Abstract
Mitochondrial homeostasis is crucial for energy production and neuronal survival in neurological primary burning mouth syndrome (npBMS). Photobiomodulation therapy (PBMT) has been utilised in npBMS management, however, its role of intervention remains controversial. The aim of this systematic review and meta-analysis of CRD 42020198921 PROSPERO registration reference was to oversee and determine the efficacy of PBMT in patients with npBMS, identifying the gaps and bridge them by proposing recommendations for future studies purposes. PRISMA guidelines and Cochrane Collaboration recommendations followed. Various search engines employed to analyse a total of 351 studies of which 12 were included. A wide range of utilised PBM wavelengths was between 635–980 nm and the power output ranged between 30 mW and 4000 mW. A high risk of bias (RoB) was noted in 7 out of 12 included studies (58.3%), as results of qualitative analysis. Meta-analysis findings of 4 out of 12 studies showed statistically significant intergroup differences (SSID) for visual analogue scale (VAS) values (MD = −1.47; 95% CI = −2.40 to −0.53; Z = 3.07 (p = 0.002) whereas meta-analysis on 5 out of 12 studies revealed SSID for anxiety/depression and quality of life (MD = −1.47; 95% CI = −2.40 to −0.53; Z = 3.07 (p = 0.002), favouring PBMT group to the control treatment strategies. Despite the inconsistency and diversity in PBM parameters (wavelength, power, light source, spot size, emission mode, energy per point, total energy) and treatment protocols (exposure time, number of sessions, time interval between sessions, treatment duration)—majority of the included studies showed positive PBM results. The high RoB and meta-analytical heterogeneity in the eligible studies warrant the necessity to perform well-designed and robust RCTs after acknowledging the drawbacks of the available scientific literature and addressing our suggested recommendations highlighted in our review.
Highlights
Idiopathic or primary burning mouth syndrome (BMS) is defined by the InternationalHeadache Society (IHS) as “an intraoral burning or dysaesthetic sensation, recurring daily for more than two hours per day over more than three months, without evident causative lesions on clinical examination and investigation” [1]
After combining papers reported in both searches, 325 duplicate studies were excluded resulting in further evaluation of 30 records
Ten studies were excluded for the following reasons; combined medications and PBMT [65]; uncontrolled randomised trials [47,66,67,68]; case series [69,70]; secondary BMS [71]; mixed primary and secondary BMS [72]; PBM-acupuncture intervention [73]
Summary
Idiopathic or primary burning mouth syndrome (BMS) is defined by the InternationalHeadache Society (IHS) as “an intraoral burning or dysaesthetic sensation, recurring daily for more than two hours per day over more than three months, without evident causative lesions on clinical examination and investigation” [1]. Idiopathic or primary burning mouth syndrome (BMS) is defined by the International. BMS depends on its clinical features and its response to therapies It is a term of “stomatodynia” referred to persistent idiopathic orofacial pain based on their homogenous topography feature according to the available multivariate analysis [2]. Authors using International Association for the Study of Pain (IASP) criteria [5] can include heterogeneous patients, some of whom present with burning sensations that do not fulfil current BMS criteria [6]. This can indicate a diversity in the clinical outcomes
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