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Gonçalves DR, Botelho LM, Carrard VC, Martins MAT, Visioli F. Amitriptyline effectiveness in burning mouth syndrome: An in-depth case series analysis. Gerodontology 2024. [PMID: 38515010 DOI: 10.1111/ger.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Douglas Rodrigues Gonçalves
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo Monteiro Botelho
- Pain Management and Palliative Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinícius Coelho Carrard
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Antônio Trevizani Martins
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Visioli
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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2
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Le KDT, DosSantos MF, Gazerani P. Is Burning Mouth Syndrome Associated with Extraoral Dryness? A Systematic Review. J Clin Med 2023; 12:6525. [PMID: 37892662 PMCID: PMC10607144 DOI: 10.3390/jcm12206525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Burning mouth syndrome (BMS) is characterized by a persistent intraoral burning sensation, often experienced by postmenopausal women. The etiology of BMS remains partially understood, and consequently, treatments remain suboptimal. Extraoral manifestations of BMS, such as extraoral dryness, are less studied. However, it has been suggested that the identification of the frequency and patterns of extraoral dryness and potential underlying mechanisms are essential to optimize treatment strategies and reduce the burden of disease. Therefore, we conducted this systematic review to provide existing evidence about extraoral dryness in BMS. The guidelines for the conduction and reporting of systematic reviews were followed. An electronic search was conducted in four major databases-PubMed, Web of Science, COCHRANE Library, and EBSCOhost-and the grey literature was assessed through Google Scholar. From each included article, information on extraoral dryness in BMS was extracted, and odds ratios were calculated for extraoral dryness among BMS patients compared with non-BMS controls. The findings demonstrated higher odds of the prevalence of extraoral dryness in BMS, which was found to a high degree in the lips, eyes, skin, and genitalia. The pattern of spread and locations of extraoral dryness propose a potential central mechanism. Based on our findings, we encourage the standardization of the assessment, recording, and reporting of the extraoral characteristics of BMS, including extraoral dryness, which can lead to better management strategies and enhance the quality of life of the affected patients.
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Affiliation(s)
- Kim Devon Terga Le
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Marcos Fabio DosSantos
- Laboratório de Propriedades Mecânicas e Biologia Celular (PropBio), Departamento de Prótese e Materiai Dentários, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, RJ, Brazil
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, RJ, Brazil
- Programa de Pós-Graduação em Neurociência Translacional, Instituto Nacional de Neurociência Translacional (INNT-UFRJ), Rio de Janeiro 21941-590, RJ, Brazil
- Programa de Pós-Graduação em Odontologia (PPGO), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, RJ, Brazil
| | - Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
- Centre for Intelligent Musculoskeletal Health (CIM), Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9260 Gistrup, Denmark
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3
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Kim MJ, Choi JH, Kho HS. In Reply. Int J Oral Maxillofac Surg 2023; 52:1014-1015. [PMID: 36737353 DOI: 10.1016/j.ijom.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Affiliation(s)
- M-J Kim
- Department of Oral Medicine, Seoul National University Gwanak Dental Hospital, Seoul, South Korea
| | - J-H Choi
- Department of Dental Hygiene, Yonsei University Graduate School, Seoul, South Korea
| | - H-S Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea; Institute on Aging, Seoul National University, Seoul, South Korea.
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4
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Karamat A, Smith JG, Melek LNF, Renton T. Psychologic Impact of Chronic Orofacial Pain: A Critical Review. J Oral Facial Pain Headache 2022; 36:103-140. [PMID: 35943323 PMCID: PMC10586586 DOI: 10.11607/ofph.3010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2023]
Abstract
AIMS To explore the prevalence of clinically significant anxiety and depression in adult patients with chronic orofacial pain (COFP) conditions. METHODS A systematic online search of the Medline (PubMed) and Ovid databases was performed for articles published from 2006 to 2019. Observational studies- including cross-sectional, case-control, and case series-and longitudinal prospective studies were included. A total of 118 articles were selected for inclusion, and the prevalence rates of clinically significant anxiety and depression were summarized. RESULTS Most studies focused on temporomandibular disorder (TMD) pain and less often on neuropathic COFP conditions. Prevalence rates varied widely across studies according to OFP condition and assessment measure; most questionnaire-based assessments yielded rates of clinically significant depression and anxiety in, respectively, 40% to 60% and 40% to 65% of individuals with TMD and in 20% to 50% and 25% to 55% of patients with neuropathic, mixed, or idiopathic/atypical COFP conditions. Rates of anxiety and depression were lower in studies using diagnostic instruments and in TMD studies with nonpatient samples. Most controlled studies showed a higher prevalence of anxiety and depression in individuals with COFP than in those without. Higher COFP pain levels and the presence of comorbid conditions such as migraines or widespread pain increased the likelihood of anxiety and/or depressive symptoms in individuals. CONCLUSION Clinically significant anxiety and depression were commonly observed in patients with COFP, were present at higher rates than in pain-free participants in controlled studies, and were closely linked to pain severity. More research is needed to evaluate the psychologic impact of multiple COFP conditions in an individual and the prevalence of precondition psychologic morbidity.
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Aitken-Saavedra J, Tarquinio SBC, da Rosa WLDO, Gomes APN, da Silva AF, Fernandez MDS, Moreira AG, Maturana-Ramirez A, Vasconcellos ACU. Salivary characteristics may be associated with burning mouth syndrome? J Clin Exp Dent 2021; 13:e542-e548. [PMID: 34188758 PMCID: PMC8223150 DOI: 10.4317/jced.58033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background Burning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesis of this condition. This case-control study aimed to trace the salivary profile of women with burning mouth syndrome (BMS).
Material and Methods 40 women with BMS and 40 control women were recruited. Unstimulated salivary flow rate (uSFR), pH, salivary cortisol levels, salivary viscosity, and oral health impact profile (OHIP-14 questioner) were determined. P< 0.05 was considered statistically significant.
Results For uSFR, mean values obtained for BMS and for control group respectively were 0.35 and 0.61 mL/min; for pH, 7.23 and 7.34; for cortisol levels, 0.36 and 0.15 μg/dL; for viscosity values, 31.1 and 45.01 mPas and for OHIP-14 scores, 21.7 and 5.7. To uSFR, cortisol levels, viscosity values and OHIP-14 scores, differences were statistically significant. Salivary cortisol levels and OHIP-14 scores were correlated positively (rho = 0.624; p< 0.05).
Conclusions BMS women have lower uSFR and salivary viscosity and higher salivary cortisol levels that were associated with worse quality of life, compared with the control group. Key words:Xerostomia, Burning mouth syndrome, Viscosity.
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Affiliation(s)
- Juan Aitken-Saavedra
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile. Santiago, Chile.,Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | - Sandra-Beatriz-Chaves Tarquinio
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Diagnostic Center for Oral Diseases, School of Dentistry, Federal University of Pelotas, Brazil
| | - Wellington-Luiz-De Oliveira da Rosa
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | | | - Adriana-Fernandes da Silva
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | | | | | - Andrea Maturana-Ramirez
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile. Santiago, Chile
| | - Ana-Carolina-Uchoa Vasconcellos
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Diagnostic Center for Oral Diseases, School of Dentistry, Federal University of Pelotas, Brazil
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6
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Aitken-Saavedra J, Chaves Tarquinio SB, De Oliveira da Rosa WL, Fernandes da Silva A, Almeida Machado BM, Santos Castro I, Oliveira Wennesheimer A, Morales-Bozo I, Uchoa Vasconcelos AC, Neutzling Gomes AP. Effect of a Homemade Salivary Substitute Prepared Using Chamomile ( Matricaria chamomilla L.) Flower and Flax ( Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report. J Altern Complement Med 2021; 26:799-806. [PMID: 32924561 DOI: 10.1089/acm.2019.0478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives: To evaluate (1) the effect of a salivary substitute prepared using chamomile (Matricaria chamomilla L.) flower and flax (Linum usitatissimum L.) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect. Subjects: 40 women aging >40 years with diagnosis of primary BMS. Settings/Location: Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil. Design: This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately. Interventions: Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min. Outcome measures: A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively. Results: After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (p < 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects. Conclusion: This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.
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Affiliation(s)
- Juan Aitken-Saavedra
- Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Pelotas, Brazil.,Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.,Department of Oral Pathology and Medicine, School of Dentistry, University of Chile, Santiago, Chile
| | | | | | - Adriana Fernandes da Silva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - Irene Morales-Bozo
- Institute for Research in Dental Sciences, School of Dentistry, University of Chile, Santiago, Chile
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7
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Kim MJ, Kim J, Kho HS. Treatment outcomes and related clinical characteristics in patients with burning mouth syndrome. Oral Dis 2020; 27:1507-1518. [PMID: 33098162 DOI: 10.1111/odi.13693] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/27/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the treatment outcomes of medication therapies in patients with burning mouth syndrome (BMS) and to identify the clinical characteristics that may affect the efficacy of prescribed medications. METHODS This is a retrospective study of 769 patients with oral burning sensations. Of these patients, 420 patients diagnosed as the primary BMS received an "Initial Approach" that involved a detailed explanation about its etiopathophysiology, self-care instruction, and use of an oral lubricant. Neuropathic medications were prescribed for 277 patients who did not respond to the initial approach. Clinical characteristics, prescribed medications, and changes in intensity of oral symptoms were reviewed. RESULTS Clonazepam was administered as the first-line medication. Alpha-lipoic acid (ALA), gabapentin, and nortriptyline were commonly administered in combination with clonazepam. More than two-thirds of the patients reported a marked improvement in oral symptoms after treatments with combination of neuropathic medications and ALA. The efficacies of the initial approach and clonazepam had significant positive associations with the initial intensity of oral symptoms and significant negative associations with depression. CONCLUSIONS Clonazepam therapy in combination with appropriate medications was effective for managing patients with BMS. The initial intensity of oral symptoms and psychological status were significantly associated with treatment outcomes.
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Affiliation(s)
- Moon-Jong Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Jihoon Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.,Institute on Aging, Seoul National University, Seoul, South Korea
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8
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Sekine N, Okada-Ogawa A, Asano S, Takanezawa D, Nishihara C, Tanabe N, Imamura Y. Analgesic effect of gum chewing in patients with burning mouth syndrome. J Oral Sci 2020; 62:387-392. [PMID: 32893197 DOI: 10.2334/josnusd.19-0501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The cause of burning mouth syndrome (BMS) is unknown. Although no effective treatment has been established, BMS patients frequently chew gum to alleviate pain. To identify the cause and new treatments for BMS, this study investigated the psychophysical and pharmacological properties of gum chewing to better understand its pain-relieving effects. In this prospective, blinded study, plasma catecholamine and serotonin levels and Profile of Mood States (POMS) scores were assessed after gum chewing or simulated chewing in 40 women (20 BMS patients and 20 age-matched controls). Visual analogue scale (VAS) scores for pain decreased significantly in BMS patients after gum chewing and simulated chewing. Moreover, resting VAS scores of BMS patients were significantly positively correlated with plasma adrenaline level. Furthermore, gum chewing was significantly correlated with lower plasma adrenaline level, VAS score, and tension-anxiety score. These results suggest that adrenaline is important in the pathogenesis of BMS pain and that the analgesic effect of gum chewing is induced through the potential effects of anxiety reduction, although this effect might not be specific to BMS. In addition, the analgesic effect of gum chewing was not induced solely by chewing motion.
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Affiliation(s)
- Naohiko Sekine
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Orofacial Pain Clinic, Nihon University Dental Hospital.,Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry
| | - Sayaka Asano
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Daiki Takanezawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Chisa Nishihara
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Natsuko Tanabe
- Department of Biochemistry, Nihon University School of Dentistry
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Orofacial Pain Clinic, Nihon University Dental Hospital.,Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry
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9
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Pereira SR, Tello Velasquez J, Duggan S, Ivanisevic B, McKenna JP, McCreary C, Downer EJ. Recent advances in the understanding of the aetiology and therapeutic strategies in burning mouth syndrome: Focus on the actions of cannabinoids. Eur J Neurosci 2020; 55:1032-1050. [DOI: 10.1111/ejn.14712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Sónia R. Pereira
- Discipline of Physiology School of Medicine Trinity Biomedical Sciences Institute Trinity College Dublin Dublin 2 Ireland
| | - Johana Tello Velasquez
- Discipline of Physiology School of Medicine Trinity Biomedical Sciences Institute Trinity College Dublin Dublin 2 Ireland
| | - Sarah Duggan
- Discipline of Physiology School of Medicine Trinity Biomedical Sciences Institute Trinity College Dublin Dublin 2 Ireland
| | - Bojana Ivanisevic
- Cork University Dental School and Hospital University College Cork Cork Ireland
| | - Joseph P. McKenna
- Cork University Dental School and Hospital University College Cork Cork Ireland
| | - Christine McCreary
- Cork University Dental School and Hospital University College Cork Cork Ireland
| | - Eric J. Downer
- Discipline of Physiology School of Medicine Trinity Biomedical Sciences Institute Trinity College Dublin Dublin 2 Ireland
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10
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de Pedro M, López-Pintor RM, Casañas E, Hernández G. General health status of a sample of patients with burning mouth syndrome: A case-control study. Oral Dis 2020; 26:1020-1031. [PMID: 32153093 DOI: 10.1111/odi.13327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship of burning mouth syndrome (BMS) with possible alterations in patients' general health has been subject of study and controversy during the last years. OBJECTIVE To analyse the general health status of patients with BMS, comparing it with a control group. METHODS A case-control study was conducted to compare the diseases, medications, blood test alterations, disturbances in general health, oral quality of life, xerostomia, sleep quality and psychological status between a group of 20 patients with BMS and a group of 40 patients who did not suffer from this disease. RESULTS BMS patients suffered more comorbidities and consumed more medications than controls. More mental, behavioural or neurodevelopmental disorders in BMS patients were found, consuming more drugs for nervous and cardiovascular systems, and alimentary tract and metabolism. Lower levels of iron and higher levels of folic acid were found in BMS patients compared to controls. General health status, oral health impact, sleepiness, psychological status and xerostomia levels were also significantly worsened in BMS patients than in controls. CONCLUSIONS BMS patients presented a worsened health status over controls suffering more comorbidities, consuming more medications and showing adverse results in all the health variables analysed in this study.
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Affiliation(s)
- Miguel de Pedro
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Rosa María López-Pintor
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Elisabeth Casañas
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
| | - Gonzalo Hernández
- Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain
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11
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Freilich JE, Kuten-Shorrer M, Treister NS, Woo SB, Villa A. Burning mouth syndrome: a diagnostic challenge. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:120-124. [DOI: 10.1016/j.oooo.2019.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 01/03/2023]
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12
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Kim MJ, Kho HS. Treatment Outcomes of Venlafaxine and Duloxetine in Refractory Burning Mouth Syndrome Patients. ACTA ACUST UNITED AC 2019. [DOI: 10.14476/jomp.2019.44.3.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Moon-Jong Kim
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
- Institute on Aging Seoul National University, Seoul, Korea
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13
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Imamura Y, Shinozaki T, Okada-Ogawa A, Noma N, Shinoda M, Iwata K, Wada A, Abe O, Wang K, Svensson P. An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives. J Oral Rehabil 2019; 46:574-587. [PMID: 30892737 DOI: 10.1111/joor.12795] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/19/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Burning mouth syndrome (BMS) is a chronic oro-facial pain disorder of unknown cause. It is more common in peri- and post-menopausal women, and sex hormone dysregulation is believed to be an important causative factor. Psychosocial events often trigger or exacerbate symptoms, and persons with BMS appear to be predisposed towards anxiety and depression. Atrophy of small nerve fibres in the tongue epithelium has been reported, and potential neuropathic mechanisms for BMS are now widely investigated. Historically, BMS was thought to comprise endocrinological, psychosocial and neuropathic components. Neuroprotective steroids and glial cell line-derived neurotrophic factor family ligands may have pivotal roles in the peripheral mechanisms associated with atrophy of small nerve fibres. Denervation of chorda tympani nerve fibres that innervate fungiform buds leads to alternative trigeminal innervation, which results in dysgeusia and burning pain when eating hot foods. With regard to the central mechanism of BMS, depletion of neuroprotective steroids alters the brain network-related mood and pain modulation. Peripheral mechanistic studies support the use of topical clonazepam and capsaicin for the management of BMS, and some evidence supports the use of cognitive behavioural therapy. Hormone replacement therapy may address the causes of BMS, although adverse effects prevent its use as a first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) may have important benefits, and well-designed controlled studies are expected. Other treatment options to be investigated include brain stimulation and TSPO (translocator protein 18 kDa) ligands.
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Affiliation(s)
- Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.,Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan
| | - Takahiro Shinozaki
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.,Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan
| | - Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.,Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.,Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan
| | - Masahiro Shinoda
- Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan.,Department of Physiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Koichi Iwata
- Nihon University School of Dentistry Dental Research Center, Chiyoda-ku, Tokyo, Japan.,Department of Physiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Akihiko Wada
- Department of Radiology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kelun Wang
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Peter Svensson
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark
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Tu TTH, Takenoshita M, Matsuoka H, Watanabe T, Suga T, Aota Y, Abiko Y, Toyofuku A. Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review. Biopsychosoc Med 2019; 13:1. [PMID: 30733824 PMCID: PMC6357406 DOI: 10.1186/s13030-019-0142-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.
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Affiliation(s)
- Trang T H Tu
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Miho Takenoshita
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Hirofumi Matsuoka
- 2Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Takeshi Watanabe
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Takayuki Suga
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yuma Aota
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yoshihiro Abiko
- 3Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Akira Toyofuku
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
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Abstract
Chronic pain is a frequent condition that affects an estimated 20% of people worldwide, accounting for 15%-20% of doctors' appointments (Treede et al., 2015). It lacks the acute warning function of physiologic nociception, and instead involves the activation of multiple neurophysiologic mechanisms in the somatosensory system, a complex neuronal network under the control of powerful autoregulatory loops and able to undergo rapid neuroplastic alteration (Verdu et al., 2008). There is a growing body of research suggesting that some such pathways are shared by major psychologic disorders such as depression and anxiety, opening new avenues in co-treatment strategies. In particular, besides anticonvulsants, which are today used as analgesics, other psychopharmaceuticals, such as the tricyclic antidepressants, are displaying efficacy in the treatment of neuropathic and nociceptive chronic pain. The state of the art regarding the mechanisms of nociception and the pharmacology of both the neurotransmitters involved and the wide range of psychoactive compounds that may be useful in the treatment of chronic pain are discussed.
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Acharya S, Carlén A, Wenneberg B, Jontell M, Hägglin C. Clinical characterization of women with burning mouth syndrome in a case-control study. Acta Odontol Scand 2018; 76:279-286. [PMID: 29284330 DOI: 10.1080/00016357.2017.1420226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Shikha Acharya
- Department of Oral Microbiology and Immunology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anette Carlén
- Department of Oral Microbiology and Immunology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Wenneberg
- Department of Orofacial Pain, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Jontell
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catharina Hägglin
- Department of Behavioral and Community Dentistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Gerodontology, Public Dental Service, Region Västra Götaland, Sweden
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Kundu S, Dutta M, Adhikary BK, Ghosh B. Encountering Chronic Sore Throat: How Challenging is it for the Otolaryngologists? Indian J Otolaryngol Head Neck Surg 2017; 71:176-181. [PMID: 31741956 DOI: 10.1007/s12070-017-1191-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 01/27/2023] Open
Abstract
Objective To explore and diagnose the underlying causes of chronic, recalcitrant sore throat. Methodology In this descriptive, cross-sectional study spanning 3 years (January 2014-December 2016), 1580 patients with chronic sore throat (>12 weeks duration, despite conventional medication) were evaluated for the possible cause(s) in a tertiary care teaching institute of eastern India, through proper history, appropriate investigations, and a self-designed algorithm. Results The common causes for chronic sore throat were chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder, respectively. Allergy, psychiatric illnesses, oral submucous fibrosis, systemic comorbidities (diabetes mellitus, hypothyroidism, uremia, arthritides), stylalgia, Koch's pneumonitis, recurrent aphthous ulcers, and dietary deficiencies formed the other major causes. There was a minimal female preponderance, the female: male ratio being 1.25. About 39% patients were chronic smokers, and 31% addicted to alcohol. Forty-three (2.72%) patients were reactive to HIV 1/2. Conclusion The study provided with a detailed account of the heterogeneous etiology of chronic sore throat, and an overall structured idea on how to approach to its work-up and diagnosis. Proper history taking and appropriate structured investigations are the keys. Chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder were the chief causes of chronic sore throat.
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Affiliation(s)
- Sohag Kundu
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata, West Bengal 700073 India
| | - Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata, West Bengal 700073 India
| | - Bijan Kumar Adhikary
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata, West Bengal 700073 India
| | - Bhaskar Ghosh
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, 88, College Street, Kolkata, West Bengal 700073 India
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