An updated review on pathophysiology and management of burning mouth syndrome with endocrinological,psychological and neuropathic perspectives

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.     

The Transmission of Trauma from Mother to Infant: Radioactive Residues and Counter-Transference in the Case of a Haitian Mother and Her Two-Year-Old Son*

ABSTRACT

Close observation of the interactions between a traumatised mother and her infant son provides information on the modes of transmission of psychic trauma in the mother–infant dyad. Following the presentation of a current literature review on the theme, the subject of “radioactive residue” and counter-transference in the transmission of psychic trauma from mother to infant will be illustrated through a clinical case study that focuses on a Haitian mother and her two-year-old infant son who has been referred to a “transitional care nursery” in urban Paris. The encounter with this mother–infant dyad is analysed through observing the quality of the interactions that take place between the mother and infant in order to determine how a particularly traumatic narrative impacts the mother–infant relationship, in addition to relations with the clinician. Mother and infant respond to one another through the emission and reception of “radioactive residues” as hypothesized by Gampel. This clinical case study shows that there is a need to consider transcultural factors and collective experience and history when analysing traumatic events. Additionally, the case study shows that counter-transference can be an effective clinical tool for gaining access to an infant's experience as the recipient of a traumatic narrative.     

甘草渣化学成分及其综合利用的研究

查阅甘草渣已有的现代研究,归纳其主要化学成分的提取方法、分离鉴定、药理作用及应用,指出甘草渣中富含黄酮类、多糖类及木质纤维素等,其综合利用涉及燃料、禽畜饲料及添加剂、食用菌栽培、培养基质、有机肥和食品包装等;对甘草渣化学成分及综合利用进行研究具有一定的现实意义及可观的经济效益,其广阔的应用前景对可持续发展意义重大。     

Oral carriage of Candida species and coliforms in patients with burning mouth syndrome

The oral carriage of Candida species and coliforms in a healthy adult population and a group of patients with burning mouth syndrome (BMS) was investigated. The intra-oral prevalence of Candida species and coliforms was higher in the BMS group compared with the controls. The most frequent yeast isolated from the BMS group was Candida albicans while Enterobacter and Klebsiella species were the most prevalent coliforms. The possible reasons and the significance of the above findings are discussed.     

Dysgeusia: A review in the context of COVID-19

BackgroundTaste disorders in general, and dysgeusia in particular, are relatively common disorders that may be a sign of a more complex acute or chronic medical condition. During the COVID-19 pandemic, taste disorders have found their way into the realm of general as well as specialty dentistry, with significance in screening for patients who potentially may have the virus.Types of Studies ReviewedThe authors searched electronic databases (PubMed, Embase, Web of Science, Google Scholar) for studies focused on dysgeusia, ageusia, and other taste disorders and their relationship to local and systemic causes.ResultsThe authors found pertinent literature explaining the normal physiology of taste sensation, proposals for suggested new tastes, presence of gustatory receptors in remote tissues of the body, and etiology and pathophysiology of taste disorders, in addition to the valuable knowledge gained about gustatory disorders in the context of COVID-19. Along with olfactory disorders, taste disorders are one of the earliest suggestive symptoms of COVID-19 infection.ConclusionsGustatory disorders are the result of local or systemic etiology or both. Newer taste sensations, such as calcium and fat tastes, have been discovered, as well as taste receptors that are remote from the oropharyngeal area. Literature published during the COVID-19 pandemic to date reinforces the significance of early detection of potential patients with COVID-19 by means of screening for recent-onset taste disorders.Practical ImplicationsTimely screening and identification of potential gustatory disorders are paramount for the dental care practitioner to aid in the early diagnosis of COVID-19 and other serious systemic disorders.     

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.