Oral dysaesthesia: a special focus on aetiopathogenesis, clinical diagnostics and treatment modalities.

Oral dysaesthesia is a condition characterised by persistent alteration to oral sensation, perceived by the patient to be abnormal and/or unpleasant, in the absence of any mucosal pathology. The condition can be difficult to detect and diagnose. A possible peripheral or central neuropathic aetiology has been proposed. Burning mouth syndrome (BMS) is the most common idiopathic oral dysesthesia in which long-term suffering is often reported by patients. Recent efforts from professional organisations and study groups have provided a consensus on BMS disease definition and diagnostic criteria. Large-scale epidemiological studies are required to provide an accurate estimate for prevalence and incidence of the condition. Meticulous diagnostic investigations which may require interdisciplinary teamwork are often warranted to reach an accurate diagnosis. A combination of interventional modalities, with a holistic approach, is key for successful management and improvement in patients' quality of life.

Burning mouth in oncology care: a systematic review.

Burning mouth, also referred to as oral dysesthesia, is an underreported condition among cancer patients that may represent an early symptom of cancer or an adverse effect of treatment. This review sought to characterize this symptom in oncology care where burning symptoms may occur. A systematic review of the literature was performed based on the PRISMA statement, and the protocol was registered at PROSPERO database. A structured search was done using eight databases. The process of study selection was conducted in two distinct phases. The JBI Critical Appraisal Tools were utilized to evaluate the risk of bias in the studies included. Of the total number of studies assessed, sixteen met the eligibility criteria. Of these studies included, 7 were case reports, 7 cross-sectional studies, and 2 non-randomized clinical trials. Most studies presented low risk of bias (n = 9), while the remaining studies were evaluated and scored as moderate (n = 5) or high (n = 2) risk of bias. Burning mouth was reported as a first symptom of cancer in three studies, and as an adverse event of radiotherapy (n = 2), chemoradiotherapy (n = 2), and chemotherapy (n = 9). Burning mouth was a first symptom in 0.62% of oral squamous cell carcinoma (OSCC), and 3.3% of patients with pain as chief complaint. Oral dysesthesia prevalence was 13.6% in patients experiencing chemotherapy-induced oral adverse events. The symptom of burning mouth should be examined in oncology care, as it may be underreported and therefore undertreated. New therapies may be related to a higher risk of oral burning and studies assessing approach to management are needed. Current management borrows from the current management of burning mouth in the non-cancer setting.

Sphenopalatine ganglion block - a new treatment for burning mouth syndrome?: a case report

Abstract Burning mouth syndrome is a poorly understood entity for which current treatment modalities fail to provide effective relieve. Branches of the maxillary and mandibular nerves are responsible for the innervation of the affected area. These are also the nerves involved in trigeminal neuralgia, an entity where sphenopalatine block has proved to be effective. We present a case of a patient with burning mouth syndrome in whom a bilateral sphenopalatine ganglion block was successfully performed for pain treatment. It is an easy and safe technique that can be a valuable treatment option for these patients, although more studies are needed.

Burning mouth syndrome and pelvodynia: A literature review.

Burning mouth syndrome (BMS) and pelvodynia are chronic pain still poorly understood and the links between them are all the more so. Health professionals therefore have few resources to understand, diagnose and treat these pains. They may consider and treat these ailments individually, which does not represent optimal care management for the patient and leads to overmedication. This article aims to highlight their contiguity from epidemiological, etiological, diagnostic, and therapeutic perspectives. This study was based on articles which were found using databases such as PubMed and Web of Science. No exclusion criteria were used. Fourteen studies were reviewed. This present work shows that the clinical presentations of these syndromes are similar, as exemplified by their strong association with anxiety and depression. The neurophysiological mechanisms involved in these conditions are similar to those in patients. The diagnosis is essentially based on visual examination and an elimination of all other possible causes. In addition, this work promotes the fact that a common therapy can be implemented when BMS and pelvodynia co-occur. However, the literature on the subject is still very limited. This can be deepened by exploring all the effective treatments in BMS and vulvodynia for penoscrotodynia. Finally, for all these pains, there is a therapeutic order to respect starting with a psychological approach, then topical treatments, systemic therapy and surgical. This therapeutic gradient assists practitioner in their patient's pain management. This article also allows health care providers to quickly find an effective systemic treatment for a patient with both BMS and pelvodynia.

Sphenopalatine ganglion block ... a new treatment for burning mouth syndrome?: a case report.

Burning mouth syndrome is a poorly understood entity for which current treatment modalities fail to provide effective relieve. Branches of the maxillary and mandibular nerves are responsible for the innervation of the affected area. These are also the nerves involved in trigeminal neuralgia, an entity where sphenopalatine block has proved to be effective. We present a case of a patient with burning mouth syndrome in whom a bilateral sphenopalatine ganglion block was successfully performed for pain treatment. It is an easy and safe technique that can be a valuable treatment option for these patients, although more studies are needed.

Burning Mouth Syndrome.

Burning mouth syndrome (BMS) is a rare chronic neuropathic pain condition characterized by recurring burning pain or dysesthesia in the absence of any local or systemic causes of symptoms. The exact pathophysiology of BMS is unknown, but recent research suggests a medley of neuropathic, endocrinological, and psychosocial elements. This article presents a case history and reviews the epidemiology, diagnostic criteria, clinical features, diagnostic investigations, pathophysiology, and management of BMS.

Challenge in the diagnosis, evaluation, and management of burning mouth sensation: A retrospective cohort study.

BACKGROUND: Burning mouth sensation is a common symptom with varying etiologies that can affect patient quality of life. The authors aimed to investigate the clinical characteristics, differentiate the underlying causes, and evaluate the impact on quality of life of patients with burning mouth sensation. CASE DESCRIPTION: A retrospective cohort study of 583 patients with burning mouth sensation symptoms was conducted. Demographic features, clinical characteristics, and associated systemic comorbidities of patients were collected. The 14-item Oral Health Impact Profile Questionnaire score and posttreatment follow-up were evaluated and analyzed among patients. In total, 583 patients with burning mouth sensation symptoms were enrolled; perimenopausal women were most affected; mean (SD) age was 57.04 (12.03) years, and the female to male ratio was 7:1. Patients were stratified into 178 patients (30.53%) with burning mouth syndrome (BMS) and 405 patients (69.47%) without BMS. No significant differences were found for age, sex, clinical characteristics, and 14-item Oral Health Impact Profile Questionnaire scores between BMS and no BMS groups. Notably, 72 of 119 patients without BMS who participated in follow-up had received referrals and treatment for systemic diseases, of which 76.39% achieved complete (45.83%) or partial (30.56%) remission. Among these patients, treatment for gastrointestinal disorders (92.59%), oral candidiasis (78.57%), thyroid diseases (66.67%), and avoidance of local irritants (62.50%) were most effective, and they were perpetuated as the common underlying causes. PRACTICAL IMPLICATIONS: The study results implied significance of adopting multidisciplinary management of burning mouth sensation. It is imperative for dentists and physicians to strengthen their collaborative relationships and focus on both systemic and oral conditions in these patients.

Long-term prognosis of burning mouth syndrome following treatment.

The purpose of this study was to evaluate the long-term prognosis of patients with burning mouth syndrome (BMS) after the termination or discontinuation of treatment and to identify the clinical characteristics that might affect that prognosis. Of 769 patients with an oral burning sensation, 202 with primary BMS who had been treated for at least 3 months were included. Among them, 28 patients who responded to the treatment and 25 patients who did not were assigned to responder and non-responder groups, respectively. Based on telephone interviews, the responders were classified into relapse and non-relapse subgroups, and the non-responder group into persistence and remission subgroups. The majority of responders reported no oral discomfort since their last visit. Compared with the non-relapse subgroup, the relapse subgroup had significantly higher levels of xerostomia at the first visit (P = 0.026) and taste disturbance at the last visit (P = 0.015). The majority of non-responders reported persistent oral discomfort since their last visit. No significant differences were found in the characteristics of oral symptoms between the persistence and remission subgroups. In conclusion, the treatment outcomes in the majority of responders and non-responders were maintained following treatment. Xerostomia and taste disturbance were associated with relapse of oral discomfort in the responders.

[My tongue is burning!-Glossodynia/orofacial pain disorder]. / Meine Zunge brennt! ­ Glossodynie/orofaziales Schmerzsyndrom.

Glossodynia or orofacial pain disorder is known as burning mouth syndrome. It is a therapeutic challenge. Its etiology is not well defined. Recent studies show not only a correlation with neuropathic changes, but there are also indications of comorbidities such as depression, anxiety, and carcinophobia. These can also manifest as a reaction to the disease and are not necessarily considered causative. Burning mouth syndrome poses a diagnostic challenge since its differential diagnosis is broad. With regard to dermatological aspects, lichen planus mucosae, oral leucoplakia, pemphigus vulgaris, and aphthous mouth ulcers should be considered. Diabetes, anemia, vitamin deficiency, and endocrinological influences should be considered regarding the predominance of elderly and female patients. Meta-analyses of treatment studies usually show a low level of evidence of the randomized, controlled trials. According to the literature mainly psychotherapy and antidepressants are proposed for therapy. Alpha lipoic acid as a dietary supplement shows short-term improvement and low-level laser therapy might have some benefit.

Análise comparativa do tratamento do ardor bucal com terapia a laser de baixa intensidade e estimulação elétrica nervosa transcutânea: um ensaio clínico randomizado / Comparative analysis of the treatment of burning mouth with low-intensity laser therapy and transcutaneous electrical nerve stimulation: a randomized clinical trial

Introdução: O manejo de pacientes com ardor bucal é um desafio no cotidiano clínico da odontologia. Objetivo: Comparar o efeito da Terapia a Laser de Baixa Intensidade (LLLT) e da Estimulação Elétrica Nervosa Transcutânea (TENS) no tratamento do ardor bucal. Metodologia: Ensaio clínico randomizado constituído por 25 pacientes com ardor bucal que foram tratados por TENS (n=12) e por LLLT (n=13). Os protocolos de tratamento foram aplicados semanalmente por 8 semanas. O teste análise de variância (ANOVA) dois fatores foi usado para verificar se existia diferença significativa entre os tempos T0 (antes de iniciar o tratamento), T1 (após a 4ª sessão de tratamento), T2 (após a 8ª sessão de tratamento) e T3 (30 dias após o término do tratamento) em relação aos sintomas, analisados por meio da Escala Visual Analógica (EVA), fluxo salivar não estimulado, xerostomia e disgeusia com as intervenções de TENS e LLLT. Resultados: A maioria dos pacientes foi do sexo feminino no período pós-menopausa com média de idade no grupo TENS de 59,25 anos e no grupo LLLT de 62,08. Hipertensão e dislipidemia foram as alterações sistêmicas mais frequentes. Ansiedade e depressão foram os únicos transtornos psiquiátricos relados. A maioria dos pacientes fazia uso de medicamentos como anti-hipertensivos e antidepressivos. Não foram observadas variações expressivas no que se refere a xerostomia e a disgeusia nos dois grupos analisados. A TENS e a LLLT foram eficazes na redução dos sintomas relatados pelos pacientes (p˂0,001), entretanto, observou-se entre os tempos T2 e T3 que o grupo LLLT apresentou uma melhor resposta quando comparado ao TENS (p=0,003). Os pacientes do grupo TENS apresentaram aumento do fluxo salivar entre os tempos T1 e T2, enquanto o grupo LLLT apresentou uma diminuição (p=0,052). Conclusão: A TENS e a LLLT foram eficazes na redução dos sintomas do ardor bucal durante o tratamento e 30 dias após o término do tratamento, sendo que o grupo LLLT apresentou uma melhor resposta na sessão de acompanhamento pós-tratamento quando comparado ao grupo TENS (AU).

Introduction: The management of patients with burning mouth is a challenge in the clinical routine of dentistry. Objective: To compare the effect of Low Intensity Laser Therapy (LLLT) and Transcutaneous Electrical Nerve Stimulation (TENS) in the treatment of burning mouth. Methodology: Randomized clinical trial consisting of 25 patients with burning mouth who were treated with TENS (n=12) and LLLT (n=13). Treatment protocols were applied weekly for 8 weeks. The two-way analysis of variance (ANOVA) test was used to verify whether there was a significant difference between the times T0 (before starting treatment), T1 (after the 4th treatment session), T2 (after the 8th treatment session) and T3 (30 days after the end of treatment) in relation to symptoms, analyzed using the Visual Analogue Scale (VAS), unstimulated salivary flow, xerostomia and dysgeusia with TENS and LLLT interventions. Results: Most patients were female in the postmenopausal period, with a mean age of 59.25 years in the TENS group and 62.08 in the LLLT group. Hypertension and dyslipidemia were the most frequent systemic alterations. Anxiety and depression were the only psychiatric disorders reported. Most patients used drugs such as antihypertensives and antidepressants. Significant variations were not observed with regard to xerostomia and dysgeusia in the two groups analyzed. TENS and LLLT were effective in reducing the symptoms reported by patients (p˂0.001), however, it was observed between times T2 and T3 that the LLLT group showed a better response when compared to TENS (p=0.003). Patients in the TENS group showed an increase in salivary flow between times T1 and T2, while the LLLT group showed a decrease (p=0.052). Conclusion: TENS and LLLT were effective in reducing the symptoms of burning mouth during treatment and 30 days after the end of treatment, and the LLLT group showed a better response in the posttreatment follow-up session when compared to the TENS group (AU).

Síndrome da ardência bucal: relato de caso clínico / Oral burning syndrome: a clinical case report

O presente estudo teve como objetivo principal descrever por meio de um relato de caso clínico o diagnóstico e a conduta clínica de uma paciente portadora da Síndrome da Ardência Bucal (SAB). A SAB é definida como uma dor crônica e de difícil diagnóstico e difícil tratamento. O local mais acometido pela SAB é a língua, lábios e mucosa jugal, mas pode estar presente em qualquer parte da mucosa oral, causando desconforto e interferindo na qualidade de vida do paciente. Paciente do sexo feminino, leucoderma, 39 anos, sem histórico de doenças sistêmicas, saúde geral em bom estado, procurou atendimento no Centro Universitário da Serra Gaúcha ­ FSG por apresentar sensação de ardência recorrente na língua e na mucosa, que aumentava em momentos de estresse ou durante a ingestão de alimentos cítricos, picantes ou quentes. A paciente realizou exames complementares (hemograma completo, glicemia de jejum, exame de vitamina B12) e primeiramente, iniciou-se o tratamento com antifúngico tópico para remoção de uma camada esbranquiçada presente no dorso da língua. Após a remissão desta, foi utilizado AD-Muc tópico 2 vezes ao dia, durante 2 semanas e relatou ter reduzido seus sintomas em torno de 70%. A paciente ainda apresentava xerostomia e, então foi prescrita saliva artificial. A paciente teve a regressão total de seus sintomas. Pode-se concluir que diversos fatores etiológicos estão relacionados com a SAB, porém sua causa específica permanece desconhecida. O tratamento é paliativo, entretanto, o Ad-muc tópico se mostrou eficaz na redução da sintomatologia da SAB juntamente com o uso da saliva artificial(AU)

The present study aimed to describe, through a clinical case report, the diagnosis and clinical conduct of a patient with Burning Mouth Syndrome (BMS). BMSis defined as chronic pain that is difficult to diagnose and difficult to treat. The site most affected by BMS is the tongue, lips, and cheek mucosa, but it can be present in any part of the oral mucosa, causing discomfort and interfering with the patient's quality of life. Female patient, leucoderma, 39 years old, with no history of systemic diseases, general health in good condition, sought care at the Centro Universitário da Serra Gaúcha - FSG for presenting a recurrent burning sensation in the tongue and mucosa, which increased in times of stress or while eating citrus, spicy or hot foods. The patient underwent complementary tests (complete blood count, fasting blood glucose, vitamin B12 test) and first, treatment with topical antifungal was started to remove a whitish layer present on the back of the tongue. After remission, topical AD-Muc was used twice a day for 2 weeks and reported to have reduced his symptoms by around 70%. The patient still had xerostomia and then artificial saliva was prescribed. The patient had a total regression of her symptoms. It can be concluded that several etiological factors are related to SAB, but its specific cause remains unknown. Treatment is palliative, however, topical Ad-muc is effective in reducing the symptomsof BMS also with the use of artificial saliva(AU)

Síndrome de la boca ardiente: revisión de la literatura / Burning mouth syndrome: literature review

Resumen El síndrome de la boca ardiente (SBA) es una condición de dolor crónico en la cavidad oral, que se presenta mayoritariamente en mujeres de edad media. Diversas causas locales y sistémicas pueden producirlo en forma secundaria, o bien, puede representar un cuadro primario, sin etiología específica identificable. Su etiopatogenia y evolución clínica es poco comprendida. Las opciones terapéuticas son variadas y en general es necesario un tratamiento multidisciplinario. A continuación, se presenta una revisión de la literatura respecto a esta patología para difusión en nuestro medio.

Abstract Burning mouth syndrome (BMS) is a chronic pain condition of the oral cavity, which occurs more frequently in middle-aged women. It can be secondary to different local and systemic causes, or represent a primary condition, with no specific identifiable etiology. Its etiopathogenesis and clinical evolution are poorly understood. Therapeutic options are multiple and a multidisciplinary treatment is necessary. We present a review of the literature regarding BMS, to provide information relevant to our area of expertise.

Burning mouth syndrome: a review of therapeutic approach.

Burning mouth syndrome (BMS) is described by an intense burning sensation of the tongue or other oral areas without a clear etiopathology. The diagnosis of BMS is challenging due to variations of manifestations. The management of BMS is complicated due to the complex etiology of the disease. Many medications and treatment methods have been recommended for BMS management, but no one confirmed as the standard method. In this study, the therapeutic approaches of BMS were evaluated. The data of the article was obtained from PubMed/MEDLINE, Cochrane Library, and Web of Science. The following terms including "burning mouth syndrome", "therapy", and "treatment" were used for search in the databases. A wide range of articles about the therapeutic approach of BMS was searched and reviewed. Pharmacological and non-pharmacological approaches have been used for BMS management. Pharmacological treatments are including Capsaicin, Clonazepam, Low-dose aripiprazole, Alpha-lipoic acid, Duloxetine, Amitriptyline, Gabapentin, and Pregabalin, and ultra-micronized palmitoylethanolamide. Non-pharmacological therapies for BMS are cognitive therapy, Electroconvulsive therapy, Laser therapy, Acupuncture and auriculotherapy, Transcranial Magnetic Stimulation (rTMS), Salivary Mechanical Stimulation, and Botulinum Toxin. A detailed assessment of the etiology and pathophysiology of BMS, and having information about novel therapeutic interventions are essential for the management of BMS.

Effectiveness of Nonpharmacologic Treatments of Burning Mouth Syndrome: A Systematic Review.

AIMS: To assess the efficacy of nonpharmacologic treatments for burning mouth syndrome (BMS). METHODS: PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were systematically searched. Reference lists from the latest systematic reviews (2015 to 2020) on BMS treatment in the PubMed, Scopus, Web of Science, and Cochrane Library databases were also scrutinized. Randomized controlled trials (RCTs) or clinical controlled trials (CCTs) in English were considered eligible. Trials on photobiomodulation were excluded to avoid redundancy with recent publications. Risk of bias was established through the Cochrane Risk of Bias tool for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool for CCTs. RESULTS: This review included 27 RCTs and 6 open clinical trials (OCTs) describing 14 different nonpharmacologic interventions. Eleven trials experimented with 600 to 800 mg/day of alpha-lipoic acid for 30 to 120 days, with 7 placebo-controlled studies showing significant pain relief. Four trials tested topical and systemic capsaicin for 7 to 30 days, with 2 placebo-controlled studies revealing significant efficacy. Four of the 5 trials testing acupuncture offered favorable evidence of pain relief. Two trials reported significant pain relief after a 2- to 3-month regimen with tongue protectors and showed no difference after aloe vera addition. Short-term pain relief was reported in anecdotal placebo-controlled trials deploying tocopherol, catuama, ultramicronized palmitoylethanolamide, group psychotherapy, cognitive therapy, and repetitive transcranial magnetic stimulation of the prefrontal cortex. Most therapies were safe. CONCLUSION: Evidence was collected from highly biased, short-term, heterogenous studies mainly focused on BMS-related pain, with scarce data on quality of life, psychologic status, dysgeusia, and xerostomia. Long-term effectiveness of nonpharmacologic treatments should be further investigated, with a more rigorous, bias-proof study design.

Prediction of treatment outcome in burning mouth syndrome patients using machine learning based on clinical data.

The purpose of this study is to apply a machine learning approach to predict whether patients with burning mouth syndrome (BMS) respond to the initial approach and clonazepam therapy based on clinical data. Among the patients with the primary type of BMS who visited the clinic from 2006 to 2015, those treated with the initial approach of detailed explanation regarding home care instruction and use of oral topical lubricants, or who were prescribed clonazepam for a minimum of 1 month were included in this study. The clinical data and treatment outcomes were collected from medical records. Extreme Gradient-Boosted Decision Trees was used for machine learning algorithms to construct prediction models. Accuracy of the prediction models was evaluated and feature importance calculated. The accuracy of the prediction models for the initial approach and clonazepam therapy was 67.6% and 67.4%, respectively. Aggravating factors and psychological distress were important features in the prediction model for the initial approach, and intensity of symptoms before administration was the important feature in the prediction model for clonazepam therapy. In conclusion, the analysis of treatment outcomes in patients with BMS using a machine learning approach showed meaningful results of clinical applicability.