Burning Mouth Syndrome Patients Research Articles

Rikkosan's Short-Term Analgesic Effect on Burning Mouth Syndrome: A Single-Arm Cohort Study.

Burning mouth syndrome (BMS) is a chronic oral pain disorder. There is a theory that BMS is a form of nociplastic pain. A standard treatment for BMS has not yet been established. Kampo medicine is a traditional oriental medicine. The purpose of this study is to evaluate the effectiveness of Rikkosan-a traditional Japanese herbal medicine (Kampo)-in the treatment of BMS. A single-center retrospective study was conducted on 20 patients who were diagnosed with BMS and treated with Rikkosan alone (total daily dose; 7.5 g) three times daily for approximately 4 weeks (29.5 ± 6.5 days). Rikkosan was dissolved in hot water and taken internally. They had an average age of 63 years, and 90% were being treated for other illnesses, but their medication status was the same during this study period, except for Rikkosan. No adverse events were observed in patients. Numerical rating scale (NRS) or visual analog scale (VAS)/10 scores decreased significantly between the time of the initiation of Rikkosan and one month after (-2.1 ± 1.2, p < 0.05). Rikkosan has a short-term effect of reducing NRS by two levels in BMS patients.

The improvement of pain symptoms in patients with burning mouth syndrome through combined laser and medication therapy.

The etiology of Burning Mouth Syndrome (BMS) remains unclear. To explore the differences in the therapeutic efficacy of pain improvement between medication therapy and laser therapy in patients with BMS. 45 BMS patients were randomly divided into three groups: The Combination therapy group (Group A, n= 15), The Medication therapy group (Group B, n= 15), and the Laser therapy group (Group C, n= 15). The pain condition of the patients was evaluated using the Numeric Rating Scale (NRS), and the improvement in pain before and after treatment was compared among the three groups. All three groups (A, B, and C) showed a significant reduction in NRS scores after treatment, with statistically significant differences observed among the different groups. Group A exhibited the most significant improvement, with a statistically significant difference before and after treatment. Laser and medication therapy are effective methods for reducing oral burning pain * symptoms, and their combined use yields more significant therapeutic effects.

Clinical characteristics and salivary biomarkers of burning mouth syndrome.

To investigate the clinical characteristics and salivary biomarkers in each type of burning mouth syndrome (BMS) patients. Ninety-eight postmenopausal female patients with BMS were included. Fifty and 21 patients were assigned to the primary and secondary groups, respectively. Twenty-seven patients with both primary and secondary characteristics were assigned to the intermediate group. Comprehensive clinical characteristics and salivary biomarkers were analyzed. Significant differences in age, proportion of hyposalivator patients based on unstimulated whole saliva (UWS), symptom distribution, severties of burning sensation and effect of oral complaints in daily life (Eff-life), and positive symptom distress index (PSDI) were observed among the three groups. The primary group had significant higher UWS flow rate, fewer UWS hyposalivator proportions, and lesser severity of Eff-life than the secondary group. The intermediate group had significantly greater intensities of burning sensation and Eff-life and higher PSDI score than did the primary group. The primary group had significantly higher cortisol and dehydroepiandrosterone (DHEA) levels in stimulated whole saliva than did the secondary group. This study's findings show that clinical characteristics differentiate each BMS type. Cortisol and DHEA levels are potential salivary biomarkers for discriminating between the primary and secondary types of BMS.

Saliva and tongue microbiota in burning mouth syndrome: An exploratory study of potential roles.

Burning mouth syndrome (BMS) is a chronic orofacial pain disorder with unclear etiology, in which the tongue is most commonly affected. This study aims to provide implication of the possible relationship between oral microbiota and the pathogenesis of BMS. Saliva and tongue swabs of 15 primary BMS patients and 10 healthy controls were collected and assessed by 16S rRNA gene amplicon sequencing. The microbiota compositions were compared and bioinformatic analysis was conducted. Differences in microbiota compositions between BMS patients and healthy controls were revealed in both saliva and tongue samples. In saliva, Streptococcus, Rothia, and Neisseria were the predominant genus at the taxonomic level in BMS patients. In tongue samples, Prevotella, Streptococcus, and Neisseria were the dominant genus at thetaxonomic level in BMS patients. LEfSe analysis and linear discriminant analysis score showed that Actinobacteria were the predominant phylum in saliva, and Selenomonas were enriched in the dorsum of the tongue of BMS patients. This study for the first-time reported saliva and tongue microbiota profiles were distinguished from that of healthy controls, indicating a necessity for further research on the possible relationship between oral microbes and the pathogenesis of BMS.

COVID-19 impact on post-traumatic stress symptoms in burning mouth syndrome: A multicentric study.

This study investigates the psychological impact of COVID-19 on burning mouth syndrome (BMS) patients. It focuses on comparing post-traumatic stress symptoms (PTSS), post-traumatic growth (PTG), and resilience between BMS patients and Controls. A total of 100 BMS patients and 100 Controls from five Italian centers participated in this observational cross-sectional study. They completed several assessments, including the General Health Questionnaire, Depression Anxiety and Stress Scale, Insomnia Severity Index, National Stressful Events Survey Short Scale, Impact of Event Scale-Revised, Post Traumatic Growth Inventory Short Form, and Connor-Davidson Resilience Scale. BMS patients had significantly higher stress, anxiety, and depression (DASS-21 score) and post-traumatic stress symptoms (IES-R-6 score), particularly in terms of intrusive thoughts. They showed lower post-traumatic growth (PTGI-SF score) compared to Controls. The resilience scale (CDRS-10) was a key predictor of PTG in both groups, explaining a significant variance in PTGI-SF scores. BMS patients experienced heightened post-traumatic stress, stress, anxiety, and depression during the COVID-19 pandemic, with reduced post-traumatic growth. This highlights the need to prioritize their psychological well-being, focusing on stress management and fostering post-traumatic growth in challenging times.

Salivary and serum biomarkers to evaluate psychological disorders in burning mouth syndrome: A systematic review and meta-analysis.

Burning mouth syndrome is a chronic pain syndrome mainly characterized by an intensive burning sensation of tongue. Previous studies have suggested that saliva/serum biomarkers in burning mouth syndrome might be associated with psychological disorders. The aim of systematic review was to observe whether the biomarkers in serum/saliva could be an alternative method to evaluate the psychological disorders in patients with burning mouth syndrome. The PubMed, Embase, and Cochrane Library databases were searched for papers published up to March 15, 2023. Risk of bias was measured by using the Newcastle-Ottawa Scale. RevMan was used for meta-analysis. A total of 467 articles were screened, which of 12 studies were included. These studies collected 43 different biomarkers in saliva and 35 in serum. Of these biomarkers, only three (cortisol, α-amylase, and IL-6) were analyzed in two or more studies. Only salivary cortisol levels were significantly higher in the patient group compared to the controls (Mean Difference = 1.39; 95% CI [0.80-1.97]; p < 0.001). Moreover, cortisol might be relevant to psychological scores, especially anxiety. Different papers have investigated salivary and serum biomarkers in burning mouth syndrome patients with controversial results. This meta-analysis showed that cortisol levels in saliva may be a potential biomarker to assess the psychological disorders in burning mouth syndrome patients.

Gender differences in pain perception among burning mouth syndrome patients: a cross-sectional study of 242 men and 242 women

Several orofacial painful conditions are influenced by gender-related factors, but no studies are available with regard to Burning Mouth Syndrome (BMS). The present study aimed at investigating gender differences among BMS patients and their influence on pain perception. 242 BMS males (BMSm) and 242 BMS females (BMSf) matched for age were consecutively enrolled. Sociodemographic and clinical characteristics were recorded and the numeric rating scale (NRS), the Total Pain Rating Index (T-PRI), the Hamilton rating scale for anxiety and depression (HAM-A, HAM-D), the Pittsburgh sleep quality index (PSQI) and the Epworth sleepiness scale (ESS) were administered. The BMSm presented statistically significant higher levels of education and rate of employment compared to the BMSf (p-values: 0.001**). Moreover, the BMSm were greater consumers of alcohol and had a higher BMI than the BMSf (p-values: < 0.001**, 0.034*). With respect to systemic comorbidities, cardiovascular diseases were statistically more prevalent among the BMSm, while hypothyroidism was more frequent in the BMSf (p-vales: < 0.001**). No differences were noted between the two groups in terms of oral symptoms and in the median scores of NRS, T-PRI, HAM-A, HAM-D, PSQI and ESS. Interestingly, the multivariate regression analysis revealed that, while anxiety, high BMI, poor sleep and high level of T-PRI were correlated to the intensity of pain (NRS) in both groups, low education was additional predictor of pain in BMSf. Further, depression, alcohol and intensity of pain were factors positively associated to the quality of pain (T-PRI) in the BMSm, whereas low education, non-married status and NRS were correlated to the T-PRI, in the BMSf. Surprisingly, smoking was inversely correlated to the intensity of pain and quality of pain respectively in BMSf and BMSm. Sociodemographic and risk factors were found to differently influence pain perception in BMSm and BMSf. Therefore, clinicians should take into account gender differences in the assessment of BMS patients to better tailor the overall pain management.

Micronutrients status as a contributing factor in secondary burning mouth syndrome: A review of the literature.

Patients with burning mouth syndrome (BMS)experience an annoying feeling without clinical evidence of any mucosal lesion. Deficiency or excess of micronutrients is a common feature in secondary BMS. There is limited knowledge among oral healthcare providers regarding the significance of micronutrients in oral health, so the current review focuses on the critical role of these elements in oral health implications as secondary BMS. For the data collection, the authors searched for key terms without time limitation (1900-2021) in databases comprised of PubMed, Google Scholar, Scopus, Web of Science (SCI),and Embase. The total number of matched articles with inclusion criteria involved in this review article was 59 original articles. Among these, 20 randomized clinical trials (RCT),31case-control or Crossectional, and8 case reports/series are reviewed in this review article. One of the important etiological factors in patients with secondary BMS is micronutrientimbalance. The iron, zinc, vitamin B family, vitamin D deficiency and increased levels of homocysteine and oxidant agents were examined in secondary BMS patients. In addition, oral medicine specialists must consider the possible toxic effects of some elements in restorations and dental prostheses. Further studies, such as RCTs in the future, are recommended.

QTc Shortening on Electrocardiogram With Amitriptyline May Indicate No Effect on Pain Relief in Burning Mouth Syndrome.

Burning mouth syndrome (BMS) is an intractable chronic pain disorder characterized by a burning sensation without organic abnormalities in the oral mucosa. Amitriptyline may be effective for BMS or, conversely, may exacerbate pain. QTc is necessary for monitoring psychotropic adverse effects, but it is not known if it is a predictor of efficacy for BMS. We investigated the efficacy of amitriptyline in BMS and its effect on QTc. Visual analog scale and electrocardiogram were examined before and 1 month after treatment in 51 consecutive patients diagnosed with BMS according to the International Classification of Headache Disorders, Third Edition (ICHD-3), criteria and treated with amitriptyline. There were 26 amitriptyline responders and 25 nonresponders, with no differences in age, sex, and amitriptyline dosage. Amitriptyline responders showed little change in QTc, whereas nonresponders showed a trend toward significantly shorter QTc. Changes in visual analog scale correlated statistically significantly with changes in QTc (Spearman rank correlation coefficient: 0384; P = 0.0054). The degree of pain tended to worsen with QTc shortening. Amitriptyline provides analgesia in about half of BMS patients, but some BMS patients have worse pain with amitriptyline. Not only do changes in the QTc detect amitriptyline adverse effects with prolongation, but also, conversely, its shortening predicts amitriptyline ineffectiveness.

Effectiveness of herbal medicine as an alternative therapy for burning mouth syndrome: a systematic review

Background: Burning mouth syndrome (BMS) is characterized by a burning sensation or dysesthesia of the oral mucosa without accompanying abnormal clinical or laboratory findings. Management of BMS is very important to reduce pain, support nutrition and improve patients’ quality of life. Various studies on BMS therapy have been carried out, one of which is by using alternative materials derived from nature known as herbal ingredients. The objective of this systematic review is to review the effectiveness of herbal medicine to reduce pain in BMS patients. Methods: This systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Article searches were conducted through Pubmed, Scopus, Science Direct, Cochrane, and Springer Link published from 2012 to 2022 with specific keywords. The search for articles was limited to human studies and randomized controlled trial (RCT), papers written in English and availability of full text. The risk assessment of bias uses the Modified Jadad Scale. Results: Seven articles with good eligibility that meet the inclusion criteria were analyzed. The herbal medicine reviewed were capsaicin (two articles), Aloe vera, catuama, capsaicin, virgin olive oil, chamomile and crocin (one article for each herbal medicine). All of the herbal medicine reviewed were proven to reduce pain in BMS patients, but capsaicin and catuama showed significant differences with the comparison group. Minimal side effects were also observed with capsaicin and catuama. Conclusion: Herbal medicinal ingredients have been proven to be effective, useful and safe alternative therapies for BMS patients.

Clinical Features and Variations of Pain Expressions in 834 Burning Mouth Syndrome Patients With or Without Psychiatric Comorbidities.

Introduction Burning mouth syndrome (BMS) is characterized as chronic burning pain or unpleasant discomfort in the oral region without any corresponding clinical abnormalities. The aim of this study is to investigate the difference in clinical features and the variations of pain expressions between BMS patients with and without psychiatric comorbidities. Methodology The patients with BMS who first visited between April 2016 and March 2020 were involved and the clinical data including the presence of psychiatric comorbidities and scores of self-rating depression scale (SDS), pain catastrophizing scale (PCS), and pain quality from short-form McGill pain questionnaire (SF-MPQ) were collected retrospectively. Results In 834 patients with BMS (700 females, 63.9 ± 13.1 years old), 371 patients (44.5%) had psychiatric comorbidities. There was no significant between-group difference in demographic data. However, significantly higher scores were observed in SDS (p < 0.001) and PCS (p < 0.001) in the patients with psychiatric comorbidities. Moreover, the patients with psychiatric comorbidities showed significantly stronger pain intensity (p < 0.001) besides higher scores of each descriptor in SF-MPQ. In addition, they had chosen more descriptors in SF-MPQ (p < 0.001); furthermore, the number of selected pain descriptors showed a stronger correlation with PCS than with SDS regardless of the presence of psychiatric comorbidities. Conclusion BMS patients may complain of various pain expressions regardless of the psychiatric comorbidities; however, more severe complaints relating to high pain catastrophizing are more likely in patients with psychiatric comorbidities. These results suggested that underlying anxiety exacerbated the variety of pain expressions in BMS patients with psychiatric comorbidities.

Assessment of Clinical Characteristics and Pharmacotherapy in Burning Mouth Syndrome Patients

Assessment of Clinical Characteristics and Pharmacotherapy in Burning Mouth Syndrome Patients

Occlusal tactile acuity in patients with burning mouth syndrome: A case-control study

ObjectivesOcclusal Tactile Acuity (OTA) is the ability to detect small thicknesses between occluding teeth. Individuals diagnosed with Burning Mouth Syndrome (BMS) often refer an uncomfortable sensation associated with their occlusion. The aim of the current study was to measure the OTA in BMS patients, and to compare it with that of age and gender matched pain free controls. Materials and methods25 BMS patients and 25 controls were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 –72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total). ResultsSignificantly increased OTA was observed in the BMS group, compared to the controls group, for the foil thicknesses between 8 µm and 48 µm. Furthermore, BMS patients showed substantial impairment in the detection of the sham test, even if this finding did not reach statistically significance (P = 0.743). ConclusionsBMS patients presented increased ability to detect small thicknesses between antagonist teeth during intercuspation. These findings might explain the high somatosensory distortion referred by those patients, in absence of objective clinical findings.

Non-Communicable Diseases and Associated Risk Factors in Burning Mouth Syndrome Patients.

Background and Objectives: Noncommunicable diseases (NCDs) are a group of non-transmissible conditions that tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioral factors. Although an association between oral disorders and NCDs has been suggested, the relationship between Burning Mouth Syndrome (BMS) and NCDs and their associated risk factors has not been deeply investigated. In this study, we aim to identify associations between BMS and NCDs in the Romanian population. Materials and Methods: Ninety-nine BMS patients and 88 age-matched controls (aged 50 and over) were clinically evaluated for the presence of eight noncommunicable diseases (NCDs) and their most common risk factors, including hypertension, dyslipidemia, smoking, and obesity. Results: The results of our study showed that the BMS in the Romanian population seems to be significantly associated with cardiovascular diseases (CVDs) (p < 0.001) and two of their risk factors, hypertension (p < 0.001) and dyslipidemia (p < 0.001). Moreover, evaluating the Framingham Risk Score (FRS) in the individuals not affected by CVDs (73 CTRL and 38 BMS), we found that 13.2% of BMS patients reported a moderate risk of developing CVDs in ten years, compared to the controls, all of whom presented a low risk (p = 0.002). Conclusions: Our findings suggest that a multidisciplinary clinical approach, which also includes a cardiovascular evaluation, is essential for the successful management of BMS. Moreover, these data highlighted the importance of introducing an integrated strategy for the prevention and care of NCDs in BMS patients.

Loneliness during the COVID-19 Pandemic in Patients with Burning Mouth Syndrome: A Multicentric Case-Control Italian Study

Background. Lockdown restrictions during the COVID-19 pandemic exerted a strong impact on people’s quality of life and increased loneliness. This study evaluates the effect of the pandemic on loneliness in patients with burning mouth syndrome (BMS) compared with the general population. Methods. 100 BMS patients versus 100 healthy controls (HC) were recruited in five Italian centers. The 12-Item General Health Questionnaire (GHQ-12), the Depression Anxiety Stress Scales-21 (DASS-21), the Insomnia Severity Index (ISI), the short-form UCLA Loneliness Scale-8 (ULS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Suicidal Ideation Attribute Scale (SIDAS) were administered. Results. BMS patients and HC showed high scores (16 [14-20.25] and 16 [14-18]) in the ULS-8. Statistically significant differences have been found considering the BMS patients lived with fewer relatives during the lockdown compared with the HC (2 [2-3] and 3 [2-4]; p : 0.012) with a lower level of satisfaction in relationships with relatives (4 [1.75-5] and 5 [4-5]; p &lt; 0.001 ) and also in the DASS-21 total scores between the BMS patients and HC (16 [10-24.2] and 10 [4-17]; p &lt; 0.001 ). The multivariate logistic regression revealed that age, education, DASS-21, and MSPSS were the most predictive variables and could explain 34.68% of the variance in the ULS-8 score ( p &lt; 0.001 ) in the BMS group. However, only the DASS-21 was significant in the HC group, explaining 10.11% of the variance of the ULS-8 ( p : 0.033). Conclusions. Both the patients and controls experienced deep loneliness during the pandemic. However, in the BMS group, loneliness was significantly correlated with age, a higher level of education and stress, and a lower level of satisfaction in relationships with relatives and social support perceived compared with the controls.

Is Burning Mouth Syndrome Associated with Extraoral Dryness? A Systematic Review.

Burning mouth syndrome (BMS) is characterized by a persistent intraoral burning sensation, often experienced by postmenopausal women. The etiology of BMS remains partially understood, and consequently, treatments remain suboptimal. Extraoral manifestations of BMS, such as extraoral dryness, are less studied. However, it has been suggested that the identification of the frequency and patterns of extraoral dryness and potential underlying mechanisms are essential to optimize treatment strategies and reduce the burden of disease. Therefore, we conducted this systematic review to provide existing evidence about extraoral dryness in BMS. The guidelines for the conduction and reporting of systematic reviews were followed. An electronic search was conducted in four major databases-PubMed, Web of Science, COCHRANE Library, and EBSCOhost-and the grey literature was assessed through Google Scholar. From each included article, information on extraoral dryness in BMS was extracted, and odds ratios were calculated for extraoral dryness among BMS patients compared with non-BMS controls. The findings demonstrated higher odds of the prevalence of extraoral dryness in BMS, which was found to a high degree in the lips, eyes, skin, and genitalia. The pattern of spread and locations of extraoral dryness propose a potential central mechanism. Based on our findings, we encourage the standardization of the assessment, recording, and reporting of the extraoral characteristics of BMS, including extraoral dryness, which can lead to better management strategies and enhance the quality of life of the affected patients.

Salivary Complaints in Burning Mouth Syndrome: A Cross Sectional Study on 500 Patients.

Xerostomia and sialorrhea often accompany Burning Mouth Syndrome (BMS) despite no change in saliva quantity. This study analyzed BMS patients with different symptom combinations: burning only (B), burning and xerostomia (BX), burning and sialorrhea (BS), and burning with xerostomia and sialorrhea (BXS), using a large sample of 500 patients from the University of Naples Federico II. After a medical evaluation, patients were divided into four groups based on their reported symptoms: B (140), BX (253), BS (49), and BXS (58). Patient data on education, BMI, smoking/alcohol habits, comorbidities, medication use, pain intensity, quality, and psychological profile were collected. The BX group showed a higher prevalence of patients taking blood thinners. Additional symptoms varied among groups, with the BX group experiencing more dysgeusia and globus, and the BS group reporting more tingling. Multivariate analysis identified BMI, dysgeusia, globus, and blood thinner use as significant factors in the B and BX groups, while male gender, tingling, alcohol use, and pain quality were significant in the BS and BXS groups. Overall, BMS patients display a complex range of symptoms, with xerostomia being the most frequent additional symptom. Sociodemographic, psychological, and medical factors cannot fully explain the variations in symptomatology among different patient subgroups. Further research is needed to understand the underlying causes and develop tailored treatment approaches.

Burning mouth syndrome- An overview

A burning sensation of the oral mucosa without any obvious oral lesions is a defining feature of the burning mouth syndrome (BMS), a chronic and untreatable orofacial pain syndrome. Women in their later years of life who are experiencing hormonal shifts or psychological issues are most affected by this ailment. BMS patients also complains of pain in oral mucosa, taste perception changes and dry mouth with burning sensation. Even though the exact cause of BMS is unknown, a complicated correlation between biological and psychological components has been found, pointing to the possibility of a multiple etiology. This article's goal is to review the etiology, clinical manifestation, and management of BMS.

Potential salivary and serum biomarkers for burning mouth syndrome and their relationship with anxiety/depression

Background/purposeThe pathophysiology of burning mouth syndrome (BMS), although considered a multifactorial etiology including psychological factors, is still not well understood. Hence, this study aimed to investigate the potential usage of salivary and serum biomarkers, including brain-derived neurotrophic factor (BDNF), interferon-gamma (IFN-γ), interleukin-1beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α), in diagnosing BMS and their correlations with anxiety/depression. Materials and methods45 BMS patients and 14 healthy volunteers were enrolled. The patients were divided into BMS with anxiety/depression group and BMS without anxiety/depression group according to the scores of the Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS). Additionally, concentrations of BDNF, IFN-γ, IL-1β, IL-6, IL-8, and TNF-α in saliva and those in serum among the patients and healthy volunteers were assessed by multiplex assay using Luminex 200TM system and Enzyme-linked immunosorbent assay (ELISA), respectively. ResultsAmong all the serum biomarkers, only BDNF showed a statistically significant decrease in the patients than the healthy volunteers (P < 0.05). Regarding saliva biomarkers, BDNF, IL-1β, and IL-8 all exhibited a statistically significant increase in all the BMS patients versus the healthy volunteers (P < 0.05) but only BDNF was significantly different between patients with anxiety/depression and healthy individuals when considering anxiety/depression. Among BMS patients with anxiety/depression, saliva TNF-α had positive associations with other biomarkers including BDNF, IFN-γ, IL-1β, IL-6, and IL-8 (P < 0.05). ConclusionThe increased concentration of saliva BDNF holds strong potential for diagnosing BMS and the elevated level of saliva TNF-α is crucial in identifying BMS patients with anxiety/depression.

Somatization in Burning Mouth Syndrome patients- a cross-sectional study in Romania

Somatization in Burning Mouth Syndrome patients- a cross-sectional study in Romania