Burning mouth complaints: clinical characteristics of a Brazilian sample.

OBJECTIVE: Evaluation of the clinical characteristics of burning mouth complaints (BMC) in a series of Brazilian patients referred to a large teaching hospital. MATERIALS AND METHODS: 66 patients with burning mouth complaints were evaluated through a standardized protocol. RESULTS: 56 women and 10 men were examined, ranging in age from 35-83 years. The primary location of the complaints was reported to be the tongue. Thirty-six patients reported a precipitating event. The mean VAS pain levels were 7.5 in women and 6.11 in men. The average estradiol levels in women were low (<13 pg/ml); 80% of all patients reported a concomitant chronic disease, 55% of all patients wore total dentures, 54% of all patients reported subjective xerostomia, 48% of all patients reported sleep disturbances and 66% reported phantom taste. No statistical differences were found between groups with or without a precipitating event in VAS: (p=0.139), in the Number of Words Chosen (NWC) (p=0.259) and Pain Rating Index (PRI) (p=0.276) sections of the McGill Pain Questionnaire (MPQ). CONCLUSION: The existence of systemic comorbidities, self-reported sleep disturbances and taste alterations indicates possible correlations and the need for a careful systemic evaluation of each patient; there were no differences between patients with and without precipitating events.

Liposomal topical capsaicin in post-herpetic neuralgia: a safety pilot study.

UNLABELLED: Topical treatments have gained popularity for general use as an adjunct to systemic drugs in neuropathic pain, but their use produces variable clinical results and local adverse events. OBJECTIVE: To evaluate the safety and analgesic effect of a formulation of liposomal capsaicin (LC) (0.025%) in patients with post herpetic neuralgia (PHN). METHOD: Patients who remained symptomatic after first-and second-line treatment were randomized to receive LC for six weeks in a placebo-controlled, crossover design study. Clinical assessment was performed at baseline, in the second, fourth and sixth week of treatment. RESULTS: Thirteen patients completed both treatment periods. Visual Analog Scale (VAS) was significantly decreased after the end of the study (p = 0.008), however the effect of treatment was not significant (p = 0.076). There was no difference on global impression of change and other pain characteristics. LC was safe and well tolerated. However, at the concentration used, its analgesic effects were marginal and not significant.

Facial sensibility of patients with trigeminal neuralgias.

OBJECTIVES: Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. METHODS: 18 patients with PHN and 26 patients with ITN were diagnosed by the IASP criteria. They were evaluated with a systematic approach, which included mechanical, thermal (cold and warm) and painful stimuli. RESULTS: We found statistical significance at the ophthalmic branch of PHN in pain (p=0.001), tactile (p=0.002), cold (p=0.016) and warm (p=0.013); in ITN, the maxillary branch had higher threshold with pinpricks (p=0.016) and the mandibular branch had higher tactile threshold. CONCLUSIONS: The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.

Burning mouth syndrome following damage to the olfactory system? An atypical case report / Síndrome da ardência bucal após lesão do sistema olfativo? Um relato atípico de caso

BACKGROUND AND OBJECTIVES: Burning Mouth Syndrome (BMS) is a chronic pain condition in which the patient reports an intraoral burning sensation in absence of clinical and laboratory findings. Although its etiology is still unknown, recent studies suggests a neuropathic pain origin for this syndrome. This article reports a very unusual case of a patient who developed BMS and phantom taste after damage to the olfactory system exploring a possible association between BMS, gustatory and olfactory systems.CASE REPORT: Male patient, 50-years-old had a chief complaint of burning sensation on the soft palate area for six years. He reported that the onset of burning was immediately after he had painted his house and slept overnight in a freshly painted room. He also reported worsening of his symptoms in the presence of strong aromas or when he gets a cold, and a constant bitter taste. A clinical exam of the intra-oral mucosa was normal with no signs of lesions or any other pathology which could justify his complaint. All exams, serological and metabolic (glucose, iron, vitamin B12, folate levels and CBC), did not show any significant findings. The final diagnosis was an atypical presentation of BMS. CONCLUSION: Although the mechanisms involved are not clear, the case report a possible association between BMS, gustatory and olfactory systems. Future research is necessary to better understand the features involved.

JUSTIFICATIVA E OBJETIVOS: A Síndrome da Ardência Bucal (SAB) é uma condição de dor crônica em que os pacientes relatam uma queimação intraoral na ausência de achados clínicos e laboratoriais. Embora sua etiologia seja ainda desconhecida, estudos recentes sugerem uma origem de dor neuropática para tal síndrome. Este artigo relata um caso bastante raro de paciente que desenvolveu SAB e gosto fantasma após lesão do sistema olfatório, e explora uma possível associação entre SAB e sistemas gustativo e olfatório.RELATO DO CASO: Paciente do sexo masculino, 50 anos, com queixa importante de queimação na área do palato mole por seis anos. Informou que o início da queimação foi imediatamente após ele haver pintado sua casa e ter dormido em um quarto recém-pintado. Também informou piora dos sintomas na presença de cheiros fortes ou quando pega um resfriado, além de um gosto amargo constante. O exame clínico da mucosa intraoral foi normal sem sinais de lesões ou outras patologias que pudessem justificar suas queixas. Nenhum exame sorológico e metabólico (glicose, ferro, vitamina B12, níveis de folato e hemograma completo) apresentou achados importantes. O diagnóstico final foi uma apresentação atípica de SAB. CONCLUSÃO: Embora os mecanismos envolvidos não estejam claros, o caso relata uma possível associação entre SAB e sistemas gustativo e olfatório. São necessárias mais pesquisas para melhor entender as características envolvidas.

Burning mouth complaints: clinical characteristics of a Brazilian sample

OBJECTIVE: Evaluation of the clinical characteristics of burning mouth complaints (BMC) in a series of Brazilian patients referred to a large teaching hospital. MATERIALS AND METHODS: 66 patients with burning mouth complaints were evaluated through a standardized protocol. RESULTS: 56 women and 10 men were examined, ranging in age from 35-83 years. The primary location of the complaints was reported to be the tongue. Thirty-six patients reported a precipitating event. The mean VAS pain levels were 7.5 in women and 6.11 in men. The average estradiol levels in women were low (<13 pg/ml); 80 percent of all patients reported a concomitant chronic disease, 55 percent of all patients wore total dentures, 54 percent of all patients reported subjective xerostomia, 48 percent of all patients reported sleep disturbances and 66 percent reported phantom taste. No statistical differences were found between groups with or without a precipitating event in VAS: (p=0.139), in the Number of Words Chosen (NWC) (p=0.259) and Pain Rating Index (PRI) (p=0.276) sections of the McGill Pain Questionnaire (MPQ). CONCLUSION: The existence of systemic comorbidities, self-reported sleep disturbances and taste alterations indicates possible correlations and the need for a careful systemic evaluation of each patient; there were no differences between patients with and without precipitating events.

OBJETIVO: Avaliar as características clínicas de pacientes brasileiros com queixas de ardência buccal atendidos em um hospital escola. MÉTODO: 66 pacientes com queixas de ardência bucal foram avaliados através de exame padronizado para esse tipo de queixa. RESULTADOS: 56 mulheres e 10 homens foram examinados consecutivamente. As idades variaram de 35-83 anos. A localização das queixas foi principalmente na língua e 36 pacientes relataram algum evento precipitante. A Escala Visual Analógica (EVA) a intensidade da ardência (dor) foi: mulheres 7.5 (média) e homens 6.11 (média). Os níveis de estradiol foram baixos (<13 pg/ml); 80 por cento dos pacientes relataram doença crônica associada, 55 por cento usavam dentadura; 54 por cento relataram xerostomia subjetiva; 48 por cento distúrbios subjetivos do sono e 66 por cento gosto fantasma. Não houve diferença da intensidade da EVA (p=0.139) ou dor pelo questionário McGill NWC (p=0.259) and PRI (p=0.276), entre os grupos com e sem eventos precipitantes. CONCLUSÕES: A existência de doenças crônicas associadas, o auto-relato de distúrbios do sono e as alterações de paladar indicam necessidade de avaliação sistêmica cuidadosa nesses pacientes; não houve diferenças entre os grupos com e sem evento precipitante.