[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.

Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour.

A woman in her late 80s with severe bronchomalacia was referred to a tertiary orofacial pain clinic for unexplained right unilateral glossodynia of progressive and continuous evolution for the past 8 months, spreading to the ipsilateral labiomental region, associated with ipsilateral hypoacusia. Local and general clinical examinations were unremarkable and routine blood work could not reveal any underlying systemic disease explaining the glossodynia and burning/pricking labiomental pain. Suspecting a painful trigeminal neuropathy secondary to a space-occupying lesion, a cerebral MRI was prescribed, revealing an ipsilateral cerebellopontine angle lesion, compatible with either a schwannoma or meningioma. This lesion invaded the root entry zones of cranial nerves V and VIII explaining the patient's oral pain and hypoacusia. Following a neurosurgical consultation where surgical treatment was rejected, her pain was successfully managed by topical pregabalin mouthwashes, to prevent any risk of respiratory depression related to her underlying severe bronchomalacia.

Glossodynia, burning mouth syndrome, and COVID-19.

PURPOSE: To evaluate whether the prevalence of glossodynia increased among patients affected by COVID-19 compared to other hospital populations. METHODS: The i2b2 patient registry platform at the University of Florida Health Center was used to generate a count of patients using the international classification of diseases (ICD)-10 diagnosis codes from October 2015 to June 2021. Logistic regression of the aggregates was used for analysis. RESULTS: Of the patients with both glossodynia and COVID-19, 60% were females, 32% were African American, 64% were white, and 100% were adults. There were 72% females, 19% African Americans, 72% whites, and 93% adults with glossodynia only. For COVID-19 patients, 57% were females, 23% were African American, 56% whites, and 90% were adults. The odds ratio (OR) for glossodynia in the COVID-19 patients was significant (OR = 2.9; 95% CI, 1.94-4.32; P < 0.0001). CLINICAL SIGNIFICANCE: Glossodynia is significantly more common in COVID-19 patients and should be considered in the differential diagnoses among the oral complications of this infection.

Metastatic gastric adenocarcinoma of the tongue with initial symptoms of glossodynia.

A 60-year-old woman presented to our department with severe tongue pain. On initial examination, the mucosal surface of the tongue was intact but a hard submucosal mass on the dorsum of the tongue was detected on palpation. Magnetic resonance imaging demonstrated an ill-defined tumor in the intrinsic tongue muscles. Sequential whole-body positron emission tomography/computed tomography revealed a tumor of the pancreas apart from the tongue lesion, and upper gastrointestinal endoscopy revealed gastric mucosa ulceration. On biopsy, the tongue lesion was confirmed to be metastatic gastric adenocarcinoma, and the gastric ulcer was simultaneously diagnosed as poorly differentiated gastric adenocarcinoma. The definitive diagnosis was thus gastric adenocarcinoma and synchronous pancreatic cancer, with gastric carcinoma metastases to the tongue. We administered FOLFIRINOX treatment for pancreatic cancer and FLTAX treatment for gastric cancer. Because of difficulty with oral intake due to the growth of the tongue lesion, we administered palliative radiation therapy at a dose of 30 Gy in 10 fractions following which the patient was able to resume oral intake and was satisfied with this outcome. She died 8 months after her first visit to our department.

Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region.

Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM-IV. The patient was a 71-year-old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become 'limp and floppy' and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.

Clinical study of tongue pain: Serum zinc, vitamin B12, folic acid, and copper concentrations, and systemic disease.

The aim of this retrospective study of patients with tongue pain who showed no improvement after initial treatment and examination was to find out if their lack of response correlated with serum concentrations of zinc, vitamin B12, folic acid, and copper, and if it was associated with coexisting systemic diseases. We studied 311 patients for whom we had data about serum concentrations of these elements, and recorded whether they had any systemic diseases and were taking medicines regularly. One patient (0.3%) had a copper concentration outside the reference range; 2 patients (0.6%) had folic acid concentrations outside the reference range. The corresponding number for vitamin B12 was 5 (2%), and for zinc 30 (10%). The systemic diseases with the highest rates were: hyperlipidaemia (n=53, 17%), gastritis or gastric ulcer (n=51, 16%), angina pectoris (n=39, 13%), diabetes mellitus (n=31, 10%), thyroid disease (n=31, 10%), mild mental disorder (n=27, 9%), hypertension (n=18, 6%), cerebral infarction (n=17, 6%), leiomyoma (n=15, 5%) and anaemia (n=15, 5%). Roughly 10% of the patients were deficient in zinc. This study suggested that the serum concentration of zinc was most important to the patients with tongue pain. Many patients had more than one systemic condition, and all were taking various drugs.

Síndrome de ardor bucal: actualización diagnóstica y terapéutica / Burning mouth syndrome: diagnostic and therapeutic actualisation

El síndrome de boca ardiente (SBA) es una entidad patológica caracterizada por la presencia de síntomas crónicos de ardor o dolor en la mucosa bucal clínicamente normal. El SBA afecta principalmente a mujeres peri y posmenopáusicas. Su causa es desconocida, pero su relación con una compleja asociación de factores biológicos y psicológicos hace suponer una etiología multifactorial. Aunque se han encontrado tratamientos eficaces en casos particulares, se sigue buscando un tratamiento que resulte eficaz en la mayoría de los casos. Esta revisión hace especial referencia a los factores etiológicos y al tratamiento del síndrome (AU)

The burning mouth syndrome (BMS) is characterized by the presence of chronic symptoms of burning or paining clinically normal oral mucosa. This syndrome primarily affects peri and postmenopausal women. The cause is unknown, but the relationship between the BMS and a complex association of biological and psychological factors suggest a multifactorial etiology. Although some treatments have been found effective in particular cases, the clinical searchers are still looking for a treatment that can be effective in most cases. This review makes particular reference to the etiological factors and the treatment of the síndrome (AU)

Síndrome de la boca urente / Burning mouth syndrome

El síndrome de la boca urente (SBU) se refiere a la sensación de dolor, ardor o escozor, localizadoen la lengua o en otra zona de la cavidad oral, sin causa orgánica objetivable en el examen físico. La sensaciónde boca urente puede aparecer en algunas enfermedades cutáneas o sistémicas, que habrá que descartar antes deestablecer el diagnóstico de SBU, ya que dicho término se refiere exclusivamente a las formas idiopáticas y se encuadradentro de los trastornos sensitivos (o sensoriales) cutáneos.En la mayoría de los casos los pacientes con boca urente presentan alteraciones psíquicas o psiquiátricas acompañantes.Por este motivo el SBU se ha incluido clásicamente entre las psicodermatosis. En el momento actualno está claro si los factores psíquicos son causa o consecuencia o simplemente se exacerban mutuamente. Estudiosrecientes proponen una etiología neurológica, ya sea de tipo neuropático o en relación con el sentido delgusto (AU)

Burning mouth syndrome is characterized by a painful burning or stinging sensation affecting the tongue or other areas of the mouth without obvious signs of an organic cause on physical examination. A burning mouth sensation can occur in several cutaneous or systemic diseases that must be ruled out prior to making a diagnosis of burning mouth syndrome, since this term is used exclusively to refer to idiopathic forms and is included within the cutaneous sensory disorders. In most cases, patients with burning mouth syndrome have accompanying psychologic or psychiatric conditions. Consequently, the syndrome has traditionally been included among the psychogenic dermatoses. However, it is currently unclear whether psychologic factors are a cause or a consequence of the syndrome, or whether each exacerbates the other. Recent studies propose the etiology to be neurologic, either neuropathic or related to taste (AU)

Fibromyalgia: an update for oral health care providers.

Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, stiffness, nonrestorative sleep, fatigue, and comorbid conditions. Fibromyalgia has undergone a major paradigm shift in recent years. It is no longer considered a musculoskeletal disorder per se; rather, it represents one end of a spectrum of disorders characterized by chronic widespread pain. Hence, oral health care providers may be the first to recognize signs and symptoms of this complex disorder and are often consulted to participate in the management of FM patients. This medical management update will review the epidemiology, classification, etiology and pathophysiology, clinical presentation, and therapeutic advances in FM. This review will also highlight issues that are important to the oral health care provider, including orofacial manifestations and dental considerations for patients with FM.

[Oral pain]. / Douleurs buccales.

Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

Manifestaciones orales y manejo odontológico durante la menopausia / Oral manifestations and dental treatment in menopause

La menopausia es un proceso fisiológico que acontece en la quinta década de la mujer y en el que tiene lugar el cese permanente de la menstruación. Este proceso tiene como base unos cambios hormonales que tendrán como consecuencia una serie de manifestaciones clínicas de tipo general que han cobrado especial importancia por el aumento de la esperanza de vida en la mujer, lo que significa que la mayoría de estas mujeres padecerán dichos síntomas durante la última tercera parte de su vida. Sin embargo, no son sólo los síntomas generales (sofocos y alteraciones psicológicas) los que se manifiestan en la mujer menopaúsica, sino que también se producen síntomas a nivel oral. Así pues, existe un aumento en la incidencia de xerostomía, afecciones como el liquen plano, el penfigoide benigno, el síndrome de Sjögren, el conocido síndrome de ardor bucal y la discutida prevalencia de enfermedades periodontales. El manejo odontológico de estas pacientes presenta ciertas peculiaridades que deben ser consideradas, tales como el empleo de estimulantes de la secreción salival o de sustitutivos de la saliva en el caso de la hiposialía. No obstante, una correcta prevención, con un buen control de placa bacteriana, disminuirá los riesgos de aparición de muchas de las infecciones a nivel oral (AU)