BMS: S for syndrome or S for symptom? A reappraisal of the burning mouth syndrome

In this article, some nosological and ethiopathogenetic aspects of Burning Mouth Syndrome (BMS) are critically evaluated. Despite the number of papers frequently published on this subject, there is still no universally accepted definition of this disorder. Therefore, a premise on which to base an experimental approach is missing. This also leads to a lack of parameters for comparing the clinical-experimental experiences reported in various studies in this field. Moreover, it makes it rather easy to verify the absence of definitive scientific proof as well. Such proof would allow researches to consider the etiological aspects presented in the literature thus far as certain. Due to this lack of certainty, it might be prudent to introduce the concept of idiopathic (or essential) BMS to indicate a burning sensation in the oral cavity when the etiology is unknown and not correlated to noticeable local or systemic alterations. This would be true BMS. In other words, many local and/or systemic anomalies could lead to a burning type of symptomatology localised in the oral cavity but this does not constitute a sufficient requisite to indicate a diagnosis of BMS, according to the authors.     

Saliva flow rates and clinical characteristics of patients with burning mouth syndrome: A case–control study

Burning mouth syndrome (BMS) is a chronic pain condition that most commonly affects postmenopausal women older than 50 years of age. Xerostomia is a common complaint among BMS patients. However, previous studies showed inconsistent findings regarding saliva flow rate reduction. This study examined saliva flow rates, degree of mucosal hydration, xerostomia, and clinical characteristics in BMS patients compared with healthy controls. Unstimulated whole saliva (USWS) was collected through passive drooling; residual mucosal saliva (RMS) was collected using filter paper strips. Stimulated whole saliva (SWS) was collected while chewing on gum base. Oral exam and self-report data were collected. A total of 50 women (22 BMS cases and 28 healthy controls) aged 50 years or older were included in the analysis of this study. Mean age was 62 years for cases and 56 years for controls (P = 0.05). Compared with controls, cases had significantly lower USWS flow rates (P < 0.001) and had a higher prevalence of xerostomia (P = 0.001), gastrointestinal disease (P < 0.001), and vaginal dryness (P = 0.01). These data show that oral and vaginal dryness are common among BMS patients. Further studies are needed to investigate potential pathophysiological mechanisms related to the quality of saliva and mucosal barrier status among these patients.     

Salivary cortisol, 17β-estradiol, progesterone, dehydroepiandrosterone, and α-amylase in patients with burning mouth syndrome

Oral Diseases (2012) 18, 613–620 Objective: The aim of this study was to investigate salivary markers related with burning mouth syndrome (BMS). Materials and Methods: Thirty female patients with BMS and twenty female control subjects were included. Unstimulated (UWS) and stimulated whole saliva samples (SWS) were collected, and their flow rates were determined. Salivary levels of cortisol, 17β‐estradiol, progesterone, dehydroepiandrosterone (DHEA), and enzymatic activity of α‐amylase were determined. Salivary transferrin level was measured to determine the level of blood contamination in saliva samples. Results: The levels of all analytes in UWS were significantly correlated with those of SWS. The levels of 17β‐estradiol, progesterone, and DHEA in UWS were significantly correlated with age. Age‐matched comparisons revealed that the patient group had significantly higher levels of cortisol in UWS and of 17β‐estradiol in SWS. When the patients were divided into older (≥60 years) and younger (<60 years) groups, the older group showed a significantly lower level of progesterone in UWS. There were no significant relationships between treatment efficacy and levels of salivary analytes. Conclusions: In conclusion, patients with BMS showed significantly higher levels of cortisol in UWS and of 17β‐estradiol in SWS compared with controls.     

Salivary levels of IL-1β, IL-6, IL-8, and TNF-α in patients with burning mouth syndrome

Objective

To compare salivary IL-1β, IL-6, IL-8, and TNF-α levels between patients with burning mouth syndrome (BMS) and controls.

Design

Forty female patients with BMS (mean age: 61.6 ± 10.1 years) and 20 female control subjects (mean age: 65.1 ± 9.0 years) were included in the study. Unstimulated (UWS) and stimulated whole saliva samples (SWS) were collected and their flow rates were determined. Salivary IL-1β, IL-6, IL-8, and TNF-α levels and total protein concentration were also determined. Salivary transferrin level was determined to investigate the level of blood contamination in saliva samples. Gingival index of the subjects was also examined. Student's t-test, Pearson's correlation analysis, and analysis of covariance were used.

Results

No significant differences were found in the salivary levels of IL-1β, IL-6, IL-8, and TNF-α in BMS patients compared with controls. Salivary flow rates and their total protein concentrations did not differ significantly between the groups. The levels of salivary cytokines and total protein concentration correlated significantly with the level of blood contamination in both UWS and SWS.

Conclusion

There were no differences in the salivary levels of IL-1β, IL-6, IL-8, and TNF-α in BMS patients compared with controls. Cytokine levels in whole saliva were affected mainly by the amount of blood contamination.     

Risk factors in burning mouth syndrome: a case–control study based on patient records

Burning mouth syndrome (BMS) is a multifactorial condition which is still poorly understood. The aim of this study was to evaluate a group of patients with BMS, as compared to a control group, and to describe related local and systemic factors. Records of patients referred to the Oral Pathology Service at the School of Dentistry over a period of 7 years were considered for the study, within which 32 patients with a diagnosis of BMS were found. A randomized group matched for age and gender was also evaluated for the study. Data were analyzed statistically using the SPSS 12.0 for Windows. Prevalence of BMS was 0.99% (32 BMS patients/3,243 records), considering that females were more commonly affected than were males and that the majority of the individuals were in their sixties. The univariate analysis performed comparing the two groups revealed statistical differences concerning the presence of gastrointestinal diseases (p = 0.003) and urogenital diseases (p = 0.012). The intake of H-2 receptor antagonist and proton pump inhibitor drugs (p = 0.015) also proved to be significant. Logistic regression analysis confirmed that gastrointestinal and urogenital problems were indeed risk factors that were solely associated with BMS. Although a diversity of related factors could be identified, gastrointestinal problems were the most prevalent, suggesting that the management of BMS patients requires attention and an appropriate approach to such disorders.     

Prevalence of Sjögren's syndrome in patients with dry mouth in the region of Central Hungary

Objective

One-third of the Hungarian population suffers from xerostomia. Since there is no evidence of the actual prevalence of Sjögren's syndrome (SS) in Hungary, this study aimed to evaluate the same.

Materials and Methods

Data were collected from the Faculty of Dentistry, Semmelweis University from 2008 to 2015. A diagnosis of SS was established based on the American College of Rheumatology and European League Against Rheumatism criteria.

Results

Of the 1076 patients examined with sicca symptoms, 188 patients had confirmed SS. Primary SS (pSS) was diagnosed in 135 patients and secondary SS (sSS) was confirmed in 53 patients. According to the available statistical records of the public health service of Hungary, there were an average of 16 (0.0014%, 5–26) newly diagnosed SS cases in the entire population and 141 SS patient-practitioner consultations (49–232) per 100,000 inhabitants in the country over the past 10 years (based on the past 10 years: 2011–2020).

Conclusion

Results revealed that approximately 1/5th–1/6th of patients with sicca symptoms have SS, among whom 72% and 285 have pSS and sSS, respectively. Global Hungarian records simultaneously revealed that the number of both new diagnoses and doctor-SS patient encounters has significantly decreased (by 50%) yearly over the last decade.     

Is it ethical to involve patients in state board examinations?

It is argued that the state becomes an ethical agent when it requires that candidates for licensure perform dentistry on patients. As an ethical agent, the state is required to give full information, obtain true voluntary cooperation of patients, not expose patients to increased risk, and provide oversight while unlicensed dentists are practicing and follow-up care where untoward outcomes occur. The possibility of unsuccessful outcomes is known in advance, and there is no evidence showing that known exposure of individual patients to risk is compensated by decreased risk to patients generally.     

Health promotion for patients with diabetes: health coaching or formal health education?

Purpose : The purpose of this study was to determine if a Health Coaching (HC) approach compared with formal health education (HE) resulted in better health outcomes among type II diabetes (T2DM) patients in improving glycaemic control and oral health, by use of clinical and subjective outcome measures. Methods : The study is part of a prospective intervention among randomly selected T2DM patients (n = 186) in Istanbul, Turkey. The data analysed were clinical [glycated haemoglobin (HbA_1C), clinical attachment loss (CAL)] and psychological measures [tooth‐brushing self efficacy (TBSES)]. Data were collected initially and at the end of intervention. Participants were allocated randomly to HC (intervention) (n = 77) and HE (control) (n = 111) groups. Results : At baseline, there was no statistical difference between HC and HE regarding clinical and psychological measures, (P > 0.05). At post‐intervention the HC group had significantly lower HBA_1C and CAL (reduction: 7%, 56%) than the HE group (reduction: HbA_1C 0%; CAL 26%), (P ≤ 0.01). Similarly, HC group, compared with HE group, had better TBSES (increase: 61% vs. 25%) and stress (reduction: 16% vs. 1%), (P ≤ 0.01). Among high‐risk group patients, the HC patients had significant improvements compared with the HE group (reduction: HbA_1C 16% vs. 5%; CAL 63% vs. 18%; stress 39% vs. 2%; fold increase: TBSES 6.6 vs. 3.6) (P ≤ 0.01). Conclusions : The present findings may imply that HC has a significantly greater impact on better management of oral health and glycaemic control than HE. It is notable that the impact was more significant among high‐risk group patients, thus HC may be recommended especially for high‐risk group patients.     

Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia?

AIM: The aim of this study was to investigate the influence of anxiety and type of dental injection, a plastic syringe or an electronic computerized device, on the pain perceived by children. DESIGN: Two dental injectors, a computerized device (Wand, Milestone Scientific, Livingston, NJ, USA) and a traditional plastic syringe, were compared. Forty-one children, aged 9-13 years, who had registered for treatment in Marmara University, Istanbul, Turkey, were included in the study. Both anxious and non-anxious children were included in the study group. The Children's Fear Survey Schedule-Dental Subscale, Facial Image Scale, Spielberger's State Anxiety Index for Children, and heart rates were used to determine the anxiety levels. Participants were assigned to interventions by using random allocation. The first appointment was designed as an introductive familiarization session and injections were administered in the second and third sessions, with one or the other injector. The visual analogue scale was used for pain measurement after injections. RESULTS: No significant differences in injection pain scores were observed between the Wand and traditional plastic injector. Higher levels of pre-injection anxiety were found to be related to more severe pain reports by the children. CONCLUSIONS: Anxiety plays an important role in the pain reaction of children, and was found to be more determinative in pain perception than the injection devices preferred.     

Is there an association between anxiety/depression and temporomandibular disorders in college students?

Objective

Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity.

Material and Methods

Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student''s t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05.

Results

None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55).

Conclusions

Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.     

Molecular basis of oral squamous cell carcinoma in young patients: Is it any different from older patients?

Oral squamous cell carcinoma (OSCC) is the commonest subtype of oral cancer, mainly affecting older patients. It used to be a rare disease among individuals younger than 40 years, but recently increased incidences in this age group are being reported worldwide. The pathogenesis of OSCC affecting young patients remains controversial, and the well‐known etiological factors for oral cancer, tobacco, and alcohol use are believed to play a minor role in the carcinogenesis of the neoplasm, suggesting that the etiology and the molecular basis of OSCC may differ between younger and older patients. Although several molecular markers and chromosomal abnormalities have been demonstrated to differ between both groups, most of the studies have failed to find significant differences. Moreover, divergent results have also been obtained regarding the presence of high‐risk human papillomavirus infection in OSCC of young patients. Given these contradictory results and the limited methodological approaches of the majority of the studies, the exact difference between both age groups remains to be fully established. In this review, we evaluate the available data to establish the current evidence that might support the hypothesis that the molecular basis of OSCC in young patients (especially those under 40 years) differ from the older patients.