oral cancer, dry mouth, and Sjögren's syndrome (SJS), in which use of Japanese herbal medicines, Kampo medicines (KM), on the basis of Kampo theory could exert the maximum effects on human body. (1) In acute stomatitis, heat because of agitated vital energy may affect the head, chest, and middle abdominal region. Stomatitis is also related to the generation of reactive oxygen species (ROS). There are many antioxidants in the crude extracts of KM. Thus, we can control environmental factors (cold, heat, dampness, dryness) and vital energy, blood, and fluid of the organ systemically using KM to treat stomatitis and eliminate local ROS accumulation. (2) BMS, glossalgia, and AFP are multifactorial syndromes involving the interaction of biological and psychological factors. Local temperature decrease and edema often occur in chronic pain. These are local circulatory disturbances that can be resolved by improving the flow of blood and fluid. Several KM, such as Tokishakuyakusan and Kamishoyosan (KSS), are effective for enhancing peripheral circulation. Those such as Saikokaryukotuboreito, Yokukansan, KSS, and Saibokutou can reduce stress and associated pain by altering glutamatergic and monoaminergic transmission in the brain. The clinical efficacy of KM for BMS and AFP may depend on the regulation of the mesolimbic dopaminergic and descending glutamatergic pain modulation systems. (3) Regarding oral cancer treatment, I introduce four possible applications of KM, inhibition of the proliferation of cancer cells, complementation of the main cancer therapy, reduction of side effect caused by the main anti-cancer therapy and improvement of quality of life such as the overall status and/or oral discomfort. This review explains in more details Hozai such as Hochuekkito (HET), Juzendaihoto, and Ninjinyoeito (NYT) that are frequently used to improve both immunosuppression and deficiencies of Ki, Ketsu, and Sui in oral cancer patients. (4) Heat- and cold-dryness stages exist in dry mouth and SJS. Byakkokaninjinto is useful for heat-dryness, while NYT, Bakumondoto, and HET have moisturizing effects in the cold-dryness stage. Thus, Kampo therapy is useful for many oral diseases that cannot be cured by western medicine.

Burning mouth syndrome: A review on its diagnostic and therapeutic approach

Burning mouth syndrome (BMS), a chronic and intractable orofacial pain syndrome is characterized by the presence of burning sensation of the oral mucosa in the absence of specific oral lesion. This condition affects chiefly of middle aged and elderly woman with hormonal changes or psychological disorders. In addition to burning sensation, patient with BMS also complains of oral mucosal pain, altered taste sensation, and dry mouth. This condition is probably of multifactorial origin, often idiopathic and its exact etiopathogenesis remains unclear. So far, there is no definitive cure for this condition and most of the treatment approaches, medications remains unsatisfactory. An interdisciplinary and systematic approach is required for better patient management. The purpose of this article is to present a review of epidemiology, clinical presentation, classification, etiopathogenesis, diagnosis and management of BMS.

Antidepressant-induced Burning Mouth Syndrome: A Unique Case

Burning Mouth Syndrome (BMS) is defined as a chronic orofacial pain syndrome, without evidence of mucosal lesions and other clinical signs of disease or laboratory abnormalities. Patients with BMS complain of burning pain in the mouth, xerostomia and taste disturbances. It is more common among women and the median age of occurrence is about 60 years. BMS may be primary or secondary to other diseases. The mainstay in the treatment of BMS includes antidepressants, benzodiazepines, and anticonvulsants. A few cases of BMS caused due to medication have been reported. The causative drugs include angiotensin-converting enzyme inhibitors, anticoagulants, antipsychotics, antiretrovirals, and benzodiazepines. This is a case report of a patient on antidepressants who developed symptoms of BMS thereby causing a dilemma in management.

Evaluation of the response to treatment and clinical evolution in patients with burning mouth syndrome

Objective: the aim of this study is to investigate the clinical evolution, the spontaneous remission of the symptomatology and the response to different treatments in a group of burning mouth syndrome patients. Study Design: the sample was formed by a group of patients that were visited in the Unit of Oral Medicine of the Dentistry Clinic of the University of Barcelona, from the year 2000 to 2011. After revising the clinical records of all the patients that had been under control for a period of time of 18 months or longer, they were contacted by telephone. In the telephone interview, they were questioned about the symptomatology evolution and the response to the treatments received, noting down the data in a questionnaire previously performed. Results: the average duration of the symptoms was 6.5 years (+/-2.5 years). The most frequent treatments were: chlorhexidine mouthrinses, oral benzodiazepines, topical clonazepam, antiinflamatory drugs, antidepressants, antifungicals, vitamins, psycotherapy, salivary substitutes and topical corticoids. The specialists that were consulted with a higher frequency were: dermatologists (30%), othorrynolaringologists (10%) and psychiatrists (3%). In 41 patients the oral symptoms did not improve, 35 reported partial improvements, 12 patients worsened, and only in 3 patients the symptoms remitted. Conclusions: In three of the 91 patients studied the symptoms remitted spontaneously within the five years of treatment. Only 42% of the study population had improved the symptomatology significantly, and this improvement would reach 60% if clonazepam were associated to psychotherapy.

Key words:Burning mouth syndrome, stomatodynia, oral pain, clonazepam.