Comparison between burning mouth syndrome patients with and without psychological problems

The purpose of this study was to compare clinical and socio-demographic characteristics between burning mouth syndrome (BMS) patients with and without psychological problems. Of 644 patients with symptoms of oral burning, 224 with primary BMS were selected on the basis of laboratory testing, medical history, and psychometric tests: 39 with psychological problems (age 62.5 ± 11.5 years) and 185 without psychological problems (age 58.4 ± 11.4 years). Comprehensive clinical and socio-demographic characteristics, including psychological profiles and salivary flow rates, were compared between the two groups. No significant difference in sex ratio, duration and diurnal pattern of symptoms, unstimulated whole saliva flow rate, or marital status was found between the groups. The patients with psychological problems had a significantly higher mean age, reduced stimulated whole saliva flow rate, and lower level of education than those without psychological problems. The patients with psychological problems also displayed higher rates and greater severity of various types of BMS-related symptom in most parts of the oral mucosa, higher rates of stress-related symptoms, and greater difficulties in daily activities. The severity of taste disturbance was the factor most significantly correlated with the level of psychometry. In conclusion, psychological problems in BMS patients are associated with an aggravation of BMS symptoms.     

Symptom severity in burning mouth syndrome associates with psychological factors

Burning mouth syndrome (BMS) patients are psychologically distressed, but whether this associates with symptom severity is unclear. The aim was to investigate the association of psychological factors with pain intensity and interference in BMS. Fifty-two women (mean age 63.1, SD 10.9) with BMS participated. Pain intensity and interference data were collected using 2-week pain diaries. Psychological factors were evaluated using Depression Scale (DEPS), Pain Anxiety Symptom Scale (PASS) and Pain Vigilance and Awareness Questionnaire (PVAQ). The local ethical committee approved the study. Patients were divided into groups based on pain severity distribution tertiles: low intensity (NRS ≤ 3.7) or interference (NRS ≤ 2.9) (tertiles 1-2, n = 35) and moderate to intense intensity (NRS > 3.7) or interference (>2.9) (tertile 3, n = 17). T test, Wilcoxon's test and Pearson's correlation coefficient were used in the analyses. Patients in the highest intensity and interference tertiles reported more depression (P = .0247 and P = .0169) and pain anxiety symptoms (P = .0359 and P = .0293), and were more preoccupied with pain (P = .0004 and P = .0003) than patients in the low intensity and interference groups. The score of the pain vigilance questionnaire correlated significantly with pain intensity (r = .366, P = .009) and interference (r = .482, P = .009). Depression (r = .399, P = .003) and pain anxiety symptoms (r = .452, P = .001) correlated with pain interference. Symptom severity in BMS associates with symptoms of psychological distress emphasising the need to develop multidimensional diagnostics for the assessment of BMS pain.     

灼口综合征心理治疗循证医学研究

目的评价近年来心理治疗灼口综合征的疗效情况和研究质量,为灼口综合征心理治疗提供指导。方法计算机检索CMB、CNKI、万方、维普、Web Of Science、MEDLINE、Sciencedirect、Springerlink数据库,检索时限为1991—2011年,收集发表的所有有关心理学治疗灼口综合征的文献,按照纳入标准进行文献筛选、资料提取,并依据循证医学方法对其进行分析。结果共检索到15篇符合纳入标准的论著。随机对照试验(randomized controlled trial,RCT)论著数量较少,研究质量不高,无法进行Meta分析。分析结果显示:就目前而言,心理学治疗灼口综合征有较好疗效。结论目前心理学治疗灼口综合征疗效研究文献的数量及质量均不能满足临床要求,需要更多高质量的研究为灼口综合征的心理治疗提供最佳证据。     

Type 3 burning mouth syndrome: psychological and allergic aspects

A subgroup of patients with burning mouth syndrome was investigated. The clinical history of these patients differed from the norm in that symptoms were intermittent and affected unusual sites. In addition, routine investigations were supplemented with a more detailed psychological evaluation than reported previously and also a possible allergic component was studied by patch testing. The study has shown that this subgroup differs from burning mouth syndrome patients overall in that emotional instability and allergic reactions, particularly to food additives, are of etiological significance and require to be taken into consideration in terms of patient management.     

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.     

牙周基础治疗联合心理治疗对灼口综合征的疗效观察

目的：观察牙周基础治疗联合心理治疗对灼口综合征（BMS）的临床疗效.方法：将108例BMS患者随机分为实验组和对照组各54例,实验组给予牙周基础治疗联合心理治疗,对照组给予心理治疗,分别于治疗后1个月、6个月后应用直观类比标尺法（visual analogous scale,VAS）对疗效进行评估.结果：治疗后1个月复诊,实验组和对照组比较差异无统计学意义（P＞0.05）;治疗后6个月复诊,实验组疼痛指数较治疗前和治疗后1个月减少（P＜0.05）,总有效率高于对照组,实验组与对照组比较差异有统计学意义（P＜0.05）.结论：牙周基础治疗联合心理治疗对BMS具有良好的治疗效果.     

Perception of stimulus size in patients with burning mouth syndrome

Twenty subjects with burning mouth syndrome (BMS) and 20 control subjects were tested for oral size perception. Blindfolded subjects assessed the size of holes (2.38–12.70 mm diameter) presented to the tongue, using their fingers to select a matching hole from a comparator series of 31 holes (0.76–15.87 mm diameter) using first static then phasic touch. Both groups overestimated the size of the holes less than 10 mm in diameter but no systematic disparity was evident with holes greater than 10 mm in diameter. The relationship between the stimulus size and the illusion (expressed as the ratio of apparent size to real size) was hyperbolic with the illusion tending towards unity for holes greater than 10 mm. No differences were found in object size perception amongst patients with BMS or control subjects. It is therefore unlikely that altered oral size perception is a precipitating factor or accompanying feature in patients with BMS.     

尼尔雌醇治疗女性灼口综合征的临床观察

目的：观察尼尔雌醇治疗女性灼口综合征的临床效果。方法：采用尼尔雌醇辅以孕激素的雌激素替代疗法治疗１３例月经紊乱,未进入更年期和更年期前后的女性灼口综合症患者。结果：痊愈５例,好转６例,总有效率８４．６％。其疗效与维生素治疗组相比有高度显著性差异（Ｐ＜０．０１）。结论：内分泌紊乱在女性尤其是更年期前后的中老年女性的灼口综合征发病中起着重要作用,尼尔雌醇是治疗该类患者的安全、有效药物。     

Effects of low‐level laser therapy on burning mouth syndrome

To investigate low‐level laser therapy (LLLT) applied to treat burning mouth syndrome (BMS). This prospective, comparative, partially blinded, single‐centre, clinical trial of GaAlAs Laser, with 815 nm wavelength, included 44 BMS patients divided randomly into three groups: Group I (n = 16): GaAlAs laser 815 nm wavelength, 1 W output power, continuous emissions, 4 s, 4 J and fluence rate 133·3 J cm^?2; Group II (n = 16): GaAlAs infrared laser, 815 nm wavelength, 1 W output power, continuous emissions, 6 s, 6 J and fluence rate 200 J cm^?2; Group III (n = 12) placebo group, sham laser. All groups received a weekly dose for 4 weeks. Pain intensity was recorded using a 10‐cm visual analogue scale; patients responded to the oral health impact profile (OHIP‐14), xerostomia severity test and the hospital anxiety–depression scale (HAD). These assessments were performed at baseline, 2 and 4 weeks. LLLT decreased pain intensity and improved OHIP‐14 scores significantly from baseline to 2 weeks in groups I and II compared with the placebo group. No statistically significant differences were found from 2 to 4 weeks. Overall improvements in visual analogue scale (VAS) scores from baseline to the end of treatment were as follows: Group I 15·7%; Group II 15·6%; Group III placebo 7·3%. LLLT application reduces symptoms slightly in BMS patients.     

灼口综合征的病因及发病机制

灼口综合征是一种以口腔内烧灼样疼痛为特点的慢性疾病,不伴有任何临床可查见的口腔黏膜器质性损害.该病的病因及发病机制复杂,导致临床缺乏特异有效的治疗方法.为此,研究者不断对其病因进行探索以期改善该病的治疗现状.近年来在这一领域的研究已取得显著进展,然而关于该领域的系统性、综合性的文献却相对缺乏.有鉴于此,本文就灼口综合征的病因及发病机制作一综述.     

灼口综合征患者唾液谷胱甘肽过氧化物酶活性的变化

有关灼口综合征(BMS)的发病机理目前尚未确定。本文拟通过测定唾液谷胱甘肽过氧化物酶(GPx)的活性,来了解BMS患者口腔粘膜氧自由基(OFR)代谢状况的变化,从而探讨BMS的发病机理。结果显示:BMS组和正常组唾液GPx活性分别为9.30×0.39u/L和8.96±0.29u/L,两者差异无显著性(P>0.05)。     

Salivary biomarkers in burning mouth syndrome: A systematic review and meta-analysis

The objective of this systematic review was to evaluate which salivary biomarkers are altered in patients with burning mouth syndrome (BMS) compared to a control group (CG). A comprehensive literature search was conducted in four databases. Case–control studies evaluating salivary biomarkers in BMS patients were included. Risk of bias was assessed using the Newcastle-Ottawa tool. RevMan was used for meta-analysis. Seventeen studies were selected. The included studies collected 54 different biomarkers. Of these biomarkers, only three (cortisol, α-amylase, and dehydroepiandrosterone) were analyzed in three or more studies. Dehydroepiandrosterone obtained contradictory results among the studies. However, cortisol and α-amylase levels were found to be higher in BMS patients. Cortisol was the only biomarker which could be included for meta-analysis. Cortisol levels were significantly higher in the BMS group compared to the CG (Mean Difference = 0.39; 95% CI [0.14–0.65]; p = 0.003). In conclusion, different studies investigated salivary biomarkers in patients with BMS compared to a CG, with controversial results. Meta-analysis, confirmed by trial-sequential analysis, showed how cortisol levels were significantly higher in BMS. Cortisol emerges as an interesting salivary biomarker in BMS, but future properly designed studies are needed to evaluate its role in diagnosis and/or response to treatment.     

Systemic capsaicin for burning mouth syndrome: short-term results of a pilot study

BACKGROUND: Burning mouth syndrome (BMS) is a major diagnostic and therapeutic problem. Systemic and topical treatments (capsaicin, lidocaine, anti-histamines, sucralfate and benzydiamine) have been tried, but they appear to be inadequate. Topical capsaicin is bitter, may cause burning and has low therapeutic efficacy. We hypothesized that systemic administration of capsaicin could reduce the limitations of topical administration and have better therapeutic efficacy; this hypothesis was tested in a controlled trial. METHODS: Systemic oral capsaicin 0.25% was used for patients with BMS, recruited in our single centre. After the diagnosis of BMS, patients were dentally and medically examined. They were alternatively assigned to treatment with capsaicin or to a shape/smell/taste/color matched placebo. The severity of symptoms was scored at trial entry and 30 days thereafter by investigators who were unaware of the assigned intervention. The visual analogical scale (VAS) measure was used to score the severity of pain, and results for the treated and untreated groups were compared by Fisher's exact test. Analysis was performed by intention-to-treat. Statistical significance was considered for values of P < 0.05. Data are expressed as mean +/- SD. RESULTS: Fifty patients were enrolled (25 assigned to systemic capsaicin and 25 to placebo). The VAS score was significantly lower in treated patients (5.84 +/- 1.17) as compared to the placebo-control group (6.24 +/- 0.96). The use of systemic capsaicin implied significant gastric toxicity (referred gastric pain) with eight cases (32%) documented in the treatment group as compared to zero cases (0%) in the placebo control group. CONCLUSION: Systemic capsaicin is therapeutically effective for the short-term treatment of BMS but major gastrointestinal side-effects may threaten its large-scale, long-term use. This preliminary study suggests that more, adequately powered, randomized controlled trials are necessary and worthy to come to a definitive assessment of this matter.     

Clinical study of patients with burning mouth

Analysis and treatment of dental and medical factors that can cause burning mouth were performed in 25 consecutive patients according to a treatment protocol. The effect of the dental and medical treatment on the burning mouth was evaluated. The sick leave profile was presented. Apart from burning mouth symptoms, the patients reported several oral and general symptoms, such as gustatory changes, xerostomia, back and joint muscle pain, headache, and dizziness. The most common dental diagnoses were temporomandibular joint, masticatory, and tongue muscle dysfunction and lesions in the oral mucosa. The most common medical diagnoses were low serum iron and hypersensitive reaction to mercury. None of the patients tested exceeded the limit of 100 nmol Hg/l urine. Replacement of amalgam fillings was the most common dental therapy, followed by treatment of dysfunction in the masticatory system. Iron replacement was the most frequent medical treatment. The patients had over 50% more days per year sick leave than an age- and sex-matched normal population. A follow-up found that the burning mouth had disappeared in 32% of the patients. This study confirms the opinion that burning mouth is multicausal. Hypersensitive reaction to mercury was more frequent than expected, but replacement of amalgam fillings relieved burning mouth in only two of five such patients, and one of these two patients had hypersensitive reactions to both mercury and gold. One reason that so many patients continued to have burning mouth might have been neglect of dental, medical, or both diagnoses. Another reason might be that assessment of the psychologic status of the patients and psychologic treatment when indicated were not done.     

Protein composition, adhesion, and agglutination properties of saliva in burning mouth syndrome

Resting and stimulated whole saliva and parotid saliva of men and pre- and post-menopausal women with burning mouth syndrome (BMS) and their matched controls were studied. Women with BMS had slightly, but not significantly, higher flow rates than their controls. The total protsein concentration in stimulated saliva of women with BMS was significantly lower than that of controls. This difference was not associated with the flow rate. The proportional amount of sialic acid, used as an indicator of mucin concentration, was higher in subjects with BMS than in their controls. SDS-PAGE showed no consistent differences in the protein profiles of saliva, nor were any differences observed in the adhesion or agglutination assays between subjects with BMS and their matched controls. Thus, the present results indicate that BMS is not associated with a decrease in the protecting and lubricating properties of saliva.     

Comparison of clinical characteristics between burning mouth syndrome patients with bilateral and unilateral symptoms

The purpose of the present study was to investigate and compare the clinical characteristics of burning mouth syndrome (BMS) patients with bilateral and unilateral symptoms. Of 769 patients with oral burning sensation, 421 patients with primary BMS were included. Among them, 324 patients who complained of oral symptoms on both sides of the oral cavity were assigned to the bilateral group and 97 patients who complained of symptoms only on one side of the oral cavity were assigned to the unilateral group. Clinical characteristics, psychological status, and salivary secretion were compared between the two groups. There were no significant differences in the mean age, sex ratio, unstimulated and stimulated salivary flow rates, or duration of symptoms between the two groups. The bilateral group had higher levels of psychological distresses compared with the unilateral group. The bilateral group had higher prevalence rates in burning, taste alteration, and xerostomia than the unilateral group. The proportion of patients who considered dental procedures as an initiating factor of BMS symptoms was higher in the unilateral group than in the bilateral group. Conclusively, BMS patients with bilateral and unilateral symptoms had different clinical characteristics, suggesting that the neuropathic mechanisms in these two groups are different.     

Quality of life in patients with burning mouth syndrome

Objective:  To study the quality of life in patients with burning mouth syndrome (BMS), our primary aim was to compare BMS patients with healthy controls and the secondary aim was to compare subgroups of BMS patients on the type of therapy received; using the Medical Outcome Short Form Health Survey Questionnaire (SF-36) and the Oral Health Impact Profile (OHIP-49) as measurement instruments.
Method:  Sixty consecutive patients (10 males and 50 females) with BMS were studied in the Department of Oral Medicine (Faculty of Medicine and Dentistry, University of Murcia, Spain), while 60 healthy patients were used as controls. The Spanish version of the SF-36 was used to evaluate general quality of life, together with the OHIP-49 in its Spanish version.
Results:  Regarding general quality of life as assessed with the SF-36, and on comparing the BMS vs. the control groups, lower scores were obtained in the former in all domains ( P  < 0.001). The OHIP-49 in turn yielded significant differences in each of the domains vs. the controls. No significant differences were found between the patients with BMS in any domain regarding parafunctional habits and the presence of dentures. In relation to the different treatments, significant differences were recorded in functional limitation ( P  = 0.02) and physical pain ( P  = 0.033).
Conclusion:  Patients with BMS yield poorer scores on all scales vs. the healthy controls when applying the SF-36 and OHIP-49.     

Pathophysiology of primary burning mouth syndrome with special focus on taste dysfunction: a review

Primary burning mouth syndrome (BMS) is a chronic oral condition characterized by burning pain often accompanied with taste dysfunction and xerostomia. The most compelling evidence concerning BMS pathophysiology comes from studies on the somatosensory system using neurophysiologic or psychophysical methods such as blink reflex, thermal quantitative sensory testing, as well as functional brain imaging. They have provided convincing evidence for neuropathic involvement at several levels of the somatosensory system in BMS pain pathophysiology. The number of taste function studies trying to substantiate the subjective taste disturbances or studies on salivary factors in BMS is much more limited, and most of them suffer from definitional and methodological problems. This review aims to critically evaluate the existing literature on the pathophysiology of BMS, paying special attention to the correctness of case selection and the methodology used in published studies, and to summarize the current state of knowledge. Based on the recognition of several gaps in the current understanding of the pathophysiology of BMS especially as regards taste and pain system interactions, the review ends with future scenarios for research in this area.     

国内灼口综合征抗抑郁药物治疗循证医学分析

目的:分析国内近年来抗抑郁药物治疗灼口综合征的疗效情况和研究质量.方法:检索中文科技医学期刊数据库,收集发表在1994～2007年抗抑郁药物治疗灼口综合征疗效观察的中文文献,对研究方法符合随机对照的文献进行循证医学分析.结果:共检索到16篇文章,符合纳入标准的仅为2篇,无法进行META分析.氟西汀对于心因性灼口综合征有较好的疗效.结论:目前,国内抗抑郁药物治疗灼口综合征的文献数量和质量均不能满足临床要求,需要更多高质量的研究来为抗抑郁药物治疗该病提供证据.