The atrophic oral mucosa: the dry burning feeling

The burning mouth syndrome: lack of a role for contact urticaria and contact dermatitis

BACKGROUND

The burning mouth syndrome is poorly understood and mainly affects postmenopausal women. Dental allergens have seldom explained the burning.

OBJECTIVE

Eight patients (seven women, one man) (mean age 62.5 years) who wore dentures and had the burning mouth syndrome were investigated to determine whether contact urticaria, allergic contact dermatitis, or pressure urticaria played a role. Only patients who had minimal to no erythema of the mucosa were included.

METHODS

A complete blood cell count, fasting chemistry profile, and potassium hydroxide examination and cultures for Candida and dermatophytes were obtained. Contact urticaria and patch testing with control substances were performed with a panel of 25 potential denture allergens.

RESULTS

Complete blood cell counts and fasting chemistry profiles were normal. One positive Candida culture was found, but no improvement in the symptoms was noted after treatment. All patients tested positive to histamine and to at least two of the nonimmunologic urticaria controls. No patient had a positive urticarial reaction to the potential dental allergens. Two patients with nonimmunologic urticaria to cinnamic aldehyde improved with avoidance. All patch tests were negative. In the six patients tested for pressure urticaria, the results were negative.

CONCLUSION

We cannot indict contact dermatitis, contact urticaria, or pressure urticaria as a cause of the burning mouth syndrome in the denture-wearing patient who has a normal-appearing mucosa. The burning symptoms in this syndrome may be secondary to a simple frictional phenomenon of the denture on the mucosa.

Vitamin B status and response to replacement therapy in patients with burning mouth syndrome

The aim of the study was to determine, in a group of patients with therapy-resistant burning mouth syndrome (BMS), the possible deficiency of vitamins B1, B2, and B6 and the effect of proper vitamin replacement therapy. Sixteen individuals, aged 47 to 81 years, participated in the study. All underwent a base-line examination comprising anamnestic information, subjective assessment of symptoms, dietary registration, salivary analysis, and serum analysis of thiamine (B1), riboflavine (B2), and pyridoxine (B6). Fifteen individuals had low thiamine and/or riboflavine levels in accordance with suggested levels in the literature and were given replacement therapy. No effect on BMS of vitamin replacement therapy or placebo therapy could be demonstrated.

The association between burning mouth syndrome and psychosocial disorders

Twenty-five patients with a diagnosis of nonorganic burning mouth syndrome were matched for age and sex with twenty-five patients with organically based painful disorders of the mouth. All patients were interviewed by a psychiatrist and completed the General Health Questionnaire to screen for psychiatric disorders. A diagnosis of psychiatric disorder based on clinical examination findings was made in 44% (11/25) of the patients with burning mouth syndrome and in 16% (4/25) of the controls.

Age-related changes in the epithelial dimensions and capillaries of the oral mucosa of the rat

Seven homologous regions of the oral mucosa were compared in rats 6, 18 and 30 months of age. Capillaries were visualized by their alkaline-phosphatase activity revealed by an azo-dye. Measurements on tracings of densely-spaced histological sections in two planes perpendicular to the epithelial surface showed epithelial thickness in masticatory mucosa decreased by 18 months, but increased by 30 months. In regions of lining mucosa, thickness increased by 18 months, but decreased by up to 13 per cent at 30 months. The size of the capillary bed increased substantially by 18 months and further increased by 30 months. Variability in the epithelial dimensions increased up to 18 months but not beyond; variability in the capillary measurements showed no change with age. The quantitative relationship between epithelial thickness and the size of the epithelial-connective tissue interface and the capillary bed remained unchanged with age.