Treatment Of Burning Mouth Syndrome Research Articles

Long-Term Benefits of Photobiomodulation Therapy on Health-Related Quality of Life in Burning Mouth Syndrome Patients: A Prospective Study.

Background/Objectives: Burning Mouth Syndrome (BMS) patients experience a reduction in health-related quality of life and an increased intake of medication. Photobiomodulation with low-level laser therapy has been demonstrated to be an efficacious treatment for BMS. However, its long-term benefits remain relatively unknown. This study aimed to evaluate the impact of prolonged Photobiomodulation with low-level laser therapy on BMS patients by examining the efficacy of an outpatient protocol in a real-world setting. Methods: A prospective study was designed to address the research question. Photobiomodulation was performed, irradiating the affected areas once every two weeks for 12 months. Health-related quality of life was assessed using the EQ-5D-5L questionnaire at the initial consultation and after 6 months and 12 months of treatment. Additionally, the patients' pharmacological profile was also monitored. Nonparametric statistical analysis was performed (p < 0.05 was considered statistically significant). Results: The study was completed by 15 individuals, comprising 14 females and 1 male. The results indicated a statistically significant improvement (p < 0.001) in four of the five dimensions of the health-related quality of life questionnaire, namely self-care, usual activities, pain/discomfort, and anxiety/depression, along with the patients' perceived health level. A total of 13 participants reported suspending or reducing their intake of medications for Burning Mouth Syndrome. Conclusions: Therefore, Photobiomodulation with low-level laser therapy has a positive effect on improving patients' quality of life and reducing BMS symptoms, contributing to a subsequent reduction or suspension of previous medications. These findings support the efficacy of the applied protocol. Given the innovative methodology and promising results, further research is warranted.

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.

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.

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.

Goal Attainment Scaling in Patients With Burning Mouth Syndrome: A Real-World Clinical Study Protocol.

Introduction Burning mouth syndrome (BMS) is characterized by persistent chronic burning pain. Because BMS shows various symptoms, levels of severity, and treatment outcomes, measuring recovery is difficult in this patient population. Goal attainment scaling (GAS),a flexible and responsive technique for assessing outcomes in complex interventions, assimilates the achievement of individual goals into a single standardized "goal attainment scale." To our knowledge, this is the first clinical study protocol to investigate the effectiveness of adopting GASin patients with BMS. Methods This study will involve two phases. In phase 1, the suitability of GAS for BMS will be examined in 30 patients. All practitioners will be trained to support patients in setting their clinical goals. In phase 2, all 155 patients with BMS will set two clinical goals emphasizingspecific, measurable, achievable, realistic, and timed (SMART) goals at the initiation of psychopharmacotherapy for BMS. During the follow-up at weeks four, 8, 12, and 24, the GAS T-scores for each patient will be derived from the result of the individual goal attainment scores multiplied by goal weighting. Other clinical rating scales, including the visual analog scale (VAS), oral dysesthesia rating scale, pain catastrophizing scale, patient's global impression of change, and clinical global improvement will be assessed simultaneously with the assessment of goal attainment. The interactions between GAS T-scores and other clinical scales or clinical characteristics, including baseline age and sex, will be analyzed, followed by a discussion on the effectiveness of adopting the GAS for BMS. Results The information gleaned from phase 1 will help train practitioners and develop the use of GAS for BMS. In phase 2, analyzing the GAS T-score, a quantitative assessment, will accurately reveal patient outcomes and satisfaction. The effectiveness of using the GAS and some factors contributing to patient satisfaction will be revealed by analyzing the interaction between the T-score and other clinical scales. Conclusions In addition to revealing the usefulness of GAS for BMS, we believe this studywill prompt further investigations to clarify the factors contributing to patient satisfaction and shed light on a new treatment strategy that reinforces theprevious treatments for BMS.

Photobiomodulation as a Therapeutic Strategy in Burning Mouth Syndrome: A Scoping Review

Burning mouth syndrome (BMS) is considered an atypical oral clinical-symptomatological condition because its etiopathogenesis is not yet fully clarified. It is mainly characterized by the symptom of burning, which occurs chronically and with various intensities. It is essential for making a diagnosis of BMS, clinical negativities, and instrumental investigations. It mainly affects the female sex, in the pre-post-climactic phases. A peripheral neuropathic matrix of the pain symptoms has been repeatedly demonstrated. However, this subjectivity is associated with personalities with anxiety-depressive traits, affective-behavioral difficulties, and disorders of the psycho-algogenic sphere. Numerous treatments are reported in the literature, which have rarely met lasting healing parameters. In this clinical landscape, photobiomodulation therapy (PBMT) can be considered a possible therapeutic alternative. Our study aims to present a scoping review of how photobiomodulation is used in BMS therapy and to analyze the outcome of the therapy. A literature review focused on the photobiomodulation treatment for burning mouth syndrome was conducted in the main scientific databases: PubMed, SCOPUS, and Web of Science. The results of our research highlight encouraging results regarding photobiomodulation, as in all studies, there is a reduction in symptoms.

THERAPEUTIC METHODS FOR BURNING MOUTH SYNDROME: AN OVERVIEW

Objective To perform an overview of available systematic reviews (SR) on therapeutic methods used to alleviate Burning Mouth Syndrome (BMS) symptomatology. Study Design The study was conducted following the PRISMA and is registered with PROSPERO under number (CRD42021268587). The databases searched were PubMed, The Cochrane Library, Scopus, Embase, and Web of Science. The PICO question was "For the relief of symptomatology, discomfort, and burning sensation caused by BMS, what is the best strategy?". 212 articles were retrieved, 113 studies were evaluated for inclusion, and eight SR were included. The quality of SR was analyzed through the evaluation of SR in dentistry (Glenny Scale) and the Assessment of the Methodological Quality of SR (AMSTAR2). Results The most indicated pharmacological measure was clonazepam with short- and long-term effects on symptomatology relief. However, a standardized BMS treatment protocol is not described in the literature. According to Glenny scale, the studies had moderate to high quality, but according to AMSTAR 2, only two studies showed a high-quality level, while the others were classified as critically low. Conclusion The use of pharmacological and non-pharmacological measures reduces the symptomatology of BMS, but new randomized clinical trials are suggested to investigate treatment protocols for BMS. To perform an overview of available systematic reviews (SR) on therapeutic methods used to alleviate Burning Mouth Syndrome (BMS) symptomatology. The study was conducted following the PRISMA and is registered with PROSPERO under number (CRD42021268587). The databases searched were PubMed, The Cochrane Library, Scopus, Embase, and Web of Science. The PICO question was "For the relief of symptomatology, discomfort, and burning sensation caused by BMS, what is the best strategy?". 212 articles were retrieved, 113 studies were evaluated for inclusion, and eight SR were included. The quality of SR was analyzed through the evaluation of SR in dentistry (Glenny Scale) and the Assessment of the Methodological Quality of SR (AMSTAR2). The most indicated pharmacological measure was clonazepam with short- and long-term effects on symptomatology relief. However, a standardized BMS treatment protocol is not described in the literature. According to Glenny scale, the studies had moderate to high quality, but according to AMSTAR 2, only two studies showed a high-quality level, while the others were classified as critically low. The use of pharmacological and non-pharmacological measures reduces the symptomatology of BMS, but new randomized clinical trials are suggested to investigate treatment protocols for BMS.

The efficacy of alpha-lipoic acid in the management of burning mouth syndrome: An updated systematic review of randomized controlled clinical trials.

Burning mouth syndrome (BMS) causes burning or uncomfortable feelings in the oral cavity without any obvious injuries. This condition's etiopathogenesis is still unknown, consequently, BMS management is very challenging. Alpha-lipoic acid (ALA) is a naturally occurring potent bioactive compound that has been found to be useful in the management of BMS in many studies. Therefore, we conducted a comprehensive systematic review to investigate the usefulness of ALA in the management of BMS based on randomized controlled trials (RCTs). Different electronic databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar, were extensively searched to find relevant studies. This study included nine RCTs that matched the inclusion criteria. In most studies, ALA was given at a dose of 600-800 mg/day, with up to two months of follow-up. The majority of studies (six out of nine studies) indicated that ALA was more effective in BMS patients than in the placebo-controlled group. This comprehensive systematic review provides evidence of the positive outcomes of the treatment of BMS with ALA. However, more research might be needed before ALA can be considered the first-line therapy for BMS.

Place of placebo therapy in the treatment of burning mouth syndrome: A systematic review.

Burning mouth syndrome (BMS) is defined as an idiopathic orofacial pain with intraoral burning or dysesthesia. This systematic review aimed to analyze the scientific literature with regard to the effectiveness of placebo therapy in patients with BMS. A literature search was conducted through the PubMed-indexed journals within MEDLINE®, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Trip databases from their inception to May 31, 2022. The search terms were defined by combining (medical subject headings (MeSH) terms OR keywords) "burning mouth syndrome" AND (MeSH terms OR keywords) "placebo". Methodological quality assessments were performed utilizing the Joanna Briggs Institute (JBI) Critical Appraisal tool to attribute scores from 1 to 11 to the selected studies. The literature search, study selection and data extraction were carried out by 2 authors. Disagreements between the authors were resolved by the 3rd author, if necessary. A total of 44 articles met the inclusion criteria. After assessing full-text articles for eligibility, 20 articles were excluded. Consequently, 24 articles were retained. A total of 21 studies included in this systematic review had a low score of bias. In 13 studies, a positive response to placebo was noted. Among them, 7 showed a placebo response indistinguishable from active treatment. These changes were more pronounced in patients receiving placebo therapy compared to active treatment in 1 study. Placebo therapy may occasionally be beneficial and ethically acceptable for patients with BMS. To get stronger evidence for the use of a placebo, future studies with standardized methodology and outcomes are required.

Effectiveness of Pregabalin in Treatment of Burning Mouth Syndrome

Background and Objectives Burning mouth syndrome (BMS) is a chronic pain disorder involving a burning sensation of the oral cavity without any identifiable oral lesion. According to the recent studies, the pathogenesis of BMS is presumed to be caused by a neuropathic condition. Gabapentin and pregabalin have been used for various neuropathic pains, but pregabalin has several pharmacokinetic advantages over gabapentin. To our best knowledge, there are no recent studies reported on the administration of pregabalin in treating BMS in Korea. Therefore, in this study, we investigated the therapeutic effect of pregabalin in treating BMS.Subjects and Method We chose as candidates 33 patients diagnosed as BMS and took pregabalin for more than four weeks. Pregabalin was administered at 75 mg once a day for 2 to 4 weeks at first, and then the dose was modified depending on whether or not symptoms improved. Effectiveness of treatment was evaluated in the way that the patients subjectively answered whether or not symptoms were improved.Results A total of 21 (63.6%) out of 33 patients were responsive to the treatment. Among those, at the last follow-up, 8 patients (38.1%) showed slight improvement, and 13 patients (61.9%) showed mostly improvement or disappearance of symptoms. The average time interval from starting pregabalin to the first symptom improvement was 50.1 days, and most patients showed symptom improvement within 8 weeks.Conclusion This study concludes that pregabalin can be added as a meaningful option in the treatment of BMS. The additional double-blind clinical study should be followed to further prove the effectiveness of pregabalin.

Topical tretinoin treatment for burning mouth syndrome: a pilot study.

Burning mouth syndrome is an intraoral chronic pain condition characterized by a moderate to severe sensation of burning from the oral mucosa. No clinical signs are found and there is no efficient treatment. This pilot study included 10 women that were resistant to other previous treatments or noncompliant to systemic medications. Patients were asked to apply tretinoin gel 0.05% on their tongues twice daily for 14 days. Treatment effectiveness was assessed by completing a pre-study psychologic questionnaire and recording a daily wellbeing and pain log. Significant pain-score decrease in 50% of the patients (delta numerical rating score -3.15 ± 3.02, P value = .005) was recorded. This finding was in concordance with the verbal statements including major quality-of-life improvement (P value = .05), without any treatment positive or negative predictive factors. Topical tretinoin exhibits potential efficacy in patients with treatment resistant burning mouth syndrome and may also be used as a primary treatment modality.

Oral DiseasesEarly View ERRATUMFree Access First published: 26 June 2022 https://doi.org/10.1111/odi.14263AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In the article by Suga et al (1), the author comments to a Letter to the Editor should have been published as supporting information. The documents are now available in the online version of the article. We apologize for these errors. REFERENCE 1Suga, T., Tu, T. T. H., Nagamine, T., & Toyofuku, A. (2022). Careful use of clonazepam and alpha lipoid acid in burning mouth syndrome treatment. Oral Diseases, 28, 846– 847. https://doi.org/10.1111/odi.13776Wiley Online LibraryPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Burning Mouth Syndrome Treatment. A challenge to Evidence-Based Medicine

Burning Mouth Syndrome Treatment. A challenge to Evidence-Based Medicine

Efficacy of alpha-lipoic acid in patients with burning mouth syndrome compared to that of placebo or other interventions: a systematic review with meta-analyses.

Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène®, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0–10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

Essential oils utility implications in symptomatic Burning Mouth Syndrome

Introduction. Burning mouth syndrome (BMS) is a clinical condition characterized by the presence of chronic pain in absence of clinically visible lesions of the oral mucosa. The etiology is uncertain and the therapeutic strategies still controversial. The objective of this prospective study is to analyze the efficacy of essential oils-based mouthwashes in the therapy of BMS. Material and method. This study included 16 patients affected by BMS who were treated with essential oils-based mouthwashes and glucose solution on alternated days for 30 days. Symptomatology was evaluated after 15, 30 and 90 days. Results and discussions. A the end of the treatment, most of the patients (67%) referred an improvement of symptoms up to complete remission in 90 days. Conclusions. Based on this study, essential oils-based mouthwashes could represent a valid aid in the treatment of BMS. Further studies are necessary in order to identify effective and standardized therapeutic protocols. Keywords: Burning Mouth Syndrome; oral rinse; essential oils; therapeutic strategies,

Can the chokeberry juice be used as additional therapy for burning mouth syndrome in menopausal women?

The researchers’ aims were to evaluate the effects of chokeberry juice in the treatment of burning mouth syndrome (BMS) and oral discomfort in menopausal women. The following validated scales and questionnaires were used before and after treatment: questionnaire used for selection of research participants with xerostomia, the xerostomia inventory, Visual Analogue Scale (VAS), localization of pain before and after treatment, short-form McGill pain questionnaire. There was statistically significant decrease in number of research participants who felt pain after therapeutic procedure (p < 0.05). Chokeberry juice, as additional therapy for BMS, reduced intensity of characteristic types of pain sensations and oral dryness feeling.

The efficiency of alpha-lipoic acid in the treatment of burning mouth syndrome: a systematic review.

Burning mouth syndrome (BMS) is generally characterized by oral mucosa burning in the absence of any medical and dental reasons. The findings of previous studies or reviews are generally ambiguous. Therefore, the aim of this study was to review the findings of previous studies of randomized controlled trials (RCTs) for pain as evaluated by Visual Analogue Scales (VAS). VAS is a validated, subjective measure for acute and chronic pain MATERIALS AND METHODS: A search of PubMed/MEDLINE/ScienceDirect and Embase up to 2020. By following the criteria of exclusion and inclusion, the papers were examined and divided into two categories, one based on BMS and the other that used alpha-lipoic acid to treat BMS. The reviewed results were compared in terms of methodology, size of sample, outcomes, and results. Some studies showed positive results of using ALA to treat the BMS, but these findings need more improvements, and more investigations are required.

TDCS neuromodulation to enhance cognitive and proprioceptive treatment of Burning Mouth Syndrome

Abstract Background: Burning Mouth Syndrome is an idiopathic and multifactorial condition characterized by a severely painful burning sensation of the tongue and mucosal tissue of the mouth. Its pathophysiology may be associated with both psychogenic and neuropathic pathways, but the diagnosis is made clinically, after excluding other causes of oral pain. We present a pilot study with a 74-years-old female with a 2-year history of a painful sensation in the gums and palate accompanied with alternating sialorrhea and xerostomia, pain does not increase with palpation or movement. Treatment with NSAID's and opioids, topical clonazepam, alpha-lipoic acid, botulinum toxin and neuroleptics had not been successful. A protocol of non-invasive neuromodulation, cognitive therapy and oral proprioception exercises is proposed. Method: 10 sessions of 20 min 2mA anodal TDCS stimulation at the right dorsolateral frontal cortex with two concomitant treatments: 1) 20 min sessions of attention focused neurorehabilitation protocol. 2) Training for proprioceptive rehabilitation that was performed daily at home. Pain, cognitive and psychological measurements were performed. Results: Although no changes were observed in pain threshold and conditioned pain regulation objective assessment was not evidenced, significant improvements were observed in Brief pain inventory, Inventory of disability and craniofacial pain, Oral health Impact profile scale, Pain Catastrofism scale and Lans neuropathic assessment. Improvement in scores of Trail making test A and B measuring attention and processing speed was also evidenced. (Table 1). Conclusion: TDCS may be of great relevance in burning mouth syndrome treatment when combined with different approaches as cognitive and proprioception rehabilitation. The improvement in quality of life and pain perception may be independent of objective pain assessment improvement Keywords: BMS, Therapeutic Exercise, tDCS, Cognitive Rehabilitation

A systematic review of treatment for patients with burning mouth syndrome.

BackgroundBurning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments.AimThis review aimed to study the short- (≤3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects.Materials and methodsRandomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020).ResultsTwenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment.ConclusionA more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.Registration International Prospective Register of Systematic Reviews (PROSPERO):Protocol ID - CRD42020160892.