Salivary concentrations of nickel and chromium in patients with burning mouth syndrome

It has been documented in vitro and in vivo that metal dental appliances release metal ions due to corrosion. Dentists must choose among many dental casting alloys available, often without knowledge of their biological properties and effect on oral mucosa. The aim of this study was to measure metal content of nickel (Ni) and chromium (Cr) in whole saliva of 85 patients with and without metal dental appliances. Unstimulated whole saliva was collected and analyzed by using electrothermal atomic absorption spectrometry. History data, subjective complaints and objective findings on oral mucosa were recorded. The concentration of metal ions was investigated in correlation to burning mouth syndrome, erythema of oral mucosa, pH and smoking habit. Results showed a higher Ni concentration in patients with metal restorations, especially wearers of predominantly base metal appliances. The concentration of Cr showed no difference between patient groups. Although burning mouth syndrome was more frequent in the group with dental casting alloys, there was no correlation between higher Ni and Cr concentrations and burning mouth syndrome. Erythema of oral mucosa was a common finding in study patients, but did not correlate with salivary Ni and Cr ion concentrations. Salivary Ni and Cr concentrations were not related to either pH or smoking habit.     

A review of burning mouth syndrome.

Burning mouth syndrome is a complicated, poorly understood, predominantly oral condition that affects more than 1 million people in the United States. Women are particularly affected by the condition; they are diagnosed with symptoms seven times more frequently than males. Burning mouth syndrome is characterized by a burning, painful sensation of the oral mucosa that most commonly involves the anterior tongue. Many precipitating factors to burning mouth syndrome have been proposed, and treatment addressing these factors has had limited success. Patients with burning mouth syndrome are more likely to be evaluated by physicians, and therefore it is advantageous for the physician to be familiar with this oral condition. This paper reviews burning mouth syndrome, associated causative factors, and treatment strategies for the physician.     

An overview of burning mouth syndrome for the dermatologist

Burning mouth syndrome is characterized by an idiopathic burning pain affecting the oral mucosa, with no clinically apparent changes. It can present to a variety of health professionals including dermatologists. This article summarizes the important aspects of the condition, including theories of pathogenesis, diagnosis and management.     

Contact allergy to denture materials in the burning mouth syndrome

Several factors may be responsible for stomatitis in general and the burning mouth syndrome in particular. The results of patch testing are reported in 4 patients with burning mouth symptoms thought to be due to sensitization to denture material. 2 patients reacted to substances in Luxene dentures, but the allergens were not identified. In a 3rd patient, sensitization was found to monomeric methyl methacrylate. The other patient gave positive patch tests to epoxy resin (and bisphenol A), probably present in glue used for repair of dental plates. To obtain a complete diagnosis in cases of suspected contact stomatitis due to allergens in dentures, a reliable standard test series is required.     

Skin sensitivity to denture base materials in the burning mouth syndrome

The significance of sensitizing compounds in the denture base for the etiology of the burning mouth syndrome (BMS) has been studied in 53 denture-wearing persons, seven males and 46 females. Epicutaneous patch tests were performed with standard concentrations of benzoyl peroxide, dibutylphthalate, dimethyl-p-toluidine, formaldehyde, hydroquinone, methylmethacrylate, p-phenylendiamine and with cadmium sulfate, potassium dichromate, cobalt chloride and nickel sulfate. Furthermore, patch testing was performed with filings from the denture mixed with the patient's own saliva. In cases with an inflamed oral mucosa, the presence of hyphae of Candida albicans was assessed by a smear technique. Positive skin reactions were observed in 15 persons to dimethyl-p-toluidine, hydroquinone, formaldehyde, methylmethacrylate, p-phenylendiamine, potassium dichromate, cobalt chloride and nickel sulfate, including three cases with reactions to filings from their dentures, and one patient who after subsequent testing showed skin sensitivity to balsam of Peru. In 12 cases an etiological connection could be traced between the oral symptoms and the denture base, indicating that contact sensitivity to base materials or to allergens and microbial antigens on the denture plate plays a greater role in the pathogenesis of BMS in edentulous persons than previously suggested.     

Contribution of neuroinflammation in burning mouth syndrome: indications from benzodiazepine use

Characterized by burning and painful oral sensations in absence of clinically significant mucosal abnormalities, the burning mouth syndrome is, despite numerous researches made, basically idiopathic and, consequently, difficult to treat effectively. Therapy with tricyclic antidepressants and benzodiazepines has been proposed, although the exact pathomechanism is not clear. The objective of this study is to define the possible reasons for the efficacy of benzodiazepines in the treatment of the burning mouth syndrome. Starting from the report of eight cases successfully treated with prazepam, the present authors examined the clinical features and the evidence from literature that support the possibility of a role of neuroinflammation in the pathogenesis of the burning mouth syndrome. Available data suggest that the nervous system could be crucial in the pathogenesis of the syndrome (altered perception of pain, disturbance of neural transmission, increased excitability, negative involvement of trigeminal-vascular system), and the present authors' experience lets them suppose a role for neuroinflammation. This hypothesis could also explain the positive response to benzodiazepines in some patients. The important role of neuroinflammation in dermatologic and oral diseases has been only recently investigated and acknowledged. Further studies on the connection between neuroinflammation and burning mouth syndrome could open interesting perspectives in the understanding and management of this difficult clinical condition.     

Thermal sensory and pain thresholds in the tongue and chin change with age,but are not altered in burning mouth syndrome

Background: Burning mouth syndrome (BMS) is a chronic orofacial pain syndrome that occurs in middle‐aged and postmenopausal women and poses a therapeutic challenge to dermatologists and dentists. It has been suggested previously that BMS is a small‐fiber neuropathy. Aims: This study was designed to examine thermal sensory and pain thresholds in the oral mucosa and chin, both innervated by the trigeminal nerve, in patients with BMS, as well as in healthy controls. In addition, the study proposed to examine whether there are any differences in oral thermal and pain sensations between the advanced age group, where BMS is prevalent and a younger group. Results: Thermal and pain thresholds of BMS patients did not differ significantly from those of healthy subjects. An increased threshold to thermal warmth and a decreased threshold for cold sensation for the tongue and chin were noted in the group over 50 years in comparison with younger subjects, indicating a decreased sensitivity to thermal stimuli. The group over 50 years of age displayed an increased sensitivity to cold pain and a decreased sensitivity to hot pain in the tongue (compared with the chin). Conclusion: BMS patients do not demonstrate alterations in thermal and pain detection, thus failing to support a true small nerve neuropathy in this condition.     

Illness perceptions, coping and quality of life in patients with alopecia

Background  Alopecia can have substantial psychological consequences, but there has been no research looking at patients' beliefs about their condition nor how they relate to quality of life (QoL).
Objectives  To investigate the relationships between illness perceptions, coping and QoL in patients with alopecia.
Methods  The study employed a cross-sectional design. In total, 214 individuals with alopecia were recruited from four internet support groups. There were 171 women and 43 men (mean age 35 years). Participants completed an online questionnaire comprising the Revised Illness Perception Questionnaire, the Dermatology Life Quality Index and the brief COPE.
Results  The findings indicate several areas in which alopecia impacted on individuals' QoL, particularly in relation to symptoms and feelings. Women reported poorer QoL compared with men. Impaired QoL was associated with a strong illness identity, beliefs in the serious consequences of alopecia and strong emotional representations. Hierarchical multiple regressions indicated that illness perceptions accounted for 35% of the variance in QoL after controlling for demographic and disease factors, with coping adding a further 7% to the regression model.
Conclusions  Although alopecia is not a life-threatening condition, it can impair QoL by negatively impacting on self-awareness. The strong relationships found between patients' beliefs about their condition and QoL suggests that health professionals should recognize the psychological impact of alopecia and address negative beliefs and emotions surrounding the condition in treatment programmes.     

坤泰胶囊对围绝经期综合征患者生存质量与卵巢功能影响

目的 探讨坤泰胶囊对围绝经期综合征患者的效果,并评价其对患者生存质量及卵巢功能的影响.方法 选取2016年10月至2017年10月辽宁省健康产业集团阜新矿总医院诊治的146例围绝经期综合征患者作为研究对象.随机分为观察组(n=73)与对照组(n=73).对照组采用雌孕激素治疗,观察组在对照组基础上加用坤泰胶囊,对比组间...     

Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1–2% of the general population. Although not life threatening, vitiligo may considerably influence patients’ health‐related quality of life (QoL) and psychological well‐being. Willingness‐to‐pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ‐5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71·5% women, mean age 44·4 years, mean disease duration 20·3 years) with vitiligo. The mean DLQI was 7·0 (7·5 in women, 5·5 in men) compared with 8·6 in psoriasis. Of the patients with vitiligo, 24·6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34·1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20–29 years. EQ‐5D mean score was 83·6 compared with 75·3 in psoriasis. Of the patients with vitiligo, 32·9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle‐aged patients (30–60 years). There was a significant correlation between DLQI scores and WTP (χ² = 65·43, P < 0·001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0·001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients’ compliance and empowerment.