Idiopathic Burning Mouth Syndrome Research Articles

Idiopathic Burning Mouth Syndrome: Specifics and Tactics of Cognitive Behavioral Therapy

Idiopathic Burning Mouth Syndrome: Specifics and Tactics of Cognitive Behavioral Therapy

Forensic and Ethical Particular Issues in the Case of Idiopathic Burning Mouth Syndrome (BMS)

Burning mouth syndrome (BMS) is a chronic clinical condition, characterized clinically by the persistent sensation of pain perceived in the form of burning or stinging in the oral mucosa, which does not yield to the usual local or systemic therapies, without being accompanied by BMS normal clinical or biological results. It is a little-known disease outside oral pathology, so it is frequently underdiagnosed, late-diagnosed therapies are often inadequate and sometimes can be a cause of iatrogenicity and polypragmasia. In our article, we want to expose a series of ethical and medico-legal aspects about burning mouth syndrome that will facilitate the understanding of the sources of diagnostic errors and possible malpractice in addressing this condition. It is our belief that as this pathology is better known and understood, including from an ethical and forensic perspective, therapeutic goals can be achieved more easily, within the current knowledge of the disease.

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.

Corneal Confocal Microscopy Detects Small-Fiber Neuropathy in Burning Mouth Syndrome: A Cross-Sectional Study.

To assess the utility of corneal confocal microscopy in identifying small fiber damage in patients with burning mouth syndrome (BMS). A prospective cross-sectional cohort study was conducted at two United Kingdom dental hospitals between 2014 and 2017. A total of 17 consecutive patients with idiopathic BMS aged between 18 and 85 years and 14 healthy age-matched control subjects were enrolled in this study. Corneal subbasal nerve plexus measures were quantified in images acquired using a laser-scanning in vivo corneal confocal microscope. The main outcome measures were corneal nerve fiber density, nerve branch density, nerve fiber length, and Langerhans cell density. Of the 17 patients with BMS, 15 (88%) were women, and the mean (standard deviation) age of the sample was 61.7 (6.5) years. Of the healthy controls, 7 (50%) were women, and the mean (standard deviation) age was 59.3 (8.68) years. Corneal nerve fiber density (no./mm2) (BMS: 29.27 ± 6.22 vs controls: 36.19 ± 5.9; median difference = 6.71; 95% CI: 1.56 to 11.56; P = .007) and corneal nerve fiber length (mm/mm2) (BMS: 21.06 ± 4.77 vs controls: 25.39 ± 3.91; median difference = 4.5; 95% CI: 1.22 to 6.81; P = .007) were significantly lower in BMS patients compared to controls, and Langerhans cell density (no./mm2) (BMS: 74.04 ± 83.37 vs controls: 29.17 ± 45.14; median difference = -21.27; 95% CI: -65.35 to -2.91; P = .02) was significantly higher. Using a rapid noninvasive ophthalmic imaging technique, this study provides further evidence for small fiber damage in BMS and has potential utility for monitoring disease progression and/or response. Furthermore, this technique shows a hitherto undocumented increased density of immune cells in this group of patients.

Burning mouth syndrome-a diagnostic dilemma.

Burning mouth syndrome (BMS) is a chronic pain disorder, more common in peri and postmenopausal females, with a varied symptomatology. Symptoms include a burning or stinging sensation of the tongue, lips or other oral mucosal surfaces, subjectively dry mouth or excess saliva, altered taste or loss of taste and paraesthetic sensations. These are usually present daily for more than 3months. The aims of this study were to highlight the symptomatic manifestations of BMS along with the need for prompt diagnosis and onward referral when necessary. A cross-sectional study of patients with idiopathic BMS was conducted. The presenting symptoms, time to diagnosis and number of clinicians seen in advance of a diagnosis of BMS and anxiety and depression as determined by the Hospital Anxiety and Depression Scale (HADS) was recorded. Correlations were explored. Fifty patients were enrolled in this study (38, F:12, M). The average time from onset of symptoms to diagnosis was 13months. Commonly reported symptoms included burning (n = 44) and altered taste (n = 14). The median anxiety score was 13 and the median depression score was 10. No statistically significant correlations were found between the anxiety and depression scores generated and the number of clinicians seen or the time to diagnosis. The results of this study indicate that there is a need for an increased awareness of the symptoms reported in BMS, particularly in peri and postmenopausal women. This should aid prompt diagnosis and may alleviate some of the anxiety that patients may experience.

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

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. 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. 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). These data depicted impaired taste sensitivity in iBMS patients within fungiform and foliate taste bud fields and support potent gustatory/nociceptive interaction in iBMS.

Evaluating the Etiologies of Burning Mouth Symptom in Patients of Shiraz Dental School from 2007 to 2015

Background: Burning Mouth Syndrome (BMS) is a burning sensation of the oral mucosa without any sign of mucosal abnormality for which no medical or dental cause can be detected. However, this syndrome belongs to a broader category of patients whose main complaint is mouth burning and, so, their etiologies can largely vary. Objectives: This study investigates the prevalence of burning mouth symptom for the first time in an institutional group of patients in Shiraz, Iran, among whom some were found to have BMS through excluding the recognizable physical or biochemical causes of mouth burning. Methods: In this cross sectional study, from the existing records of 2 533 patients who referred to Shiraz Dental School since 2007 To 2015, a total number of 298 patients with the chief complaint of oral burning sensation were chosen. For each patient age, sex, etiology, and site of pain were recorded. Results: Analysis revealed that amongst 298 individuals who suffered from burning sensation of the oral mucosa, the female/male ratio was 3 to 1; and local factors were found as the primary cause for the symptom development in a large proportion of the patients (63.5%). Followed by systemic diseases with a much less contribution to cause the symptom (22.8%). A number of 8.4% of the patients were idiopathic and 5.4% suffered from psychological disorders. Tongue was the most frequent location of burning (37.2%). Overall, only 25 patients (< 1%) who were mostly elderly (P < 0.001) had idiopathic BMS. The burning localization in the idiopathic cases was more likely to be reported as generalized than that in the cases with recognizable causes (P < 0.001). Conclusions: The results of this study show that oral burning is mostly caused by the factors recognized during examination and that the idiopathic form or BMS known as a neuropathic pain is uncommon. Understanding the prevalence of the etiologic factors in certain populations would lead to a better diagnostic approach to BMS through the exclusion of those factors.

Role of vitamin B6 in idiopathic burning mouth syndrome: some clinical observations

Introduction : Idiopathic burning mouth syndrome (iBMS) is a chronic oral pain syndrome mainly characterized by a burning sensation in the oral mucosa and an etiopathogenesis that remains unclear, with therapeutic options that are disappointing. Any clinical observation providing insight into the disorder can therefore be of interest. Among metabolic factors, deficiencies of vitamins have been pointed out, but only a few studies have focused on the role of vitamin B6 (vitB6) in this syndrome. In this report, we aimed to highlight the involvement of increased but not decreased vitB6 serum levels in a subgroup of BMS Patients. Patients and Methods : Medical files of patients who attended the chronic orofacial pain consultation, in the dental departement of the Groupe Hospitalier Pitie-Salpetriere (GHPS) in Paris (France) between 09/03/2008 and 12/19/2015 were retrieved from the hospital database and analyzed. This retrospective study was approved by the board of the dental department and authorization for use of patient data was obtained from the National Personal Data Protection Committee (Commission Nationale de l’Informatique et des Libertes (CNIL)) (#1913570). Results : Seven per- or postmenopausal female patients out of 42 diagnosed with iBMS (17%) displayed an increase in their serum levels of vitB6, one to six times the upper normal limits. There was a statistically significant correlation between pain and vitB6 levels. Moreover, in two patients, the reversal of vitB6 levels to normal values resulted in significant decreases in pain severity. Conclusion : These clinical observations report for the first time a potential implication of elevated vitB6 serum levels in the burning sensation which might be specific to a subgroup of iBMS patients.

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

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. 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 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). 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.

The relationship between the clinical features of idiopathic burning mouth syndrome and self-perceived quality of life.

In this descriptive study, we investigated the relationship between the clinical characteristics of idiopathic burning mouth syndrome (iBMS) and the quality of life. Eighteen iBMS patients were interviewed about their experience with pain, oral-associated complaints, cognitive status, and self-perceived quality of life using the French versions of the Hospital Anxiety and Depression Scale (HADS) and the Global Oral Health Assessment Index (GOHAI). The Spearman coefficient was used to analyze correlations. The level of significance was fixed at P < 0.05. The majority of patients described the association of oral burning sensations with other oral complaints, including dry mouth (77.8%), tactile abnormalities (66.7%), thermal abnormalities (44.5%), and taste disturbances (38.9%). HAD-anxiety scores were higher than 10 in 38.8% of iBMS patients and HAD-depression scores were higher than 10 in 33.3% of patients. A significant correlation was found between the number of associated complaints and HAD-depression scores. The mean GOHAI-add score was 37.9 ± 9.6 (mean ± SD), and 94.5% of iBMS patients had a score lower than 50. GOHAI-add scores strongly correlated with pain intensity, which was calculated using a visual analog scale and duration of pain. Our findings indicate a strong correlation between iBMS-related pain and self-perceived oral health-related quality of life. In addition, a correlation was observed between iBMS-associated oral complaints and cognitive status.(J Oral Sci 58, 475-481, 2016).

Effect of a 2% topical chamomile application for treating burning mouth syndrome: a controlled clinical trial.

The treatments for burning mouth syndrome (BMS) proposed to date have been varied but have only achieved limited efficacy. Chamomile has analgesic and anti-inflammatory properties. The aim of this study was to evaluate the efficacy of topical applications of 2% chamomile gel in comparison with a placebo for the treatment of BMS. The study was designed as a prospective randomized placebo-controlled double-blind monocentric study. A total of 62 patients with idiopathic BMS were divided into two groups: Group A received applications of a 2% chamomile gel, and Group B (placebo) were administered a placebo; both treatments were applied twice daily for 1 month. Three variables were evaluated at base line, 15 and 30 days: pain (assessed using a visual analogue scale [VAS]), xerostomia severity (Xerostomia Inventory), and oral quality of life (assessed by means of the Oral Health Impact Profile-14). A total of 57 patients completed the study. Pain, xerostomia, and quality of life underwent improvements with statistical significance at 15 and 30 days in both groups (P < 0.001). But when the two groups were compared, differences in VAS pain were not significant (P = 0.847), nor were xerostomia severity (P = 0.536), or oral quality of life (P = 0.076). The chamomile gel product was well tolerated. As treatment with chamomile and the placebo produced similar outcomes, the efficacy of 2% chamomile gel for treating BMS appears questionable. However, further studies with larger patient samples are needed to confirm this.

Therapeutic options in idiopathic burning mouth syndrome: literature review.

Introduction Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue, palate, lips, or gums of no well-defined etiology. The diagnosis and treatment for primary BMS are controversial. No specific laboratory tests or diagnostic criteria are well established, and the diagnosis is made by excluding all other possible disorders. Objective To review the literature on the main treatment options in idiopathic BMS and compare the best results of the main studies in 15 years. Data Synthesis We conducted a literature review on PubMed/MEDLINE, SciELO, and Cochrane-BIREME of work in the past 15 years, and only selected studies comparing different therapeutic options in idiopathic BMS, with preference for randomized and double-blind controlled studies. Final Comments Topical clonazepam showed good short-term results for the relief of pain, although this was not presented as a definitive cure. Similarly, α-lipoic acid showed good results, but there are few randomized controlled studies that showed the long-term results and complete remission of symptoms. On the other hand, cognitive therapy is reported as a good and lasting therapeutic option with the advantage of not having side effects, and it can be combined with pharmacologic therapy.

Idiopathic burning mouth syndrome: A common treatment-refractory somatoform condition responsive to ECT

Somatic symptom disorders are common causes of disability and suffering, and can pose significant management challenges. Idiopathic burning mouth syndrome is a challenging somatic symptom disorder with relatively high prevalence, particularly among post-menopausal women. Here, we present the case of a woman with severe treatment refractory idiopathic burning mouth syndrome and comorbid major depressive disorder, who was successfully treated with bitemporal electroconvulsive therapy. This case highlights the potential effectiveness of electroconvulsive therapy in idiopathic burning mouth syndrome when other treatment options have been exhausted.

Dopa responsive burning mouth syndrome: Restless mouth syndrome or oral variant of restless legs syndrome?

Burning mouth syndrome (BMS) is an oral dysesthesia presenting as a burning sensation of the tongue and other oral and perioral mucosae. A painful symptomatology in different bodily regions (extraoral) may also be a common feature in patient with BMS. The management of BMS is challenging and there is no clear guideline for the management of idiopathic BMS. Herein, we describe a group of patients (5 patients) in whom symptoms of BMS responded to levodopa. In parallel, four patients fulfilled the criteria for restless legs syndrome (RLS). Family history of RLS was positive in two patients. We reviewed the literature and noted a marked overlap between BMS and RLS. Overlaps were noted in epidemiological profiles, pattern of clinical features and even in neurophysiological observations (alterations in the striatal dopaminergic system). We suggest that a subset of patients with BMS may be a phenotypic variant of RLS and a trial of dopaminergic drugs should be given in patients with BMS who has a history suggestive of RLS or in a patient who do not show a response to usual therapies for BMS.

A double‐blind study on clonazepam in patients with burning mouth syndrome

In the treatment of burning mouth syndrome (BMS), various approaches have been tried with equivocal results. The aim of the present randomized clinical trial was to determine the efficacy of clonazepam, a GABA agonist designed as an antiepileptic drug that exerts the typical effects of benzodiazepines. Randomized clinical trial. Twenty patients with idiopathic BMS were carefully selected. Clonazepam (0.5 mg/day, n = 10) or placebo (lactose, n = 10) were randomly assigned to the patients. Patients on clonazepam significantly improved in pain ratings (P < .001). These changes were less pronounced in the placebo group (P < .11). No significant changes were observed in a mood scale (P = .56) or for depression scores (P = .56). Taste test and salivary flow increased over sessions, but were not different between groups (P = .83 and P = .06, respectively). Clonazepam appears to have a positive effect on pain in BMS patients.

Oral pain perception and taste in Burning Mouth Syndrome

Aim of this study was to investigate the effect of idiopathic burning mouth syndrome (BMS) on both, the pain perception within trigeminal lingual nerve distribution and gustatory sensitivity using capsaicin threshold test, and regional taste tests, respectively. Pain thresholds for capsaicin were assessed using capsaicin-impregnated filter-paper strips. The strips were placed midline on the tongue tip for whole mouth testing with the mouth closed, and on the left or right edge of the extended anterior tongue for lateralized testing. Measures of gustatory function were obtained by validated "taste strips" test kit and electrogustometry. The tests were applied to 13 patients with BMS. Results were compared with those from 28 healthy subjects. Patients with BMS exhibited a decreased gustatory and somatosensory perception compared with healthy controls. These changes were found for lateralized tests but not for the whole mouth test procedure. Duration of disorder showed an effect on the capsaicin threshold, with patients being less sensitive to capsaicin exhibiting an increased duration of disorder. Both pain-related and gustatory sensitivies of the tongue are found to be decreased in BMS.

Burning mouth syndrome: Identification, diagnosis, and treatment

To provide an overview of burning mouth syndrome (BMS), describe the role of the clinician when a patient presents with the burning mouth complaint, offer guidance in differentiating the cause of the complaint, and identify potential treatment options for the patient suffering from BMS. A search of MD Consult, Medline, and EBSCO Host Research Databases with the terms "burning mouth" and "BMS." BMS is a common, chronic disorder of unknown etiology with no underlying or systemic causes or oral signs identified. It affects more than 1 million people in the United States, predominantly postmenopausal women. Despite the common nature of the disorder, it is often misunderstood. Palliative treatment, education, and support should be offered to the patient with idiopathic BMS. A variety of treatment options exist, including benzodiazepines, tricyclic antidepressants, anticonvulsants, alpha-lipoic acid, topical capsaicin, and cognitive therapy can be added to the medication regimen for greater benefit. The role of the clinician is to obtain a meticulous history and physical examination of the patient, order relevant diagnostic tests, and rule out treatable conditions that may be causing the burning mouth symptom. If secondary causes of BMS are ruled out, the clinician should present treatment options to the patient and consider referral to specialists as necessary. A combination of medications may be more effective than a single medication.

The Effect of Citalopram and Colonazpam on Burning Mouth Syndrome

Statement of problem: Psychosocial factors are thought to play a role in burning mouth syndrome (BMS) and several therapeutic approaches for BMS are based on this consideration. Purpose: This paper evaluated the efficacy of the combined systemic administration of citalopram and clonazepam, as anti-depressa nt and antianxiety drugs, in the management of burning mouth syndrome and reduction of the burning sensation. Materials and Method: In this cross-sectional study, 80 subjects suffering from idiopathic burning mouth syndrome were enrolled. The patients underwent a thorough clinical examination. Oral symptoms before and after treatment were assessed using a Visual Analogue Scale. The mean duration of burning in our patients was 7 months. Systemic combination of citalopram (20 mg/daily) and clonazpam (0.25 mg/daily) was prescribed for all of them for 8 weeks. Then, the data were analysed, using Student’s t-test. Results: Of the 62 patients who completed the protocol, 38 reported complete remission of the oral burning sensation. However, 20 patients reported a little improvement, and four of them reported no improvement. Conclusion: These data suggest that citaloperam with colonazpam is effective in patients with BMS

Biochemical analysis of saliva and taste acuity evaluation in patients with burning mouth syndrome, xerostomia and/or gustatory disturbances

Objective: In the current study, we performed taste and salivary analysis on patients suffering from burning mouth syndrome and xerostomia or taste disturbances. Study design: A total of 180 patients who complained of idiopathic burning mouth syndrome (BMS) and taste aberrations and/or xerostomia that may accompany BMS were evaluated. These patients were compared with 90 healthy, age- and sex-matched controls. Salivary flow rate, biochemical and immunological analysis and taste acuity by the forced-choice drop technique were performed for all subjects. These analyses were found to be conclusive in distinguishing controls from patients with complaints. Results: The great similarity of both salivary and taste analysis in the BMS, taste aberration and xerostomia groups, which were significantly different from the results obtained in the control group, was found to be the most striking result. Higher salivary concentrations in the experimental group were consistent with a lower saliva (water) flow rate. Conclusion: An oral neuropathy and/or neurological transduction interruption induced by salivary compositional alterations is suggested as the possible aetiology for the complaints. This report may add an important objective diagnostic tool to the clinician treating these patients.

DIAGNOSIS AND TREATMENT OF COMMON ORAL LESIONS FOUND IN THE ELDERLY

A wide variety of oral lesions are recognized in the geriatric patient. The most common lesions include neoplasia, immunologic based mucosal disease, hematological disorders, oral manifestation of systemic disease, and conditions characterized by oral or facial pain. Diagnostic and treatment considerations for leukoplakia, carcinoma, metastatic disease, candidiasis, herpes zoster, plasmacytoma, myeloma, lymphoma, several of the more common vesiculoulcerative mucosal diseases and idiopathic burning mouth syndrome are presented.