Usefulness of pepsin saliva measurement for the detection of primary burning mouth syndrome related to reflux

OBJECTIVES

To study the diagnostic value of salivary pepsin tests for detecting laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS).

METHODS

Patients with BMS and asymptomatic individuals were consecutively recruited from September 2018 to June 2023. Patients underwent hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH) and saliva collections to measure pepsin. Stomatology evaluation was carried out to exclude other causes of BMS. Oral, pharyngeal and laryngeal signs and symptoms were evaluated with Reflux Sign Assessment (RSA) and Reflux Symptom Score (RSS). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin test were calculated considering the highest values of pepsin tests at ≥ 16, ≥ 36, and ≥ 100 ng/mL cutoffs. Receiver operating characteristic curve (ROC) was evaluated.

RESULTS

Forty-nine patients with both BMS and LPR at the HEMII-pH and 21 asymptomatic individuals were recruited. Pepsin test was 83.7%, 79.6%, and 71.4% sensitive at cutoffs ≥ 16, ≥ 36, and ≥ 100 ng/mL, respectively. The ROC analysis reported that a threshold of ≥ 21.5 ng/mL was associated with sensitivity, specificity, PPV and NPV of 81.6%, 81.0%, 90.1% and 65.4%, respectively. The severity score of burning mouth symptom was significantly associated with the saliva pepsin concentration (rs = 0.263; p = 0.029) and the oral RSA (rs = 0.474; p = 0.007).

CONCLUSION

Pepsin test is a valuable diagnostic approach for detecting LPR in patients with BMS. Patients with high level of saliva pepsin reported more severe burning mouth symptoms. Future studies are needed to confirm the role of LPR in the primary BMS.

Non-Communicable Diseases and Associated Risk Factors in Burning Mouth Syndrome Patients

Background and Objectives: Noncommunicable diseases (NCDs) are a group of non-transmissible conditions that tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioral factors. Although an association between oral disorders and NCDs has been suggested, the relationship between Burning Mouth Syndrome (BMS) and NCDs and their associated risk factors has not been deeply investigated. In this study, we aim to identify associations between BMS and NCDs in the Romanian population. Materials and Methods: Ninety-nine BMS patients and 88 age-matched controls (aged 50 and over) were clinically evaluated for the presence of eight noncommunicable diseases (NCDs) and their most common risk factors, including hypertension, dyslipidemia, smoking, and obesity. Results: The results of our study showed that the BMS in the Romanian population seems to be significantly associated with cardiovascular diseases (CVDs) (p < 0.001) and two of their risk factors, hypertension (p < 0.001) and dyslipidemia (p < 0.001). Moreover, evaluating the Framingham Risk Score (FRS) in the individuals not affected by CVDs (73 CTRL and 38 BMS), we found that 13.2% of BMS patients reported a moderate risk of developing CVDs in ten years, compared to the controls, all of whom presented a low risk (p = 0.002). Conclusions: Our findings suggest that a multidisciplinary clinical approach, which also includes a cardiovascular evaluation, is essential for the successful management of BMS. Moreover, these data highlighted the importance of introducing an integrated strategy for the prevention and care of NCDs in BMS patients.

Association of anxiety, depression, and stress with burning mouth syndrome: a case-control study

Burning mouth syndrome (BMS) is a painful disorder characterized by severe burning in the oral cavity in the absence of clinical signs. In this case-control study, 60 patients were allocated to 3 groups: patients with BMS, patients with benign changes in the oral cavity (anxiety [positive] control group), or healthy patients (negative control group). A visual analog scale (VAS), Beck Anxiety and Depression inventories, Lipp Stress Symptoms Inventory, Xerostomia Inventory-Dutch Version, and a BMS questionnaire were used. Statistical analyses (P < 0.05) were performed using the Kruskal-Wallis with Dunn post hoc, Pearson chi-square, Fisher exact, and multinomial logistic regression tests. Most of the patients were female. The BMS group had more patients who were older than 60 years (P = 0.008), more patients with high VAS scores (P < 0.001), and more patients with moderate or severe anxiety (P < 0.001) and depression (P < 0.001) than the 2 control groups. Patients in the BMS group also had higher rates of stress during the alarm (P = 0.003), resistance (P < 0.001), and exhaustion phases (P < 0.001). All patients with BMS reported burning and xerostomia, 90% reported a feeling of dry mouth, and 80% reported a change in taste; these values were significantly higher than those in the control groups (P < 0.001). Anxiety was independently associated with a 123.80 times greater risk of having BMS (P = 0.004). Psychological factors are directly associated with BMS, and anxiety is the most important of these factor.

Prevalence and Features of Laryngopharyngeal Reflux in Patients with Primary Burning Mouth Syndrome

OBJECTIVES/HYPOTHESIS

To investigate the prevalence and features of laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS).

STUDY DESIGN

Prospective uncontrolled study.

METHODS

Patients who visited our Departments of Otolaryngology-Head and Neck and Maxillofacial surgery with BMS were prospectively recruited from September 2018 to September 2020. Patients benefited from dental, maxillofacial, otolaryngological examinations, and hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH). Oral, pharyngeal, and laryngeal findings and symptoms were rated with Reflux Sign Assessment (RSA) and Reflux Symptom Score-12 (RSS-12). Patients were treated with a combination of diet, pantoprazole, and alginate.

RESULTS

From the 81 included patients, 76 reported >1 pharyngeal reflux events (93.8%), accounting for 35 (46.1%), 24 (31.6%), and 17 (22.3%) acid, mixed, and nonacid LPR, respectively. Thirty-two patients had both LPR and gastroesophageal reflux disease (GERD). Thirty-eight patients benefited from pepsin saliva measurement, which was positive in 86.8% of cases. The mean scores of mouth/tongue burning, RSS-12, and RSA significantly improved from pre- to post-treatment (P < .004). At 3-month post-treatment, 62.5% of patients reported an improvement of mouth/tongue burning score. Patients with both GERD and LPR reported higher baseline RSS-12 and RSA scores.

CONCLUSION

Acid, weakly acid, and nonacid LPR may be involved in the development of BMS. The use of an appropriate treatment considering the reflux features is associated with an improvement of symptoms and findings.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Depression and distress in burning mouth syndrome: A case control study

To compare the results of psychometric tests in patients with BMS and controls, participants were tested for depression, anxiety, fatigue and distress. Patients with BMS had noticeably higher scores for depression, fatigue and distress, compared to controls. Depression and distress were significantly correlated with the burning symptom. Moreover, distress and burning symptoms proved to be interdependent. Depression seems to play a specific role in BMS. Burning symptoms affect quality of life of patients and they could be a predictor of distress.

Simultaneous occurrence of dysaesthetic peno/scroto-dynia and stomatodynia

The 'dynias' are a group of chronic focal pain syndromes with a predilection for orocervical or urogenital regions. Only exceptionally do they involve both sites in the same patient. Here, we report a case of simultaneous occurrence of dysaesthetic peno/scroto dynia and stomatodynia.

Concurrent Presentation of Burning Mouth Syndrome and Globus Pharyngis in Enugu, Nigeria: A Ten-year Clinical Evaluation

PURPOSE

To review 22 patients with globus pharyngis among a group of 39 patients who presented with burning mouth syndrome and to highlight the clinical presentation and treatment outcome of these oropharyngeal symptoms, often ignored by practicing oral surgeons.

PATIENTS AND METHODS

We carried out a retrospective review of 39 patients with burning mouth syndrome seen at oral surgery units of three specialist hospitals in Enugu, Nigeria between 2001 and 2010. The focus was on the 22 of these patients with burning mouth syndrome and globus pharyngis (the persistent sensation of having phlegm, a pill or some other sort of obstruction in the throat when there is none). Relevant information included patients' oral habits and dental status, past medical history, sociodemographic data, onset of symptoms and treatment outcome.

RESULTS

Amongst the 22 patients, 8 (36.4%) were males while 14 (63.6%) were females, giving a male to female ratio of 1:1.8. Of the 8 male patients, 3 (37.5%) were retrenched workers, 2 (25%) were drug addicts, 2 (25%) had a history of psychiatric problems and 1 (12.5%) had post-radiation therapy due to diagnosis of adenocystic carcinoma. Amongst the 14 female patients, 6 (42.8%) were divorcees, 3 (21.4%) were unemployed and unmarried, 2 (14.3%) had menopausal problems, 2 (14.3%) had dental prostheses and 1 (7.2%) had a history of mental disorder.

CONCLUSION

Globus pharyngis can present at the same time in some individuals with burning mouth syndrome. The emotional aetiological factor in this unusual ailment calls for proper examinations and a multidisciplinary approach in the management of patients who presented with burning mouth syndrome, especially with a history of depression.

Sleep disturbance in patients with burning mouth syndrome: a case-control study

AIM

To examine sleep complaints in patients with burning mouth syndrome (BMS) and the relationships between these disturbances, negative mood, and pain.

METHODS

Fifty BMS patients were compared with an equal number of healthy controls matched for age, sex, and educational level. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) were administered. Descriptive statistics, including the Mann-Whitney U test and hierarchical multiple linear regression analyses were used.

RESULTS

BMS patients had higher scores in all items of the PSQI and ESS than the healthy controls (P < .001). In the BMS patients, a depressed mood and anxiety correlated positively with sleep disturbances. The Pearson correlations were 0.68 for PSQI vs HAM-D (P < .001) and 0.63 for PSQI vs HAM-A (P < .001).

CONCLUSION

BMS patients reported a greater degree of sleep disorders, anxiety, and depression as compared with controls. Sleep disorders could influence quality of life of BMS patients and could be a possible treatment target.

Differential diagnosis of orofacial pain and temporomandibular disorder

When a patient complains of orofacial pain, health care providers must make a correct diagnosis. Doing this can be difficult, since various signs and symptoms may not be specific for 1 particular problem or disorder. One initially should formulate a broad differential diagnosis that can be narrowed after analysis of the history and examination. In this article, orofacial pain is categorized as being caused by: intracranial pain, headaches, neuropathic pain, intraoral pain, temporomandibular disorder, cervical pain, pain related to anatomically associated structures, referred pain, or mental illness.

Burning mouth syndrome

Burning mouth syndrome (BMS) is a chronic condition that is characterized by burning symptoms of the oral mucosa without obvious clinical examination findings. This syndrome has complex characteristics, but its cause remains largely enigmatic, making treatment and management of patients with BMS difficult. Despite not being accompanied by evident organic changes, BMS can significantly reduce the quality of life for such patients. Therefore, it is incumbent on dental professionals to diagnose and manage patients with BMS as a part of comprehensive care.

Management of burning mouth syndrome taking into consideration various etiologic factors

The aim of the research was to detect the stomatologic, endocrine and psycho-neurologic status in patients with burning mouth syndrome, elaborate different diagnostic criteria and effective therapy for the patients with burning mouth syndrome. 92 patients with burning mouth syndrome were studied. Patients ranged in age from 28 to 72 years. The conducted studies gave the possibility to make conclusions, the most important of which are: burning mouth syndrome (BMS) is not only stomatologic problem; this psychosomatic syndrome belongs to gerontologic disease and tendency of its "rejuvenation" was revealed as well (in the current study --2 women (28 and 32 year old, and 38 year old man); degree of revelation of the symptoms of depression, anxiety, obsession and somatization is closely related with duration of the diseases. These symptoms are progressing together with aging and reach the peak at 60-70 years old. Individual scheme of therapy was developed on the background of clinico-paraclinical study.

The characteristics of autonomic nervous system disorders in burning mouth syndrome and Parkinson disease

AIMS

To conduct a clinical electrophysiologic evaluation of autonomic nervous system functions in patients with burning mouth syndrome and Parkinson disease and estimate the type and intensity of the autonomic dysfunction.

METHODS

The study involved 83 subjects-33 with burning mouth syndrome, 20 with Parkinson disease, and 30 controls. The BMS group included 27 women and 6 men (median age, 60.0 years), and the Parkinson disease group included 15 women and 5 men (median age, 66.5 years). In the control group, there were 20 women and 10 men (median age, 59.0 years). All patients were subjected to autonomic nervous system testing. In addition to the Low autonomic disorder questionnaire, heart rate variability (HRV), deep breathing (exhalation/inspiration [E/I] ratio), and sympathetic skin response (SSR) tests were performed in all cases. Parametric and nonparametric tests (ANOVA, Kruskal-Wallis, and Scheffe tests) were used in the statistical analysis.

RESULTS

The mean values for HRV and E/I ratios were significantly lower in the burning mouth syndrome and Parkinson disease groups. Significant prolongation of SSR latency in the foot was revealed in both burning mouth syndrome and Parkinson disease patients, and lowering of the SSR amplitude occurred in only the Parkinson disease group. The autonomic questionnaire score was significantly higher in burning mouth syndrome and Parkinson disease patients than in the control subjects, with the Parkinson disease group having the highest scores.

CONCLUSION

In patients with burning mouth syndrome, a significant impairment of both the sympathetic and parasympathetic nervous systems was found but sympathetic/parasympathetic balance was preserved. The incidence and intensity of autonomic nervous system dysfunction was similar in patients with burning mouth syndrome and Parkinson disease, which may suggest some similarity in their pathogeneses.

Pain and pain behavior in burning mouth syndrome: a pain diary study

AIMS

To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis.

METHODS

Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores.

RESULTS

The overall mean pain intensity score of the 14 diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects.

CONCLUSION

There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.

The psychological aspects of burning mouth syndrome

It should be emphasized that at the present stage there is no consensus achieved regarding the etiopathogenesis of BMS. Almost all researchers point to lots of factors, simultaneously participating in genesis and development of BMS and at the same time most of them agreed on one - psychological factors play a crucial role in formation and maintenance of painful sensations. The aim of the study was the identification of psychological or psychiatric deviations (changes) among the patients with BMS to perform an adequate differentiated therapy. Clinico-psychological examination (dentist, neurologist, psychiatrist) was carried out in 39 patients from 46 to 70 years of age. Among them women - 36 and men - 3. To identify clinical types of BMS a classification of P.J. Lamey (1996) was used and as a result, depression, insomnia, cancerophobia, severe neurologic disorders, phobic syndrome were revealed. Three main categories - a chronic somatoform dysfunction (23 cases), chronic vegetative disorders (8), and chronic pain phenomenon (12) were identified. Only in one case was revealed a paranoid syndrome. Alongside with the well-known scheme of treatment (antidepressants, anticonvulsants, or neuroleptics) Psychotherapy was conducted, while EEG-feed back (Biofeed back, Neurofeed back) method was used for the first time. A number of important decisions were made the most important of which are the following: BMS - must be regarded as a psychosomatic problem rather than a psychiatric disorder. In addition to psychotherapy, using of EEG - feedback method greatly improved patients' condition and in 4 cases BMS clinical manifestations were evened-out completely.

Candida-associated denture stomatitis in type 2 diabetes mellitus

OBJECTIVE

To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements.

MATERIALS AND METHODS

Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects.

RESULTS

Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001).

CONCLUSIONS

Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Efficacy of moclobemide in burning mouth syndrome: a nonrandomized, open-label study

AIMS

To compare burning mouth syndrome (BMS) patients with age- and gender-matched controls for psychologic conditions, to analyze the effect of menstrual state on the intensity of burning, and to assess the efficacy of an antidepressant medication on the burning pain and psychologic status.

METHODS

Ninety-four patients with BMS and 94 matched control subjects participated in the study. Anxiety and depression were analyzed by means of the Spielberger State-Trait Anxiety Inventory and Zung Self-Rating Depression Scale, and the severity of the burning sensation was measured by means of a visual analog scale (VAS). In female BMS patients and controls, the menstrual state was noted (menstruating, menopausal, or postmenopausal). BMS patients were treated with the antidepressant moclobemide (150 mg 2 times daily) for 3 months. Thereafter, anxiety, depression, and burning pain intensity were reassessed. Patient-perceived satisfactory improvement for burning sensation was assessed using a 5-point categorical rating of change scale.

RESULTS

BMS patients had significantly higher anxiety and depression scores than controls (P < .05). After treatment, anxiety and depression scores as well as the VAS values for burning pain decreased significantly (P < .001). Thirty-seven patients reported good to very good improvement, and 44 reported satisfactory improvement. No adverse reactions were reported.

CONCLUSIONS

The study confirmed earlier reports that BMS patients have higher anxiety and depression levels than controls. An antidepressant medication may be effective in alleviating the burning pain, at least in the short-term.

Vulvostomatodynia

Burning mouth syndrome associated to vulvodynia (Vulvostomatodynia) is a rare condition and is often difficult to diagnose and treat. Tongue, lips, vestibule and others mucosal sites may be affected by a tiresome burning sensation, especially in menopausal and postmenopausal women. Patients seldom report genital symptoms to the dentist and dentists do not generally investigate about genital symptoms. Delays in diagnosis may affect the quality of life. We report the clinical features of five new cases of vulvostomatodynia. A thorough multidisciplinary medical management is necessary to improve symptoms and prevent from psychologic distress. Counselling and an understanding between patient and clinician/therapist are important for long-term results.

Tongue pain: burning mouth syndrome vs Candida- associated lesion

OBJECTIVE

We investigated patients with tongue pain to examine whether the differential diagnosis of burning mouth syndrome and Candida-associated lesion was possible.

PATIENTS AND METHODS

Sixty patients with tongue pain were divided into three groups according to the intensity of pain at rest and that when eating using the visual analogue scale: Group A: Functional pain group. Group B: Non-functional pain group. Group C: Mixed pain group. Antifungal treatment was scheduled for patients suspected clinically, mycologically or cytologically as having candidal infection.

RESULTS

The results of the culture test and direct examination indicated that group A was different from others by its high positivity for Candida, a good response to the antifungal treatment was obtained. On the other hand, antifungal treatment was not useful in group B, and the low possibility of Candida infection in the direct examination supported the result in this group. In group C, the positivity of Candida and the effect of the antifungal treatment were between groups A and B.

CONCLUSION

These results may suggest that tongue pain in group A is Candida-associated, that in group B is burning mouth syndrome-induced and that of group C is mixed conditions.

Burning mouth syndrome (BMS): evaluation of thyroid and taste

BACKGROUND

Burning mouth syndrome (BMS) is a chronic, intraoral burning sensation seen mainly in middle-aged and post-menopausal females, without identifiable oral lesions or abnormal laboratory findings, but often associated with psychogenic disorders such as depression. The latter can have a range of causes, including hormonal.

OBJECTIVE

Since there may be connections between BMS, psychogenic changes, hormonal changes and taste abnormalities, we have examined aspects of taste and thyroid function.

PATIENTS AND METHODS

We selected 50 patients with BMS (study group) and 50 healthy subjects (control group) and analysed their ability to taste bitter, acid and spicy substances and analysed their thyroid function and Undertook thyroid echography.

RESULTS

Taste sensation was normal in all controls. However, 30 of the patients with BMS reported ageusia for bitter taste and 2 had ageusia for acid. The use of pepper sauce (Tabasco) (spicy substance) produced a strong burning to the tongue in 28 patients of the BMS group but only in 10 controls. No control patients showed abnormality of thyroid function or echograpic abnormality. Five patients in the BMS group had biochemical evidence of hypothyroidism, 4 patients had raised levels of thyroid auto-antibodies and, of the 41 remaining BMS patients, most (34) had thyroid echographic changes indicative of nodularity.

CONCLUSIONS

Hypothyroidism may be responsible for a negative influence on taste and consequent increase in trigeminal sensorial sensation (tactile, thermal and painful sensation).

Orofacial Pain--Part II: Assessment and management of vascular, neurovascular, idiopathic, secondary, and psychogenic causes

Chronic orofacial pain is a common health complaint faced by health practitioners today and constitutes a challenging diagnostic problem that often requires a multidisciplinary approach to diagnosis and treatment. The previous article by the same authors in this issue discussed the major clinical characteristics and the treatment of various musculoskeletal and neuropathic orofacial pain conditions. This second article presents aspects of vascular, neurovascular, and idiopathic orofacial pain, as well as orofacial pain due to various local, distant, or systemic diseases and psychogenic orofacial pain. The emphasis in this article is on the general differential diagnosis and various therapeutic regimens of each of these conditions. An accurate diagnosis is the key to successful treatment of chronic orofacial pain. Given that for many of the entities discussed in this article no curative treatment is available, current standards of management are emphasized. A comprehensive reference section has been included for those who wish to gain further information on a particular entity.

Nocturia and the burning mouth syndrome (BMS) in the elderly

The aim of this study was to assess the relationship between BMS and nocturnal micturition in a group of elderly men and women. The study comprised 6103 elderly men and women recruited from a group of pensioners by means of a questionnaire (n=10,216; response rate 61.3%). The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 years and 72.6+/-6.7 years, respectively. The questionnaire included questions on their health, diseases and symptoms, drugs, sleep habits and the number of nocturnal voiding episodes. BMS was reported by 2.4% of the men and 8.5% of the women (p<0.0001). The occurrence of BMS was unaffected by age in both sexes. In women, but not in men, there was a stepwise increase in BMS in parallel with increased nocturnal micturition. There was a strong relation between nocturnal thirst and drinking on the one hand, and reports on BMS on the other hand. BMS was also increased in diuretics users in both sexes. The results may indicate that negative fluid balance as a consequence of nocturnal polyuria is an overlooked pathogenetic mechanism in the genesis of BMS in the elderly.

Orofacial pain and sensory disorders in the elderly

Many orofacial pain conditions occur in the elderly. Specifically,this article reviews the prevalence of general and orofacial-related pain in the elderly. The authors also describe and discuss the likely disorders and diseases that produce facial pain and burning pain in the mouth. They do not cover jaw joint pain, oral sores, or ulceration-induced pain, as these conditions are better discussed in the context of arthritis and oral pathologies of the mouth. The authors discuss oral motor disorders, myogenous pain, vascular pain, headaches, trigeminal neuralgia, trigeminal neuropathic dis-ease, postherpetic neuralgia, burning mouth syndrome, and occlusal dysesthesia.

Damage to taste system and oral pain: burning mouth syndrome

The burning mouth syndrome (BMS) is an oral pain disorder. Central or peripheral pain mechanisms may play a role in the oral burning of BMS. Various local, systemic and psychological factors have been found to be associated with BMS, but its etiology is not fully understood. This syndrome mostly affects middle-aged women and is frequently accompanied by taste complaints. This association of symptoms suggests an interaction between the mechanisms of nociception and gustation, 2 senses with strong hedonic components. There are connections between taste and oral pain in the central nervous system and it is possible that BMS and other oral pain phantoms result from damage to the taste system. This suggests that individuals who suffer from BMS are likely to be supertasters.

Burning mouth syndrome and other oral sensory disorders: a unifying hypothesis

Burning Mouth Syndrome (BMS) is a sensory disorder which results in constant, bilateral burning pain of the tongue, lips, and other oral mucous membranes. Atypical odontalgia (AO) is another sensory disorder, usually defined as a toothache-like pain for which no dental cause can be identified. Previous literature has suggested that AO is often associated with a concomitant temporomandibular disorder (TMD). This hypothesis paper explores the possibility that BMS, AO and TMD can be related through hyperactivity of both the sensory and motor components of the trigeminal nerve following loss of central inhibition as a result of taste damage in the chorda tympani and/or the glossopharyngeal nerves.

Bucco-dental problems in patients with Diabetes Mellitus (I) : Index of plaque and dental caries

Diabetes mellitus is presently considered as one of the most frequent chronic disease, thus, it is important to know what its most relevant buccal disorders are.

OBJECTIVES

Study the different signs and symptoms that diabetic patients present in the oral cavity. Assess the status of oral hygiene and prevalence of dental caries in a diabetic population in regards to a control population.

STUDY DESIGN

We have performed the study on 70 diabetic patients (30 men and 40 women) whose ages ranged from 11 to 81 years, and a control population of 74 non-diabetic (29 men and 45 women) whose ages ranged from 11 to 75 years. Within the diabetic population, the type of diabetes, degree of control of their disease by glycosylated hemoglobin, diabetes evolution time and existence of late complications were assessed. Oral hygiene was measured with the O'Leary plaque index. The prevalence of caries was studied with the CAOD index.

RESULTS

The oral hygiene status was significantly worse in the diabetic patients in regards to the controls after 56 years of age. We did not find any significant differences in the prevalence of caries or in the CAOD index, although this was slightly higher in the diabetic patients. The study of the diabetic patients showed that only the type and evolution of their disease were significant parameters in relationship to the number of caries, while no significance was found on the plaque index for any of the parameters analyzed.

CONCLUSIONS

In this study, we have observed a larger number of dental absences in the diabetic population in regards to a healthy population. We have found no differences in the number of caries, absences and obturations based on metabolic control, evolution time and existence of late complications of diabetes.

Burning mouth syndrome in the Basque Country: a preliminary study of 30 cases

OBJECTIVES

To know the most important clinical features of Burning Mouth Syndrome (BMS) in our environment.

MATERIAL AND METHODS

A prospective study of 30 BMS patients, 29 female and 1 male, with a mean age of 60.2 years (range 37-89), was made. A previously designed clinical protocol, including blood counts, levadure culture, oral pH measurement and non-stimulated salivary flow rate, was completed by all patients. Comparative and descriptive statistical analysis was performed. The Chi-square test was applied (p< 0.05).

RESULTS

Moreover of a burning sensation, 60 % of patients presented oral dryness and 60 % dysgeusia. The tongue was the most frequent site affected of burning sensation (66.7 %). Type II of BMS was the most common (53.3%). In women, 82.9 % were postmenopausal. A 13.3 % of patients suffered type II Diabetes, 6.7 % vitamin deficiency and 56.6 % used xerostomy-inducer medication. The 56.6 % of patients showed chronic anxiety and/or depression. The 46.7 % had a deficient oral hygiene level and 44.4 % wore inadequate dentures. Salivary flow rate was decreased in 50 % of patients. Significant levadure growth was not detected in any case.

CONCLUSIONS

BMS patients in our environment are principally postmenopausal women, with tongue burning, xerostomy, dysgeusia and chronic anxiety and/or depression.

Perceived taste disturbance in adults: prevalence and association with oral and psychological factors and medication

Taste disturbance may cause subjective discomfort and impair appetite and food intake. The aim of this study was to estimate the prevalence of perceived taste disturbance and analyze its association to age, gender, whole salivary flow rate, subjective oral dryness, burning mouth, medication, and psychological factors. Five hundred forty-seven men and 656 women aged 20 to 69 years were randomly selected from the Public Dental Health Service register in northern Sweden. Oral complaints were registered and whole salivary flow rate measured. Medication, anxiety, depression, and stress were assessed. Thirty individuals (2.5%), five men (0.9%) and 25 women (3.8%), reported perceived taste disturbances (distorted taste or loss of taste). In men, no individual with taste disturbance was found in the youngest and oldest age groups. The prevalence in the 30-39-year age group was 1.9% and in the 40-49-year group 1.8%. In women, one individual (1%) with taste disturbance was found in the youngest age group. In the 30-39-year group, the prevalence was 3.8%, increasing to 5.1% in the oldest age group. Illness, subjective oral dryness, state anxiety, perceived stress, depression, use of antiasthmatics, and trait anxiety were associated with taste disturbance. It was concluded that perceived taste disturbance might be an interaction of various health factors such as illness and mental condition.

Burning mouth syndrome and vulvodynia coexisting in the same patient: a case report

The 'dynias' are a group of chronic focal pain syndromes with a predilection for the orocervical and urogenital regions. This is a case report of stomatodynia (burning mouth syndrome) and vulvodynia coexisting in a middle-aged woman. The dynias are an enigma in terms of aetiology, which is multifactorial, making clinical investigations difficult and often requiring liaison with other specialties.

Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation

OBJECTIVES

To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome.

DESIGN

Cross-over, double-blind study.

SETTING

Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden.

SUBJECTS

Twenty-two patients with Sjogren's syndrome.

INTERVENTION

Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period.

MEASUREMENTS

Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation.

RESULTS

Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05).

CONCLUSIONS

Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum without or with chlorhexidine.

[Relationship between the symptom of xerostomia and non-stimulated salivary flow rates in patients with burning mouth syndrome]

OBJECTIVE

Many patients with burning mouth syndrome (BMS) complain of xerostomia, but the consistent relationship between the symptom of xerostomia and non-stimulated salivary flow rates remains unclear. This study tried to investigate the variety of non-stimulated salivary flow rates in patients with BMS.

METHODS

The non-stimulated salivary flow rates of 52 BMS patients and 37 healthy controls were recorded.

RESULTS

The non-stimulated salivary flow rates were low in the group of BMS patients, but there is no statistical difference when compared with that of the normal individuals. There was also no significant difference in non-stimulated salivary flow rates among theses three subtypes of BMS patients. Further, no significant difference of non-stimulated salivary flow rates was observed in patients with and without xerostomia.

CONCLUSION

The non-stimulated salivary flow rate may be not associated with the symptom of xerostomia in patients with BMS.

Significance of saliva for the denture-wearing population

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the 'dry mouth' and its associated problems.

AIMS

To study factors affecting mucous and serous salivary gland secretion, the aetiology of the 'dry mouth' and its associated problems, causative factors for hyposalivation and it's treatment.

SETTING

Two university dental hospitals.

SUBJECTS

587 denture wearers and 521 control subjects, and autopsy material.

INTERVENTIONS

Exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion therapy, biopsy of the minor glands.

MAIN OUTCOME MEASURES

Palatal secretion (PAL, microL/cm2/min) and parotid salivary flow (PAR), subjective complaints and clinical findings.

RESULTS

Resting flow rates for PAL between 0 and 65 microliters/cm2/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL < or = 6.0 microliters/cm2 suffer from a 'dry mouth' and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, radiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion.

CONCLUSIONS

Variation in palatal salivary secretion occurs and is clinically important.

Burning mouth in Parkinson's disease sufferers

OBJECTIVE

The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced.

DESIGN

Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non-respondents.

MAIN OUTCOME

BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers.

CONCLUSION

Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.

Burning mouth syndrome

Complaint of a burning mouth is an increasingly common problem in the aging population. This has remained an enigma for the treating clinician, because visible pathologic lesions or processes are usually not evident. Local, systemic and environmental causes must be assessed to elicit the predisposing factors. Some suggestions for managing burning mouth syndrome are offered.

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.

[Burning tongue (author's transl)]

Burning tongue mostly does not occur as a disease per se, but as a symptom primarily of internal but also of neurological, dermatological, psychiatric and dental diseases. To facilitate differential diagnostic considerations, a short description is given of the individual clinical pictures as well as of the pertinent findings. The knowledge of these diseases is a prerequisite to the causal and lasting treatment of patients affected by the obstinate and occasionally even painful symptom of the burning tongue.