Psychiatric disorders in burning mouth syndrome

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

BACKGROUND

Burning mouth syndrome is a chronic pain syndrome mainly characterized by an intensive burning sensation of tongue. Previous studies have suggested that saliva/serum biomarkers in burning mouth syndrome might be associated with psychological disorders. The aim of systematic review was to observe whether the biomarkers in serum/saliva could be an alternative method to evaluate the psychological disorders in patients with burning mouth syndrome.

MATERIALS AND METHODS

The PubMed, Embase, and Cochrane Library databases were searched for papers published up to March 15, 2023. Risk of bias was measured by using the Newcastle-Ottawa Scale. RevMan was used for meta-analysis.

RESULTS

A total of 467 articles were screened, which of 12 studies were included. These studies collected 43 different biomarkers in saliva and 35 in serum. Of these biomarkers, only three (cortisol, α-amylase, and IL-6) were analyzed in two or more studies. Only salivary cortisol levels were significantly higher in the patient group compared to the controls (Mean Difference = 1.39; 95% CI [0.80-1.97]; p < 0.001). Moreover, cortisol might be relevant to psychological scores, especially anxiety.

CONCLUSION

Different papers have investigated salivary and serum biomarkers in burning mouth syndrome patients with controversial results. This meta-analysis showed that cortisol levels in saliva may be a potential biomarker to assess the psychological disorders in burning mouth syndrome patients.

Association of anxiety and depression with oral mucositis: A systematic review

OBJECTIVE

Anxiety and depression are frequent conditions among individuals undergoing antineoplastic therapy, but their relationship with oral mucositis is unclear. This systematic review evaluated the potential association of anxiety and depression with frequency and severity of chemo/radiotherapy-induced oral mucositis.

MATERIALS AND METHODS

Electronic searches were undertaken in five databases supplemented by manual scrutiny and gray literature searches in three other databases. The risk of bias was assessed using the Joanna Briggs Institute tool.

RESULTS

Eight observational studies conducted on 954 individuals (male-to-female ratio: 1.1:1; age range: six-82 years). Three (37.5%) studies included patients with solid tumors, two (25%) studies included hematopoietic/lymphoid tissue tumors, and two (25%) studies comprised mixed types of malignant neoplasms. Eight different instruments were used to assess oral mucositis, while seven different instruments were used to evaluate anxiety and depression. Associations of anxiety and/or depression with oral mucositis severity were reported in six (75.0%) studies. Oral mucositis-related symptoms, especially pain, were linked with depression in three (37.5%) studies.

CONCLUSION

A relatively low number of cases and data heterogeneity hamper definitive conclusion about the potential association between anxiety/depression and oral mucositis. Further studies that could guide more personalized treatments are warranted to investigate this plausible bidirectional interaction.

Exploring the Association of Burning Mouth Syndrome with Depressive and Anxiety Disorders in Middle-Aged and Older Adults: A Systematic Review

BACKGROUND

Burning Mouth Syndrome (BMS) is an idiopathic condition mainly affecting middle-aged and older individuals with hormonal disturbances or psychiatric disorders and is characterized by chronic pain. The etiopathogenesis of this multifactorial syndrome is largely unknown. The objective of the present systematic review was therefore to evaluate the relationship of BMS with depressive and anxiety disorders in middle-aged and older individuals.

METHODS

We selected studies evaluating BMS and depressive and anxiety disorders assessed with validated tools, published from their inception up to April 2023, using PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar databases and adhering to the PRISMA 2020 guidelines/PRISMA 2020 27-item checklist. This study is registered on PROSPERO (CRD42023409595). The National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies were used to examine the risk of bias.

RESULTS

Two independent investigators rated 4322 records against the primary endpoint and found 7 records meeting the eligibility requirements. Anxiety disorders were found to be the most common psychiatric disorders related to BMS (63.7%), followed by depressive disorders (36.3%). We found a moderate association of BMS with anxiety disorders, with multiple studies included (n = 7). Moreover, we found a low association of BMS with depressive disorders (included studies, n = 4). The role of pain appeared to be controversial in explaining these associations.

CONCLUSIONS

In middle-aged and older subjects, anxiety and depressive disorders may be potentially related to the development of BMS. Furthermore, also in these age groups, females showed higher risk of developing BMS than males, even when taking into account multimorbidity such as sleep disorders, personality traits, and biopsychosocial changes as suggested by study-specific findings.

Relationship of Depression, Anxiety, and Bipolar Disease with Burning Mouth Syndrome: A Nationwide Cohort Study

Burning mouth syndrome (BMS) is a chronic, painful condition of the oral mucosa. Although the pathogenesis remains unclear, psychological and neuroendocrine factors are considered the major contributors. Few longitudinal studies have investigated the effects of psychological factors on the occurrence of BMS. Therefore, we evaluated the risk of BMS in patients with affective disorders using a nationwide population-based cohort dataset. We identified patients with depression, anxiety, and bipolar disorder and then selected comparison participants using the 1:4 propensity score-matching method. We investigated the incidence of BMS events during the follow-up period using survival analysis, the log-rank test, and Cox proportional hazards regression models. After adjusting for other contributing conditions, the adjusted hazard ratio (HR) for developing BMS was 3.37 (95% confidence interval [CI]: 1.67-6.80) for depression and 5.09 (95% CI: 2.19-11.80) for anxiety; however, bipolar disorder showed no significant risk. Specifically, female patients with depression and anxiety had an increased risk of BMS. Moreover, patients with anxiety showed an increased adjusted HR of BMS events during the first 4 years after diagnosis, whereas patients with depression did not. In conclusion, depression and anxiety disorders are significantly associated with the risk of BMS. Additionally, female patients showed a significantly higher risk of BMS than male patients, and anxiety showed increased BMS events earlier than depression. Therefore, clinicians should consider the risk of BMS when treating patients with depression or anxiety.

Síndrome de boca ardiente, abordaje otorrinolaringológico. Revisión bibliográfica sistemática

Introducción y objetivo: El síndrome de boca ardiente (SBA) es una afección crónica, que cursa con quemazón o dolor de la mucosa bucal, afectando predominantemente a mujeres de edad media. Puede aparecer como cuadro primario o bien de forma secundaria. La fisiopatología de esta entidad es bastante desconocida. Existe un amplio abanico terapéutico, pero por lo general precisa de un abordaje multidisciplinar. Nuestra intención es realizar una puesta al día de la enfermedad para poder hacerla frente en la consulta de otorrinolaringología. Método: Revisión bibliográfica de la literatura. Fecha de publicación limitada de 2012 a 2022. Resultados: El SBA presenta una etiopatogenia de carácter multifactorial. Para su diagnóstico es necesario realizar una exhaustiva anamnesis y exploración. Se diferencian 3 tipos distintos de SBA, siendo el tipo II el más frecuente y el más refractario a la terapia. El adecuado tratamiento se fundamenta en un correcto diagnóstico y debe ser multidisciplinar. Discusión: Es importante resaltar que es una entidad benigna. Los tratamientos son variados y no hay ninguno que destaque sobre el resto, lo que dificulta el manejo de estos pacientes. Aunque la bibliografía sobre este síndrome es abundante, no se han producido en los últimos años, importantes innovaciones en cuanto a la etiología y tratamiento. Conclusiones: La anamnesis y los estudios de laboratorio son fundamentales para descartar casusas secundarias de la enfermedad. La terapia es diversa y debe incluir derivación a salud mental como parte del manejo multidisciplinar.  

White matter hyperintensities in Burning Mouth Syndrome assessed according to the Age-Related White Matter Changes scale

Background

White matter hyperintensities (WMHs) of the brain are observed in normal aging, in various subtypes of dementia and in chronic pain, playing a crucial role in pain processing. The aim of the study has been to assess the WMHs in Burning Mouth Syndrome (BMS) patients by means of the Age-Related White Matter Changes scale (ARWMCs) and to analyze their predictors.

Methods

One hundred BMS patients were prospectively recruited and underwent magnetic resonance imaging (MRI) of the brain. Their ARWMCs scores were compared with those of an equal number of healthy subjects matched for age and sex. Intensity and quality of pain, psychological profile, and blood biomarkers of BMS patients were further investigated to find potential predictors of WMHs. Specifically, the Numeric Rating Scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hamilton rating scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) were administered.

Results

The BMS patients presented statistically significant higher scores on the ARWMCs compared to the controls, especially in the right frontal, left frontal, right parietal-occipital, left parietal-occipital, right temporal and left temporal lobes (p-values: <0.001, <0.001, 0.005, 0.002, 0.009, 0.002, and <0.001, respectively). Age, a lower educational level, unemployment, essential hypertension, and hypercholesterolemia were correlated to a higher total score on the ARWMCs (p-values: <0.001, 0.016, 0.014, 0.001, and 0.039, respectively). No correlation was found with the blood biomarkers, NRS, SF-MPQ, HAM-A, HAM-D, PSQI, and ESS.

Conclusion

Patients with BMS showed a higher frequency of WMHs of the brain as suggested by the higher ARWCs scores compared with the normal aging of the healthy subjects. These findings could have a role in the pathophysiology of the disease and potentially affect and enhance pain perception.

Meine Zunge brennt! – Glossodynie/orofaziales Schmerzsyndrom

Die Glossodynie, die besser als orofaziales Schmerzsyndrom oder Burning-Mouth-Syndrom bezeichnet wird, stellt eine therapeutische Crux dar, da eine eindeutige Ätiopathogenese bisher nicht bekannt ist. Neuere Studien weisen auf einen Zusammenhang mit neuropathischen Veränderungen hin, außerdem sind Hinweise auf Komorbiditäten mit Depression, Angst und Karzinophobie evident. Diese sind zum Teil auch Folge der Erkrankung und nicht unbedingt als ursächlich anzusehen. Da eine vielfältige Differenzialdiagnostik durch klinische Untersuchungen ausgeschlossen werden sollte, ist die Glossodynie eine diagnostische Herausforderung. In Betracht kommen neben Lichen planus, Leukoplakien, Pemphigus vulgaris und Aphthen auch internistische Erkrankungen wie Diabetes oder Anämien oder Vitaminmangel und hormonelle Einflüsse bei den überwiegend älteren und überwiegend weiblichen Patienten. Metaanalysen über durchgeführte Therapiestudien zeigen einen niedrigen Evidenzgrad der vorhandenen randomisierten kontrollierten Studien (RCTs). Nach der Literatur werden v. a. Psychotherapie und Antidepressiva zur Behandlung vorgeschlagen. Alpha-Liponsäure als Nahrungsergänzung zeigt eine kurzfristige Besserung, und auch Low-Level-Lasertherapie scheint gewisse Effekte hervorzubringen.

Comparison of Clonazepam and Tongue Protector in the Treatment of Burning Mouth Syndrome

Background: BMS is a chronic pain syndrome affecting the oral mucosa. It consists of experiencing a burning or dysesthetic sensation. BMS prevalence varies, with up to 15% among women. An effective treatment is still unattainable. Material and Methods: A total of 60 patients with BMS qualified for a randomised trial, divided in two groups: the clonazepam-treated and tongue protector group. Treatment was provided for 4 weeks in both groups. In the former, the oral dosage of clonazepam 0.5 mg; in the latter, a tongue protector was used. Clinical oral examination was performed, and the presence of taste disorder and pain intensity, on the visual analogues scale, were recorded. Psychological domains were explored with the Beck depression inventory (depression), Athens insomnia scale (insomnia), Eyesenck personality questionnaire-revised (personality traits), and WHO quality of life questionnaire (quality of life). Results: Complete recovery was observed in three patients after clonazepam and one patient after tongue guard treatment. A greater improvement in the VAS scores, from baseline to the control values, was demonstrated in the clonazepam group, and it was statistically significant. In women, the level of depression significantly correlated with all domains of quality of life. Conclusions: BMS is an ongoing multi-specialist challenge. The development of new pathophysiological concepts of BMS offers hope for more effective treatment. Considering the influence of BMS on the quality of life and mental disorders in most patients, further research on the possibilities of therapy seems to be very important.

The use of self-report questionnaires in an analysis of the multidimensional aspects of pain and a correlation with the psychological profile and quality of life in patients with Burning Mouth Syndrome: a case control study

Background

The symptomatology in Burning Mouth Syndrome (BMS) is complex and it should be considered in accordance with a biopsychosocial model.

Objectives

To evaluate the multidimensional aspects of pain with a complete battery of tests and to analyse its relationship with potential predictors such as mood disorders, sleep and quality of life.

Methods

Forty patients with BMS versus an equal number of age and sex‐matched healthy controls were enrolled. The VAS, SF‐MPQ, BPI, PD‐Q, BDI‐II, STAI, PSQI, ESS, SF‐36 and OHIP‐14 were administered.

Results

The scores of the VAS, SF‐MPQ, BPI, PD‐Q, BDI‐II, STAI, PSQI, SF‐36 and OHIP‐14 were statistically significantly higher in the BMS patients than the controls (p < .001**). A strongly linear correlation between pain (VAS, SF‐MPQ, BPI and PD‐Q) and disease onset (STAI, BDI‐II, PSQI and sub‐items of SF‐36 and OHIP‐14) was found. In the multiple regression analysis, the contributions of the BDI‐II and OHIP‐14 were found to be statistically significant with the SF‐MPQ, PD‐Q and BPI in terms of severity and interference, while the contributions of the STAI and sleep were found to be statistically significant with the SF‐MPQ and BPI in terms of severity and interference, respectively.

Conclusions

Pain tests are differently correlated with mood and quality of life. Therefore, a complete analysis of the patient requires several tools to better understand the multidimensional aspects of pain in BMS.

Topical clonazepam for burning mouth syndrome: Is it efficacious in patients with anxiety or depression?

BACKGROUND

Burning mouth syndrome (BMS) is a chronic disorder characterised by pain in the oral cavity without clinically evident causative lesions. The aetiology of this condition is poorly understood, and treatment can be challenging.

METHOD

A retrospective review of the medical records of 82 patients with BMS was performed. Data on demographics, BMS associated symptoms, symptoms' intensity score (NRS: 0-10) and response to treatment with topical clonazepam were extracted from clinical notes based on a standardised clinical questionnaire. Differences in the symptoms' intensity score between patients with or without concomitant anxiety/depression or systemic psychogenic medication use were analysed using the Wilcoxon signed rank test.

RESULTS

Among the entire cohort, the median symptoms' intensity score at baseline was 4.5 and 3.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI). Among the subjects with anxiety/depression and those who were prescribed systemic psychogenic medications, the median symptoms' intensity score at baseline was 5.0 and 3.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI). Among those without anxiety/depression, the symptoms' intensity score at baseline was 4.0 and 2.0 at first follow-up, a statistically significant improvement (p < .05; 95% CI). The median symptoms' intensity score for those who were not on any psychogenic medications at baseline was 4.0 and 2.0 at first follow-up, a statistically significant improvement (p < .001; 95% CI).

CONCLUSIONS

Clinicians are encouraged to prescribe topical clonazepam for BMS regardless of concomitant use of systemic psychogenic medications or comorbid mood disorders as it is an efficacious management approach in the presence or absence of these potentially complicating factors.

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.

Differences in personality, perceived stress and physical activity in women with burning mouth syndrome compared to controls

OBJECTIVES

Burning mouth syndrome (BMS) is a long-lasting pain condition which is commonly associated with anxiety symptoms and experience of adverse, stressful life events have been reported by those diagnosed with the syndrome. Stress-related biomarkers have been related to personality traits in BMS and a personality with high stress susceptibility and perceived stress may be of importance. Although biopsychosocial approaches are suggested to manage long-lasting orofacial pain, to date little is known about physical activity in women with BMS. The aim of this study was to investigate if personality, perceived stress and physical activity distinguish women with BMS from controls.

METHODS

Fifty-six women with BMS and 56 controls matched on age and gender completed Swedish universities Scales of Personality (SSP), Perceived Stress Questionnaire (PSQ) and a general questionnaire with an item on weekly physical activity frequency. In addition, health-related quality of life was explored by additional questionnaires and reported in a companion article (Jedel et al. Scand J Pain. 2020. PubMed PMID: 32853174).

RESULTS

SSP subscales Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Verbal Trait Aggression differed between women with BMS and controls and the personality factor scores for Neuroticism and Aggressiveness were higher. Perceived stress measured by PSQ index was higher for women with BMS compared to controls. Women with BMS reported lower physical activity frequency compared to controls and those reporting physical activity <4 days/week scored higher on PSQ compared to those with weekly physical activity ≥4 days/week.

CONCLUSIONS

Personality distinguished women with BMS from controls in this study. Perceived stress was higher and weekly physical activity was lower in women with BMS compared to controls. Our findings suggest physical activity should be more comprehensively measured in future BMS studies and, by extension, physical activity may be a treatment option for women with BMS. Pain management aiming to restore function and mobility with stress reduction should be considered in clinical decision making for women with BMS who have a personality with stress susceptibility, especially if reporting high perceived stress and insufficient physical activity.

Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome

BACKGROUND

Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders.

OBJECTIVES

To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL.

METHODS

A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL.

RESULTS

Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity.

CONCLUSIONS

A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.

Personality Traits in Burning Mouth Syndrome Patients With and Without a History of Depression

Objectives: So far, the strong link between neuroticism, chronic pain, and depression has been well-documented in literatures. Some suggested that they might share etiological factors, thus resulting in overlapping constructs. However, such effect has never been tested in burning mouth syndrome (BMS) patients, a complex phenomenon influenced by both neuropathic and psychopathological factors. We aim to clarify how personality affects individual's pain and pain-related experiences. Methods: Two hundred forty-eight patients with BMS provided demographic information and psychiatric history; completed Ten-Item Personality Inventory, a Visual Analog Scale of pain, and McGill Pain Questionnaire; and provided adequate parameters of depressive state, catastrophizing thinking, and central sensitization. Results: BMS patients with depression history suffered more severe clinical symptoms and scored higher in neuroticism and less in openness and extraversion than did those without psychiatric diagnoses. After age, sex, and duration of pain were controlled, neuroticism in BMS patients with depression correlates with affective dimension of pain. Instead, if psychiatric history is absent, neuroticism correlates with sensory dimension and pain intensity. In both groups, higher neuroticism, unlike other personality facets, contributed to a more severe clinical condition. Conclusion: Of the five traits, neuroticism appears to be the most crucial dimension associated with the pain symptoms and patient's conditions. This study implies that management of pain must extend beyond solely providing pain-relieving medication and must require a holistic and multidisciplinary approach.

Burning mouth syndrome: An update

Background:

Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended.

Aim:

To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients.

Conclusion:

As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.

Global research trends in complex oral sensitivity disorder: A systematic bibliometric analysis of the structures of knowledge

OBJECTIVES

A systematic bibliometric analysis of the structure of knowledge was performed to investigate the co-word analysis, the co-citation analysis, and the social network analysis regarding complex oral sensitivity disorder (COSD).

METHODS

Web of Science database from 1985 to 2018 was systematically searched to identify all relevant articles using the MeSH terms "complex oral sensitivity disorder" and all synonyms used in the literature. We included original articles, review articles, letters to the editor, and book chapters in the English language and in 27 different ISI categories of medical sciences. Several bibliometric indicators were used.

RESULTS

The co-word analysis identified 741 KeyWords Plus (KWP) grouped into 4 different clusters. The terms "pain," "management," "prevalence," and "efficacy" reached the highest centrality, whereas the top 10 KWP had a frequency of 7%-29% in 443 articles. Over a period of 32 years, a complex thematic evolution occurred, going from 2 to 6 different themes, and the KWP migration rate from one cluster to another ranged from 11% to 100%. The co-citation network analysis based on the complete reference list (5932 references) of 443 articles identified only 2 clusters for journals, authors, and articles. The most prominent co-cited journal was "Oral Surgery Oral Medicine Oral Pathology" (centrality: 171.75), the most co-cited author was "Grushka M" (centrality: 330.95), and the most co-cited article was "Grushka M. Oral Surg Oral Med Oral Pathol (1987) 63:30-36" (centrality: 269.79). On the other hand, the direct citation network revealed that "Scala A et al, 2003" reached both the highest global citation score (GCS = 231) and local citation score (LCS = 161). Lastly, the social network analysis revealed an isolated collaboration among groups of authors, or countries or institutions. The worldwide collaboration analysis indicated that United States-Israel and United Kingdom-Italy were the most collaborative countries.

CONCLUSIONS

The structure of knowledge of publications on COSD revealed that research in this field has been dominated by few core topics and a limited collaboration among authors and institutions from different countries. More multicenter studies on COSD are warranted in the near future when launching new projects.

The Complaints, Type, and Severity of Stressful Events in Patients with Burning Mouth Syndrome Referring to Zahedan School of Dentistry, Iran

Introduction

Burning mouth syndrome (BMS) is a burning sensation in oral mucosa without visible lesions in clinical examinations. The present study aimed at comparing complaints, frequency, type, and severity of stressful events between patients with BMS and healthy individuals referred to Zahedan School of Dentistry, Zahedan, Iran.

Materials and Methods

In the present study, 30 patients with BMS were matched with controls by age and gender after enrollment. The Holmes-Rahe questionnaire and the complaint registration form were used to compare the frequency of complaints, and the type and severity of stressful events between the groups. Data were analyzed by descriptive statistics, Chi-squared and t-tests.

Results

The mean age of the subjects in the case and control groups was 40.13 ± 2.30 and 40.07 ± 2.31 years, respectively. The obtained results showed no statistically significant difference between the groups in terms of mean age and gender distribution (P>0.05). The results of the Chi-squared test showed a significant difference in the frequency of complaints between the two groups (P<0.001). The t-test results indicated that the average severity of complaints and the average severity of stressful events were significantly different between patients with BMS and controls (P<0.001). The results of Chi-squared test revealed that the mean frequency of complaints (P<0.001) and mean frequency of stressful events (P<0.001) were significantly different between the two groups.

Conclusions

Based on the study results, the frequency of complaints, and the type and severity of stressful events were significantly different between patients with BMS and healthy individuals referred to the clinic of Zahedan School of Dentistry.

Evaluation of the effectiveness of crocin isolated from saffron in treatment of burning mouth syndrome: A randomized controlled trial

Objective

Burning mouth syndrome (BMS) is a debilitating disorder with few limited treatment modalities. Because of the proven association between BMS symptoms, and depression and anxiety, treatment modalities that alleviate the two latter etiologic factors can be clinically effective. Thus, owing to the antidepressant and potential analgesic effects of crocin (as an active constituent of saffron), the present study was performed to compare the effect of crocin and citalopram (as control) on BMS symptoms and depression/anxiety in patients with BMS.

Materials and Methods

The present double-blind randomized clinical trial was carried out on BMS patients. Patients were randomly divided into citalopram (n=21) and crocin (n=26) groups and treated for 11 weeks. BMS symptoms (based on Visual Analysis Scale (VAS)), as well as anxiety and depression (based on Hamilton questionnaire) were evaluated at baseline and during the treatment period. Mann-Whitney, Chi-Square test, Independent t-test, Friedman, and Spearman correlation were employed for statistical analysis.

Results

Our findings showed a significant effect for crocin on the severity of BMS symptoms, anxiety and depression in BMS patients.

Conclusion

Crocin can be considered for treatment of BMS subjects with concurrent anxiety and/or depression.

Psychological factors in oral mucosal and orofacial pain conditions

The psychological aspects of chronic pain conditions represent a key component of the pain experience, and orofacial pain conditions are not an exception. In this review, we highlight how psychological factors affect some common oral mucosal and orofacial pain conditions (namely, oral lichen planus, recurrent aphthous stomatitis, burning mouth syndrome, and temporomandibular disorders) with emphasis on the significance of supplementing classical biomedical treatment modalities with appropriate psychological counseling to improve treatment outcomes in targeted patients. A literature search restricted to reports with highest relevance to the selected mucosal and orofacial pain conditions was carried out to retrieve data.

Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review

Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.

Oral medicine psychiatric liaison clinic: study of 1202 patients attending over an 18-year period

Patients with orofacial pain and discomfort often suffer from psychiatric disorders. However, few studies involving a large sample have examined the diagnostic results of patients with orofacial pain or discomfort in relation to psychiatric disorders. The purpose of this study was to summarize and clarify the characteristics and demographic data of 1202 patients attending the psychiatric liaison clinic at Aichi Gakuin University Hospital. Psychiatric diagnosis was performed by psychiatrists for all patients, based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Among the 1202 patients, 992 (82.5%) were female. The average age of the patients was 57.2±15.0years. The predominant broad categories of orofacial pain and discomfort seen were burning mouth syndrome (n=484, 40.3%), persistent idiopathic facial pain (n=258, 21.5%), and oral dysesthesia (n=215, 17.9%). The predominant broad categories of psychiatric diagnoses seen were somatic symptoms and related disorders (n=934, 77.7%) and depressive disorders (n=76, 6.3%). Among the 934 patients with somatic symptoms and related disorders, 678 had a somatic symptom disorder with predominant pain. The results confirmed that most patients with orofacial pain and discomfort were middle-aged and elderly women suffering from a somatic symptom disorder with predominant pain.

Psycho-stomatodynia

Introduction:Burning mouth syndrome is an enigmatic condition whose etiopathogenic origin remains largely unknown and whose treatment remains unsatisfactory. It is often considered to be of “psychosomatic” origin, and this etiology is frequently reported in the French medical literature.Corpus:This narrative review examines the arguments supporting this point of view, in its historical, clinical, and therapeutic aspects, in order to shed light on the patientʼs point of view.Conclusion:The etiopathogenic uncertainty does not let us give the patient an erroneous conception of the affliction.

Psychological problems and quality of life of patients with oral mucosal diseases: a preliminary study in Chinese population

BACKGROUND

Psychological problems might play important roles in oral mucosal diseases such as recurrent aphthous ulcers (RAU), oral lichen planus (OLP), burning mouth syndrome (BMS), but the relevance to patients' quality of life remained controversial. The aim of this study was to investigate the psychological problems and oral health-related quality of life in patients with RAU, OLP, and BMS in China, to assess the relationship between psychological problems and quality of life.

METHOD

Thirty-nine RAU patients, 45 OLP patients, 15 BMS patients and 45 healthy controls were enrolled in the study. Hospital Anxiety and Depression Scale (HADS) were chosen to analyze the patients' psychological problems. Oral Health Impact Profile (OHIP-14) was used to measure the OHRQoL. The scores of HADS and OHIP-14 were used to analyze the relationship between psychological problems and the quality of life of oral mucosa patients.

RESULTS

Each of OHIP-14 scores and HADS scores in RAU, OLP, BMS was higher than the control group, and there was significant difference in the patients groups with the control cases(P < 0.05). OHIP-14 score of RAU was the highest in three patient groups. Its OHRQoL was lowest in the three groups, which had statistical significance (P < 0.05). Positive correlations existed between the psychological problems and the quality of life of the three patient groups (rs > 0, P < 0.05), except for the depression of the BMS group (rs = 0.168, P = 0.395).

CONCLUSION

Patients with oral mucosal diseases such as RAU, OLP, and BMS had higher levels of anxiety, depression, and lower quality of life. The patient's psychological problems were related to their quality of life, suggesting that the psychological state of patients with oral mucosal disease need more attention.

Changes in the vibration sensitivity and pressure pain thresholds in patients with burning mouth syndrome

OBJECTIVE

To investigate the presence of changes in vibration detection and pressure pain threshold in patients with burning-mouth syndrome (BMS).

DESIGN OF THE STUDY

Case-control study. The sample was composed of 30 volunteers, 15 with BMS and 15 in the control group. The pressure-pain threshold (PPT) and vibration-detection threshold (VDT) were examined. The clinical evaluation was complemented with the McGill Pain Questionnaire (MPQ), Douleur Neuropathique 4 (DN4) and Beck Depression and Anxiety Inventories (BDI and BAI, respectively).

RESULTS

BMS subjects showed a statistically significant higher PPT in the tongue (p = 0.002), right (p = 0.001) and left (p = 0.004) face, and a significant reduction of the VDT in the tongue (p = 0.013) and right face (p = 0.030). Significant differences were also found when comparing the PPT and the VDT of distinct anatomical areas. However, a significant interaction (group × location) was only for the PPT. BMS subjects also showed significantly higher levels of depression (p = 0.01), as measured by the BDI, compared to controls; and a significant inverse correlation between the VDT in the left face and anxiety levels was detected.

CONCLUSIONS

The study of somatosensory changes in BMS and its correlations with the clinical features as well as the levels of anxiety and depression expands current understanding of the neuropathic origin and the possible contribution of psychogenic factors related to this disease.

Clinical characterization of women with burning mouth syndrome in a case-control study

OBJECTIVE

Burning mouth syndrome (BMS) is a chronic orofacial pain disorder that is defined by a burning sensation in the oral mucosa. The aim of this study was to investigate the underlying factors, clinical characteristics and self-reported oral and general health factors associated with BMS.

MATERIAL AND METHODS

Fifty-six women with BMS (mean age: 67.7) and their age-matched controls were included in the study. A general questionnaire, an OHRQL index and BMS-specific questionnaires were used. Each subject underwent an oral examination.

RESULTS

The mean severity of the BMS symptoms (VAS, 0-100) was 66.2 (SD 19.7). Overall, 45% of the patients reported taste disturbances. More of the patients than the controls rated their general health, oral health and life situation as 'less satisfactory'. The patients also reported more frequently on-going medications, diseases/disorders, xerostomia, allergy and skin diseases. Except for more bruxofacets among the patients, there were no significant differences regarding signs of parafunction. In a multiple logistic regression analysis, xerostomia and skin diseases showed the strongest prediction for BMS and no significant effect was found for medication, allergy or bruxofacets.

CONCLUSIONS

Skin diseases and xerostomia but not parafunction were strongly associated with BMS. Our findings provide the basis for additional studies to elucidate the causal factors of BMS.

Comparison of Risk Factors in Patients With Acute and Chronic Orofacial Pain

Management of patients with orofacial pain may benefit from a better understanding about patient factors that may lead pain chronicity. In this study, we retrospectively compared physical and psychological factors in patients with acute and chronic orofacial pain. We analyzed data from 854 patients presenting to the Orofacial Pain Center, Department of Dental Anesthesiology, Tokyo Dental College, Suidobashi Hospital between April 2010 and March 2014. We categorized patients into the acute group if their condition had persisted <6 months and the chronic group if their condition had lasted 6 months or longer, based on the classification by the International Association for the Study of Pain. The retrospective data were analyzed by using univariate analysis on background factors from a health questionnaire, pain evaluation sheet, and psychological test completed at the time of presentation. Multiple logistic regression was applied on these factors. Our results suggest that female gender and high trait anxiety may be involved in orofacial pain becoming chronic.

Patients with Psychiatric Disorders: What the General Dental Practitioner Needs to Know

Psychiatric illness is extremely common and the general dental practitioner (GDP) will inevitably encounter patients with such an illness. This article outlines common psychiatric conditions that the GDP should be familiar with alongside its impact on oral health. It also gives a systematic approach to dealing with a patient who presents to practice with an undiagnosed psychiatric illness, whereby the illness interferes with delivery of suitable dental care.

Comparison of Salivary Cortisol and α-amylase Levels and Psychological Profiles in Patients with Burning Mouth Syndrome

PURPOSE

The aim of the study was to compare salivary cortisol and α-amylase levels and psychological profiles in patients with burning mouth syndrome (BMS) and healthy subjects.

METHODS AND MATERIALS

Spitting method was used to collect unstimulated salivary. Salivary cortisol and α-amylase levels were determined using ELISA and the Caraway starch-iodine technique. SLC-90 questionnaire was used to determine the psychological profiles.

RESULTS

The difference between mean of salivary cortisol levels in patients with BMS and in healthy subjects was not significant (4.50 ± 3.68 ng/mL vs. 3.69 ± 3.07 ng/mL, p = 0.377). The difference between mean of α-amylase levels in the BMS patients and healthy subjects was significant (351.68 ± 142.5 and 146.22 ± 130.4, p = 0.001). Note that, 83.4% and 18% of the patients in the case and control groups had psychological problems (p = 0.001).

CONCLUSION

The results showed higher salivary levels of cortisol and α-amylase in patients with BMS compared to healthy individuals. Psychological problem was prevalent in patients.

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

OBJECTIVES

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.

MATERIALS AND METHODS

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

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).

CLINICAL RELEVANCE

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.

Role of psychological factors in burning mouth syndrome: A systematic review and meta-analysis

Background

Burning mouth syndrome (BMS) is a chronic medical condition characterised by hot, painful sensations in the lips, oral mucosa, and/or tongue mucosa. On examination, these appear healthy, and organic causes for the pain cannot be found. Several studies have yielded scant evidence of the involvement of psychological and/or psychopathological factors, and several have outlined a model for the classification of BMS.

Aim

This review aims to provide a systematic review of research examining the psychological, psychiatric, and/or personality factors linked to BMS.

Findings

Fourteen controlled studies conducted between 2000 and the present were selected based on stringent inclusion/exclusion criteria. All studies but one reported at least some evidence for the involvement of psychological factors in BMS. Anxiety and depression were the most common and the most frequently studied psychopathological disorders among BMS patients.

Discussion and conclusion

Anxiety and depression play critical roles in this condition. Evidence on the role of personality characteristics of BMS patients has also been produced by a few studies. Further studies on the role of specific psychological factors in BMS are warranted, but the importance of a multidisciplinary approach (medical and psychological) to BMS is no matter of discussion.

Primary Burning Mouth Syndrome: A Questionnaire Study of Neuropathic and Psychological Components

BACKGROUND

The pathophysiology of primary burning mouth syndrome (BMS) is extensively debated but poorly understood.

OBJECTIVE

The aim of the study was to evaluate neuropathic and psychological components of BMS in patients with primary BMS.

METHODS

Subjects were recruited through a consultation dedicated to mouth diseases, during which a diagnosis of primary BMS was assessed. Patients answered the abbreviated Douleur Neuropathique 4 questionnaire (DN4i), the Hospital Anxiety and Depression Scale (HADS) and the questionnaire de la douleur de Saint-Antoine (QDSA), the French version of the McGill pain questionnaire.

RESULTS

Thirty-five patients with primary BMS were included in the study: 31 % of them had a DN4i score in favour of neuropathic pain and 34.3 % had a HADS overall score in favour of anxiety and depressive disorder.

CONCLUSION

Both physiological and psychological aspects of BMS need to be actively investigated by clinicians to successfully manage these patients. The physiological and psychological aspects are not mutually exclusive. The DN4i and the HADS are easy-to-use tools and could be used in an initial assessment of BMS patients.

Burning mouth syndrome: Current concepts

Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.

Burning Mouth Syndrome: A Review of the Etiopathologic Factors and Management

Burning mouth syndrome (BMS) is characterized by pain in the mouth with or with no inflammatory signs and no specific lesions. Synonyms found in literature include glossodynia, oral dysesthesia, glossopyrosis, glossalgia, stomatopyrosis, and stomatodynia. Burning mouth syndrome generally presents as a triad: Mouth pain, alteration in taste, and altered salivation, in the absence of visible mucosal lesions in the mouth. The syndrome generally manifests spontaneously, and the discomfort is typically of a continuous nature but increases in intensity during evening and at night. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. The differential diagnosis requires the exclusion of oral mucosal lesions or blood test alterations that can produce burning mouth sensation. Management is always based on the etiological agents involved. If burning persists after local or systemic conditions are treated, then treatment is aimed at controlling neuropathic symptoms. Treatment of BMS is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. The aim of this review was to discuss several aspects of BMS, update current knowledge, and provide guidelines for patient management.

Individual oral symptoms in burning mouth syndrome may be associated differentially with depression and anxiety

BACKGROUND

Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms.

OBJECTIVE

In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms.

METHODS

Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised).

RESULTS

Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores.

CONCLUSION

Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

Temperament and character profiles of patients with burning mouth syndrome

OBJECTIVE

Burning mouth syndrome (BMS) is a chronic disease in which patients feel a burning sensation and pain in the oral cavity. Although personality traits have been suggested to influence the development and course of BMS, they have not yet been examined in detail. We therefore investigated the personality traits of BMS patients.

METHODS

Sample consisted of 65 BMS patients presenting to the Aichi-Gakuin Dental School Hospital between May 2005 and April 2009. They were also diagnosed as having pain disorder by a psychiatrist. The control group consisted of 116 healthy subjects. The Temperament and Character Inventory (TCI) was used to evaluate personality traits, while the Beck Depression Inventory (BDI) was used to evaluate the depression rate in both groups.

RESULTS

In TCI, we found that, in comparison to the control group, the novelty seeking score was significantly lower (p = 0.009), the harm avoidance score was significantly higher (p < 0.001), and the self-directedness score was significantly lower (p = 0.039) in the BMS group. To remove the influence of depression, we performed an analysis of covariance of each TCI item using the BDI score as a covariate. No significant differences were observed in harm avoidance or self-directedness, whereas the differences noted in novelty seeking were significant (p = 0.008).

CONCLUSION

The novelty seeking score was low in BMS patients in comparison to the control group. They also had high harm avoidance and low self-directedness tendencies, but these were attributed to the influence of depression.