Neuropathic and Psychogenic Components of Burning Mouth Syndrome: A Systematic Review.

The pathophysiology of primary burning mouth syndrome (BMS) has been extensively debated but is poorly understood despite a large number of hypotheses attempting to explain its etiopathogenic mechanisms. The aim of the present work was to systematically review papers that could provide arguments in favour of the neuropathic and psychogenic components of primary BMS for a better understanding of the disease. This systematic review (SR) was registered in PROSPERO (CRD42021224160). The search was limited to articles in English or French from 1990 to 01 December 2020. A total of 113 articles were considered for data extraction. We divided them into four subgroups: pharmacological and nonpharmacological management studies (n = 23); neurophysiological studies (n = 35); biohistopathological studies (n = 25); and questionnaire-based studies (n = 30). Several of these studies have shown neuropathic involvement at various levels of the neuraxis in BMS with the contribution of quantitative sensory testing (QST), functional brain imaging, and biohistopathological or pharmacologic studies. On the other hand, the role of psychological factors in BMS has also been the focus of several studies and has shown a link with psychiatric disorders such as anxiety and/or depression symptoms. Depending on the patient, the neuropathic and psychogenic components may exist simultaneously, with a preponderance of one or the other, or exist individually. These two components cannot be dissociated to define BMS. Consequently, BMS may be considered nociplastic pain.

The Association between Emotional Stress, Sleep Disturbance, Depression, and Burning Mouth Syndrome.

INTRODUCTION: Burning mouth syndrome (BMS) is one of the challenging clinical problems not only in its diagnosis and treatment but also its concurring mental impact. This study is aimed at determining the association between psychological factors, including emotional stress, depression, anxiety, and sleep pattern among BMS patients. METHODS: In this cross-sectional study, 19 patients with idiopathic BMS were enrolled along with a control group equivalent in age and sex, but without BMS. Questionnaires used were the Visual Analog Scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale (DASS-21). Demographic information was also recorded and analyzed. RESULTS: There was a significant correlation among the two groups of BMS and non-BMS patients regarding stress, depression, and sleep disorder. The average severity of the burning score was 8.31 among the patients. Furthermore, a significant correlation was observed among mental disorders and educational level and sex, but not with age. There was also no significant correlation among the severity of the burning score with sex, education, and mental disorder. CONCLUSION: BMS is significantly associated with psychological symptoms. This condition requires proper treatment and support because it can represent psychological or mental issues and/or have a significant effect on daily life.

Conhecimento científico produzido sobre a Síndrome da Ardência Bucal nos últimos cinco anos / Scientific knowledge produced about Bucal Ardence Syndrome in the last five years

Objetivo: realizar revisão integrativa da literatura sobre a Síndrome da Ardência Bucal (SAB). Materiais e Método: trata-se de uma revisão integrativa da literatura sobre a SAB nos últimos cinco anos. Utilizou-se as bases de dados Medline, SciELO e Lilacs para a pesquisa, empregando de forma combinada os descritores relacionados à temática. Como critérios de inclusão, decidiu-se selecionar publicações sobre a temática que estivessem disponíveis para leitura em qualquer idioma dos últimos cinco anos. Foram excluídos os estudos sem relação com o tema. Resultados: após análise, apenas 42 estudos foram selecionados para esta revisão. A maior parte dos artigos era publicada em inglês, porém, foi o Brasil que apresentou o maior número de publicações. As pesquisas avaliadas demonstraram os seguintes resultados: o sexo feminino é o mais acometido; maior prevalência acima dos 60 anos; dor, queimação e xerostomia são os sintomas mais relatados. O laser foi bastante relatado como terapia, além do uso de fármacos. Conclusão: a revisão apresentada neste artigo constatou que a maioria dos artigos, apesar de oriundos do Brasil, foi publicada no idioma inglês. A maioria dos trabalhos destacou que indivíduos do sexo feminino acima dos 60 anos são mais acometidos. Pacientes com SAB apresentam dor e queimação em língua e palato, principalmente. Fatores psicológicos e gastrointestinais podem estar associados ao aparecimento desta síndrome, e os usos do laser e de fármacos fitoterápicos, ou não, parecem melhorar o quadro clínico dos indivíduos acometidos.(AU)

Objective: to perform an integrative review of the literature on Burning Mouth Syndrome (BMS). Materials and Method: This is an integrative review of the literature on Burning Mouth Syndrome over the last five years. The Medline, SciELO, and Lilacs databases were used for the research, using the descriptors related to the topic in combination. The inclusion criteria consisted of publications on the topic that were available for reading in any language over the last five years. Studies unrelated to the topic were excluded. Results: After the analysis, only 42 studies were selected for this review. Most articles were published in English but Brazil had the highest number of publications. The studies evaluated showed the following results: women are the most affected; highest prevalence over 60 years old; and pain, burning, and xerostomia are the most reported symptoms. The laser was extensively reported as therapy, as well as the use of other drugs. Conclusion: The review presented in this article found that most studies were published in Brazil but in the English language. Most studies highlighted that women over 60 years old are more affected. Patients with BMS experience pain and burning especially in the tongue and palate. Psychological and gastrointestinal factors may be associated with the onset of this syndrome, and the use of laser and other drugs, either herbal medicines or not, seems to improve the clinical condition of the individuals affected.(AU)

Neurophysiology and genetics of burning mouth syndrome.

BACKGROUND AND AIMS: Neuropathic mechanisms are involved in burning mouth syndrome (BMS), and variation of the dopamine D2 receptor (DRD2) gene contributes to experimental pain perception. We investigated whether neurophysiologic findings differ in BMS patients compared to healthy controls, and whether 957C>T polymorphism of the DRD2 gene influences thermal sensitivity or pain experience in BMS. METHODS: Forty-five BMS patients (43 women), mean age 62.5 years, and 32 healthy controls (30 women), mean age 64.8 years, participated. Patients estimated pain intensity, interference, suffering and sleep with Numeric Rating Scale. Blink reflex tests of the supraorbital (SON), mental (MN) and lingual (LN) nerves, and thermal quantitative sensory testing were done. The results were analysed with ANOVA. DRD2 gene 957C>T polymorphism was determined in 31 patients, and its effects on neurophysiologic and clinical variables were analysed. RESULTS: Cool (p = 0.0090) and warm detection thresholds (p = 0.0229) of the tongue were higher in BMS patients than controls. The stimulation threshold for SON BR was higher in patients than in controls (p = 0.0056). The latencies of R2 component were longer in BMS patients than in controls (p = 0.0005) at the SON distribution. Habituation of SON BR did not differ between the groups. The heat pain thresholds were highest (p = 0.0312) in homozygous patients with 957TT, who also reported most interference (p = 0.0352) and greatest suffering (p = 0.0341). Genotype 957CC associated with sleep disturbances (p = 0.0254). CONCLUSIONS: Burning mouth syndrome patients showed thermal hypoesthesia within LN distribution compatible with small fibre neuropathy. The DRD2 957C>T genotype influences perception and experience of BMS pain. SIGNIFICANCE: The results confirm earlier findings of neuropathic pain in BMS. The DRD2 957 C>T genotype influences perception and experience of clinical pain in BMS.

Mechanical sensitivity and psychological factors in patients with burning mouth syndrome.

OBJECTIVES: The aim of this study was to compare mechanical sensitivity on the tongue using quantitative sensory testing (QST) and psychological factors using the General Health Questionnaire (GHQ) between burning mouth syndrome (BMS) patients and healthy participants. MATERIALS AND METHODS: Participants comprised 20 female BMS patients (68.1 ± 7.4 years) and 20 healthy females (65.4 ± 4.6 years). Psychological factors were evaluated with GHQ. Tactile detection thresholds (TDT) and filament-prick pain detection thresholds (FPT) were used to evaluate mechanical sensitivity on the tongue in all participants. TDT and FPT were measured on the tongue within both the painful area and the non-painful area in BMS patients, and on the tongue on both sides in healthy participants. As controls, TDT and FPT were measured with Semmes-Weinstein monofilaments on the skin of the mentum and palm in all participants. RESULTS: GHQ scores were significantly higher in BMS patients than in healthy participants (P = 0.024). No significant differences in TDT or FPT on the tongue, mentum, or palm were seen between BMS patients and healthy participants (P > 0.05). BMS patients showed no significant differences in TDT or FPT between the painful and non-painful areas on the tongue (P > 0.05). There were no significant correlations among TDT/FPT and GHQ score in BMS patients (P > 0.05). CONCLUSIONS: These findings could indicate a more important role for psychological factors than mechanical sensitivity in BMS pathophysiology. CLINICAL RELEVANCE: Pain on the tongue in elderly female patients with BMS may be more related to psychological factors.

Burning Mouth Syndrome.

Burning mouth syndrome (BMS) is a chronic disorder for which a definitive etiopathology is not known. The BMS patient often experiences a continuous burning pain in the mouth without any clinical signs. This confusing condition can create frustration for both patient and practitioner. Ultimately, it is important for the practitioner who treats head and face pain to become knowledgeable in the recognition of the many complexities and various presentations associated with BMS. In doing so, the practitioner can be better prepared to help patients cope with this confounding disorder and gain a better quality of life.

Understanding of Burning Mouth Syndrome Based on Psychological Aspects.

Burning mouth syndrome (BMS) is a chronic pain condition characterised by a persistent burning sensation in clinically normal oral mucosa. BMS most commonly occurs in middleaged and elderly women. Various local and systemic factors can cause oral burning symptoms. When all possible local and systemic factors are excluded, burning mouth symptoms can be diagnosed as BMS. Psychophysical tests and histopathological data suggest the involvement of peripheral and central neuropathic mechanisms in BMS etiopathogenesis. Psychological problems are frequently observed in BMS patients. Several mechanisms, including increased parafunctional habits, steroid dysregulation, central disinhibition due to taste dysfunction, and low dopamine levels in the brain, have been proposed as an explanation for the role of psychological factors in BMS pathophysiology. However, the causal relationship between BMS and psychological problems remains controversial. Given the neuropathic nature of BMS, treatment for it is similar to other neuropathic pain conditions. Although various treatment modalities, including pharmacological intervention, behavioural therapy and psychotherapy, have been proposed, there is no definitive treatment always effective for the majority of BMS patients. In conclusion, for better understanding of the relationship between BMS and psychological factors, well-designed prospective studies are needed. In addition, the evaluation and treatment of psychological problems are essential for successful management of BMS patients.

Clinical characterization of women with burning mouth syndrome in a case-control study.

OBJECTIVE: Burning mouth syndrome (BMS) is a chronic orofacial pain disorder that is defined by a burning sensation in the oral mucosa. The aim of this study was to investigate the underlying factors, clinical characteristics and self-reported oral and general health factors associated with BMS. MATERIAL AND METHODS: Fifty-six women with BMS (mean age: 67.7) and their age-matched controls were included in the study. A general questionnaire, an OHRQL index and BMS-specific questionnaires were used. Each subject underwent an oral examination. RESULTS: The mean severity of the BMS symptoms (VAS, 0-100) was 66.2 (SD 19.7). Overall, 45% of the patients reported taste disturbances. More of the patients than the controls rated their general health, oral health and life situation as 'less satisfactory'. The patients also reported more frequently on-going medications, diseases/disorders, xerostomia, allergy and skin diseases. Except for more bruxofacets among the patients, there were no significant differences regarding signs of parafunction. In a multiple logistic regression analysis, xerostomia and skin diseases showed the strongest prediction for BMS and no significant effect was found for medication, allergy or bruxofacets. CONCLUSIONS: Skin diseases and xerostomia but not parafunction were strongly associated with BMS. Our findings provide the basis for additional studies to elucidate the causal factors of BMS.

Plasma IL-8 signature correlates with pain and depressive symptomatology in patients with burning mouth syndrome: Results from a pilot study.

BACKGROUND: Burning mouth syndrome (BMS) is a neuropathic orofacial pain condition of unknown aetiology that encompasses intra-oral burning pain without abnormal clinical findings. Psychological, neural and inflammatory processes are associated with BMS pathogenesis. Currently, studies characterising plasma cytokine/chemokine profiles with pain and depression in patients with BMS are lacking. Considering that inflammation is associated with the pathophysiology of BMS, and that inflammation is closely associated with pain and depression, we aimed to correlate depressive symptomatology and oral cavity pain with plasma cytokine/chemokine signatures in a cohort of patients with BMS. METHODS: In this study, plasma protein levels of Th1 cytokines (IFN-γ, IL-2, IL-12p70, TNF-α), Th2 cytokines (IL-4, IL-10, IL-6, IL-13) and the chemokine IL-8 were assessed in patients with BMS (n = 10) and healthy volunteers (n = 10), using pro-inflammatory-10-plex assays. Clinical histories, alongside self-rated oral cavity pain intensities and depressive symptomatology were assessed using a visual analogue scale and the 16-item Quick Inventory of Depressive Symptomatology questionnaires, respectively. RESULTS: We present evidence that BMS is associated with increased depressive symptomatology and enhanced oral cavity pain. Plasma isolated from BMS patients display enhanced expression of the pro-inflammatory chemokine IL-8, when compared to plasma from healthy individuals. Plasma IL-8 signature correlates with pain and depressive symptomatology in the study cohort. CONCLUSIONS: Overall, these findings indicate that plasma IL-8 profiles are dysregulated in BMS and that modulation of IL-8 production in the disorder may be a tool in the management of BMS symptomatology.

Is burning mouth syndrome a neuropathic pain condition?

Primary burning mouth syndrome (BMS) is defined as an "intraoral burning or dysaesthetic sensation, recurring daily… more than 3 months, without clinically evident causative lesions" (IHS 2013). In addition to pain, taste alterations are frequent (dysgeusia, xerostomia). Although lacking clinical signs of neuropathy, more accurate diagnostic methods have shown neuropathic involvement at various levels of the neuraxis in BMS: peripheral small fiber damage (thermal quantitative sensory testing, electrogustatometry, epithelial nerve fiber density), trigeminal system lesions in the periphery or the brainstem (brainstem reflex recordings, trigeminal neurography, evoked potentials), or signs of decreased inhibition within the central nervous system (deficient brainstem reflex habituation, positive signs in quantitative sensory testing, neurotransmitter-positron emission tomography findings indicative of deficient striatal dopamine function). Abnormalities in electrogustatometry indicate the involvement of the small Aδ taste afferents, in addition to somatosensory small fibers. According to these findings, the clinical entity of BMS can be divided into 2 main subtypes compatible with either peripheral or central neuropathic pain, which may overlap in individual patients. The central type does not respond to local treatments and associates often with psychiatric comorbidity (depression or anxiety), whereas the peripheral type responds to peripheral lidocaine blocks and topical clonazepam. Burning mouth syndrome is most prevalent in postmenopausal women, having led to a hypothesis that BMS is triggered as a consequence of nervous system damage caused by neurotoxic factors affecting especially vulnerable small fibers and basal ganglia in a setting of decrease in neuroprotective gonadal hormones and increase in stress hormone levels, typical for menopause.

A case-control evaluation of fungiform papillae density in burning mouth syndrome.

HYPOTHESIS: It has been hypothesized that high fungiform papillae density may be a risk factor for developing the taste and pain alterations characteristic of burning mouth syndrome. OBJECTIVE: Evaluate whether fungiform papillae density, taste sensitivity, and mechanical pain sensitivity differ between burning mouth syndrome cases and controls. STUDY DESIGN: This case-control study compared cases diagnosed with primary burning mouth syndrome with pain-free controls. METHODS: Participants (17 female cases and 23 female controls) rated the intensity of sucrose, sodium chloride, citric acid, and quinine applied separately to each side of the anterior tongue and sampled whole mouth. Mechanical pain sensitivity was assessed separately for each side of the tongue using weighted pins. Digital photographs of participants' tongues were used to count fungiform papillae. RESULTS: Burning mouth syndrome cases had increased whole mouth taste intensity. Cases also had increased sensitivity to quinine on the anterior tongue, as well as increased mechanical pain sensitivity on the anterior tongue. Fungiform papillae density did not differ significantly between cases and controls. Fungiform papillae density on the left and right sides of the tongue were correlated in controls; however, there was no left/right side correlation in cases. CONCLUSION: Cases had increased pain and taste perception on the anterior tongue. The lack of correlation between left and right fungiform papillae density in cases may be an indication of asymmetrical lingual innervation in these patients. LEVEL OF EVIDENCE: 3b. Laryngoscope, 128:841-846, 2018.

Therapeutic Applications of Capsaicin in Upper Airways.

BACKGROUND: Capsaicin (8-methyl-N-vanillyl-6-nonenamide) is the substance responsible of the irritation caused by the contact of chili peppers with the skin or mucous membranes. This protoalkaloid acts by stimulating the transient receptor potential cation channel subfamily V member 1 (TRPV1), which is mainly expressed by nociceptive fibers of peripheral sensory neurons, but is also present in the central nervous system, and in some non-neuronal cells. Following the initial, intense neuronal excitation, a brief refractory period occurs. However, repeated and massive exposures to capsaicin can impair nociceptive fiber function for weeks or months. During this lapse of time, disorders related to the hyperreactivity of peripheral nociceptors are abolished or greatly reduced. Capsaicin has been utilized to treat several diseases of upper airways. OBJECTIVE: The objective of this review was to report the latest findings on the use of Capsaicin in the treatment of upper airway diseases. RESULTS: Capsaicin effectiveness has been proved in non allergic rhinitis. Some studies suggest that this substance may be also effective in nasal polyposis and in the burning mouth syndrome. No clear evidence has been obtained about its use in allergic rhinitis. CONCLUSION: To date, the use of capsaicin to treat upper airway diseases is still limited in clinical practice. This may originate by the lack of strong, conclusive evidences of its effectiveness, by the variety of therapeutic schemes used in literature, and finally by the unpleasant effects of the exposure to capsaicin, which are only partly relieved by the pretreatment with local anesthetics.

Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis.

This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

[Personal response to disease at paresthesia oral mucosa].

A study related to the disease in 39 (7 men and 32 women) people aged 61-86 years, suffering from paresthesia oral mucous membranes (POMM). To determine the type of relationship to the patient's illness was used clinical test method which employs a clinical-psychological typology of relationship to the patient's illness. It was found that for patients with middle and old age (69,2 %), suffering from severe and moderate POMM severity of pathology characteristic intrapsychic focus of personal response to the disease, is caused due to the presence of a constant burning sensation in the mouth, often accompanied by the syndrome of «dry mouth¼ violation of social adaptation of patients. For the older age groups suffering POMM, which proceeded in a light, at least moderate disease severity (28,2 %) is characteristic orientation interpsychic personal response to the disease, also causes disturbances of social adaptation of patients. The obtained information about the type of relationship the patients of elderly and senile age, suffering POMM show that to achieve a positive therapeutic outcome and successful rehabilitation is necessary to change their existing inadequate response to disease, it is possible by attracting clinical pharmacologist and (or) the therapist.

Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica / Burning mouth syndrome: clinical description, pathophysiological approach, and a new therapeutic option

Introducción. El síndrome de la boca ardiente se define como sensación de ardor intrabucal, en ausencia de lesiones locales o patología sistémica que lo justifique. Se trata de una entidad con pobre respuesta a los tratamientos comúnmente utilizados, que puede resultar muy discapacitante. Métodos. Analizamos prospectivamente las características clínicas, demográficas y la respuesta a tratamiento de 6 casos de síndrome de la boca ardiente diagnosticados en las consultas de cefaleas de 2 hospitales de tercer nivel. Resultados. Se trata de 6 pacientes de sexo femenino, con edades entre 34 y 82 años, que referían síntomas compatibles con síndrome de la boca ardiente. En 5 pacientes, las molestias empeoraban a última hora del día y 4 referían mejoría de los síntomas con los movimientos linguales. En todos los casos la exploración neurológica fue normal, los estudios analíticos no mostraron alteraciones que justificaran los síntomas y en el examen odontológico no se evidenciaron lesiones intrabucales. Todas las pacientes habían sido tratadas previamente con los tratamientos convencionales, sin mejoría. Se instauró pramipexol a dosis entre 0,36mg y 1,05mg al día, con lo que se consiguió mejoría evidente en todos los casos, que persiste tras una media de 4 años de seguimiento. Conclusiones. El síndrome de la boca ardiente sigue siendo una entidad de etiología desconocida, que comparte ciertos patrones clínicos y respuesta al tratamiento con el síndrome de piernas inquietas. Los agonistas dopaminérgicos deberían considerarse como tratamiento de primera línea en esta entidad (AU)

Introduction. Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. Methods. We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. Results. Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. Conclusions. Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity (AU)

Altered structural connectivity of pain-related brain network in burning mouth syndrome-investigation by graph analysis of probabilistic tractography.

PURPOSE: Burning mouth syndrome (BMS) is a chronic intraoral pain syndrome featuring idiopathic oral pain and burning discomfort despite clinically normal oral mucosa. The etiology of chronic pain syndrome is unclear, but preliminary neuroimaging research has suggested the alteration of volume, metabolism, blood flow, and diffusion at multiple brain regions. According to the neuromatrix theory of Melzack, pain sense is generated in the brain by the network of multiple pain-related brain regions. Therefore, the alteration of pain-related network is also assumed as an etiology of chronic pain. In this study, we investigated the brain network of BMS brain by using probabilistic tractography and graph analysis. METHODS: Fourteen BMS patients and 14 age-matched healthy controls underwent 1.5T MRI. Structural connectivity was calculated in 83 anatomically defined regions with probabilistic tractography of 60-axis diffusion tensor imaging and 3D T1-weighted imaging. Graph theory network analysis was used to evaluate the brain network at local and global connectivity. RESULTS: In BMS brain, a significant difference of local brain connectivity was recognized at the bilateral rostral anterior cingulate cortex, right medial orbitofrontal cortex, and left pars orbitalis which belong to the medial pain system; however, no significant difference was recognized at the lateral system including the somatic sensory cortex. A strengthened connection of the anterior cingulate cortex and medial prefrontal cortex with the basal ganglia, thalamus, and brain stem was revealed. CONCLUSION: Structural brain network analysis revealed the alteration of the medial system of the pain-related brain network in chronic pain syndrome.

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome.

BACKGROUND: The aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol. METHODS: The study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference. RESULTS: For patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05-0.001) and mechanical (p < 0.01-0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected. CONCLUSIONS: The results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.

Taste function assessed by electrogustometry in burning mouth syndrome: a case-control study.

OBJECTIVE: Idiopathic burning mouth syndrome (iBMS) is characterized by oral persistent pain without any clinical or biological abnormality. The aim of this study was to evaluate taste function in iBMS subjects and healthy controls. MATERIAL AND METHODS: Electrogustometric thresholds (EGMt) were recorded in 21 iBMS patients and 21 paired-matched controls at nine loci of the tongue assessing fungiform and foliate gustatory papillae function. Comparison of EGMt was performed using the nonparametric Wilcoxon signed-rank test. A correlation between EGMt and self-perceived pain intensity assessed using a visual analogic scale (VAS) was analyzed with the Spearman coefficient. The level of significance was fixed at P < 0.05. RESULTS: Mean EGMt were significantly increased with iBMS for right side of the dorsum of the tongue and right lateral side of the tongue (P < 0.05). In the iBMS group, VAS scores were significantly correlated to EGMt at the tip of the tongue (r = -0.59; P < 0.05) and at the right and left lateral sides of the tongue (respectively, r = -0.49 and r = -0.47; P < 0.05). CONCLUSION: These data depicted impaired taste sensitivity in iBMS patients within fungiform and foliate taste bud fields and support potent gustatory/nociceptive interaction in iBMS.

Combined Acupuncture and Auriculotherapy in Burning Mouth Syndrome Treatment: A Preliminary Single-Arm Clinical Trial.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic pain disorder that is difficult to diagnose and refractory to treatment; it is more prevalent in pre- and postmenopausal women. Acupuncture and auriculotherapy have been suggested as options for the treatment of pain because they promote analgesia and allow for the reduction of symptoms with lower doses of drugs; this leads to greater patient compliance with treatment and has a positive effect on quality of life. Clinical trials investigating the effectiveness of acupuncture in the treatment of BMS are scarce in the literature. OBJECTIVE: To investigate the effect of combined acupuncture and auriculotherapy on pain management and quality of life in patients with BMS. METHODS: Sixty patients with BMS were subjected to a thorough differential diagnosis. Of these, 12 met the inclusion criteria and agreed to participate. Eight patients completed treatment with acupuncture and auriculotherapy using a previously established protocol. The outcome variables were analyzed before and after treatment: pain/burning (visual analog scale; VAS), salivary flow (unstimulated sialometry), and quality of life (Short-Form Oral Health Impact Profile [OHIP-14]). Two-year follow-up was carried out by assessing VAS and OHIP-14. RESULTS: The intensity of pain/burning decreased significantly after the first treatment sessions, as shown by low values on the VAS (0-2) and a subjective indicator of quality of life (mean = 5.37 ± 3.50). There was no relationship between salivary flow and the intensity of pain/burning. At 2-year follow-up, no statistically significant difference was observed for VAS, but improvement on OHIP-14 was seen. CONCLUSIONS: Combined acupuncture/auriculotherapy was effective in reducing the intensity of burning and improving quality of life. There was no relationship between salivary flow and the intensity of burning mouth. Patients' status improved after acupuncture and auriculotherapy at 2-year follow-up.

Burning mouth syndrome: Clinical description, pathophysiological approach, and a new therapeutic option. / Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica.

INTRODUCTION: Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. METHODS: We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. RESULTS: Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. CONCLUSIONS: Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity.