Burning mouth syndrome: prevalence and associated factors

Burning mouth syndrome (BMS) is characterized by a burning sensation in the oral cavity although the oral mucosa is clinically normal. The syndrome mostly affects middle-aged women. Various local, systemic and psychological factors have been found to be associated with BMS, but its etiology is not fully understood. Oral complaints and salivary flow were surveyed in 669 men and 758 women randomly selected from 48,500 individuals between the ages 20 and 69 years. Fifty-three individuals (3.7%), 11 men (1.6%) and 42 women (5.5%), were classified as having BMS. In men, no BMS was found before the age group 40 to 49 years where the prevalence was 0.7%, which increased to 3.6% in the oldest age group. In women, no BMS was found in the youngest age group, but in the age group 30 to 39 years the prevalence was 0.6% and increased to 12.2% in the oldest age group. Subjective oral dryness, age, medication, taste disturbances, intake of L-thyroxines, illness, stimulated salivary flow rate, depression and anxiety were factors associated with BMS. In individuals with BMS, the most prevalent site with burning sensations was the tongue (67.9%). The intensity of the burning sensation was estimated to be 4.6 on a visual analogue scale. There were no increased levels of depression, anxiety or stress among individuals with more pain compared to those with less pain. It was concluded that BMS should be seen as a marker of illness and/or distress, and the complex etiology of BMS demands specialist treatment.     

Burning mouth syndrome: a systematic review of treatments

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri‐ and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized controlled trials. Eight studies examined alpha‐lipoic acid (ALA), three clonazepam, three psychotherapy, and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea, and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.     

Burning mouth syndrome: a retrospective study investigating spontaneous remission and response to treatments

OBJECTIVE: The aim of this investigation was to evaluate the spontaneous remission rate of burning mouth syndrome (BMS) in a group of subjects suffering from this syndrome. SUBJECTS AND METHODS: The medical records of BMS patients attending the Unit of Oral Medicine (1995-2002) were reviewed. The patients with a follow-up period of at least 18 months were then contacted over phone and interviewed using a structured ad hoc questionnaire to record their current symptoms and data about their treatment responses to the therapies. RESULTS: Forty-eight women and five men with a mean age of 67.7 years (range 33-82 years) were included in the study (mean duration of BMS 5.5 years, s.d. +/-1.9 years, mean follow-up period of 56 months). As a consequence of different treatments, 26 patients (49.0%) reported no change in oral symptoms, 15 (28.3%) moderate improvement and 10 (18.9%) a worsening of oral complaints. Only two patients (3.7%) reported a complete spontaneous remission of oral symptoms without any treatment. CONCLUSIONS: In this study, a complete spontaneous remission was observed in 3% of the patients within 5 years after the onset of BMS. A moderate improvement was obtained in <30% of the subjects.     

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.     

Burning mouth syndrome and psychological disorders

Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.     

Burning mouth syndrome: the relationship between the HAD scale and parafunctional habits

This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.     

Burning mouth syndrome: the role of contact hypersensitivity

Background:  Burning mouth syndrome is a burning sensation or stinging disorder affecting the oral mucosa in the absence of any clinical signs or mucosal lesions. Some studies have suggested that burning mouth syndrome could be caused by the metals used in dental prostheses, as well as by acrylate monomers, additives and flavouring agents, although others have not found any aetiologic role for hypersensitivity to dental materials.
Objective:  To evaluate the extent and severity of adverse reactions to dental materials in a group of patients with burning mouth syndrome, and investigate the possible role of contact allergy in its pathogenesis.
Materials and methods:  We prospectively studied 124 consecutive patients with burning mouth syndrome (108 males; mean age 57 years, range 41–83), all of whom underwent allergen patch testing between 2004 and 2007.
Results:  Sixteen patients (13%) showed positive patch test reactions and were classified as having burning mouth syndrome type 3 or secondary burning mouth syndrome (Lamey's and Scala's classifications).
Conclusion:  Although we did not find any significant association between the patients and positive patch test reactions, it would be advisable to include hypersensitivity to dental components when evaluating patients experiencing intermittent oral burning without any clinical signs.     

Burning mouth syndrome: an update on recent findings

Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of mucosal abnormality. Various local, systemic and psychological factors are associated with BMS, but its aetiology is not fully understood. Recently, significant inroads have been made, producing a better understanding of this complex condition. The aim of the current paper is to explore the condition of BMS in an educational context with the specific outcome of increasing awareness of the condition.     

Placebo effect in burning mouth syndrome: a systematic review

Placebo controls play a critical role in the evaluation of any pharmacotherapy. This review surveys the placebo arm in 12 randomized controlled trials (RCTs) investigating burning mouth syndrome (BMS) and documents a positive placebo response in 6 of them. On average, treatment with placebos produced a response that was 72% as large as the response to active drugs. The lack of homogeneity in the use of placebos adds to the difficulty in comparing results and aggregating data. Future RCTs investigating BMS would benefit from larger sample sizes, adequate follow‐up periods, and use of a standard placebo.     

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。     

Burning mouth syndrome: an evaluation of in vivo microcirculation

BACKGROUND: Burning mouth syndrome (BMS) is an atypical orofacial algesic syndrome. The aim of the authors' research was to investigate the morphological characteristics of peripheral blood circulation in patients with BMS in comparison with those of the peripheral blood circulation in healthy people. METHODS: The authors examined 28 subjects, of whom 14 (10 women and four men) had BMS and 14 (nine women and five men) were healthy control subjects. They performed videocapillaroscopic examination with a capillaroscope with a fiber-optic probe at a magnification of x200, which allowed them to examine the morphological characteristics within the capillaroscopic area accurately. RESULTS: The capillaroscopic examination provided important diagnostic results regarding alterations of the local microcirculation in subjects with BMS when compared with healthy subjects. The results also showed a statistically significant increase in the diameter of the capillary ansae, afferent ansae and efferent ansae in subjects with BMS compared with subjects in the control group (P = .05). CONCLUSION AND CLINICAL IMPLICATIONS: The results revealed a vascular involvement in BMS. This information could improve the understanding of etiopathogenetic factors and aid in the development of therapeutic strategies for treating this disorder.     

Burning mouth in a Finnish adult population

Abstract – Burning mouth syndrome is an oral pain disorder with a prevalence of 5–18% in patient materials. The aim of this study was to determine the prevalence of Burning mouth syndrome in a representative sample of the general adult population. Altogether 431 subjects (237 females, 194 males) participated in the study. Subjects were questioned about the experience of prolonged burning sensation; the site, severity, pattern, duration and possible associations of the onset of the burning sensation, and a thorough clinical examination was performed. In all, 15% of the subjects had experienced prolonged oral burning but a half of them had some clinically observable oral mucosal lesion or oral candidosis. The prevalence of the complaint was significantly higher in females than in males.     

Burning mouth syndrome and saliva: detection of salivary trace elements and cytokines

Background: Burning mouth syndrome (BMS) is considered a syndrome with an unknown cause. Roles of various trace elements and cytokines in saliva have been implicated in the development of BMS. The aim of the present study was to compare the levels of salivary trace elements [magnesium (Mg), zinc (Zn), copper (Cu)] and interleukin (IL)‐2 and IL‐6, and to search for a correlation between depression/anxiety and salivary trace elements and cytokines in BMS patients and controls. Methods: Thirty patients with BMS and 30 matched healthy controls participated in the study. Unstimulated saliva was collected from participants and salivary flow rates were determined. Mg, Zn and Cu levels were determined by atomic absorbance spectrophotometry. Cytokine immunoassay kits were used to determine the concentration of IL‐2 and IL‐6 in the whole saliva samples. Anxiety and depression were analyzed by means of the Speilberger State‐Trait Anxiety Inventory (SAI‐TAI) and Zung Self‐Rating Depression Scale. Results: Although subjects in the control group had significantly higher mean levels for Mg compared with BMS patients (P < 0.01), no statistically significant differences were observed in relation to Zn and Cu levels between the two groups (P < 0.001). There were no statistically significant differences in IL‐2 and IL‐6 levels of BMS and control groups, but subjects in BMS group had slightly, not significantly, higher mean levels for IL‐6 compared with controls. Subjects in BMS group had significantly higher mean values for TAI compared with controls (P < 0.05). There were no statistically significant differences in relation to salivary levels of Mg, Zn, Cu, IL‐2, IL‐6 and depression/anxiety between BMS and control groups. Conclusions: The results of our study indicate that Mg levels could have an impact on symptoms of BMS and further studies are necessary to determine the importance of cytokines in the pathogenesis of BMS.     

Burning mouth syndrome: experiences from the perspective of female patients

The aim of this study was to gain a deeper understanding of the development of burning mouth syndrome (BMS). Eighteen females (43-80 yr old), referred to the Clinic of Oral Medicine, formed the study group. Oral examination did not reveal any mucosal lesion or dental pathology, blood analyses of vitamin B12 and serum iron levels were within normal reference values, and no allergies to dental materials were reported. Reported pain/discomfort was 49.4 (mean) on a 100-mm visual analog scale and duration of symptoms was, on average, 8.1 yr (median = 1.5 yr). Taped semistructured interviews were transcribed and analysed in line with grounded theory methodology. In the analysis, a core category emerged, labeled communicating psychological discomfort. This category indicated musings about the meaning of life and interacted with a personality characterized by a strong need for conscientiousness, a life style including long-standing struggle with psychosocial overload, and external social and cultural influences. The debut of the BMS was then preceded by an acutely stressful event. A psychosocial history, in addition to a detailed dental and medical history, seems to be crucial in diagnosing patients. If a psychological disorder and somatization of anxiety and depression is suggested, as indicated in our study, the patient should be offered counseling by a psychologist.     

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.     

Burning mouth syndrome: Patient management

Burning mouth syndrome is an underdiagnosed and often poorly managed oral sensory disturbance. This paper discusses the recognition of the condition and suggests clinical approaches to ensure a correct diagnosis and appropriate management. The expansion of the traditional dental rote of the dentist is reviewed in the context of overall oral and general health particularly with respect to the syndrome which demands an intensive workup, open discussions with the patient, and a carefully planned long-term management strategy.     

灼口综合征的心理学相关研究进展

随着心理学的迅速发展,灼口综合征与心理因素的关系越来越受到人们的重视。下面就近期有关灼口综合征患者的心理背景因素、心因性躯体症状、心理量表的研究分析以及心理行为治疗的文献进行综述,以期为从心理学角度治疗灼口综合征提供新的方法。     

佳蓉片治疗灼口综合征的临床疗效观察

目的:观察佳蓉片治疗灼口综合征的临床疗效。方法:60例灼口综合征患者随机分为治疗组30例、对照组30例,应用疼痛评分法比较其临床疗效。结果:治疗组总有效率明显优于对照组(P<0.01)。结论:佳蓉片治疗灼口综合征具有良好的临床疗效。     

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.