Efficacy of moclobemide in burning mouth syndrome: a nonrandomized, open-label study

AIMS: To compare burning mouth syndrome (BMS) patients with age- and gender-matched controls for psychologic conditions, to analyze the effect of menstrual state on the intensity of burning, and to assess the efficacy of an antidepressant medication on the burning pain and psychologic status. METHODS: Ninety-four patients with BMS and 94 matched control subjects participated in the study. Anxiety and depression were analyzed by means of the Spielberger State-Trait Anxiety Inventory and Zung Self-Rating Depression Scale, and the severity of the burning sensation was measured by means of a visual analog scale (VAS). In female BMS patients and controls, the menstrual state was noted (menstruating, menopausal, or postmenopausal). BMS patients were treated with the antidepressant moclobemide (150 mg 2 times daily) for 3 months. Thereafter, anxiety, depression, and burning pain intensity were reassessed. Patient-perceived satisfactory improvement for burning sensation was assessed using a 5-point categorical rating of change scale. RESULTS: BMS patients had significantly higher anxiety and depression scores than controls (P < .05). After treatment, anxiety and depression scores as well as the VAS values for burning pain decreased significantly (P < .001). Thirty-seven patients reported good to very good improvement, and 44 reported satisfactory improvement. No adverse reactions were reported. CONCLUSIONS: The study confirmed earlier reports that BMS patients have higher anxiety and depression levels than controls. An antidepressant medication may be effective in alleviating the burning pain, at least in the short-term.     

灼口综合征患者的疼痛与个性,情绪间因果关系的研究

为了深入了解灼口综合征（ＢＭＳ）精神因素个中性，情绪与疼痛间的淮因谁果的焦点问题，本研究选用了２８例病史较长，疼痛明显且高频复发的复发性阿弗它溃疡（ＲＡＵ）患才为对照，应用ＥＰＱ，ＳＣＬ－９０，ＬＥＳ三个量表了解ＲＡＵ患者与病较短的２９例ＢＭＳ患者间个性，情绪，应激三方面的差异性，结果显示在ＢＭＳ组较ＲＡＵ组个性偏内向，且精神质（Ｐ值）得分显著高于ＲＡＵ组，ＢＭＳ组经历的负性生活事件及多项情绪因子     

Burning mouth syndrome: an update on diagnosis and treatment methods

Burning mouth syndrome is characterized by both positive (burning pain, dysgeusia and dysesthesia) and negative (loss of taste and paraesthesia) sensory symptoms involving the lips and tongue, mainly the tip and anterior two-thirds. BMS patients report a persistently altered (metallic) taste or diminished taste sensations. Acidic foods such as tomatoes and orange juice cause considerable distress. Most of the common laboratory tests suggested for BMS patients will be negative as well. BMS is best subcategorized as primary BMS, no other evident disease, and secondary BMS, which is defined as oral burning from other clinical abnormalities. The presence of BMS is very uncommon before the age of 30; 40 years for men. The onset in women usually occurs within three to 12 years after menopause, and is higher in women who have more systemic disease. Quantitative assessment of the sensory and chemosensory functions in BMS patients reveals that the sensory thresholds (significantly higher) are different than in controls. Tongue biopsies have shown that there is a significantly lower density of epithelial nerve fibers for BMS patients than controls. The above data generally support the idea that BMS is a disorder of altered sensory processing which occur following the small fiber neuropathic changes in the tongue. BMS patients frequently have depression, anxiety, sometimes diabetes, and even nutritional/mineral deficiencies, but overall these co-morbid diseases do not fully explain BMS. The management of BMS is still not satisfactory, but because BMS is now largely considered to be neuropathic in origin, treatment is primarily via medications that may suppress neurologic transduction, transmission, and even pain signal facilitation more centrally. Finally, spontaneous remission of pain in BMS subjects has not been definitely demonstrated. The current treatments are palliative only, and while they may not be much better than a credible placebo treatment, few studies report relief without intervention.     

Burning mouth syndrome and mast cell activation disorder

Burning mouth syndrome (BMS), a chronic diffuse oral pain syndrome affecting ～1% of the general population, is diagnosed when explanatory oral pathology and other identifiable causes are absent. BMS has been recognized for decades, but its etiology remains unknown and has not previously been attributed to mast cell disease. Three cases of BMS are reported in which evidence of an underlying mast cell activation disorder (MCAD) was found; all 3 patients' oral pain responded well to MCAD-directed therapy. Mediators released from mast cells have a wide range of local and remote effects and potentially may cause the neuropathic changes and/or inflammation thought to lead to the symptoms of BMS. Mast cell disease either in oral tissue or at sites remote from the mouth should be considered in the differential diagnosis of BMS.     

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.     

Randomized trials for the treatment of burning mouth syndrome: an evidence-based review of the literature

Burning mouth syndrome (BMS) is defined as a chronic pain condition, characterized symptomatically by a generalized or localized burning sensation in the oral cavity. Various drugs have been used in attempting to treat BMS, but there is insufficient evidence to show the effect of any effective treatment. The aim of this review was to assess the effectiveness of therapies for BMS. Randomized controlled trials (RCTs) enrolling patients with a diagnosis of BMS were identified by searching Pubmed and Scoppus databases. The methodological quality of included studies was assessed on the basis of the method of allocation concealment, blindness of the study, loss of participants, size sample, and outcome concealment. A total of 12 relevant articles were analyzed. Therapies that used capsaicin, alpha-lipoic acid (ALA), and clonazepam were those that showed more reduction in symptoms of BMS. However, many studies of therapeutic interventions in BMS lack consistency in their results, because they use in their methodology, sample and a relatively short time of therapy and often do not provide a follow-up of patients treated. Thus, future studies are required to establish the treatment for patients suffering from this chronic and painful syndrome.     

Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma

Burning mouth syndrome (BMS) is characterized by burning pain in the tongue or other oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paraesthesia and altered taste for which no medical or dental cause can be found. The difficulty in diagnosing BMS lies in excluding known causes of oral burning. A pragmatic approach in clarifying this issue is to divide patients into either primary (essential/idiopathic) BMS, whereby other disease is not evident or secondary BMS, where oral burning is explained by a clinical abnormality. The purpose of this article was to provide the practitioner with an understanding of the local, systemic and psychosocial factors which may be responsible for oral burning associated with secondary BMS, therefore providing a foundation for diagnosing primary BMS.     

Damage to taste system and oral pain: burning mouth syndrome

The burning mouth syndrome (BMS) is an oral pain disorder. Central or peripheral pain mechanisms may play a role in the oral burning of BMS. Various local, systemic and psychological factors have been found to be associated with BMS, but its etiology is not fully understood. This syndrome mostly affects middle-aged women and is frequently accompanied by taste complaints. This association of symptoms suggests an interaction between the mechanisms of nociception and gustation, 2 senses with strong hedonic components. There are connections between taste and oral pain in the central nervous system and it is possible that BMS and other oral pain phantoms result from damage to the taste system. This suggests that individuals who suffer from BMS are likely to be supertasters.     

灼口综合征病因及发病机制

灼口综合征（burning mouth syndrome，BMS）是一种发生在口腔黏膜的慢性疼痛性疾病，临床症状多样，包括舌部、唇或其他口腔黏膜表面的灼烧感或刺痛感，可伴有口腔干燥或唾液过少、味觉改变或感觉麻痹。多年来，学者们对BMS病因的研究众多，但关于BMS确切的病因及发病机制仍不明确。文章就多年来学者们对BMS病因及发病机制的研究做一综述。     

Burning mouth syndrome (BMS): controlled open trial of the efficacy of alpha-lipoic acid (thioctic acid) on symptomatology

BACKGROUND: Alpha-lipoic acid (ALA), is a potent antioxidant mitochondrial coenzyme, the trometamol salt of thioctic acid that has been shown in clinical studies to be neuroprotective. This study examined the effect of ALA on the symptomatology of Burning mouth syndrome (BMS). SUBJECTS AND METHODS: Forty-two patients with BMS and no clinical or laboratory evidence of organic oral disease were divided into two groups (Test and Control) each of 21 subjects, matched for age and sex. The Test group were given ALA (thioctic acid; Tiobec) for 30 days, as 600 mg per day orally for 20 days followed by 200 mg per day for 10 days. The Control group were given cellulose starch 100 mg per day as placebo for 30 days. All BMS patients were reviewed at 10-day intervals and scored for changes in symptomatology. RESULTS: Significant improvements were shown in the symptomatology of BMS in up to two-thirds of patients with BMS receiving alpha-lipoic acid, in about 15% of those using placebo and also in up to two-thirds of those who, having tried placebo, were switched to ALA.     

US6Burning mouth syndrome

Burning mouth syndrome (BMS) is an idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa in whom a medical or dental cause has been excluded. Associated symptoms include altered taste and a sensation of oral dryness. Terms previously used to describe BMS include glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, sore tongue, and oral dysaesthesia. BMS mainly affects women particularly after the menopause, when its prevalence may be 18–33%. Suggested causal factors include hormonal disturbances associated with the menopause and psychogenic factors (including anxiety, depression, stress, life events, personality disorders, and cancer phobia). There is increasing evidence that a sensory neuropathy underlies BMS symptoms. Management of the symptoms of BMS can be challenging. It has been hampered by a relative lack of high quality evidence and randomised controlled trials into BMS treatment. Many studies have not differentiated between those with burning mouth syndrome (i.e. idiopathic disease) from those with other conditions (such as haematinic deficiencies) causing symptoms of a burning mouth, making results unreliable. Local and systemic factors (such as mucosal disorders, allergies, ill fitting dentures, hypersensitivity reactions and vitamin deficiencies) may cause the symptom of burning mouth and should be excluded before reaching the diagnosis of BMS. Various interventions have been proposed to be beneficial in managing BMS ranging from cognitive behaviour therapy, antidepressants, dietary supplements, hormone replacement in postmenopausal women, topical benzydamine hydrochloride, capsaician and clonazepam. This presentation will critically review BMS diagnosis, the evidence concerning the efficacy of potential interventions and propose a management protocol.     

Clinical features of burning mouth syndrome

A study was carried out to compare the clinical features of 102 subjects suffering from burning mouth syndrome (BMS) and 43 age- and sex-matched control subjects. In comparison with those in the control group, the BMS subjects reported a significantly higher prevalence of dry mouth, thirst, taste and sleep disturbances, headaches, nonspecific health problems, pain complaints, and severe menopausal symptoms, but no significant differences in other oral or dental features or in the prevalence of candidiasis infection. In addition, there was no hematologic evidence of a nutritional disturbance in more than 90% of the BMS subjects tested, but immunologic abnormalities and an elevation of the erythrocyte sedimentation rate were found in more than 58% and 63% of the BMS subjects, respectively. These findings demonstrate those features which distinguish BMS subjects from age- and sex-matched control subjects but provide no confirmatory evidence for many of the etiologic factors frequently suggested for BMS.     

General health factors and denture function in patients with burning mouth syndrome and matched control subjects

summary A total of 30 denture-wearing patients with burning mouth syndrome (BMS) referred to a Pain Clinic Unit and 26 age- and sex-matched control subjects were examined and compared with respect to general health factors and denture function. The study demonstrated a significantly higher frequency of multiple chronic diseases, psychosocial stress factors, and tenderness/pain in masticatory, neck, shoulder, and suprahyoid muscles in patients with BMS. Denture function differed also between the two groups as patients with BMS had significantly less daily use of dentures, reduced tongue space, incorrect placement of occlusal table and increased vertical dimension. Pain interview with the use of the McGill Pain Questionnaire demonstrated that pain in parts of the body other than the oral cavity were reported more frequently and that the intensity of past pain experiences was not rated higher except for pain in the head in patients with BMS. The results suggested a complex interaction between several general health factors, psychosocial stressors and denture dysfunction in order to explain an idiopathic burning pain in the anterior part of the oral cavity. The existence of demonstrable load factors does not seem to support the suggestion that BMS is primarily a psychogenic disorder.     

Clinical application of a questionnaire for diagnosis and treatment of halitosis.

To treat halitosis, clinicians must examine the psychologic condition of a patient as well as the disease history and plausible causes of oral malodor, such as periodontal disease. However, it is not easy for a practitioner to carry out a psychologic examination other than the normal inquiry concerning oral malodor itself. Hence, a questionnaire that appears to be a normal inquiry, rather than one containing psychologic questions, was composed to survey the causes of halitosis and psychosomatic tendencies.     

Burning mouth syndrome

Burning Mouth Syndrome (BMS) is a frequent disease characterized by a burning or painful sensation in the tongue and/or other oral sites without clinical mucosal abnormalities or lesions. The etiopathology is unknown although local, systemic and psychological factors have been connected with BMS. As this syndrome is a multifactorial disease, the diagnostic and therapeutic approach should be multidisciplinary. In this paper a review of the literature is presented and the most recent advancement on clinical, etiologic, diagnostic and therapeutic aspects of BMS are discussed.     

Pharmacological treatment of burning mouth syndrome: A review and update

Burning mouth syndrome (BMS) is defined as a burning sensation in the tongue or in any other region of the oral mucosa, in the absence of specific oral lesions. The present study reviews the pharmacological treatments used in the last 10 years to reduce the symptoms of BMS, and assesses the efficacy and safety of pharmacological interventions destined to alleviate the symptoms of BMS. To this effect, searches were made in the following databases: Micromedex, Cochrane Database and PubMed, crossing the following key words: drug, treatment, clinical trial, pain management, and burning mouth syndrome. The searches were limited to articles published in the last 10 years in English or Spanish, and involving human subjects. The searches were conducted in November 2006. The literature contains clinical studies in which BMS has been treated with drugs belonging to different pharmacological groups: antidepressants, antipsychotics, antiepileptic drugs, analgesics and mucosal protectors, among others. Although effective therapies have been identified in concrete cases, a treatment modality offering efficacy in most cases of BMS remains to be established. It is essential to gain further insight to the physiopathological mechanisms of BMS, and to establish differential diagnostic criteria to develop drugs with improved efficacy and safety profiles in the treatment of BMS.     

Psychologic response of the edentulous patient after primary surgery for oral cancer: A cross-sectional study.

STATEMENT OF PROBLEM: Edentulous patients can have difficulty in tolerating dentures and this may lead to psychologic disturbance. The problem is potentially more severe for edentulous patients after primary surgery for oral cancer, where treatment can include composite resection and reconstruction, followed by adjuvant radiotherapy. PURPOSE: This study investigated the psychologic response and oral satisfaction of edentulous patients treated by surgery for oral squamous cell carcinoma, and to make a comparison to edentulous noncancer counterparts. METHODS AND MATERIAL: The cross-sectional study included patients who were alive and disease-free 2 to 3 years after primary surgery. Seventy patients underwent surgery at the Regional Maxillofacial Unit, Liverpool, in 1993 and 1994. Twenty-eight patients were disease-free; 26 completed questionnaires that included a general health questionnaire (GHQ), a body satisfaction scale, a self-esteem scale, an oral symptom checklist, and a denture satisfaction questionnaire. Comparison was made with 98 noncancer edentulous patients from the same unit. RESULTS: There were similarities in psychologic and oral satisfaction scores between the noncancer and cancer edentulous patients. Cancer patients reported lower self-esteem (P <.02). Cancer patients who were not rehabilitated with either conventional or implant-retained prostheses had significant psychologic morbidity as measured by the GHQ, self-esteem, and body satisfaction scales. Cancer patients with implant-retained overdentures reported greater satisfaction with their dentures compared with their counterparts who wore conventional dentures (P <.05). CONCLUSION: Edentulous cancer patients who do not achieve oral rehabilitation after surgery for oral cancer exhibited significant psychologic morbidity. Patients with implant-retained overdentures exhibited a tendency to adopt the same psychologic response with improved denture satisfaction as edentulous patients with conventional dentures, despite the former having more extensive disease that would otherwise make the provision of dentures much more difficult if implants were not used.     

Pharyngeal airway changes five years after bimaxillary surgery – A retrospective study

The aim of this study was to retrospectively evaluate pharyngeal airway (PA) changes after bimaxillary surgery (BMS).Preoperative, immediate- and 5-year postoperative cone-beam computed tomography images of subjects who underwent BMS were assessed. The primary outcome variable was the PA volume. The secondary outcome variables were the retropalatal and oropharyngeal volumes, cross-sectional area, minimal hydraulic diameter, soft tissue, skeletal movements and sleep-disordered breathing (SDB).A total of 50 patients were included, 33 female and 17 male, with a mean age of 26.5 years. A significant increase in the PA volume was seen immediately after surgery (40%), and this increase was still present at 5-year follow-up (34%) (P < 0.001). A linear mixed model regression analysis revealed that a mandibular advancement of ≥5 mm (P = 0.025) and every 1-mm upward movement of epiglottis (P = 0.016) was associated with a volume increase of the oropharyngeal compartment. Moreover, ≥5-mm upward movement of hyoid bone (P = 0.034) and every 1-mm increase in minimal hydraulic diameter (P < 0.001) correlated with an increase of the PA volume. A total of 30 subjects reported improvement in the SDB at 5-year follow-up.This study demonstrated that BMS led to an increase in PA dimensions in non-OSA patients, and these changes were still present at 5-year follow-up. BMS seemed to induce clinical improvement in SDB.     

Calcitonin gene-related peptide levels in saliva of patients with burning mouth syndrome

Burning mouth syndrome (BMS) is an intraoral burning sensation for which no medical or dental cause can be found. Recent studies suggest that primary neuropathic dysfunction might be involved in the pathogenesis of BMS. Calcitonin gene-related peptide (CGRP) plays an important role in the development of pain and serves as a biological marker of trigeminovascular activation. The aim of this study was to determine the levels of CGRP in the saliva of BMS patients and estimate the trigeminovascular activation in BMS. CGRP levels were measured, by RIA method in 78 BMS patients and 16 healthy subjects. The levels of CGRP were non-significantly decreased in BMS patients in comparison to healthy subjects. These results suggest that trigeminal nerve degeneration may be the underlying cause of BMS.     

Validity of a newly developed ultraminiature cordless EMG measurement system

To verify validity of a newly developed ultraminiature EMG measurement system (BMS), the ability of BMS to record masseteric EMG was compared with that of a conventional polygraph system (PG) in the daytime. Effective distance between the transmitter unit and receiver unit of BMS was also examined. Subjects were 12 healthy volunteers. During tapping, maximum clenching, and gum chewing of all subjects, distinct bursts were observed in EMG recorded by BMS as well as PG. RMS values of maximum clenching measured by BMS and PG showed a linear and significant correlation, and there was no significant difference between the data of BMS and PG. When distance between the transmitter unit and receiver unit of BMS was 100 cm or less, no artifact signal was observed. Having obtained these findings suggesting ability for precise measurement in the daytime, we are planning to use BMS in home sleep studies in the next step.