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Affiliation(s)
- Kiran Beneng
- Consultant Oral Surgeon, Department of Oral Surgery, Guy's and St Thomas' Trust, Tooley Street, London SE1 9RT, UK
| | - Tara Renton
- Professor of Oral Surgery, King's College London Dental Institute, King's College Hospital London, Bessemer Road, London SE5 9RS, UK
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Abstract
The aetiology of BMS remains an enigma, however novel evidence suggests a neuropathic basis, which may explain concomitant vulvodynia in some patients.The constant high level spontaneous chronic pain in BMS has significant functional and psychological repercussions for these patients.Cognitive behavioural therapy remains the sole evidence based management of this condition, whilst some patients respond to treatment with Tricyclic antidepressants, SSRIs or SNRIs, compliance with medication remains an issue due to pharma side effects.Increasing evidence suggests that there may be 3 subgroups that should be managed differently.
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Affiliation(s)
- Tara Renton
- Professor in Oral Surgery, Kings College Dental Institute, Kings College Hospital, London SE5 9RS
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Cho GS, Han MW, Lee B, Roh JL, Choi SH, Cho KJ, Nam SY, Kim SY. Zinc deficiency may be a cause of burning mouth syndrome as zinc replacement therapy has therapeutic effects. J Oral Pathol Med 2010; 39:722-7. [DOI: 10.1111/j.1600-0714.2010.00914.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eliav E, Kamran B, Schaham R, Czerninski R, Gracely RH, Benoliel R. Evidence of chorda tympani dysfunction in patients with burning mouth syndrome. J Am Dent Assoc 2007; 138:628-33. [PMID: 17473041 DOI: 10.14219/jada.archive.2007.0234] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND More than two-thirds of patients with burning mouth syndrome (BMS) have altered taste sensation. The authors conducted a study to assess chorda tympani and trigeminal nerve function in these patients. METHODS The study was composed of 48 patients; 22 were diagnosed as having BMS, 14 had burning symptoms related to other diseases and were diagnosed as having secondary burning mouth syndrome (SBMS), and 12 were healthy volunteers. The authors evaluated the electrical detection thresholds of the infraorbital and mental nerves and the electrical taste and electrical detection/tingling thresholds in the anterior two-thirds of the tongue for all patients. Electrical taste threshold is thought to be dictated by chorda tympani nerve function while electrical detection/tingling thresholds are regulated by trigeminal nerve function. RESULTS The mean electrical taste/tingling detection thresholds ratio and the taste detection thresholds were significantly higher in patients with BMS than in patients with SBMS and in control subjects, indicating chorda tympani nerve dysfunction. Eighteen (82 percent) of the 22 patients with BMS demonstrated chorda tympani dysfunction (13 unilateral and five bilateral). CONCLUSIONS Chorda tympani hypofunction may play an important role in BMS pathology. Unilateral hypofunction may be sufficient to produce generalized burning sensation exceeding the affected nerve area. CLINICAL IMPLICATIONS Elevated taste detection threshold levels determined via electrogustatory testing and an elevated taste/tingling detection thresholds ratio may assist clinicians in the diagnosis of BMS. More studies are needed to validate these findings.
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Affiliation(s)
- Eli Eliav
- Department of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
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Maltsman-Tseikhin A, Moricca P, Niv D. Burning Mouth Syndrome: Will Better Understanding Yield Better Management? Pain Pract 2007; 7:151-62. [PMID: 17559486 DOI: 10.1111/j.1533-2500.2007.00124.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
"Burning mouth syndrome" (BMS) refers to a chronic orofacial pain disorder usually unaccompanied by mucosal lesions or other clinical signs of organic disease. BMS is typically characterized by a continuous, spontaneous, and often intense burning sensation as if the mouth or tongue were scalded or on fire. Burning mouth syndrome is a relatively common condition. The estimated prevalence of BMS reported in recent studies ranges between 0.7 and 4.6% of the general population. About 1.3 million American adults, mostly women in the postmenopausal period, are afflicted with BMS. The etiology of this disorder is poorly understood even though new evidence for a possible neuropathic pathogenesis of idiopathic BMS is emerging. Burning mouth syndrome may present as an idiopathic condition (primary BMS type) distinct from the symptom of oral burning that can potentially arise from various local or systemic abnormalities (secondary BMS type), including nutritional deficiencies, hormonal changes associated with menopause, local oral infections, denture-related lesions, xerostomia, hypersensitivity reactions, medications, and systemic diseases including diabetes mellitus. In more than a third of patients, multiple, concurrent causes of BMS may be identified. It is important to note that the diagnosis of BMS should be established only after all other possible causes have been ruled out. Professional delay in diagnosing, referring, and appropriately managing of BMS patients occurs frequently. Treatment should be tailored to each patient and it is recommended to practice the treatment in a multidisciplinary facility. This article discusses our current understanding of the etiology and pathogenesis of BMS. The authors have tried to emphasize new pharmacological approaches to manage this challenging disorder.
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Affiliation(s)
- Alexander Maltsman-Tseikhin
- Center for Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Scala A, Checchi L, Montevecchi M, Marini I, Giamberardino MA. Update on burning mouth syndrome: overview and patient management. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:275-91. [PMID: 12907696 DOI: 10.1177/154411130301400405] [Citation(s) in RCA: 324] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting muco-sal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.
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Affiliation(s)
- A Scala
- Department of Oral Surgery, School of Dentistry, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy.
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Bessho K, Okubo Y, Hori S, Murakami K, Iizuka T. Effectiveness of kampo medicine (sai-boku-to) in treatment of patients with glossodynia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:682-6. [PMID: 9868725 DOI: 10.1016/s1079-2104(98)90204-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of a Kampo medicine (Sai-boku-to) for treatment of patients with glossodynia. STUDY DESIGN Sai-boku-to or an antianxiety drug (diazepam) with vitamin B complex was administered orally for 3 months to each of 200 patients with glossodynia. Clinical examination evaluated the following subjective symptoms: pain, burning sensation, and discomfort. Effectiveness was evaluated as follows: "markedly effective," all 3 symptoms disappeared; "effective," pain improved; "ineffective," no improvement in pain. RESULTS The effective rates were 70% after 1 month, 85% after 2 months, and 92% after 3 months of administration of Sai-boku-to (the Kampo group) and 74% after 1 month, 71% after 2 months, and 69% after 3 months of administration of the antianxiety drug with vitamin B complex (the control group). No significant side effect was noted in the Kampo group, but sleepiness was recorded in 33 cases in the control group. CONCLUSIONS The results indicate that Sai-boku-to may be a clinically useful medicine for the long-term treatment of patients with glossodynia.
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Affiliation(s)
- K Bessho
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Japan
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Abstract
STATEMENT OF PROBLEM Dental practitioners occasionally have patients present clinically with a history of chief complaint of burning and painful sensations in the oral cavity. Often the patient demonstrates clinically normal mucosa, which can make formulating a diagnosis challenging. This scenario, has been referred to as burning mouth syndrome, a multifactorial syndrome. PURPOSE The purpose of this article is to present a review of etiologic factors and clinical implications related to the condition of burning mouth syndrome.
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Affiliation(s)
- R M Cibirka
- Department of Oral Rehabilitation, School of Dentistry, Medical College of Georgia, Augusta, USA
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Lamey PJ, Hobson RS, Orchardson R. Perception of stimulus size in patients with burning mouth syndrome. J Oral Pathol Med 1996; 25:420-3. [PMID: 8930819 DOI: 10.1111/j.1600-0714.1996.tb00290.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twenty subjects with burning mouth syndrome (BMS) and 20 control subjects were tested for oral size perception. Blindfolded subjects assessed the size of holes (2.38-12.70 mm diameter) presented to the tongue, using their fingers to select a matching hole from a comparator series of 31 holes (0.76-15.87 mm diameter) using first static then phasic touch. Both groups overestimated the size of the holes less than 10 mm in diameter but no systematic disparity was evident with holes greater than 10 mm in diameter. The relationship between the stimulus size and the illusion (expressed as the ratio of apparent size to real size) was hyperbolic, with the illusion tending towards unity for holes greater than 10 mm. No differences were found in object size perception amongst patients with BMS or control subjects. It is therefore unlikely that altered oral size perception is a precipitating factor or accompanying feature in patients with BMS.
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Abstract
Burning mouth syndrome is a common condition particularly affecting elderly women. Numerous precipitating factors are recognized that lead to a burning sensation in clinically normal mucosa. By taking each precipitating factor into account, a favorable treatment outcome usually can be achieved. This article highlights the significance of precipitating factors in burning mouth syndrome and suggests a treatment protocol based on current scientific evidence.
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Affiliation(s)
- P J Lamey
- Department of Oral Medicine, School of Clinical Dentistry, Queen's University of Belfast, Northern Ireland
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Bergdahl J, Anneroth G, Perris H. Personality characteristics of patients with resistant burning mouth syndrome. Acta Odontol Scand 1995; 53:7-11. [PMID: 7740935 DOI: 10.3109/00016359509005936] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The personality characteristics in 32 patients with resistant burning mouth syndrome (BMS) after treatment of diagnosed medical and odontologic diseases were examined and compared with a sex- and age-matched control group. After evaluation of burning mouth symptoms, the personality, the psychologic functioning, and the quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). The result showed that, compared with a control group, the patients with resistant BMS had a significantly lower score in socialization scale and significantly higher scores in somatic anxiety, muscular tension, and psychasthenia scales. Furthermore, the patients with resistant BMS were significantly more easily fatigued and more sensitive and showed a tendency to be more concerned about their health. With regard to the psychologic functioning, the BMS patients had significantly more problems taking the initiative, more easily became dizzy, and had more sad thoughts. They also showed a tendency to report palpitations and/or indigestions more often. The observed significant differences in personality and psychologic functioning might suggest that the burning sensations are psychosomatic symptoms in these patients. We recommend that patients with resistant BMS should undergo psychologic investigation. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered.
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Affiliation(s)
- J Bergdahl
- Department of Oral Pathology, Umeå University, Sweden
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Bergdahl BJ, Anneroth G, Anneroth I. Clinical study of patients with burning mouth. SCANDINAVIAN JOURNAL OF DENTAL RESEARCH 1994; 102:299-305. [PMID: 7817155 DOI: 10.1111/j.1600-0722.1994.tb01473.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Analysis and treatment of dental and medical factors that can cause burning mouth were performed in 25 consecutive patients according to a treatment protocol. The effect of the dental and medical treatment on the burning mouth was evaluated. The sick leave profile was presented. Apart from burning mouth symptoms, the patients reported several oral and general symptoms, such as gustatory changes, xerostomia, back and joint muscle pain, headache, and dizziness. The most common dental diagnoses were temporomandibular joint, masticatory, and tongue muscle dysfunction and lesions in the oral mucosa. The most common medical diagnoses were low serum iron and hypersensitive reaction to mercury. None of the patients tested exceeded the limit of 100 nmol Hg/l urine. Replacement of amalgam fillings was the most common dental therapy, followed by treatment of dysfunction in the masticatory system. Iron replacement was the most frequent medical treatment. The patients had over 50% more days per year sick leave than an age- and sex-matched normal population. A follow-up found that the burning mouth had disappeared in 32% of the patients. This study confirms the opinion that burning mouth is multicausal. Hypersensitive reaction to mercury was more frequent than expected, but replacement of amalgam fillings relieved burning mouth in only two of five such patients, and one of these two patients had hypersensitive reactions to both mercury and gold. One reason that so many patients continued to have burning mouth might have been neglect of dental, medical, or both diagnoses. Another reason might be that assessment of the psychologic status of the patients and psychologic treatment when indicated were not done.
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Affiliation(s)
- B J Bergdahl
- Department of Oral Pathology, Umeå University, Sweden
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Bergdahl J, Anneroth G. Burning mouth syndrome: literature review and model for research and management. J Oral Pathol Med 1993; 22:433-8. [PMID: 8126660 DOI: 10.1111/j.1600-0714.1993.tb00120.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The literature on burning mouth syndrome (BMS) is reviewed with particular reference to its prevalence, local and systemic etiologic factors, psychogenic background and treatment. Research requirements are discussed, which focus on different clinical and psychological parameters and the necessity to evaluate BMS. Finally, a treatment protocol including oral, medical and psychological investigations is presented.
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Affiliation(s)
- J Bergdahl
- Department of Oral Pathology, University of Umeå, Sweden
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