Burning Mouth Syndrome Research Articles

Evaluating the Efficacy of Two Pharmaceutical Therapies for Burning Mouth Syndrome

ABSTRACT Background: Burning mouth syndrome (BMS) is a chronic pain disorder characterized by a persistent burning sensation in the oral cavity, affecting quality of life significantly. Pharmacological therapy is commonly employed in the management of BMS, but the comparative efficacy of different pharmaceutical agents remains uncertain. Materials and Methods: This study was conducted involving 80 participants diagnosed with BMS, randomly assigned to two treatment groups: Group A received tricyclic antidepressants (TCAs), while Group B received anticonvulsants. Baseline assessments of pain intensity, oral health-related quality of life, and psychological distress were conducted using standardized measures. Treatment outcomes were evaluated at 3-month and 6-month follow-up visits. Pain intensity was assessed using a visual analog scale (VAS), while oral health-related quality of life and psychological distress were measured using validated questionnaires. Results: Both treatment groups demonstrated significant improvements in pain intensity, oral health-related quality of life, and psychological distress compared to baseline. At the 6-month follow-up, Group A (TCAs) showed a mean reduction of 70% in pain intensity from baseline, whereas Group B (anticonvulsants) exhibited a mean reduction of 65%. The difference in pain reduction between the two groups was not statistically significant (P = 0.35). Both groups also showed similar improvements in oral health-related quality of life and psychological distress measures. Conclusion: TCAs and anticonvulsants are both effective pharmaceutical therapies for managing BMS, resulting in significant improvements in pain intensity, oral health-related quality of life, and psychological distress.

Oral Findings and Salivary Alpha-Amylase in Major Depressive Disorder Patients

Background: The increasing global prevalence of major depressive disorder (MDD) has become an important challenge, leading to a heightened demand for oral medicine in developed nations. This demand arises from the recognition of the association between psychiatric disorders and other conditions, including various orofacial pain disorders. Objective: This study are to evaluate oral conditions such as recurrent aphthous ulcers, burning mouth syndrome, and altered taste and to assess salivary alpha-amylase in individuals diagnosed with major depressive disorder. Methods: This research uses a cross-sectional study design that includes a sample of 49 patients who have been diagnosed with major depressive disorder and who have undergone treatment for at least two weeks. The control group consists of 34 healthy subjects with no signs or symptoms of systemic disease. The study group received the diagnosis in Najaf City according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). With respect to recurrent aphthous ulcers, the results of this study show the percentage of patients with oral ulcers is significantly higher than in the control group. Results: The results also show that the prevalence of burning mouth syndrome is significantly higher in patients with major depressive disorder than in healthy controls. A highly statistically significant difference was found between the study group and the control group regarding altered taste. There is also a significant difference in salivary alpha-amylase levels between the study and control groups (p = 0.009). Conclusion: Major depressive disorder patients have much higher incidences of reported recurrent aphthous ulcers, burning mouth syndrome, and altered taste than healthy subjects, indicating the importance of psychological factors in these conditions. Additionally, salivary alpha-amylase levels were higher in patients with major depressive disorder than in the control group.

Menopause and Oral Health: Clinical Implications and Preventive Strategies

ABSTRACT Menopause, occurring typically between the ages of 45 and 55 years, marks the end of a woman’s reproductive years and is characterized by the cessation of menstruation and a significant decline in estrogen and progesterone production. These hormonal changes impact various aspects of health, including oral health. This review explores the clinical implications of menopause on oral health and outlines preventive strategies. Hormonal changes during menopause can lead to xerostomia (dry mouth), periodontal disease, burning mouth syndrome (BMS), oral mucosal changes, altered taste sensation, and osteoporosis-related oral health issues. Xerostomia results from decreased salivary flow, increasing the risk of dental caries and oral infections. Periodontal disease is exacerbated by estrogen deficiency, leading to bone loss and increased tooth mobility. BMS, characterized by a chronic burning sensation, and oral mucosal atrophy are linked to hormonal fluctuations. In addition, altered taste perception and osteoporosis further complicate oral health management. Effective prevention and management strategies include regular dental checkups, good oral hygiene practices, and tailored treatments such as fluoride treatments, saliva substitutes, and hormone replacement therapy. Nonpharmacological approaches such as stress management and lifestyle modifications also play a role. This review emphasizes the importance of a multidisciplinary approach, involving dental and medical professionals, to address the complex oral health challenges faced by menopausal women. Understanding the underlying mechanisms and implementing evidence-based preventive measures can significantly enhance the oral health and overall well-being of menopausal women.

Comprehensive analysis of the oral microbiota and metabolome change in patients of burning mouth syndrome with psychiatric symptoms

ABSTRACT Background Burning mouth syndrome (BMS) is a chronic idiopathic facial pain with intraoral burning or dysesthesia. BMS patients regularly suffer from anxiety/depression, and the association of psychiatric symptoms with BMS has received considerable attention in recent years. The aims of this study were to investigate the potential interplay between psychiatric symptoms and BMS. Methods Using 16S rRNA sequencing and liquid chromatography-mass spectrometry (LC/MS) to evaluate the oral microbiota and saliva metabolism of 40 BMS patients [including 29 BMS patients with depression or anxiety symptoms (DBMS)] and 40 age matched healthy control (HC). Results The oral microbiota composition in BMS exhibited no significant differences from HC, although DBMS manifested decreased α-diversity relative to HC. Noteworthy was the discernible elevation in the abundance of proinflammatory microorganisms within the oral microbiome of individuals with DBMS. Parallel findings in LC/MS analyses revealed discernible disparities in metabolites between DBMS and HC groups. Principal differential metabolites were notably enriched in amino acid metabolism and lipid metabolism, exhibiting associations with infectious and immunological diseases. Furthermore, the integrated analysis underscores a definitive association between the oral microbiome and metabolism in DBMS. Conclusions This study suggests possible future modalities for better understanding the pathogenesis and personalized treatment plans of BMS.

A retrospective study on the clinical characteristics and treatment outcomes of patients with burning mouth syndrome.

Burning mouth syndrome (BMS) refers to a condition characterized by pain sensations such as burning or tingling, or sensory disturbances in the tongue or oral mucosa without any specific local or systemic cause for more than 3 months. This study retrospectively investigated the clinical characteristics of 248 BMS patients (217 women, 31 men, mean age 64.7±11.2 years). Treatment outcomes were assessed using the Numeric Rating Scale (NRS). Parafunctional habit control education, saliva substitute, and counselling for psychological stability were implemented at the first visit, resulting in a significant reduction in NRS scores at the second visit. Medication such as clonazepam or zinc supplements were administered from the second to fourth visit, leading to a significant reduction in NRS scores compared to the initial visit. The various treatment options can be applied to alleviate the symptoms of BMS. Forty-eight patients (19.35%) exhibited serum zinc concentration of 70μg/dL or lower. A well-designed clinical study with a large number of patients is needed to compare the therapeutic effects between underlying conditions, medications, and nutritional supplementation including zinc.

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.

Efficacy of Danzhixiaoyao tablets combined with methylcobalamin tablets in the treatment of burning mouth syndrome: an open-label, randomized controlled trial

ObjectivesThis randomized controlled trial compared the efficacy and tolerability of danzhixiaoyao pills in the accurate treatment of patients with burning mouth syndrome (BMS).MethodCollect a total of 78 patients (75 female patients and 3 male patients) from the oral mucosa department who were considered eligible fromOctober 2020 to October 2022.The patients were randomized and divided into trial group and control group.The trail group received danzhixiaoyao pills and mecobalamine tablets while the control group was given mecobalamine tablets.The Visual Analogue Scale (VAS), Beck Anxiety Inventory(BAI), Beck Depression Inventory (BDI), Oral Health Impact Profile (OHIP-14), Traditional Chinese medicine(TCM) syndrome integral and adverse reactions were performed at baseline and after 2, 4, and 6 weeks of treatment. Descriptive statistics, including the Wilcoxon rank-sum test and the Chi-square test for median comparisons between different times, were used.Result1.After treatment, the VAS, BDI,OHIP-14, and TCM syndrome integral in the trial group had a significant decrease than the control group(P< 0.05).However, there was no statistical difference in the BAI scores between the two groups (P> 0.05). 2.According to the efficacy determination criteria , the total effective rate of the test group was 73.68% , the control group was 52.94% and the recurrence rate was 0. There was a significant difference between the two groups (Z=-2.688, P < 0.05). The results showed that the curative effect of test group was better than that of control group.3. No adverse effects occurred in patients in either group.ConclusionDanzhixiaoyao pills has demonstrated to have a positive effect in relieving BMS symptoms and in improving a patient's overall quality of life with no AEs compared with the control group. The efficacy evaluation systems that can be verified and complementary in this study provide a perfect, effective and referential evaluation system for the use of Chinese patent medicine in the treatment of oral mucosal diseases.Trial RegistrationRegistry name: Chinese Clinical trail RegistryRegistration number: ChiCTR2000038189Date of Registration: 2020-09-13Please visit (https://www.chictr.org.cn/showproj.html?proj=61462) to the protocol.

Drug-induced Tongue Disorders: A Comprehensive Literature Review.

Some drugs cause tongue disorders as adverse effects. Most of the druginduced tongue disorders are benign and will resolve after drug discontinuation. However, the changes in the color or appearance of the tongue may frighten patients and decrease compliance with drug therapy. To review the literature to find all reports of drug-induced tongue disorders, their presentation, management, and outcome of patients Methods: The search was conducted in Google Scholar and PubMed using key words "ageusia," "burning tongue," "coated tongue," "drug-induced taste disturbances," "dysgeusia," "glossitis," "glossodynia," "hairy tongue," "hypogeusia," "stomatodynia," "stomatopyrosis," "swollen tongue" "tongue discoloration," "tongue irritation," "tongue numbness, "tongue oedema," and "tongue ulcer. All reports that were published from 1980 to 2022 in the English language were included in the study. Reports that were not in English language but had English abstracts with adequate data for extraction were also included. A total of 208 case reports and case series were included. The most reported drug classes were antineoplastic and immunomodulating agents and anti-infectives for systemic use, and the most common tongue disorders were tongue discoloration and black hairy tongue. Having good oral hygiene and discontinuing the offending drug could manage and resolve the problem. Drug-induced tongue disorders are not rare adverse drug reactions. They are benign in most cases, and withholding offending agents results in significant improvement or complete resolution of tongue lesions.

Manifestations and Treatment of Hypovitaminosis in Oral Diseases: A Systematic Review.

This review's objective is to examine the findings from various studies on oral signs and symptoms related to vitamin deficiency. In October 2023, two electronic databases (Scopus and PubMed) were searched for published scientific articles following PRISMA principles. Articles eligible for inclusion in this review had to be published in English between 2017 and 2023, be original studies, and involve human subjects. Fifteen studies were included in this review: three examining oral symptoms of vitamin B12 deficiency; one assessing vitamin B complex and vitamin E for recurrent oral ulcers; one investigating serum vitamin D levels in recurrent aphthous stomatitis patients; three exploring hypovitaminosis effects on dental caries; two measuring blood serum vitamin D levels; one evaluating vitamin B12 hypovitaminosis; three investigating hypovitaminosis as indicative of gingival disease; one focusing on vitamin deficiencies and enamel developmental abnormalities; one assessing vitamin deficiencies in oral cancer patients; one examining vitamin K as an oral anticoagulant and its role in perioperative hemorrhage; and one evaluating vitamin effects on burning mouth syndrome. Despite some limitations, evidence suggests a correlation between vitamin deficiencies and oral symptoms. This systematic review was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) database (202430039).

Relationship Between Clinical Course of Treatment for Burning Mouth Syndrome in Early Period and Aggression Using Rosenzweig Picture Frustration Study: A Retrospective Observational Study.

Burning mouth syndrome (BMS) is characterized by a chronic, ongoing sensation of intraoral burning or discomfort without causative lesions. This study sought to examine the relationship between personality traits in patients with BMS using the Rosenzweig Picture Frustration (PF) study, a projective psychological test, and their progress in treatment. Data were collected from outpatients diagnosed with BMS at our clinic between April 2017 and March 2021. The data were analyzed for 28 patients with BMS, of which nine showed improvement earlier than three months (early responders; ER), and the others did not (non-early responders; NER). The mean visual analog scale (VAS scores for BMS pain at the first visit were 52.8 in the ER and 59.6 in NER (n.s.). No significant differences were detected in the type and direction of aggression between ER and NER in the PF study. In contrast, the group conformity score of the ER (63.7%) was significantly higher than that of the NER (51.4%). Personal traits reflected in the PF study may have affected the course of improvement in the BMS. To understand the characteristics of patients with BMS and achieve more favorable treatment outcomes, further study on their personality organization is necessary.

Reappraising the psychosomatic approach in the study of "chronic orofacial pain": looking for the essential nature of these intractable conditions.

As burning mouth syndrome (BMS) and atypical odontalgia (AO) continue to remain complex in terms of pathophysiology and lack explicit treatment protocol, clinicians are left searching for appropriate solutions. Oversimplification solves nothing about what bothers us in clinical situations with BMS or AO. It is important to treat a complicated phenomenon as complex. We should keep careful observations and fact-finding based on a pragmatic approach toward drug selection and prescription with regular follow-up. We also need to assess the long-term prognosis of treatment with a meticulous selection of sample size and characteristics. Further investigation of BMS and AO from a psychosomatic perspective has the potential to provide new insight into the interface between brain function and "chronic orofacial pain."

Burning Mouth Syndrome Treated with Low-Level Laser and Clonazepam: A Randomized, Single-Blind Clinical Trial.

Burning mouth syndrome (BMS) is a chronic pain disorder characterized by intraoral burning or dysaesthetic sensation, with the absence of any identifiable lesions. Numerous treatments for BMS have been investigated, though without conclusive results. An analysis was conducted of the efficacy of treatment with a low-level diode laser and clonazepam in patients with BMS, and a study was carried out on the levels of different salivary biomarkers before and after treatment. A randomized, single-blind clinical trial was carried out involving 89 patients divided into the following groups: group 1 (laser, The Helbo® Theralite Laser 3D Pocket Probe + clonazepam) (n = 20), group 2 (sham laser placebo) (n = 19), group 3 (laser) (n = 21) and group 4 (clonazepam) (n = 18). Symptom intensity was scored based on a visual analogue scale (VAS). Sialometry was performed before and after treatment, and the Xerostomia Inventory, Oral Health Impact Profile-14 (OHIP-14) and Mini-Nutritional Assessment (MNA) questionnaires were administered. The following markers were measured in saliva samples: interleukins (IL2, IL4, IL5, IL6, IL7, IL8, IL1β, IL10, IL12, IL13, IL17, IL21 and IL23), proteins (MIP-3α, MIP-1α and MIP-1β), GM-CSF, interferon gamma (IFNγ), interferon-inducible T-cell alpha chemoattractant (ITAC), fractalkine and tumor necrosis factor α (TNFα). A significant decrease in the VAS scores was observed after treatment in group 1 (laser + clonazepam) (p = 0.029) and group 3 (laser) (p = 0.005). In turn, group 3 (laser) showed a decrease in the salivary concentration of fractalkine (p = 0.025); interleukins IL12 (p = 0.048), IL17 (p = 0.020), IL21 (p = 0.008), IL7 (p = 0.001) and IL8 (p = 0.007); proteins MIP1α (p = 0.048) and MIP1β (p = 0.047); and TNFα (p = 0.047) versus baseline. Following treatment, group 1 (laser + clonazepam) showed significant differences in IL21 (p = 0.045) and IL7 (p = 0.009) versus baseline, while group 4 (clonazepam) showed significant differences in IL13 (p = 0.036), IL2 (p = 0.020) and IL4 (p = 0.001). No significant differences were recorded in group 2 (sham laser placebo). The low-level diode laser is a good treatment option in BMS, resulting in a decrease in patient symptoms and in salivary biomarkers. However, standardization of the intervention protocols and laser intensity parameters is needed in order to draw more firm conclusions.

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.

A Structured Approach for the Management of Orodynia (Burning Mouth Syndrome).

Orodynia (OD) manifests as an unexplained burning sensation in the oral cavity, often persisting for years without clear clinical findings. Currently, there is no clear protocol for managing OD. We propose a systematic approach that aims to exclude common potential causes and attempt proactive treatments. Anecdotally, we have found that our structured approach improves clinical outcomes.

Distinctive salivary oral microbiome in patients with burning mouth syndrome depending on pain intensity compared to healthy subjects

Background/purposeBurning moouth syndrome (BMS) is a chronic pain condition similar to neuropathic pain. It is characterized by a persistent burning sensation in the oral cavity. Despite the lack of clarity regarding the etiology of BMS, recent studies have reported an association between the gut microbiome and neuropathic pain. However, few studies have investigated the association between the oral microbiome and orofacial pain, such as BMS. This study aimed to compare the oral microbial profiles of healthy controls (HC) and patients with BMS. Materials and methodsThe BMS group was further divided into BMS_low and BMS_high groups according to pain intensity. A total of 60 patients with BMS (BMS_low, n = 16; BMS_high, n = 44) and 30 HC provided saliva samples, which were sequenced and analyzed for the V1–V2 region of the 16S rRNA gene. ResultsThe alpha diversity was similar among the three groups. However, a significant difference in the distribution of microbiome composition was observed between BMS_high and HC, as revealed by the Bray–Curtis distance analysis (P < 0.01). At the genus level, Prevotella and Alloprevotella were the most abundant genera in the BMS group. Compared to HC, BMS_high exhibited a relatively higher abundance of bacterial species. Some bacteria, including Prevotella spp., exhibit an increasing pattern with subjective pain intensity. ConclusionThese results suggest the potential involvement of oral microbiota in BMS pathogenesis. Additionally, variations in the microbiome may occur not only in the presence or absence of pain, but also with pain severity.

Burning measure for burning mouth syndrome: a systematic review.

This current systematic review aimed to evaluate the current evidence on the effect of topical capsaicin application to alleviate symptoms related to burning mouth syndrome (BMS). PubMed, Ovid SP, and Cochrane were searched from 1980 to 2022 to identify relevant literature. A total of 942 titles (PubMed, 84; Ovid SP, 839; Cochrane, 19) was retrieved, of which 936 were excluded based on the title and abstract. A total of 11 studies were further evaluated for full text analysis, of which 7 were excluded. As a result, 4 articles were included for qualitative synthesis of data. Capsaicin as a mouthwash can have potential application in the treatment of symptoms related to burning mouth. The quality of available studies is moderate to low, and a well-designed randomized multicentric study comparing capsaicin with other active agents is planned to obtain more definitive conclusions.

Effect of anemia on oral cavity and hematological assessments

Background: Anemia is a decrease in the amount of hemoglobin, or red blood cells, in the blood. Slow-onset symptoms, such as dyspnea, exhaustion, weakness, or impaired exercise capacity, are frequently nonspecific. Red blood cells' capacity to carry oxygen is limited by anemia. This suggests that the body's tissues and organs take less oxygen from the blood. Objective: To determine the effect of anemia on oral cavity in addition hematological assessments and compare them with healthy controls. Patients and Methods: Among 80 people, a cross-sectional study was conducted. Twenty healthy control participants (9 male and 11 female) and sixty patients with anemia (22 male and 38 female) made up the study samples. Study was directed in September 2023 in Alkhalis hospital-Diyala. Results: Level of hemoglobin in the control group showed a statistically highly significant increase with mean ± SE (14.12 ±0.35) as compared with patients’ group. The white blood cell counts showed an increase in the control group with mean ± SE (9.92 ±0.54) as compared with patients’ group, with a statistically highly significant correlation. Out of 60 patients, 2 (3.33%) were complaining from angular cheilitis, 6 (10%) were complaining from burning mouth syndrome, 5 (8.33%) were complaining from recurrent aphthous stomatitis, and 13 (21.67%) were complaining from atrophic glossitis, with a statistically highly significant relationship. Conclusion: Differences in white blood cell counts in patients with anemia and healthy control. Many oral manifestations associated with anemia such as atrophic glossitis, burning mouth syndrome, angular cheilitis, and recurrent aphthous stomatitis.

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.

Amitriptyline at low dose for burning mouth syndrome.

Amitriptyline at low dose for burning mouth syndrome.

Calling Attention to the Unusual: Burning Mouth Syndrome in the Context of Idiopathic Basal Ganglia Calcification. A Case Report (P2-4.003)

Calling Attention to the Unusual: Burning Mouth Syndrome in the Context of Idiopathic Basal Ganglia Calcification. A Case Report (P2-4.003)