1
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Farag AM, Kuten-Shorrer M, Natto Z, Ariyawardana A, Mejia LM, Albuquerque R, Carey B, Chmieliauskaite M, Miller CS, Ingram M, Nasri-Heir C, Sardella A, Carlson CR, Klasser GD. WWOM VII: Effectiveness of systemic pharmacotherapeutic interventions in the management of BMS: A systematic review and meta-analysis. Oral Dis 2023; 29:343-368. [PMID: 33713052 DOI: 10.1111/odi.13817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the effectiveness of systemic pharmacotherapeutic interventions compared to placebo in burning mouth syndrome (BMS) randomized controlled trials (RCTs) based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS A systematic literature review of RCTs, concerning systemic pharmacotherapeutic interventions for BMS, published from January 1994 through October 2019, and meta-analysis was performed. RESULTS Fourteen RCTs (n = 734 participants) were included. Of those, nine were eligible for the quantitative assessment due to the availability/homogeneity of data for at least one of the IMMPACT domains. Pain intensity was the only domain reported in all RCTs. Weighted mean changes in pain intensity, based on visual analogue scale (ΔVAS), were reported in three RCTs at 6 ± 2 weeks and only one RCT at 10+ weeks follow-ups. Quantitative assessment, based on ΔVAS, yielded very low evidence for the effectiveness of alpha-lipoic acid and clonazepam, low evidence for effectiveness of trazodone and melatonin, and moderate evidence for herbal compounds. CONCLUSIONS Based on the RCTs studied, variable levels of evidence exist that suggest that select pharmacological interventions are associated with improved symptoms. However, the underreporting of IMMPACT domains in BMS RCTs restricts the multidimensional assessment of systemic interventions outcomes. Standardized outcome measures need to be applied to future RCTs to improve understanding of intervention outcomes.
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Affiliation(s)
- Arwa M Farag
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia.,Division of Oral Medicine, Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA
| | - Michal Kuten-Shorrer
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA.,Department of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Zuhair Natto
- Department of Dental Public Health, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia.,Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,Metro South Oral Health, Brisbane, Australia
| | - Lina M Mejia
- Department of Oral Medicine and Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Rui Albuquerque
- Oral Medicine Department, Guy's and St Thomas Hospital NHS Foundation Trust, King's college London, London, UK
| | - Barbara Carey
- Oral Medicine Department, Guy's and St Thomas Hospital NHS Foundation Trust, King's college London, London, UK
| | - Milda Chmieliauskaite
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Mark Ingram
- Medical Center Library, University of Kentucky Libraries, Lexington, KY, USA
| | - Cibele Nasri-Heir
- Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, The State University of New Jersey, Newark, NJ, USA
| | - Andrea Sardella
- Unit of Oral Medicine, Oral Pathology and Gerodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Charles R Carlson
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Gary D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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2
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Alvarenga-Brant R, Costa FO, Mattos-Pereira G, Esteves-Lima RP, Belém FV, Lai H, Ge L, Gomez RS, Martins CC. Treatments for Burning Mouth Syndrome: A Network Meta-analysis. J Dent Res 2023; 102:135-145. [PMID: 36214096 DOI: 10.1177/00220345221130025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The aim of this systematic review and network meta-analysis (NMA) of randomized controlled trials was to evaluate the effectiveness of treatments for pain relief of burning mouth syndrome (BMS). Five databases and gray literature were searched. Independent reviewers selected studies, extracted data, and assessed the risk of bias. The primary outcome was pain relief or burning sensation, and the secondary outcomes were side effects, quality of life, salivary flow, and TNF-α and interleukin 6 levels. Four comparable interventions were grouped into different network geometries to ensure the transitivity assumption for pain: photobiomodulation therapy, alpha-lipoic acid, phytotherapics, and anxiolytics/antidepressants. Mean difference (MD) and 95% CI were calculated for continuous outcomes. The minimal important difference to consider a therapy beneficial against placebo was an MD of at least -1 for relief of pain. To interpret the results, the GRADE approach for NMA was used with a minimally contextualized framework and the magnitude of the effect. Forty-four trials were included (24 in the NMA). The anxiolytic (clonazepam) probably reduces the pain of BMS when compared with placebo (MD, -1.88; 95% CI, -2.61 to -1.16; moderate certainty). Photobiomodulation therapy (MD, -1.90; 95% CI, -3.58 to -0.21) and pregabalin (MD, -2.40; 95% CI, -3.49 to -1.32) achieved the minimal important difference of a beneficial effect with low or very low certainty. Among all tested treatments, only clonazepam is likely to reduce the pain of BMS when compared with placebo. The majority of the other treatments had low and very low certainty, mainly due to imprecision, indirectness, and intransitivity. More randomized controlled trials comparing treatments against placebo are encouraged to confirm the evidence and test possible alternative treatments (PROSPERO CRD42021255039).
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Affiliation(s)
- R Alvarenga-Brant
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - F O Costa
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G Mattos-Pereira
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - R P Esteves-Lima
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - F V Belém
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - H Lai
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - L Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - R S Gomez
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C C Martins
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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3
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Okayasu I, Mizuki T, Sanuki T, Kurata S, Ayuse T. A pilot study of pain-relieving effect of Goreisan in glossodynia with dry mouth symptoms: an open-label single-group study. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-020-00441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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4
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Ayuse T, Okayasu I, Tachi-Yoshida M, Sato J, Saisu H, Shimada M, Yamazaki Y, Imura H, Hosogaya N, Nakashima S. Examination of pain relief effect of Goreisan for glossodynia. Medicine (Baltimore) 2020; 99:e21536. [PMID: 32872000 PMCID: PMC7437797 DOI: 10.1097/md.0000000000021536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pain in glossodynia may be severe; it may prevent patients from working, interfere with daily life activities, and necessitate a patient's visit to a medical institution for consultation and treatment. The pain may be described as persistent and burning (tingling, tingling) or stinging. Patients may complain of dry mouth (dryness), which is thought to cause inflammation of the tongue and gingival mucous membranes and increased pain. Medications are prescribed based on the symptoms of glossodynia, and the therapeutic effect is confirmed. However, each drug has side effects, for example, pain may reduce, but drowsiness and dizziness may occur; further, there is always a tendency of drowsiness.On the other hand, Goreisan, a Chinese herbal medicine, has already been used by physicians to treat pain in the oral and maxillofacial regions resulting from rapid changes in air pressure. However, the lack of high-quality clinical research has been of concern, and a randomized clinical trial to investigate the efficacy and safety of Goreisan for treatment of pain in glossodynia is warranted. METHODS/DESIGN This multicenter, randomized, controlled study will involve patients treated for glossodynia-related pain. In the experimental group, Goreisan will be taken for 12 weeks in combination with conventional treatment. Participants in the control group will not take any Kampo medicine; only the standard treatment will be taken. Subsequently, the degree of pain will be assessed, and saliva tests of all the patients on their first visit will be performed. Goreisan will be taken at a dose of 7.5 g/d (minute 3) for 12 consecutive weeks. Twelve weeks later, the degree of pain of each patient will be assessed. DISCUSSION The purpose of this study is to investigate the efficacy of Goreisan for pain reduction in patients undergoing treatment for glossodynia-related pain. If pain in glossodynia patients can be reduced by the administration of Goreisan, its candidacy as an alternative treatment for pain in glossodynia can be further supported by more reliable research. TRIAL REGISTRATION The study was registered in the jRCTs071200017. URL https://jrct.niph.go.jp/latest-detail/jRCTs071200017.
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Affiliation(s)
- Takao Ayuse
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Ichiro Okayasu
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Jun Sato
- Aichi Medical University, Nagoya
| | | | - Masahiko Shimada
- Orofacial Pain Clinic, Tokyo Medical and Dental University Dental Hospital, Tokyo
| | - Yoko Yamazaki
- Orofacial Pain Clinic, Tokyo Medical and Dental University Dental Hospital, Tokyo
| | - Hiroko Imura
- Orofacial Pain Clinic, Tokyo Medical and Dental University Dental Hospital, Tokyo
| | - Naoki Hosogaya
- Nagasaki University Hospital, Clinical Research Center, Nagasaki, Japan
| | - Sawako Nakashima
- Nagasaki University Hospital, Clinical Research Center, Nagasaki, Japan
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5
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Takayama S, Tomita N, Arita R, Ono R, Kikuchi A, Ishii T. Kampo Medicine for Various Aging-Related Symptoms: A Review of Geriatric Syndrome. Front Nutr 2020; 7:86. [PMID: 32766269 PMCID: PMC7381143 DOI: 10.3389/fnut.2020.00086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
With the continued growth of the aging population in Japan, geriatric syndrome (GS), which is associated with aging-related symptoms, has become a social problem. GS is caused by physiological and pathological aging and may manifest various symptoms. Physicians use multidisciplinary approaches to provide treatment for individual GS symptoms. Kampo medicine, a Japanese traditional medicine that uses multiple pharmacologically active substances, is useful for many syndromes, conditions, disorders, and diseases associated with GS. Evidence of the effectiveness of Kampo medicine for GS has accumulated in recent years. The effects of Kampo treatment for symptoms related to functional decline of the cardiovascular, respiratory, and digestive systems, cognitive impairment and related disorders, pain and other sensory issues, among others, support the use of Kampo medicine for the management of GS. The role of Kampo medicine for GS is summarized in this review.
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Affiliation(s)
- Shin Takayama
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Naoki Tomita
- Department of Geriatrics and Gerontology, Institue of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryutaro Arita
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Rie Ono
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Akiko Kikuchi
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
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6
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Abstract
Kampo, a branch of traditional Japanese herbal medicine, has been the backbone of Japanese medicine for more than 1500 years. The health insurance system in Japan allows patients to access both Western and Kampo medical care at the same time in the same medical institution. Kampo has been used for the treatment of not only acute but also chronic pain in Japan. In this review, we will elaborate on the short history of Kampo, its basic concepts, and use for the treatment of pain.
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7
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Farag AM, Albuquerque R, Ariyawardana A, Chmieliauskaite M, Forssell H, Nasri‐Heir C, Klasser GD, Sardella A, Mignogna MD, Ingram M, Carlson CR, Miller CS. World Workshop in Oral Medicine VII: Reporting of IMMPACT‐recommended outcome domains in randomized controlled trials of burning mouth syndrome: A systematic review. Oral Dis 2019; 25 Suppl 1:122-140. [DOI: 10.1111/odi.13053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Arwa M. Farag
- Department of Oral Diagnostic Sciences, Faculty of Dentistry King AbdulAziz University Jeddah Saudi Arabia
- Division of Oral Medicine, Department of Diagnostic Sciences Tufts School of Dental Medicine Boston Massachusetts
| | - Rui Albuquerque
- Oral Medicine Department Guy’s and St. Thomas Hospital NHS Foundation Trust, King’s College London London UK
| | - Anura Ariyawardana
- College of Medicine and Dentistry James Cook University Brisbane Queensland Australia
- Clinical Principal Dentist Metro South Oral Health Brisbane Queensland Australia
| | - Milda Chmieliauskaite
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine Case Western Reserve University Cleveland Ohio
| | - Heli Forssell
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry University of Turku Turku Finland
| | - Cibele Nasri‐Heir
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine The State University of New Jersey Newark New Jersey
| | - Gary D. Klasser
- Department of Diagnostic Sciences, School of Dentistry Louisiana State University Health Sciences Center New Orleans, Los Angeles
| | - Andrea Sardella
- Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Medicine, Oral Pathology and Gerodontology University of Milan Milano Italy
| | - Michele D. Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine Federico II University of Naples Naples Italy
| | - Mark Ingram
- Medical Center Library, College of Communication and Information University of Kentucky Lexington Kentucky
| | - Charles R. Carlson
- Orofacial Pain Clinic, College of Dentistry University of Kentucky Lexington Kentucky
| | - Craig S. Miller
- Department of Oral Health Practice, College of Dentistry University of Kentucky Lexington Kentucky
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8
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Ariyawardana A, Chmieliauskaite M, Farag AM, Albuquerque R, Forssell H, Nasri‐Heir C, Klasser GD, Sardella A, Mignogna MD, Ingram M, Carlson CR, Miller CS. World Workshop on Oral Medicine VII: Burning mouth syndrome: A systematic review of disease definitions and diagnostic criteria utilized in randomized clinical trials. Oral Dis 2019; 25 Suppl 1:141-156. [DOI: 10.1111/odi.13067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Anura Ariyawardana
- College of Medicine and DentistryJames Cook University Queensland Australia
- Clinical Principal DentistMetro South Oral Health Brisbane Queensland Australia
| | - Milda Chmieliauskaite
- Department of Oral and Maxillofacial Medicine and Diagnostic SciencesSchool of Dental MedicineCase Western Reserve University Cleveland Ohio
| | - Arwa M. Farag
- Department of Oral Diagnostic SciencesFaculty of DentistryKing AbdulAziz University Jeddah Saudi Arabia
- Division of Oral MedicineDepartment of Diagnostic SciencesTufts School of Dental Medicine Boston Massachusetts
| | - Rui Albuquerque
- Oral Medicine DepartmentGuy's and St Thomas Hospital NHS Foundation TrustKing's college London London UK
| | - Heli Forssell
- Department of Oral and Maxillofacial SurgeryInstitute of DentistryUniversity of Turku Turku Finland
| | - Cibele Nasri‐Heir
- Department of Diagnostic SciencesRutgers School of Dental MedicineCenter for Temporomandibular Disorders and Orofacial PainRutgers The State University of New Jersey Newark New Jersy
| | - Gary D. Klasser
- Department of Diagnostic SciencesSchool of DentistryLouisiana State University Health Sciences Center New Orleans Louisiana
| | - Andrea Sardella
- Department of Biomedical, Surgical and Dental SciencesUnit of Oral Medicine, Oral Pathology and GerodontologyUniversity of Milan Milano Italy
| | - Michele D. Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological SciencesSchool of MedicineFederico II University of Naples Naples Italy
| | - Mark Ingram
- Medical Center LibraryUniversity of Kentucky Lexington Kentucky
| | - Charles R. Carlson
- Department of PsychologyCollege of Art & SciencesCollege of DentistryOrofacial Pain ClinicUniversity of Kentucky Lexington Kentucky
| | - Craig S. Miller
- Department of Oral Health PracticeCollege of DentistryUniversity of Kentucky Lexington Kentucky
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9
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What still remains missing from participants' selection criteria in clinical trials and systematic reviews? J Am Dent Assoc 2019; 149:931-934. [PMID: 30724166 DOI: 10.1016/j.adaj.2018.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023]
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10
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McMillan R, Forssell H, Buchanan JAG, Glenny A, Weldon JC, Zakrzewska JM. Interventions for treating burning mouth syndrome. Cochrane Database Syst Rev 2016; 11:CD002779. [PMID: 27855478 PMCID: PMC6464255 DOI: 10.1002/14651858.cd002779.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Burning mouth syndrome (BMS) is a term used for oral mucosal pain (burning pain or discomfort in the tongue, lips or entire oral cavity) without identifiable cause. General population prevalence varies from 0.1% to 3.9%. Many BMS patients indicate anxiety, depression, personality disorders and impaired quality of life (QoL). This review updates the previous versions published in 2000 and 2005. OBJECTIVES To determine the effectiveness and safety of any intervention versus placebo for symptom relief and changes in QoL, taste, and feeling of dryness in people with BMS. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11) in the Cochrane Library (searched 31 December 2015), MEDLINE Ovid (1946 to 31 December 2015), and Embase Ovid (1980 to 31 December 2015). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any treatment against placebo in people with BMS. The primary outcomes were symptom relief (pain/burning) and change in QoL. Secondary outcomes included change in taste, feeling of dryness, and adverse effects. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcome data were analysed as short-term (up to three months) or long-term (three to six months). MAIN RESULTS We included 23 RCTs (1121 analysed participants; 83% female). Interventions were categorised as: antidepressants and antipsychotics, anticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies, and topical treatments.Only one RCT was assessed at low risk of bias overall, four RCTs' risk of bias was unclear, and 18 studies were at high risk of bias. Overall quality of the evidence for effectiveness was very low for all interventions and all outcomes.Twenty-one RCTs assessed short-term symptom relief. There is very low-quality evidence of benefit from electromagnetic radiation (one RCT, 58 participants), topical benzodiazepines (two RCTs, 111 participants), physical barriers (one RCT, 50 participants), and anticonvulsants (one RCT, 100 participants). We found insufficient/contradictory evidence regarding the effectiveness of antidepressants, cholinergics, systemic benzodiazepines, dietary supplements or topical treatments. No RCT assessing psychological therapies evaluated short-term symptom relief.Four studies assessed long-term symptom relief. There is very low-quality evidence of a benefit from psychological therapies (one RCT, 30 participants), capsaicin oral rinse (topical treatment) (one RCT, 18 participants), and topical benzodiazepines (one RCT, 66 participants). We found no evidence of a difference for dietary supplements or lactoperoxidase oral rinse. No studies assessing antidepressants, anticonvulsants, cholinergics, electromagnetic radiation or physical barriers evaluated long-term symptom relief.Short-term change in QoL was assessed by seven studies (none long-term).The quality of evidence was very low. A benefit was found for electromagnetic radiation (one RCT, 58 participants), however findings were inconclusive for antidepressants, benzodiazepines, dietary supplements and physical barriers.Secondary outcomes (change in taste and feeling of dryness) were only assessed short-term, and the findings for both were also inconclusive.With regard to adverse effects, there is very low-quality evidence that antidepressants increase dizziness and drowsiness (one RCT, 37 participants), and that alpha lipoic acid increased headache (two RCTs, 118 participants) and gastrointestinal complaints (3 RCTs, 138 participants). We found insufficient/contradictory evidence regarding adverse events for anticonvulsants or benzodiazepines. Adverse events were poorly reported or unreported for cholinergics, electromagnetic radiation, and psychological therapies. No adverse events occurred from physical barriers or topical therapy use. AUTHORS' CONCLUSIONS Given BMS' potentially disabling nature, the need to identify effective modes of treatment for sufferers is vital. Due to the limited number of clinical trials at low risk of bias, there is insufficient evidence to support or refute the use of any interventions in managing BMS. Further clinical trials, with improved methodology and standardised outcome sets are required in order to establish which treatments are effective. Future studies are encouraged to assess the role of treatments used in other neuropathic pain conditions and psychological therapies in the treatment of BMS.
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Affiliation(s)
- Roddy McMillan
- Eastman Dental HospitalDepartment of Oral Medicine and Facial Pain256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Heli Forssell
- University of TurkuOral & Maxillofacial Surgery, Institute of DentistryLemminkäisenkatu 220520TurkuFinland
| | - John AG Buchanan
- Barts and The London School of Medicine and DentistryDepartment of Oral MedicineTurner StreetLondonUKE1 2AD
| | - Anne‐Marie Glenny
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Weldon
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Joanna M Zakrzewska
- Eastman Dental HospitalDepartment of Oral Medicine and Facial Pain256 Gray's Inn RoadLondonUKWC1X 8LD
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11
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Yamaguchi K. Traditional Japanese herbal medicines for treatment of odontopathy. Front Pharmacol 2015; 6:176. [PMID: 26379550 PMCID: PMC4551818 DOI: 10.3389/fphar.2015.00176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/05/2015] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Kojiro Yamaguchi
- *Correspondence: Kojiro Yamaguchi, Oral and Maxillofacial Surgery, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
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12
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13
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Abstract
BACKGROUND The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort. DATA COLLECTION AND ANALYSIS Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate. MAIN RESULTS Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. AUTHORS' CONCLUSIONS Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.
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Affiliation(s)
- J M Zakrzewska
- Oral Medicine, St Bartholomew's and the Royal London, Queen Mary's School of Medicine and Dentistry, Turner Street, London, UK, E1 2AD.
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Nakase M, Okumura K, Tamura T, Kamei T, Kada K, Nakamura S, Inui M, Tagawa T. Effects of near-infrared irradiation to stellate ganglion in glossodynia. Oral Dis 2004; 10:217-20. [PMID: 15196143 DOI: 10.1111/j.1601-0825.2004.01001.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was designed to assess the effect of stellate ganglion near-infrared irradiation (SGR) on glossodynia and the mechanism of action. STUDY DESIGN Thirty-seven patients with glossodynia received SGR once weekly for 4 weeks. The response to treatment was evaluated on the basis of the change in pain intensity, assessed with a visual analogue scale (VAS) before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight healthy subjects were studied. RESULTS Tongue pain as assessed by the VAS decreased in 28 of the 37 patients (75.7%). Mean pain intensity decreased significantly from 5.1 +/- 2.2 to 1.9 +/- 2.1 (P < 0.05). Tongue blood flow at rest in the patients with glossodynia [7.2 +/- 1.6 ml min(-1) (100 g)(-1)] was significantly lower than that in the healthy subjects [7.8 +/- 0.23 ml min(-1) (100 g)(-1)]. Five minutes after SGR, the temperature of the tongue rose 1.5 +/- 0.21 degrees C, and blood flow increased to 8.5 +/- 1.2 ml min(-1) (100 g)(-1). Tongue blood flow (at rest) after 4 weeks of SGR had increased to 7.7 +/- 1.1 ml min(-1) (100 g)(-1). CONCLUSION SGR is an effective treatment for glossodynia. The mechanism by which SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associated with glossodynia. This is followed by normalization of decreased tongue blood flow, thereby alleviating pain.
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Affiliation(s)
- M Nakase
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Mie University, Tsu, Japan.
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15
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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: 321] [Impact Index Per Article: 15.3] [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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Abstract
BACKGROUND The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY Electronic databases (The Cochrane Library, the Cochrane Oral Health Group's Specialised Register, MEDLINE, EMBASE), Clinical Evidence Issue No. 3, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort DATA COLLECTION AND ANALYSIS Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop-outs. Due to differences in patient type, treatment and outcome measures, statistical pooling of the data was inappropriate. MAIN RESULTS Six trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial) and vitamin complexes (one trial). The participants included in the six identified trials reported suffering from BMS from six months to 20 years. Diagnostic criteria were not always clearly reported. Out of the six trials included in the review, only two interventions demonstrated a reduction in BMS symptoms; vitamin complexes and cognitive behavioural therapy. Neither of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. REVIEWER'S CONCLUSIONS Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.
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Affiliation(s)
- J M Zakrzewska
- Oral Medicine, St Bartholomew's and the Royal London, Turner Street, London, UK, E1 2AD
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