Primary Burning Mouth Syndrome Research Articles

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.

Ardência Bucal: Como o clínico deve interpretar?

The Burning Mouth Syndrome (BMS), a complex condition characterized by chronic pain or a burning sensation in the oral cavity without evidence of lesions or detectable changes in clinical and laboratory examinations. Highlighting its higher prevalence in women, especially in the age group of 50 to 70 years, the text explores the possible etiologies of BMS, including neuropathies, endocrine dysfunctions, psychological factors, among others. Through a literature review, the classifications of BMS are discussed, ranging from progressive daily pain to intermittent pain, in addition to the importance of distinguishing between primary and secondary BMS for effective treatment. The management of BMS requires a multidisciplinary approach, with treatments that range from pharmacological therapies to alternative methods such as acupuncture. The article also emphasizes the need for a detailed clinical assessment to identify underlying causes and propose appropriate therapy, considering local, systemic, nutritional, hormonal, and psychological factors. It concludes that BMS represents a significant diagnostic and therapeutic challenge, requiring comprehensive investigation and interdisciplinary collaboration to alleviate symptoms and improve the quality of life of patients.

Amitriptyline effectiveness in burning mouth syndrome: An in-depth case series analysis.

To assess the effectiveness of amitriptyline (AMT), and to identify the determinants of the treatment's effectiveness in patients diagnosed with burning mouth syndrome (BMS). Treatment of BMS is challenging and no established treatment protocol is available. AMT may be an important treatment option, cout not all patients benefit from this drug. Studies assessing factors related to treatment response are valuable in improving decision-making. This case series study examined the medical records of all patients diagnosed with BMS at an oral medicine unit in a university hospital from 2008 to 2022. The patients were divided into responders to AMT and non-responders to AMT. Data on demographic information, comorbidities, medications, types of symptoms and oral subsites affected were collected. Descriptive and bivariate analyses were conducted to assess the association between the independent variables and the outcome, using the Chi-squared test (P < .05). Three hundred and fourty-nine patients reported a burning mouth sensation, 50 of them (14.3%) being diagnosed with primary BMS. Of these, 35 were treated with AMT, and 26 (74.2%) responded significantly to AMT. All males responded to AMT, whereas only 67.9% of females responded. The mean dose of AMT among responders was 29.8 ± 12.3 mg, with most patients achieving a response with 25 mg (61.5% of patients), followed by 50 mg (23%). The concomitant use of an anticonvulsant resulted in non-response. AMT may be effective in BMS management for most patients.

Efficacy of laser therapy on primary burning mouth syndrome: a systematic review

The objective of this study was to perform a systematic review of the literature to determine the overall efficacy of low-level laser therapy (LLLT) in managing burning mouth syndrome (BMS). A literature search was conducted through PubMed, Scopus, Web of Sciences, and Cochrane Central Register of Controlled Trials from their inception up to 28 March 2023. The search terms were defined by combining (Mesh Terms OR Key Words) from “Burning mouth syndrome” AND (Mesh Terms OR Key Words) from “Laser therapy”. Methodological quality assessment was performed using the Joanna Briggs Institute Critical appraisal tool, attributing scores from 1 to 13 to the selected studies. Literature search, study selection, and data extraction were carried out by two authors. Differences on issues were resolved by a third author, if required. The primary investigated outcome was reducing BMS pain. A total of 21 articles met the inclusion criteria. After assessing full-text articles for eligibility, 12 articles were excluded. Consequently, 9 articles were retained. A low score of bias was calculated in 66% of the included studies. Compared to placebo, a significant reduction in pain or burning sensation was reported in 5 studies. This significant reduction was still observed in the laser group at the two- and four-month follow-ups in 2 studies. LLLT could be beneficial for patients suffering from BMS. In order to get strong evidence for placebo use, future studies with standardized methodology and outcomes are required.

Usefulness of pepsin saliva measurement for the detection of primary burning mouth syndrome related to reflux.

To study the diagnostic value of salivary pepsin tests for detecting laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS). Patients with BMS and asymptomatic individuals were consecutively recruited from September 2018 to June 2023. Patients underwent hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH) and saliva collections to measure pepsin. Stomatology evaluation was carried out to exclude other causes of BMS. Oral, pharyngeal and laryngeal signs and symptoms were evaluated with Reflux Sign Assessment (RSA) and Reflux Symptom Score (RSS). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin test were calculated considering the highest values of pepsin tests at ≥ 16, ≥ 36, and ≥ 100ng/mL cutoffs. Receiver operating characteristic curve (ROC) was evaluated. Forty-nine patients with both BMS and LPR at the HEMII-pH and 21 asymptomatic individuals were recruited. Pepsin test was 83.7%, 79.6%, and 71.4% sensitive at cutoffs ≥ 16, ≥ 36, and ≥ 100ng/mL, respectively. The ROC analysis reported that a threshold of ≥ 21.5ng/mL was associated with sensitivity, specificity, PPV and NPV of 81.6%, 81.0%, 90.1% and 65.4%, respectively. The severity score of burning mouth symptom was significantly associated with the saliva pepsin concentration (rs = 0.263; p = 0.029) and the oral RSA (rs = 0.474; p = 0.007). Pepsin test is a valuable diagnostic approach for detecting LPR in patients with BMS. Patients with high level of saliva pepsin reported more severe burning mouth symptoms. Future studies are needed to confirm the role of LPR in the primary BMS.

Association between Salivary Cortisol and α-Amylase with the Psychological Profile of Patients with Oral Lichen Planus and Burning Mouth Syndrome: A Case-Control Study.

The aim of our study was to assess the relationship between the concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and the psychological profile of patients with oral lichen planus (OLP) and primary burning mouth syndrome (BMS). A total of 160 subjects participated in this case-control study: 60 patients with OLP; 60 patients with primary BMS; and 40 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 a.m. Salivary biomarkers were analyzed by enzyme-linked immunosorbent assays (ELISAs). Psychological assessment was evaluated with the Depression, Anxiety, and Stress Scale (DASS-21). The patients with primary BMS had higher salivary cortisol concentrations and α-amylase activity (0.52 vs. 0.44 µg/dL; 160,531 vs. 145,804 U/L; one-way analysis of variance (ANOVA) with post hoc Scheffe test) compared with patients with OLP. The patients with primary BMS had statistically significant higher scores for depression, anxiety, and stress compared with patients with OLP and control subjects (p < 0.001, Kruskal-Wallis test). There was a strong positive correlation between anxiety and depression, stress and depression, and stress and anxiety in patients with OLP and BMS (p < 0.001 and p < 0.001, respectively; Spearman's correlation). There was a good positive correlation between symptom intensity (pain/burning) and psychological profile (depression, anxiety, stress) in patients with primary BMS (r = 0.373, p = 0.003; r = 0.515, p < 0.001; r = 0.365, p = 0.004, respectively; Spearman's correlation). This case-control study is the first to compare the psychoendocrinological profile of patients with two different oral diseases. The patients with BMS showed a higher concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and a stronger association with mental disorders compared with patients with OLP. However, an interdisciplinary psychoneuroimmunological approach is equally important in both patient groups (OLP and BMS), regardless of whether mental disorders are the cause or the consequence.

Cannabis and cannabinoid medications for the treatment of chronic orofacial pain: A scoping review

To collate and summarize existing evidence for the use of cannabis and cannabinoids to treat chronic orofacial pain (COP) by oral and maxillofacial surgeons (OMFS), oral medicine specialists (OMS), and orofacial pain specialists (OPS). We systematically screened for sources including a measure of effect of a cannabinoid compound on pain in COP patients that might be treated by our target specialists. Sources were selected by two authors independently. Sources were summarized by country, publication date, objective(s), COP condition(s) studied, cannabinoid(s) studied, methods, results, limitations, and conclusions. A thematic analysis and word cloud were conducted to elucidate commonalities, emphases, and gaps amongst identified sources. Retrieved from MEDLINE, EMBASE, Web of Science Core Collections, Dentistry and Oral Sciences, DARE, CCRCT, and US National Institute of Health and Controlled Trials Register. Of 705 retrieved titles, 8 met inclusion/exclusion criteria and were included for review. Included sources dealt with COP attributed to: head and neck cancer (3), multiple sclerosis-related trigeminal neuralgia-like symptoms (2), post-herpetic neuralgia (1), temporomandibular dysfunction (1), and primary burning mouth syndrome (1). Cannabinoids studied included: self-administered cannabis (3), topical N-palmitoyle-thanolamine (1), topical cannabis extract (1), cannabis sativa oil (1), nabiximols oromucosal spray (1), and nabilone (1). Most sources concluded their respective cannabinoid treatments to provide some therapeutic benefit for COP (6 of 8) and all concluded their treatments to be safe. Current research is wholistically focused, recording outcome measures for pain, anxiety, depression, quality of life, functional disability. Cannabinoids are most often studied as adjunctive and palliative treatments. Cannabinoids are becoming increasingly accessible and might benefit many COP patients. Patients and clinicians require more and higher quality evidence to make confident and informed decisions regarding treatment of COP with cannabis or cannabinoids. This review summarizes current evidence for patients, clinicians, and future researchers.

Clinical Utility of Quantitative Parameters of Salivary Gland Scintigraphy for Diagnosing Burning Mouth Syndrome.

Burning mouth syndrome (BMS) is a chronic disorder characterized by a burning sensation in the oral cavity, often accompanied by xerostomia, with no relevant clinical or laboratory findings. This study aimed to investigate diagnostic values of quantitative parameters of salivary gland scintigraphy for BMS in patients with xerostomia. A total of 164 patients who underwent salivary gland scintigraphy for the workup of xerostomia were retrospectively reviewed. All patients were classified into patient groups with primary BMS, secondary BMS, and non-specific xerostomia. From salivary gland scintigraphy, 22 quantitative parameters were calculated and their diagnostic values were assessed based on the area under the receiver operating characteristic curve (AUC) values. Among salivary gland scintigraphy parameters, uptake speed in the left submandibular gland showed the highest AUC value (0.647) for detecting BMS and pre-stimulatory oral activity showed the highest AUC value (0.710) for detecting primary BMS. A salivary gland scintigraphy scoring system based on these two parameters further enhanced the diagnostic ability, demonstrating AUC values of 0.731 for BMS and 0.782 for primary BMS. These results suggest a potential diagnostic value of the quantitative parameters of salivary gland scintigraphy for detecting BMS in patients with xerostomia.

Long-term prognosis of burning mouth syndrome following treatment

The purpose of this study was to evaluate the long-term prognosis of patients with burning mouth syndrome (BMS) after the termination or discontinuation of treatment and to identify the clinical characteristics that might affect that prognosis. Of 769 patients with an oral burning sensation, 202 with primary BMS who had been treated for at least 3 months were included. Among them, 28 patients who responded to the treatment and 25 patients who did not were assigned to responder and non-responder groups, respectively. Based on telephone interviews, the responders were classified into relapse and non-relapse subgroups, and the non-responder group into persistence and remission subgroups. The majority of responders reported no oral discomfort since their last visit. Compared with the non-relapse subgroup, the relapse subgroup had significantly higher levels of xerostomia at the first visit (P = 0.026) and taste disturbance at the last visit (P = 0.015). The majority of non-responders reported persistent oral discomfort since their last visit. No significant differences were found in the characteristics of oral symptoms between the persistence and remission subgroups. In conclusion, the treatment outcomes in the majority of responders and non-responders were maintained following treatment. Xerostomia and taste disturbance were associated with relapse of oral discomfort in the responders.

Salivary metabolome indicates a shift in tyrosine metabolism in patients with burning mouth syndrome: a prospective case-control study.

The pathophysiology of primary burning mouth syndrome (BMS) remains controversial. Targeted analyses or "omics" approach of saliva provide diagnostic or pathophysiological biomarkers. This pilot study's primary objective was to explore the pathophysiology of BMS through a comparative analysis of the salivary metabolome among 26 BMS female cases and 25 age- and sex-matched control subjects. Secondary objectives included comparative analyses of inflammatory cytokines, neuroinflammatory markers, and steroid hormones among cases and control subjects, and among BMS patients according to their clinical characteristics. Salivary metabolome, neuroinflammatory markers, cytokines, and steroids were, respectively, analysed by liquid chromatography coupled with mass spectrometry, ELISA and protease activity assay, and multiparametric Luminex method. Among the 166 detected metabolites, univariate analysis did not find any discriminant metabolite between groups. Supervised multivariate analysis divided patients into 2 groups with an accuracy of 60% but did not allow significant discrimination (permutation test, P = 0.35). Among the metabolites contributing to the model, 3 belonging to the tyrosine pathway ( l -dopa, l -tyrosine, and tyramine) were involved in the discrimination between cases and control subjects, and among BMS patients according to their levels of pain. Among the detectable molecules, levels of cytokines, steroid hormones, and neuroinflammatory markers did not differ between cases and control subjects and were not associated with characteristics of BMS patients. These results do not support the involvement of steroid hormones, inflammatory cytokines, or inflammatory neurogenic mediators in the pathophysiology of pain in BMS, whereas the observed shift in tyrosine metabolism may indicate an adaptative response to chronic pain or an impaired dopaminergic transmission.

Burning Mouth Syndrome Etiology: A Narrative Review.

Burning mouth syndrome (BMS) is defined as "idiopathic orofacial pain with intraoral burning or dysesthesia recurring daily for more than 2 hours per day and more than 3 months, without any identifiable causative lesions, with or without somatosensory changes" in International Classification of Orofacial Pain, 2020. Worldwide prevalence of BMS was estimated to be 1.73% in population-based studies, while female and elderly are at higher risk of BMS. The aim of this narrative review is to clarify the main etiopathogenetic factors of BMS investigated so far in the scientific literature. There is growing evidence of an important role of peripheral neuropathology in BMS, supported by immunohistochemical studies which have demonstrated a significant loss of epithelial and subepithelial nerve fibers. Other possible etiopathogenetic factors emerging from literature are laryngopharyngeal reflux and hormonal and salivary changes related to aging and menopause. Finally, the role of the oral microbiota in BMS has not yet been thoroughly investigated. Further studies are necessary to investigate the probably multifactorial etiopathogenesis of primary BMS, a pathology which has a serious impact on the quality of life of our patients, a disease we find ourselves treating without the adequate therapy and the necessary knowledge.

Comparative analysis of the oral microbiome of burning mouth syndrome patients

ABSTRACT Burning mouth syndrome(BMS) is a chronic pain condition accompanied by unpleasant burning sensationsof the oral mucosa. While multiple factors were proposed for the etiology, evidencesuggested a neuropathic pain origin while others suspected the use ofantibiotics as the underlying cause. Interestingly, several reports demonstratedthe intimate interaction of the nervous system and the microbiome. The currentstudy aims to elucidate the correlation of the oral microbiome with the pathophysiologyof the primary BMS. Microbiome samples obtained from the unstimulated wholesaliva of 19 primary BMS patients and 22 healthy controls were sequenced and analyzedof the V3-V4 region of 16S rRNA gene. There was a distinct difference in themicrobial composition between the BMS and the control groups at all taxonomic levels.Alpha diversity indexes of the oral microbiome were significantly lower in theBMS group. The samples were readily distinguished by multidimensional scalinganalysis and linear discriminant analysis effect size. Streptococcus, Rothia, Bergeyella, and Granulicatellagenus were dominant in the BMS group, while Prevotella, Haemophilus,Fusobacterium, Campylobacter,and Allorevotella genus were moreabundant in the healthy group. Distinct microbiome signatures of BMS patientssuggested a diagnostic value and a potential role in the pathogenesis of BMS.

Outpatient Oral Neuropathic Pain Management with Photobiomodulation Therapy: A Prospective Analgesic Pharmacotherapy-Paralleled Feasibility Trial.

Neuropathic pain (NP) can be challenging to treat effectively as analgesic pharmacotherapy (MED) can reduce pain, but the majority of patients do not experience complete pain relief. Our pilot approach is to assess the feasibility and efficacy of an evidence-based photobiomodulation (PBM) intervention protocol. This would be as an alternative to paralleled standard analgesic MED for modulating NP intensity-related physical function and quality of life (QoL) prospectively in a mixed neurological primary burning mouth syndrome and oral iatrogenic neuropathy study population (n = 28). The study group assignments and outcome evaluation strategy/location depended on the individual patient preferences and convenience rather than on randomisation. Our prospective parallel study aimed to evaluate the possible pre/post-benefit of PBM and to allow for a first qualitative comparison with MED, various patient-reported outcome measures (PROMs) based on Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT-II) were used for up to a nine-month follow-up period in both intervention groups (PBM and MED). The PBM protocol applied to the PBM group was as follows: λ810 nm, 200 mW, 0.088 cm2, 30 s/point, 9 trigger and affected points, twice a week for five consecutive weeks, whereas the MED protocol followed the National Institute of Clinical Excellence (NICE) guidelines. Our results showed that despite the severe and persistent nature of the symptoms of 57.50 ± 47.93 months at baseline in the PBM group, a notably rapid reduction in PISmax on VAS from 7.6 at baseline (T0) to 3.9 at one-month post-treatment (T3) could be achieved. On the other hand, mean PISmax was only reduced from 8.2 at baseline to 6.8 at T3 in the MED group. Our positive PBM findings furthermore support more patients’ benefits in improving QoL and functional activities, which were considerably impaired by NP such as: eating, drinking and tasting, whereas the analgesic medication regimens did not. No adverse events were observed in both groups. To the best knowledge of the authors, our study is the first to investigate PBM efficacy as a monotherapy compared to the gold standard analgesic pharmacotherapy. Our positive data proves statistically significant improvements in patient self-reported NP, functionality, psychological profile and QoL at mid- and end-treatment, as well as throughout the follow-up time points (one, three, six and nine months) and sustained up to nine months in the PBM group, compared to the MED group. Our study, for the first time, proves the efficacy and safety of PBM as a potent analgesic in oral NP and as a valid alternative to the gold standard pharmacotherapy approach. Furthermore, we observed long-term pain relief and functional benefits that indicate that PBM modulates NP pathology in a pro-regenerative manner, presumably via antioxidant mechanisms.

Role of Photobiomodulation Therapy in Neurological Primary Burning Mouth Syndrome. A Systematic Review and Meta-Analysis of Human Randomised Controlled Clinical Trials.

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.

Efficacy of rikkosan for primary burning mouth syndrome: a retrospective study

BackgroundBurning mouth syndrome (BMS) is a chronic condition characterized by pain in the oral cavity. Kampo medicine is a traditional Japanese medical system that has its roots partly in ancient Chinese medicine. The purpose of this study is to evaluate the efficacy of rikkosan—a traditional Japanese herbal medicine (Kampo)—in the treatment of primary BMS.Main bodyA single-center retrospective study was conducted in 32 patients who were diagnosed with primary BMS and treated with rikkosan alone through gargling (2.5 g rikkosan dissolved in 50 mL hot water) three times daily. Patients were asked to evaluate their pain using a numerical rating scale (NRS) at first visit and after 1 month. One patient had stomatitis as a side effect after gargling with rikkosan, however, no side effects were observed in other patients. Overall NRS scores decreased significantly between the first visit (7.6 ± 2.7) and the 1-month visit (5.6 ± 2.8).ConclusionsRikkosan may be an effective treatment for primary BMS.

Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome.

Burning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited. This study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome. One hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala's criteria for the diagnosis of burning mouth syndrome, including "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test. The mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren's syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients.Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.

Neuropathic and Psychogenic Components of Burning Mouth Syndrome: A Systematic Review

The pathophysiology of primary burning mouth syndrome (BMS) has been extensively debated but is poorly understood despite a large number of hypotheses attempting to explain its etiopathogenic mechanisms. The aim of the present work was to systematically review papers that could provide arguments in favour of the neuropathic and psychogenic components of primary BMS for a better understanding of the disease. This systematic review (SR) was registered in PROSPERO (CRD42021224160). The search was limited to articles in English or French from 1990 to 01 December 2020. A total of 113 articles were considered for data extraction. We divided them into four subgroups: pharmacological and nonpharmacological management studies (n = 23); neurophysiological studies (n = 35); biohistopathological studies (n = 25); and questionnaire-based studies (n = 30). Several of these studies have shown neuropathic involvement at various levels of the neuraxis in BMS with the contribution of quantitative sensory testing (QST), functional brain imaging, and biohistopathological or pharmacologic studies. On the other hand, the role of psychological factors in BMS has also been the focus of several studies and has shown a link with psychiatric disorders such as anxiety and/or depression symptoms. Depending on the patient, the neuropathic and psychogenic components may exist simultaneously, with a preponderance of one or the other, or exist individually. These two components cannot be dissociated to define BMS. Consequently, BMS may be considered nociplastic pain.

Prevalence and Features of Laryngopharyngeal Reflux in Patients with Primary Burning Mouth Syndrome.

To investigate the prevalence and features of laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS). Prospective uncontrolled study. Patients who visited our Departments of Otolaryngology-Head and Neck and Maxillofacial surgery with BMS were prospectively recruited from September 2018 to September 2020. Patients benefited from dental, maxillofacial, otolaryngological examinations, and hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH). Oral, pharyngeal, and laryngeal findings and symptoms were rated with Reflux Sign Assessment (RSA) and Reflux Symptom Score-12 (RSS-12). Patients were treated with a combination of diet, pantoprazole, and alginate. From the 81 included patients, 76 reported >1 pharyngeal reflux events (93.8%), accounting for 35 (46.1%), 24 (31.6%), and 17 (22.3%) acid, mixed, and nonacid LPR, respectively. Thirty-two patients had both LPR and gastroesophageal reflux disease (GERD). Thirty-eight patients benefited from pepsin saliva measurement, which was positive in 86.8% of cases. The mean scores of mouth/tongue burning, RSS-12, and RSA significantly improved from pre- to post-treatment (P < .004). At 3-month post-treatment, 62.5% of patients reported an improvement of mouth/tongue burning score. Patients with both GERD and LPR reported higher baseline RSS-12 and RSA scores. Acid, weakly acid, and nonacid LPR may be involved in the development of BMS. The use of an appropriate treatment considering the reflux features is associated with an improvement of symptoms and findings. 4 Laryngoscope, 131:E2627-E2633, 2021.

Low-level laser therapy in cases of burning mouth syndrome

Burning mouth syndrome is an intraoral burning sensation which develops in the absence of mucosal changes. It is a chronic condition and, in most of the cases, it is idiopathic – no cause or mechanism can be identified and no effective treatment can be prescribed. A variety of therapeutic approaches have been applied – cognitive-behavioral therapy, different drugs and supplements, acupuncture, lasers – none of them has achieved a definitive solution of the problem. This leads to anxiety, altered pain perception, and, therefore, reduced quality of life of the affected patients. The aim of this study is to present low-level laser therapy as a pain control option in patients with burning mouth syndrome. We reveal the potential of a diode laser to reduce the unpleasant burning sensation. We also apply laser therapy on patients with primary burning mouth syndrome. The affected sites on the oral mucosa in the selected cases are various – tongue, lower lip, upper lip, palate, cheeks. They are irradiated 10 times (two or three times a week) by an infrared laser (λ = 904 nm) and a red laser (λ = 658 nm). The probe is kept in contact with the tissue and the mucosal surface is scanned during the irradiation. The burning intensity is evaluated through a visual analogue scale before and after the treatment. The low-level laser illumination decreases significantly and for a longer period the burning sensation. The low-level laser therapy is a valuable alternative for BMS treatment and can be combined with other treatment methods.

Therapeutic use of alpha lipoic acid in burning mouth syndrome: A meta-analysis

Introduction: Primary burning mouth syndrome (BMS) is a chronic pain disorder of the oral cavity without any apparent local or systemic etiologic factor. There is no specific therapy for primary BMS and treatment is basically supportive or symptomatic. There are many pharmacological and nonpharmacological approaches reported by different studies to alleviate pain in primary BMS. Alpha lipoic acid (ALA) has also been used as a therapeutic agent in BMS by many clinicians and researchers. Aims: The aim of this review and meta-analysis was to evaluate the double-blinded placebo controlled randomized clinical trials of ALA to determine its efficacy and potential as therapeutic agent in primary BMS. Six studies were selected for the systematic review after a thorough manual and electronic searching of the databases. Methods: Five out of the 6 selected studies were used for quantitative data synthesis. Results and discussion: The ALA therapy for 2 months provided symptomatic relief to more people in the study groups than in the placebo groups (risk ratio 2.34, 95% confidence interval [CI]: 1.71–3.19). The mean visual analog scale (VAS) scores of the test groups improved (decreased) after 2 months of ALA therapy (standardised mean difference [SMD] 0.72, 95% CI 0.20–1.24). When compared with placebo therapy, mean VAS scores improved (decreased) more with placebo than with ALA after 2 months of treatment (SMD −0.23, 95% CI: −0.70–0.24). The positive responders in the ALA groups presented less incidence of deterioration than the positive responders in placebo groups during the follow-up period. Conclusion: It was concluded from this meta-analysis that ALA could be used as a potential therapeutic agent in primary BMS. It should be administered in proper therapeutic doses and for sufficient time to elicit positive outcome. ALA can be used for a long time without any severe side effect and very few recipients complained about worsening of the situation. It certainly improves pain symptoms in a considerable number of patients when compared with placebo therapy.