Opiorphin levels in fluids of burning mouth syndrome patients: a case-control study.

OBJECTIVES: Idiopathic Burning mouth syndrome (iBMS) is a poorly understood affection characterized by persistent pain in the oral cavity without any clinical or biological abnormality. Opiorphin is a natural inhibitor of enkephalin-inactivating ectopeptidases, mainly produced by salivary glands, that has demonstrated analgesic properties. The objective of the present case-control study was to test the hypothesis of a decrease in opiorphin levels in iBMS patients. MATERIALS AND METHODS: Twenty-one iBMS patients and 21 matched controls subjects were included between 2011 and 2013. Submandibular and sublingual salivary, blood, and urinary opiorphin levels of iBMS patients were compared to controls. RESULTS: Results are expressed as mean values ± SD and compared using the Wilcoxon Signed Rank test. Correlations were analyzed with Spearman coefficient. The level of significance was fixed at p < 0.05. Opiorphin levels in iBMS and controls were respectively (in ng/ml) in basal saliva: 37.8 ± 42.5 and 67.6 ± 188.9 (p = NS); stimulated saliva: 28.8 ± 25.3 and 31.1 ± 29.1 (p = NS); blood: 4.6 ± 5.4 and 1.9 ± 1.4 (p < 0.05); and urines: 68.5 ± 259.8 and 8.9 ± 6.2 (p = NS). CLINICAL RELEVANCE: In conclusion, the lack of significative difference in salivary opiorphin levels between iBMS and controls does not favor a direct local role for opiorphin in the etiopathogeny of iBMS. However, higher blood opiorphin levels may reflect a systemic dysregulation in iBMS. Trial registration NCT02686359 https://clinicaltrials.gov/ct2/show/NCT02686359.

Characteristics of pain assessed with visual analog scale and questionnaire in burning mouth syndrome patients: a pilot study.

AIMS: To test the validity of the use of the Douleur Neuropathique en 4 Questions (DN4) questionnaire for burning mouth syndrome (BMS) patients, and to differentiate patients by measuring the time course of the pain in BMS patients over a period of 7 days with a visual analog scale (VAS). METHODS: Patients completed the DN4 questionnaire and a VAS every hour for 7 days. The data were expressed as mean ± SEM. Correlations were searched using the Spearman correlation test with a significance level at P < .05. RESULTS: Data were fully analyzed for the 22 patients (21 females, 1 male, mean [± SEM] age 62.7 ± 2.3 years) for the DN4 and 17 patients for the VAS. DN4 scores ranged from 2 to 7 (mean score: 3.9 ± 0.3), and 59% of the patients had a DN4 score ≥ 4. Burning was found in all the patients, followed by pricking pain (pins and needles) and allodynia (pain on brushing) (both 68%), tingling (45%), numbness (32%), itching (27%), and electrical discharges (23%). Monitoring the hourly time-course of the pain led to the identification of two groups with intermittent or constant pain. In the latter, averaging the VAS for 7 days enabled plotting a curve, the slope of which could be calculated. The range of the slopes was 0.00 to 0.59, and a regular increase of pain during the day was seen for the majority of the patients. CONCLUSION: The findings support the use of DN4 as a tool for screening BMS and reinforce the view that BMS is a clinical manifestation of a neuropathic disease. The methodology of this study can be used for a better description of the patients and the identification of subgroups.

A Retrospective Study of 23 Cases: Are Lichenoid Lesions of the Labial Mucosa Induced?

Background Lichen planus (LP) is a pathology that affects the skin and the mucosa. The lips are rarely involved but represent a diagnostic challenge in those cases. Oral lichenoid lesions (OLL) are defined as lesions that resemble oral lichen planus (OLP) but do not fully meet the clinical and/or histologic criteria for OLP. This study aimed to present our case series and to study the correlation between the location of the lesion and the dental factor (resin composite, amalgams, crowns, abrasive teeth, and mandibular crossbite) that could cause the lesion. Methods We conducted a retrospective observational study of 23 patients with LP/OLL of the lips treated in the Department of Oral Mucosal Pathology of the Department of Stomatology and Maxillofacial Surgery of the Pitié-Salpêtrière Hospital in Paris between January 2017 and February 2021. We noted the location of the lesion (upper, lower, or both lips), medical history, treatments, smoking habits, and the aspect of the teeth facing the lesion. Patients received a local corticoid treatment and were monitored via follow-up. Results Sixteen patients had lesions on the upper lip, two on the lower lip, and five on both lips, and most patients (n = 14, 60.1%) had a dental factor facing the lesion (e.g., abrasive teeth, resin composites, dental crowns, and mandibular crossbite). Six patients received clobetasol propionate, and 15 patients received a preparation combining betamethasone and benzocaine (Orabase, ConvaTec, Deeside, UK). Fourteen patients returned for post-treatment follow-up consultations approximately two months after treatment. Seven patients saw clinical improvement, five had partial improvement, and two had no improvement. Conclusions Lesions of the labial mucosa appear to be a rare condition in LP/OLL. The difference between LP and OLL can be difficult, even with histological analysis. Its pathogenesis remains unknown, although some studies found evidence of lichenoid reactions of the lips in contact with dental composite restorations. In our study, 14 of our patients had a dental factor facing the lesions. However, our study failed to show a correlation between the presence of an inducing factor and the lesion. In a future study, the potential effect of dental inducing factor removal could be studied. This topic requires further investigations, particularly regarding the inducing factor and the optimal therapeutic approach.

Multiple oral papillomas after antiretroviral treatment resumption.

Lesions of the oral mucosa due to human papillomavirus (HPV) present in various clinical forms. The case of a man in his 50s is reported. This patient was referred for multiple whitish oral lesions, unresponsive to antifungal drugs, in a context of pneumocystis having revealed a therapeutic break of an HIV antiretroviral treatment. The lesions had appeared a few days after treatment resumption. Clinical examination revealed multiple lesions on the lips, the inner sides of the cheeks and lips and on the tongue. The patient reported burning sensations in the mouth. The diagnosis of multiple papillomas was made in view of the characteristic clinical picture and history of the disease: appearance of oral papular lesions with multiple locations, which may reveal a context of severe immunodeficiency. HPV lesions are more frequent in HIV-positive patients and may increase on initiation of antiretroviral therapy.

[Management of side effects of targeted therapies in renal cancer: stomatological side effects (mucositis, epistaxis)]. / Gestion des effets secondaires des thérapies ciblées dans le cancer du rein : effets secondaires stomatologiques (mucites, épistaxis).

The advent of targeted therapies in the treatment of renal cancer has shown different types of lesions of the oral cavity, which appear to be specific to the drug classes used (mTOR inhibitors, anti-angiogenic agents and conventional cytotoxic drugs). Before starting treatment with targeted therapy, it is essential to have an oral and a dental examination. The treatment of mucositis induced by targeted therapies is based on bicarbonate-based mouthwash, with the optional addition of an antifungal or a local antiseptic. It is possible to use topical or systemic analgesics for the pain. Dietary advice for patients is also useful. Most cases of epistaxis caused by anti-angiogenics stop spontaneously and require no medical intervention. Regular application of an emollient can be used to prevent the formation of scabs.

[Benign pathologies of the oral mucosa]. / Pathologies bénignes de la muqueuse buccale.

Benign pathologies of the oral mucosa. An overview of some common benign oral diseases whose diagnostic orientation begins and is based primarily on a precise clinical analysis. Canker sores and benign traumatic ulcers must not make a novice carcinoma go unnoticed. Apart from bacterial stomatitis of dental origin, the most common infectious stomatitis is viral with herpes and papilloma, mycotic with acute and chronic forms. Oral dryness and glossodynia are two common situations that are difficult to manage.

Pathologies bénignes de la muqueuse buccale. Un aperçu de quelques pathologies bénignes buccales fréquentes dont l'orientation diagnostique débute et repose avant tout sur une analyse clinique précise. Les aphtes et ulcérations traumatiques bénignes ne doivent pas faire méconnaître un carcinome débutant. Mises à partir les stomatites bactériennes d'origine dentaire, les stomatites infectieuses les plus courantes sont virales avec l'herpès et les papillomes, mycosiques avec des formes aiguës et chroniques. La sécheresse buccale et les glossodynies sont deux situations courantes posant essentiellement des difficultés de prise en charge thérapeutique.

[Xerostomia]. / Sécheresse buccale (xérostomie).

Xerostomia is a frequent complaint and a real handicap for many patients, often drug-induced. Treatments, even if they are currently unsatisfactory, are aimed at improved oral comfort and quality of life for patients, and to prevent or treat local complications. It consists in humecting buccal mucous membranes with artificial saliva; or in stimulating the glands if functional salivary tissue still exists.

[Aphthous stomatitis]. / Aphtoses buccales.

Aphthous stomatitis remains an illness of unknown aetiology, probably drawing on immunological mechanisms. The diagnosis of an oral aphthous ulcer is clinical, corresponding to a precise primary lesion. The benign form is the most frequent, however the illness sometimes evolves into a severe form which can then be considered as a generalised illness. The management of the patient must distinguish the evolving clinical form of the aphthous ulcer, search for a likely aetiology, and employ a therapeutic approach, which actually remains disappointing with the basic treatments being of solely temporary efficacity.

[Infectious stomatitis]. / Stomatites infectieuses.

Infectious stomatitis is bacterial essentially when of dental origin, the viral forms most often causing a vesicular and erosive stomatitis, and fungal secondary to a modification of the oral commensal flora. The diagnosis is often clinical with the lesions being of characteristic appearance and arising in a suggestive context. When the appearance is less typical or when the choice of treatment necessitates the identification of the germ, specific samples are taken. The treatment of viral stomatitis is essentially symptomatic, that of bacterial and fungal stomatitis comprising two arms: the specific treatment of the acute episode and then that of the particular oral-dental terrain.