灼口综合征患者心理学相关因素的临床分析

的　对 98例灼口综合征 (BMS)患者进行心理学相关因素研究 ,以了解BMS与心理障碍关系 ,为进一步心理行为治疗提供理论依据。方法　对 98例非病理性BMS患者进行心理学病因、心因性躯体症状观察 ,并对BMS患者组和相配对的正常组进行SAS、SDS和SCL90量表的分析。结果　 98例BMS患者中 ,有 95 %有各种心理学病因 ,所有患者存在各种心因性躯体症状 ,最常见的为睡眠障碍 ( 90 .8% ) ;有 96 %患者存在中重度的抑郁 ,75 %患者存在中重度的焦虑 ;SCL90量表主要以躯体化、强迫症状、抑郁、焦虑、精神病性为主。结论　BMS是一类以抑郁为主的心理障碍症状群 ;心理学病史、心因性躯体症状具有临床诊断的参考价值 ,心理量表分析则可进一步明确心理障碍的类型和程度 ,心理行为治疗可能是治疗精神性BMS的有效方法。     

颞颌关节紊乱病患者心理学相关因素分析

目的对40例非咬合因素引起的颞颌关节紊乱病(TMD)患者进行心理学研究,了解TMD与心理障碍的关系。方法对40例TMD患者进行心理学病因、心因性躯体化症状观察,并对与TMD患者相配对的正常组进行自评焦虑量表(SAS)、自评抑郁量表(SDS)、症状自评量表(SCL90)量表分析。结果40例TMD患者主要的心理学病因有恐癌症、疑病症,工作紧张,生活事件,家庭矛盾。所有患者均存在心因性躯体化症状,最常见为睡眠障碍;存在中、重度的焦虑(75％)和抑郁(90％);SCL90量表主要是焦虑、抑郁、敌对和躯体化(P<0.01)。结论 非咬合因素引起的TMD患者存在着不同程度的心理障碍,心理学病史、躯体化症状具有临床参考价值;心理量表分析可进一步明确心理障碍的类型和程度,心理行为治疗对这类TMD有一定的帮助。     

复发性口腔溃疡患者心理学相关因素分析

目的探讨心理因素在复发性口腔溃疡(RAU)发生发展中的作用。方法选择门诊复发性口腔溃疡患者102例为实验组,健康者102名为对照组,采用SIMH焦虑自评量表(SAS)、抑郁自评量表(SDS)及RAU组SCL-90症状自评量表测查。结果RAU患者均存在心因性躯体化症状,最常见为睡眠障碍,存在中、重度焦虑(75.49%)和抑郁(85.30%)症状。SCL-90结果显示,RAU患者躯体化、强迫、人际关系、抑郁、焦虑、恐怖等因子分值高于中国常模,差异有显著性(P<0.01或0.05)。结论心理因素对RAU有一定的影响。     

颞下颌关节紊乱病患者轴Ⅱ测评临床调查研究

目的通过颞下颌关节紊乱病诊断标准(diagnostic criteria for temporomandibular disorders,DC/TMD)的轴Ⅱ评价量表调查,筛查引发TMD的身体、心理及行为因素,为临床制订个性化诊疗方案及疾病预防提供参考。方法选择2018年10月至2021年2月就诊于武汉大学口腔医学院口腔颌面外科颞下颌关节门诊的TMD患者141例(TMD组),其中女性121例,男性20例,平均年龄30岁;2021年1至2月于武汉市在校大学生、教师、公职人员等人群中招募普通健康者90名作为对照组,其中女性66名,男性24名,平均年龄30岁。对所有受试者进行问卷调查,问卷包括一般状况调查表和TMD症状问卷;轴Ⅱ评价量表包括:慢性疼痛等级量表、下颌功能受限量表、口腔行为检查、患者健康问卷-9(抑郁情绪)、广泛性焦虑症量表、患者健康问卷-15(躯体化症状)等评价量表。主要观察指标包括疼痛程度、疼痛对患者影响分级、慢性疼痛整体分级、下颌功能受限量表指标得分、抑郁得分、焦虑得分、躯体化症状得分和口腔行为得分。比较TMD组不同诊断患者之间轴Ⅱ各量表评价指标的差异。结果TMD组具有不同程度疼痛的患者占60.3%(85/141);疼痛影响分级1~3级者占24.1%(34/141);慢性疼痛整体分级为Ⅰ~Ⅳ级者占61.0%(86/141)。TMD组咀嚼功能受限、运动功能受限、交流功能受限及总体下颌功能受限得分均显著高于对照组(P<0.05)。TMD组轻度抑郁以上患者占59.6%(84/141),轻度焦虑以上患者占56.7%(80/141),46.1%(65/141)患者有躯体化症状。TMD组患者的等级分布均显著高于对照组(P<0.05)。颞下颌关节骨关节病和关节半脱位患者中出现躯体化症状者显著多于关节盘移位患者(P<0.05)。TMD组内不同的慢性疼痛状态分级之间在下颌功能障碍各指标以及抑郁、焦虑和躯体化症状等方面差异均有统计学意义(P<0.05)。结论TMD患者比普通健康人口腔行为异常增加,下颌功能活动受到不同程度的限制,同时抑郁、焦虑情绪以及躯体化症状方面更严重。颞下颌关节骨关节病和关节半脱位患者更易出现躯体化症状。TMD患者伴有疼痛症状者下颌功能障碍受限及抑郁、焦虑和躯体化方面症状较重。     

耳穴贴敷法对灼口综合征患者心理状态及血浆β-内啡肽的影响

目的 探讨耳穴贴敷法对灼口综合征患者心理状态及血浆β-内啡肽的影响。方法 105例灼口综合征（burning mouth syndrome,BMS）患者随机分为耳穴贴敷组50例,药物治疗组55例,疗程为1个月,耳穴贴敷组通过对BMS患者进行中医辨证,选取舌、心、神门3穴。使用王不留行籽进行贴敷,每次单耳贴敷时对双耳交替按压治疗,嘱患者每日按压治疗部位3次,每次1～2 min,至耳廓发红发热为止;药物对照组口服维生素E 100 mg+谷维素10 mg+维生素B2 10 mg,3次/d。分别于治疗前后评估患者疼痛感觉强度、精神及心理状态及检测血浆β-内啡肽的变化。结果 两组患者治疗后疼痛感觉强度均较治疗前下降（P<0.001）;耳穴贴敷组患者治疗后躯体化（t=2.118,P=0.037）、恐惧（t=2.084,P=0.039）及饮食睡眠（t=2.047,P=0.043）评分较治疗前有显著改善,且血浆β-内啡肽水平提高,差异具有统计学意义（t=2.247,P=0.027）。结论 耳穴贴敷法是一种有效的BMS治疗手段,可改善患者心理状态,促进血浆β-内啡肽的合成可能是其作用机制。     

灼口综合征患者心理状态分析及临床心理护理措施

目的探讨灼口综合征（burning mouth syndrome,BMS）患者的心理状态与护理措施。方法 150例BMS患者,针对其不同的心理问题和心理要求进行心理护理。主要措施包括：倾听、告知、鼓励。结果患者消除了焦虑、抑郁、恐癌等反常心理和伸舌自检等不良习惯,以良好的心态配合治疗,150例患者中有139例（92.7%）自觉症状减轻,其中90例（60.0%）症状完全消失。结论通过心理护理,改善BMS患者的心理状态和行为方式,可以减轻症状和提高治疗效果。     

口腔异感症患者的心理学相关研究

目的 了解口腔异感症（OPS）与心理障碍关系，为进一步心理行为治疗提供依据。方法 对31例非病理性OPS患者进行心理学病因、躯体化症状观察，并对24例OPS和相配对的正常组进行SAS、SDS和SCL90量表的分析。结果 31例OPS患者中，95％有各种心理学病因，所有患者存在各种躯体化症状，最常见为睡眠（90．3％）；全部患者存在中、重度的抑郁，83．4％患者存在中、重度的焦虑；SCL90是表主要以躯体化、强追症状、抑郁、焦虑、精神病性为主。结论 OPS是一类以抑郁为主的心理障碍症状群；心理学病史、躯体化症状具有临床诊断的参考价值，心理是表分析则可进一步明确心理障碍的类型和程度，心理行为治疗可能是治疗精神性OPS的有效方法。     

上前牙全瓷冠贴面修复前后患者心理状况变化的研究

目的评价上前牙美容修复治疗后患者的心理状况变化。方法选择来我院以美容为主诉要求的适合并接受瓷贴面和全瓷冠治疗的患者78例(男29例、女49例),治疗后对患者进行满意度调查。采用SCL-90问卷对患者初诊时及修复治疗3个月后的心理状况进行研究分析,Spss 13.0软件对所获资料进行均数比较、配对t检验和两独立样本t检验。结果患者对瓷贴面和全瓷冠修复效果的主观满意度分别为97.8%和100.0%。上前牙美容修复患者治疗前SCL-90躯体化、强迫症状、人际关系敏感、抑郁、焦虑、偏执和精神症状均数均高于正常。美容修复3个月后,患者心理状况得到了有效改善,躯体化、强迫症状、人际关系敏感、抑郁、焦虑和偏执改善具有显著性(P<0.05);其中人际关系敏感、抑郁和焦虑改善效果女性好于男性(P<0.05)。结论瓷贴面和全瓷冠修复具有良好的主观疗效,患者的心理状况较正常人心理状况差,治疗后心理状况得到明显改善。     

灼口综合征患者静态唾液流量及泪液分泌量的相关研究

目的 探讨灼口综合征(burning mouth syndrome,BMS)患者静态唾液流速及泪液分泌量与其口干症状之间的相关性.方法 检测57例BMS患者和47例正常对照组静态唾液流速和泪液分泌量.结果 BMS组的平均静态唾液流速和泪液流量与对照组相比,具口干症状的BMS患者静态唾液流速和泪液流量不具口干症状的BMS患者相比,差异均无统计学意义(P>0.05).结论 BMS患者口干症状与外分泌腺分泌障碍之间的无明显相关性.     

氟哌噻吨美利曲辛片治疗伴郁抑性精神障碍灼口综合征的临床疗效

观察氟哌噻吨美利曲辛片(黛力新)对灼口综合征(BMS)的干预效应。纳入120例确诊的BMS患者,随机分成2组,试验组60人,服用氟哌噻吨美利曲辛片,每次1片,1次/d,晨服,连服6周;对照组60人服用谷维素,每次1粒,3次/d,连服6周。治疗前后观察患者的疼痛程度和发生频率。试验组痊愈32例,显效21例,有效6例,无效1例,总改善率80.5%;对照组改善率21.2%,差异有显著性(P<0.01)。灼口综合征是心因性疾病,用抗抑郁药物黛力新治疗效果好。     

Burning mouth syndrome (BMS) and the concept of alexithymia – a preliminary study

Twenty women suffering from burning mouth syndrome (BMS) were rated with regard to alexithymic traits, depressive symptoms and anxiety: values were compared to disability level assessed by interviews. Results confirm earlier reports that BMS symptomatology is associated with depression and anxiety. The majority of patients were rated as alexithymic and. supported by interview data; these results indicate that somatization should be taken into consideration during clinical evaluation of BMS symptoms. The study included a psychological analysis of the communication pattern in the patient-doctor relationship, leading to the assumption that the patient's appeal for somatic treatment, dependency and hopelessness may activate defensive reactions in the dentist. Such reactions can be either rejection of. or compliance with, the patient's demands. The importance of a differentiated assessment and treatment approach for these patients is emphasized. Due to lack of control data the report should be viewed as a pilot study.     

The role of psychological factors in the development of burning mouth syndrome

The psychiatric profiles of 50 patients diagnosed with burning mouth syndrome (BMS) were compared to those of 50 age- and sex-matched individuals as the control group. The Symptom Checklist-90-Revised (SCL-90-R) questionnaire was used to evaluate the role of psychological factors in the development of BMS. Somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety, psychoticism, global severity index (GSI), positive symptom total (PST), and positive symptom distress index (PSDI) scores were significantly higher in the patients with BMS than in the control group. In a subgroup analysis according to sex, women with BMS had higher T-scores for somatization, obsessive-compulsive, paranoid ideation, GSI, PST, and PSDI than women in the control group. In contrast, only the PSDI score was significantly higher in men with BMS compared to men in the control group. There was a significant difference in the T-scores for somatization, psychoticism, and GSI between the three age subgroups (≤50, 51–65, and ≥66 years). The obsessive-compulsive and PSDI scores were significantly higher in patients with BMS who also had at least one chronic disease than in patients with BMS who had no chronic disease. In conclusion, psychological factors are correlated with BMS.     

Burning mouth syndrome: a review and update

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle‐aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha‐lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.     

A case–control study on etiological factors involved in patients with burning mouth syndrome

Objective:  To evaluate and analyze the risk factors for burning mouth syndrome (BMS).
Methods:  Eighty-seven consecutive patients with BMS and a randomly selected control group ( n  = 82) were comprehensively investigated with a self-designed questionnaire, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). A complete blood count and serum sex hormone were also examined in patients with BMS and control subjects. All the data obtained were transferred to a data bank and analyzed statistically in spss 11.5 for windows.
Results:  No statistical difference between the BMS group and the control group was found in blood analyses including white blood cell count, red blood cell count, hemoglobin and platelet count. Among the menopausal or postmenopausal women with BMS, the follicle stimulating hormone (FSH) level was significantly higher, but the estradiol level was significantly lower. The BMS group reported adverse life events more frequently than the control group. Patients with BMS significantly exhibited symptoms of somatization, and both the scores of anxiety, depression in patients with BMS were higher than those of the control group ( P  < 0.05). A regression equation which included six variables had been established by using logistic regression analysis, indicating that the habit of tongue thrusting, lip sucking, periodontitis, smoking, outcome of recent medication, depression were the principal risk factors, among which tongue thrusting was the most significant.
Conclusion:  Our study indicated that BMS may be of psychological origin, and the measures such as refraining from oral parafunctional activities, removing local irritating factors, stopping smoking, good mental health status could help in the prevention of BMS.     

The diagnosis of burning mouth syndrome represents a challenge for clinicians

AIMS: To evaluate the occurrence of professional delay in the diagnosis, referral, and treatment of patients with burning mouth syndrome (BMS). METHODS: Fifty-nine patients (51 women and 8 men; average age, 60.5 years; age range, 32 to 88 years) diagnosed with BMS at our institution were retrospectively studied. Data were collected about the onset of oral symptoms, consultations with medical and dental practitioners, and misdiagnosis before definitive BMS diagnosis and treatment. RESULTS: The average delay from the onset of the symptoms to definitive diagnosis was 34 months (range, 1 to 348 months; median, 13 months). The average number of medical and dental practitioners consulted by each patient over this period and who initially misdiagnosed BMS was 3.1 (range, 0 to 12; median, 3). Candidiasis and aspecific stomatitis were the most frequent misinterpretations of the symptoms before appropriate referral. In about 30% of cases, no diagnosis of the oral symptoms was made or explanation given. CONCLUSION: Professional delay in diagnosing, referring, and appropriately. managing BMS patients occurred frequently in the group studied. No significant differences were found in the number of medical and dental practitioners who were consulted. Emphasis must therefore be placed upon educational efforts to improve health care providers' awareness of BMS. This should increase the rate of recognition and appropriate referral or treatment of patients with chronic orofacial pain due to BMS.     

Comparison of treatment modalities in burning mouth syndrome

Background: Burning mouth syndrome (BMS) is characterized by a spontaneous burning pain in the oral mucosa without known organic cause or standardized treatment. The aims of this study were to assess and compare the efficacy of clonazepam and diazepam in relieving the symptoms associated with BMS and evaluate for which patients this treatment might be effective by correlating treatment efficacy with underlying psychological status. Methods: The medical records of BMS patients attending an oral medicine private practice (1999–2004) were reviewed. The patients were then contacted and asked to complete a short questionnaire regarding their response to diazepam/clonazepam drug therapies. A second group of patients attending the above clinic (n = 30) were asked to fill out a hospital anxiety and depression assessment form in an attempt to correlate treatment success with underlying psychological status. Results: A total of 71.4 per cent of patients treated with clonazepam had partial or complete resolution of their oral symptoms, while 55.1 per cent of patients treated with diazepam had improvement of their oral symptoms. There was no correlation between underlying anxiety or depression and efficacy of benzodiazepine medication. Conclusions: A greater percentage of patients taking clonazepam reported either partial or complete relief of symptoms compared to diazepam. However, the differences were not statistically significant. There was no correlation found between underlying psychopathology and treatment success with benzodiazepines.