Glossodynia from Candida-associated lesions, burning mouth syndrome, or mixed causes.

OBJECTIVE: Candida-associated lesions (CALs) and burning mouth syndrome (BMS) may induce glossodynia without objective manifestations. We investigated patients with glossodynia to examine the relationship between CAL and BMS. PATIENTS AND METHODS: A visual analog scale was used to divide 95 patients with glossodynia into three groups according to intensity of pain at rest and when eating. Group A was the functional pain group; group B was the nonfunctional pain group; and group C was a mixed pain group. Antifungal treatment was scheduled for patients with suspected Candida infection by clinical, mycological, or cytological criteria. RESULTS: Culture tests and direct examination results indicated that group A had high Candida positivity (73.0% by culture and 59.5% by direct examination), and showed a good response to antifungal treatment (75.7%). Antifungal treatment was not useful in group B. This was supported by a low Candida infection rate, as determined by direct examination (3.1%). For group C, Candida positivity and antifungal treatment effectiveness were between groups A and B. Furthermore, six patients in group C showed complete remission of functional pain by antifungal treatment only. Favorable outcomes were obtained for 23 patients (10 in group B and 13 in group C), who received antidepressant treatment. CONCLUSION: These results suggested that glossodynia was Candida-associated in group A, and BMS-induced in group B, while group C contained patients with both CAL and BMS.

Burning mouth disorder (bmd) and taste: A hypothesis

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Background: Burning mouth disorder (BMD) is a burning or stinging sensation affecting the oral mucosa, lips, and/or tongue, in the absence of clinically visible mucosal lesions. There is a strong female predilection, with the age of onset being approximately 50 years.The causes of BMD are multifactorial and remain poorly understood.Often BMD patients report, in association, change in taste.In this regards, it is relevant that in central nervous system connections exist between taste and oral pain and that taste normally inhibits oral pain.Aim: The working hypothesis of this study considers a possible relationship between burning mouth disorders andalterations of taste. Several conditions or pathologies can be responsible of taste disturbances that might be the cause of oral pain in BMD patients.Subjects and methods: We have analyzed, retrospectively, 142 cases of BMD with associated taste disturbance. Possible causes that could be responsible for alterations of taste were investigated.Results and conclusions: Sixty-one subjects revealed the habitual use of drugs having a documented interference with taste perception. Thirty-five subjects, among the 81 patients who had no associated pathology or habitual use of drugs, noticed in their clinical history conditions, pathologies or use of drugs that are known to affect the gustatory system. Therefore, we propose that BMD may represent an oral phantom pain induced in susceptible individuals by alteration of taste

Effects of near-infrared irradiation to stellate ganglion in glossodynia.

OBJECTIVE: This study was designed to assess the effect of stellate ganglion near-infrared irradiation (SGR) on glossodynia and the mechanism of action. STUDY DESIGN: Thirty-seven patients with glossodynia received SGR once weekly for 4 weeks. The response to treatment was evaluated on the basis of the change in pain intensity, assessed with a visual analogue scale (VAS) before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight healthy subjects were studied. RESULTS: Tongue pain as assessed by the VAS decreased in 28 of the 37 patients (75.7%). Mean pain intensity decreased significantly from 5.1 +/- 2.2 to 1.9 +/- 2.1 (P < 0.05). Tongue blood flow at rest in the patients with glossodynia [7.2 +/- 1.6 ml min(-1) (100 g)(-1)] was significantly lower than that in the healthy subjects [7.8 +/- 0.23 ml min(-1) (100 g)(-1)]. Five minutes after SGR, the temperature of the tongue rose 1.5 +/- 0.21 degrees C, and blood flow increased to 8.5 +/- 1.2 ml min(-1) (100 g)(-1). Tongue blood flow (at rest) after 4 weeks of SGR had increased to 7.7 +/- 1.1 ml min(-1) (100 g)(-1). CONCLUSION: SGR is an effective treatment for glossodynia. The mechanism by which SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associated with glossodynia. This is followed by normalization of decreased tongue blood flow, thereby alleviating pain.

[Glossodynia and the function of the autonomic nervous system--frequency spectrum analysis of RR intervals recorded electrocardiographically].

This study explored the relationship between the function of the autonomic nervous system (ANS) and glossodynia. The function of the ANS was examined in patients with glossodynia by frequency analysis of heart rate variability. The subjects were 50 women given the diagnosis of glossodynia and 24 healthy volunteers. The heart rate variability of these subjects was evaluated. Mean values of the high frequency power at rest were 1.323 +/- 1.484 ms2 in the group without functional disorders (NF group), 1.861 +/- 1.601 ms2 in the group with functional disorders (F group), and 3.229 +/- 2.044 ms2 in the standard group (H group). Mean values of HF/LF were 0.968 +/- 0.961 in the NF group, and 1.696 +/- 0.847 in the H group. Mean values of the high frequency power at rest were 1.032 +/- 977 ms2 in the group with CMIs in regions III and IV (III-IV group), 3.299 +/- 2.044 ms2 in the H group, and 2.314 +/- 1.883 ms2 in the group with CMIs in regions I and II (I-II group). Mean values of HF/LF were 0.965 +/- 0.744 in the III-IV group and 1.696 +/- 0.847 in the H group. The results of this study suggest that nervous tension, which was the cause of indefinite complaints in patients with glossodynia, had resulted from a pronounced reduction in activities of the parasympathetic nervous system, but not from an excessive increase in activities of the sympathetic nervous system. An assessment of the function of the ANS by means of heart rate variability seemed to be useful for comprehending the clinical conditions of glossodynia.

[Stress on development of glossalgia and validation of treatment]. / Rol' stressa v vozniknovenii glossalgii i obosnovanie lecheniia.

Study of psychoemotional and neurological status of 58 patients with glossalgia showed that stress plays the leading role in development of this abnormality. Neurophysiological analysis of electroencephalograms of patients with glossalgia revealed pronounced generalized restructuring of rhythmic activity of the brain. Ultrasonic dopplerography of the tongue vessels and laser Doppler flowmetry of capillary bloodflow in the tongue confirmed the presence of short-term ischemia in the tongue at the moment of painful attack. Use of modern anxiolytics and antidepressants in combination with ozone therapy in combined therapy of patients with glossalgia is validated.

A psychiatric appraisal of "glossodynia".

"Glossodynia" is a diagnostic rubric that includes patients enduring pain or a burning sensation in the tongue without any oral pathology or systemic disease. Psychiatric profiles of 50 women patients with "glossodynia" were compared with those of control subjects. The patients scored significantly lower on the Extraversion Scale of the Eysenck Personality Questionnaire and higher on the Toronto Alexithymia Scale than the control subjects, whereas there was no significant difference in the mean General Health Questionnaire score. The psychopathology of "glossodynia" may be more markedly associated with personality trait characteristics than with neurotic or depressive symptoms.

The dynias.

The "dynias" are a group of chronic, focal pain syndromes with a predilection for the orocervical and urogenital regions. They include glossodynia, carotidynia, vulvodynia, orchidynia, prostatodynia, coccygodynia, and proctodynia. In some cases, the dynias occur secondarily, but more often, despite an exhaustive evaluation, no etiology is found and in these remaining cases, the cause of the pain remains enigmatic. The controversy that surrounds this group of disorders, which ranges from questioning their existence to suggesting that they are purely psychosomatic, is counterbalanced by an extensive literature attesting to their organicity. The approach to the patient begins with acknowledging that the symptom is well described, searching for a secondary cause, and performing a careful psychologic assessment. Treatment is empirical and patients can often be helped with medications used to treat neuropathic pain, all the while providing psychologic support and exercising caution toward invasive and irreversible therapeutic procedures.

[The neurogenic aspects of the pathogenesis of glossalgia]. / Neirogennye aspekty patogeneza glossalgii.

Comprehensive clinical, biochemical, and electrophysiologic examinations of 250 glossalgia patients have revealed disintegration of supra-segmentary vegetative formations: increased activity of sympathoadrenal and serotonin systems, depressed kallikrein-kinin system, changed level of salivary electrolytes, reduced blood supply to the facial and oral tissues and decreased sensitivity of these tissues. Based on these findings, the authors suggest a scheme of glossalgia pathogenesis, with disorders in the autonomic nervous system underlying the development of the condition. Correction of the detected shifts contributes to a more effective therapy of glossalgia.

Clinical oral test for the assessment of oral symptoms of glossodynia and glossopyrosis.

Subjective oral symptoms of a burning sensation and pain in the tongue may exist in the absence of any pathological changes in the oral mucosa. Owing to different treatment approaches and the lack of any specific therapy, it appeared potentially useful to identify these subjective symptoms by means of a test for an improved therapy evaluation. In this study, we have attempted to develop a method for the objective assessment of oral symptoms of glossodynia and glossopyrosis, by recording the local temperature. The temperature of the tongue was determined using a DT-1 electron thermoesthesiometer, that was highly sensitive to temperatures between 36 degrees C and 38 degrees C. Measurements were performed in topographic areas recommended by the World Health Organization in 1980. The study sample consisted of a group of 50 patients with glossopyrosis and glossodynia, without any clinically manifest pathological changes in the oral cavity, who were compared with a group of 50 age- and sex-matched subjects free of these oral symptoms and with normal oral mucosa. Statistically significant temperature differences were observed between the patients and the controls, as measured in seven different areas. The lowest temperatures (33 degrees C) were measured in the apex linguae area. The minimum temperature was significantly lower in the study group. Significant differences in temperature were also observed between the sexes. It was concluded that glossodynia and glossopyrosis, both inflammation and diminished circulation without any visible clinical signs, can be diagnosed using the thermoesthesiometry test. Such an objective test allows appropriate therapeutic treatment to be selected for patients with the above-mentioned symptoms.

[Glossodynia]. / Les glossodynies.

Glossodynias are a build up of painful lingual syndromes with neither a detectable visible lesion, nor of a known organic origin. An obvious discordance between the subjective feelings and the weakness, even absence of an objective lesion support able to explain them, can be observed. Being often considered by physicians to be of a psychological origin, they are always the object of never-ending research for a detectable lesion which would explain their complications. Following consultations with 114 patients in the department of Stomatology, and in collaboration with our neuropsychiatrist colleagues in the same hospital, we took stock of this frequent application which bothers the buccal specialist, who does not know to consider it or how to treat it.

Glossodynia as an oral manifestation of sex hormone alterations.

Oral inflammation occurs during puberty, pregnancy, menses, and therapy with hormones (especially oral contraceptive agents), and other medications such as phenytoin. Alterations of the oral environment result from fluctuations of plasma and salivary sex steroids. The ratio of the sex steroids to one another, and their absolute concentration, determine the amount of prostanoid and peroxidase production and salivary flow. These relationships are complex and are not readily predictable; however, they are reproducible in both humans and animals. The sex steroids exert profound effects on the function of many nonsexual organs; particularly the skin, bone, liver, salivary glands, and oral tissues. We reviewed the currently available information concerning sex steroid action on salivary glands and oral epithelium. In light of the dramatic drop in sex steroid levels at menopause, the purely psychogenic nature of glossodynia or burning mouth (stomatopyrosis), first manifested at menopause, requires further consideration and study.

Xerostomia and glossodynia in patients with autoimmune disorders.

Xerostomia presents a difficult challenge for the clinician to manage and a serious problem for the afflicted patient. Patients with dysfunctional or hypofunctional salivary or lacrimal glands suffer considerably both emotionally and physically. Because of the ever-increasing geriatric population, health practitioners can expect to encounter a substantial number of patients with xerostomia or salivary gland disorders. Early detection and appropriate management will improve the quality of these patient's lives.

[Neurophysiological analysis of the central mechanisms of glossalgia]. / Neirofiziologicheskii analiz tsentral'nykh mekhanizmov glossalgii.

Bioelectrical activity of the brain was studied in 20 patients with glossalgia characterized by a most severe clinical symptomatology. Neurophysiological analysis has shown a marked imbalance of the leading neuromediator cerebral systems, namely, deficiency of ascending activating reticular effects, tense functioning of syncronizing systems, and involvement into the chain of impaired relationships of the limbic-reticular complex and inhibitory systems of the brain. It has been established that general disorganization of the activity of the cerebral mechanisms is attended by impaired control of ascending afferentation. As a result, any type of chronic stimulation of the peripheral receptors is no longer blocked when entering the central nervous system and manifests in a clinically marked syndrome of glossalgia. On the basis of clinico-physiological correlations the authors draw a conclusion that the syndrome of glossalgia should be considered as one of the links in the chain of chronic emotional stress manifestations.