Evaluation of peripheral nerve fibers and mast cells in burning mouth syndrome.

Emerging evidence has revealed a cross-talk in the etiopathogenesis of burning mouth syndrome (BMS) related to peripheral nerve fibers (NF) and neuropeptides secreted by mast cells. Here, we investigated the S-100+ density and PGP 9.5+ integrity of peripheral NF and the tryptase+ mast cell density in the oral mucosa of BMS patients and healthy individuals. A total of 23 oral mucosa specimens (12 BMS and 11 controls) were evaluated. The clinical diagnosis of BMS was based on a careful examination, excluding other local and systemic causes. Samples were taken from an incisional biopsy of the tongue mucosa of individuals with symptomatic BMS, while the margins of the non-neoplastic tongue biopsy served as controls of healthy individuals. Immunohistochemistry was performed to determine the density/mm2 of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells. Similar densities of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells were found in cases of BMS, with a median value of 3.70, 0.70, and 29.24/mm2, respectively, and in the control group, with a median value of 2.60, 0.80, and 26.01/mm2, respectively (p > 0.05). Moreover, the relationship between S100+ and PGP 9.5+ peripheral NF was the same in both groups (p = 0.70). This study demonstrated that there were no alterations in the density and integrity of peripheral NF in the tongue of symptomatic BMS patients. However, the sensitization of peripheral NF in this disease may not depend on mast cell density.

Evaluation of the effect of melatonin in patients with Burning mouth syndrome: a double-blind, placebo-controlled randomized clinical trial

Abstract The present study was carried out to evaluate the effect of Melatonin and Placebo in the patient with the Burning mouth (BMs). This double-blind, placebo-controlled randomized clinical trial study was carried out on 30 patients who were suffering from BMS. During this period patients were divided into 2 study and control groups. The study group used four 3 mg Melatonin daily and the control group received a placebo. Then the severity of the burning sensation was measured by the physician Sleep quality was measured using the VAS scale using the Petersburg questionnaire. Data in the application Enter SPSS 20 and then using T test or equivalent Nonparametric was analyzed, mean sleep score and mean severity of oral irritation before and after treatment in two the group was evaluated using T-test Independent. Level significance was considered 0.05. The results of the present study show that the use of melatonin and a placebo in patients with BMS reduces sensation and improves their sleep quality, although it may not reduce it completely. In this study severity of burning was 4.93±2.56 after treatment in the study group and 6.93±2.12 in the control group, which was statistically significant (P =0.036). No significant difference was observed between the two groups in the sleep quality score (P-value = 0.43). Using Melatonin can be a reliable way to treat pain for which there is no standard treatment to date. Although evidence suggests an association between sleep disorders and BMS, melatonin was not superior to a placebo in reducing BMS-induced burning in the present study. Identification of stressors and the ways to struggle with them, further studies with larger samples and higher oral doses, extended follow-up periods and control of psychological factors, and measurement of body mass index that may affect pharmacokinetics are recommended.

Avaliação clínica dos fatores de risco sistêmicos relacionado ao ardor bucal secundário / Clinical assessment of systemic risk factors related to secondary burning mouth

O Ardor Bucal Secundário (ABS) pode estar relacionado a diferentes doenças e condições que afetam a mucosa oral, ou representar uma manifestação oral de um quadro sistêmico. O propósito deste estudo foi investigar se existe associação entre o ABS queixa de Ardor Bucal e condições sistêmicas presentes na história médica do paciente. Foi realizado um estudo retrospectivo, constituído por 102 pacientes com ABS apresentando HAS ou DM tipo II, e o grupo controle constituído por 102 pacientes pareados por idade e sexo, com HAS ou DM tipo II e sem ABS. Na comparação entre os grupos, foram empregados os testes Qui-Quadrado de Pearson (χ2) e Exato de Fisher, além da obtenção da razão de chances (Odds ratio, OR) e seu respectivo intervalo de confiança (IC) de 95%. Foi aplicado, ainda, o modelo de regressão logística multivariada, para obtenção dos Odds ratio ajustados (ORa). Após análise multivariada, a gastrite foi identificada como fator de risco para ABS (ORa=2,50; IC 95% = 1,32­4,74; p=0,005). O uso de subclasses de anti-hipertensivos, tais como betabloqueadores (ORa = 0,36; IC 95% = 0,16-0,80; p=0,012), inibidores da enzima conversora de angiotensina (ECA) (ORa = 0,19; IC 95% = 0,06-0,56; p=0,003) e bloqueadores dos receptores da angiotensina (BRA) (ORa = 0,26; IC 95% = 0,14-0,49; p<0,001), revelou-se menos associado para o ABS. O presente estudo demonstrou que os pacientes com HAS e DM tipo II não obtiveram associação com o ABS. Todavia, nos pacientes portadores de gastrite foi observado 2,5 vezes mais chances de desenvolver a ABS. Além disso, os medicamentos antihipertensivos, inibidores da ECA, BRA e betabloqueadores, foram menos associados ao ABS (AU).

Secondary Burning Mouth (SBM) can be related to different diseases that affect the oral mucosa or represent an oral manifestation of a systemic condition presented by the patient. This study aimed to investigate whether there is an association between the complaint of SBM Complaint of Burning Mouth and Systemic Conditions presents in the patient's medical history. It was a retrospective case-control study of 102 patients with BMS and SAH or type II DM and a control group of 102 patients matched by age and sex, with SAH or type II DM and without ABS. Pearson's Chi-Square (χ2) and Fisher's Exact tests were applied to compare the groups, in addition to obtaining the odds ratio (OR) and its respective confidence interval (CI) of 95%. The multivariate logistic regression model was also applied to obtain the adjusted odds ratio (ORa). After multivariate analysis, gastritis was identified as a risk factor for SBM (ORa=2.50; 95% CI = 1.32­4.74; p=0.005). The use of antihypertensive subclasses, such as beta-blockers (ORa = 0.36; 95% CI = 0.16-0.80; p=0.012), angiotensin-converting enzyme (ACE) inhibitors (ORa = 0.19; 95% CI = 0.06- 0.56; p=0.003) and angiotensin receptor blockers (ARB) (ORa = 0.26; 95% CI = 0.14-0.49; p<0.001), proved to be less associated for ABS. The present study demonstrated that SAH and type II DM were not associated with SBM. A 2.5-fold greater chance of developing SBM was observed in patients with gastritis. In addition, antihypertensive drugs from the groups of ACE inhibitors, ARBs, and beta-blockers were shown to be less associated for SBM (AU).

Treatment modalities for burning mouth syndrome: a systematic review.

OBJECTIVES: In the burning mouth syndrome (BMS), patients experience a burning sensation in the oral cavity with no associated injury or clinical manifestation. The etiology of this condition is still poorly understood, and therefore, treatment is challenging. The aim of this study is to perform a systematic review of treatment possibilities described in the literature for BMS. MATERIALS AND METHODS: PubMed, Embase, and SciELO databases were searched for randomized clinical trials published between 1996 and 2016. RESULTS: Following application of inclusion and exclusion criteria, 29 papers were analyzed and divided into five subcategories according to the type of treatment described: antidepressants, alpha-lipoic acid, phytotherapeutic agents, analgesic and anti-inflammatory agents, and non-pharmacological therapies. In each category, the results found were compared with regard to the methodology employed, sample size, assessment method, presence or absence of adverse effects, and treatment outcomes. CONCLUSIONS: The analysis revealed that the use of antidepressants and alpha-lipoic acid has been showing promising results; however, more studies are necessary before we can have a first-line treatment strategy for patients with BMS. CLINICAL RELEVANCE: To review systematically the literature about Burning Mouth Syndrome treatment may aid the clinicians to choose the treatment modality to improve patients symptoms based on the best evidence.

Diagnóstico da síndrome da ardência bucal ­ uma revisão integrativa / Diagnosis of the burning mouth syndrome ­ an integrative review

A síndrome da ardência bucal (SAB) é uma patologia crônica de difícil diagnóstico, caracterizada pela sensação de queimação da mucosa bucal, preferencialmente da língua, sem que uma causa física possa ser detectada. Sua etiologia ainda obscura gera controvérsia na literatura. Compreender os fatores que a desencadeiam, em especial seus sinais e sintomas, é extremamente importante para o cirurgião dentista. Objetivou-se verificar os sinais, sintomas e aspectos relevantes a serem considerados no diagnóstico da SAB. Realizou-se uma revisão integrativa com artigos publicados na íntegra nos idiomas português ou inglês entre 2010 e 2015, indexados nas bases Science Direct; Medline; Scielo e Pubmed. Um total de 16 artigos foram selecionados e demostraram que SAB verdadeira é aquela em que não se observam fatores locais, sistêmicos e psicogênicos envolvidos, com uma mucosa clinicamente normal e exames laboratoriais sem alteração. Porém, se existir o sintoma de queimação em uma mucosa alterada ou mesmo íntegra com algum fator predisponente, configura-se um "ardor bucal secundário". A associação de queixa de boca seca e alteração do paladar também são sintomas que portadores da SAB podem apresentar. A xerostomia que pode ou não estar relacionada à diminuição do fluxo salivar, pode potencializar os sintomas da dor e sensação de ardência, bem como influenciar negativamente na qualidade de vida do paciente. Concluiu-se que para auxiliar na busca de um diagnóstico mais preciso, o cirurgião dentista deve realizar um exame clínico minucioso e sistemático para descobrir qual o fator desencadeia o ardor bucal relatado pelo paciente (AU).

The burning mouth syndrome (BMS) is a chronic disease, difficult to diagnose, characterized by burning sensation in the oral mucosa, preferably of the tongue, without a detected physical cause. Its unclear etiology still generates literature controversy. To understand the factors that trigger this syndrome, in particular its signs and symptoms, is extremely important for the dentist. The aim was to verify the signs, symptoms and relevant aspects to be considered on diagnostic of BMS. An integrative review was carried out to find published articles in Portuguese or English in the years 2010-2015 indexed in Science Direct, Medline, Scielo or Pubmed bases which addressed signs, symptoms, etiology e differential diagnoses. A total of 16 articles was selected and they have demonstrated that true SAB is the one in which no local, systemic and psychogenic factors involved are observed, with a normal mucosa, and laboratory tests without change. However, if there is a burning symptom in an altered or not mucosa with some predisposing factor, it is considered a "secondary oral burning". Dry mouth and altered taste are also symptoms of patients with SAB. Xerostomia that can or can't be related to decrease in salivary flow, may potentialise the symptoms of pain and burning sensation, and negatively influence the patient's quality of life. Therefore to assist in the search of a more accurate diagnosis of the syndrome, the dentist should perform a thorough and systematic clinical examination in order to find out which factor triggers the oral burning reported by the patient (AU).

Análise de fatores clínico-demográficos, psicológicos, hormonais e genéticos na síndrome da ardência bucal e ardor bucal secundário / Analysis of clinical and demographic, psychological, hormonal and genetic factors in burning mouth syndrome and secondary burning mouth

A síndrome da ardência bucal (SAB) é uma condição clínica pouco esclarecida caracterizada por sensação espontânea de ardência, dor ou prurido na mucosa oral, sem alterações locais ou sistêmicas identificáveis. Sua etiopatogenia é incerta, não havendo até o momento uma padronização dos critérios utilizados para o seu diagnóstico. O presente estudo objetivou verificar a associação de fatores psicológicos, hormonais e genéticos com a SAB no sentido de propor uma melhor caracterização de sua natureza. Além de uma análise descritiva da amostra estudada, os aspectos analisados foram especificamente os níveis de estresse e sua fase, depressão, e ansiedade, compondo os fatores psicológicos; mensuração dos níveis séricos de cortisol e desidroepiandrosterona (DHEA); bem como a verificação sobre a ocorrência de polimorfismos no gene da Interleucina-6 (IL6). Foram realizadas análises comparativas entre um grupo de pacientes com SAB e um grupo composto por indivíduos com ardor bucal secundário (AB). Os resultados revelaram diferenças estatisticamente significativas entre os dois grupos com relação aos seguintes aspectos: xerostomia (p=0,01) e hipossalivação em repouso (p<0,001), que foram mais prevalentes no grupo SAB; sintomas de depressão (p=0,033), também mais presentes no grupo SAB; e dosagem de DHEA, que apresentou níveis mais reduzidos no grupo SAB (p=0,003). A dosagem desse hormônio mostrou-se amplamente sensível e específica para o diagnóstico da síndrome em estudo, sendo verificado que níveis séricos de DHEA abaixo de 0,37µg/mL para mulheres, utilizando-se os procedimentos propostos na pesquisa, possuem um Odds Ratio de 4,0 95 por cento IC (0,37 a 2,71)]. Foi verificado ainda que o alelo C do polimorfismo rs2069849 da IL-6 pode representar um alelo de risco para a ocorrência de ardor bucal em ambos os grupos, no entanto, não se pode garantir sua real implicação nos processos inflamatórios da SAB

Os presentes resultados sugerem uma provável influência da depressão, bem como de níveis diminuídos do hormônio DHEA na SAB. (AU)

The burning mouth syndrome (BMS) is a clinical condition characterized by spontaneous burning sensation, pain or itching in the oral mucosa without identifiable local or systemic changes. Its pathogenesis is uncertain, with no observable standardization in previous literature of the criteria used for its diagnosis. The present study aimed to determine demographic, psychological, hormonal and genetic factors in patients with BMS and secondary burning mouth to propose a better characterization of the nature and classification of this condition. Besides a descriptive analysis of the sample of 163 individuals, were analyzed the levels of stress and its phase, depression and anxiety; measurement of serum levels of cortisol and dehydroepiandrosterone (DHEA), as well as checking on the occurrence of polymorphisms in the gene of interleukin-6 (IL6). Comparative analysis between a group of patients with BMS and a group of individuals with secondary burning mouth (BM) were performed. The results revealed statistically significant differences between the two groups with respect to the following aspects: xerostomia (p=0.01) and hyposalivation at rest (p<0.001), which were more prevalent in the BMS group; symptoms of depression (p=0.033), more present in the BMS group, and dosage of DHEA, which showed lower levels in BMS patients (p=0.003). The dosage of this hormone was largely specific and sensitive for the diagnosis of the studied syndrome, and was verified that serum levels of DHEA below 0.37 pg/mL in women, using the procedures proposed in this research, have an Odds Ratio of 4.0 95 per cent Cl (0.37 to 2.71)]. These results suggest a possible influence of depression and decreased levels of the hormone DHEA in the pathogenesis of BMS. (AU)

Síndrome da ardência bucal, correlações fisiopatológicas, medicamentosas: revisão de literatura

A síndrome da Ardência Bucal (SAB) é uma condição onde a ausência de sinais encontrado na maioria dos casos, dificulta seu diagnóstico. Os objetivos desse trabalho são classificar os mecanismos fisiopatológicos da SAB, estabelecendo uma opção de tratamento

The syndrome of burning Bucal (SAB) is a condition where the absence of signs found in most cases, its diagnosis difficult. In order to classify the pathophysiology of SAB, and the search for their treatment, are the main goals of this work

Exfoliative cytology of the oral mucosa in burning mouth syndrome: a cytomorphological and cytomorphometric analysis.

OBJECTIVE: The aim of this study was to evaluate oral epithelial cells by exfoliative cytology in burning mouth syndrome (BMS). MATERIAL AND METHODS: Oral smears were collected from clinically normal-appearing mucosa by liquid-based exfoliative cytology in 40 individuals (20 BMS patients and 20 healthy controls matched for age and gender) and analysed for cytological and cytomorphometric techniques. RESULTS: Mean values of nuclear area (NA) for experimental and control groups were, respectively, 67.52 and 55.64 µm² (p < 0.05). Cytoplasmic area (CA) showed the following mean values: 1258.0 (experimental) and 2069.0 µm² (control). Nucleus-to-cytoplasm area ratio for the experimental group was 0.07, besides the control group was 0.03 (p < 0.05). Morphologically, oral smears exhibited normal epithelial cells in both experimental and control groups. There was a significant predominance of nucleated cells of the superficial layer in the smears of BMS patients (p = 0.00001). CONCLUSION: This study revealed that oral mucosa of BMS patients exhibited significant cytomorphometric changes in the oral epithelial cells. These changes probably are associated with epithelial atrophy and a deregulated maturation process that may contribute to the oral symptoms of pain and discomfort in BMS.

Subgemmal neurogenous plaque: clinical and microscopic evaluation of 7 cases.

Subgemmal neurogenous plaques (SNPs) are biphasic neural structures found on the posterolateral border of the tongue. Fewer than 40 cases have been reported and only a few were symptomatic. The present report details the features of 7 cases of SNP retrieved from the files of a single institution. Clinical and histopathological data were reviewed and immunohistochemical analysis was performed for S100, CD56, neuron-specific enolase, epithelial membrane antigen, CK7, CK8, CK14, and CK20. All cases showed similar morphological and immunohistochemical characteristics. Neural markers highlighted the biphasic pattern and CK7, CK8, and CK20 were detected on taste buds confined to the epithelium adjacent to the SNPs. Five patients presented pain/discomfort as the main symptom. Symptomatic SNPs seems to be more common than previously reported, presenting as focal burning on the posterolateral border of the tongue.

Subgemmal neurogenous plaque associated with burning tongue: report of two cases and review of the literature.

Subgemmal neurogenous plaques, biphasic structures with a neurofibroma and neuroma patterns, are observed in tongue biopsies involving subepithelial areas, being characterized as aggregates of nerve plexus and ganglion cells. Oral burning symptoms, having many possible causes, are commonly observed during oral medicine practice, but the association of subgemmal neurogenous plaque with tongue burning symptoms is very unusual. Reported here are two cases of focal burning sensation in the lateral border of the tongue diagnosed as subgemmal neurogenous plaque through biopsy. Recognizing this entity is important to avoid misdiagnosis of other neural proliferations, especially in cases involving focal tongue burning.