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Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Shein SS, Tumanov AV, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent differences in the genomic profile of lingual sensory neurons in naïve and tongue-tumor bearing mice. Sci Rep 2023; 13:13117. [PMID: 37573456 PMCID: PMC10423281 DOI: 10.1038/s41598-023-40380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: (1) FACS sorting obtained higher number of neurons from female trigeminal ganglia (TG) compared to males; (2) Naïve female neurons innervating the tongue expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. (3) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. (4) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, (5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
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Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Li-Ju Wang
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Sergey S Shein
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Alexei V Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Zhao Lai
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Tumanov A, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent Differences in the Genomic Profile of Lingual Sensory Neurons in Naïve and Tongue-Tumor Bearing Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.14.524011. [PMID: 36711730 PMCID: PMC9882171 DOI: 10.1101/2023.01.14.524011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: 1) Tongue tissue of female mice was innervated with higher number of trigeminal neurons compared to males; 2) Naïve female neurons innervating the tongue exclusively expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. 4) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. 3) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, 5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
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Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Li-Ju Wang
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Alexei Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, USA
| | - Zhao Lai
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
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Abstract
: Burning mouth syndrome (BMS) is a condition that remains a diagnostic challenge and is frequently difficult to treat. Rather than being a singular entity, more recent research has suggested that the diagnosis of BMS encompasses a family of syndromes. Of this family, type 3 has been identified as being related to contact dermatitis. Although this subtype has been most commonly associated with dental allergens, several food, cosmetic, and pharmaceutical products have also been identified as allergens related to the onset of BMS. Failure to identify these allergens prevents timely diagnosis and initiation of treatment for patients with BMS related to contact dermatitis. This article identifies the allergens most relevant to this type 3 and describes the commercially available allergy panels needed to ensure that all relevant allergens are included during patch testing. This study also describes approaches to diagnosis of BMS and discusses approaches to treatment based on subtypes of the condition.
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Characterization of sensory neuronal subtypes innervating mouse tongue. PLoS One 2018; 13:e0207069. [PMID: 30408082 PMCID: PMC6224080 DOI: 10.1371/journal.pone.0207069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
The tongue is uniquely exposed to water-soluble environmental chemicals that may lead to injury or tumorigenesis. However, comparatively little research has focused on the molecular and functional organization of trigeminal ganglia (TG) afferent neurons innervating the tongue. The current study identified and characterized lingual sensory neurons based on a neuronal subtype classification previously characterized in the dorsal root ganglion (DRG) neurons. We employed immunohistochemistry on transgenic reporter mouse lines as well as single-cell PCR of known markers of neuronal subtypes to characterize neuronal subtypes innervating the tongue. Markers expressed in retrogradely labeled TG neurons were evaluated for the proportion of neurons expressing each marker, intensity of expression, and overlapping genes. We found that tongue-innervating sensory neurons primarily expressed CGRP, TRPV1, TrkC, 5HT3A and Parvalbumin. These markers correspond to peptidergic and a subgroup of non-peptidergic C-nociceptors, peptidergic A nociceptors, proprioceptors and myelinated low-threshold mechanoreceptors (LTMRs). Interestingly, as reported previously, we also found several differences between TG and DRG neurons indicating the need for single-cell sequencing of neuronal types based on tissue type within all TG as well as DRG neurons.
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Abstract
Primary burning mouth syndrome (BMS) is an oral mucosal disorder that is characterized by a chronic and often debilitating intraoral burning sensation for which no localized or systemic cause can be found. BMS most commonly affects postmenopausal women. The pathophysiology of primary BMS is not well understood. Diagnosing BMS can prove to be challenging. BMS patients can also pose a therapeutic challenge to clinicians who are consulted to evaluate these patients. Most commonly used therapies include tricyclic antidepressants, α-lipoic acid, clonazepam, and cognitive-behavioral therapy. Clinical judgment, patient counseling, and monitoring of pain are important. Further research is required to assess the effectiveness of serotonin and newer serotonin-noradrenalin reuptake inhibitors.
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Affiliation(s)
- Siamak Moghadam-Kia
- Department of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nasim Fazel
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, CA.
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Is it Sjögren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:482-495. [PMID: 28283095 DOI: 10.1016/j.oooo.2017.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
Sjögren's syndrome (SS) and burning mouth syndrome (BMS) typically occur in postmenopausal women. Although these conditions have significantly different etiopathogeneses, patients with SS or BMS often present with analogous oral complaints. The similarities between the two conditions have led to considerable confusion on the part of medical and dental practitioners, and those with BMS or SS often wait years to receive a diagnosis. Therefore, it is imperative for clinicians to understand the characteristic subjective and objective features of each disease and how these can be used to distinguish them. This review will discuss the proposed etiology, clinical manifestations, histopathology, diagnostic criteria, and patient management of SS and BMS. We also identify key differences between the two pathoses that aid in establishing the correct diagnosis. Recognition of the defining features of each condition will lead to reduced time to diagnosis and improved patient management for these poorly understood conditions.
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Lewis AK, Prime SS, Cohen SN. An overview of burning mouth syndrome for the dermatologist. Clin Exp Dermatol 2016; 41:119-23. [PMID: 26871710 DOI: 10.1111/ced.12808] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
Abstract
Burning mouth syndrome is characterized by an idiopathic burning pain affecting the oral mucosa, with no clinically apparent changes. It can present to a variety of health professionals including dermatologists. This article summarizes the important aspects of the condition, including theories of pathogenesis, diagnosis and management.
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Affiliation(s)
- A K Lewis
- Department of Oral and Dental Science, University of Bristol, Bristol, UK
| | - S S Prime
- Department of Oral and Dental Science, University of Bristol, Bristol, UK
| | - S N Cohen
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Spierings ELH, Mulder MJHL. Persistent orofacial muscle pain: Its synonymous terminology and presentation. Cranio 2016; 35:304-307. [PMID: 27776466 DOI: 10.1080/08869634.2016.1248591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of the present paper is to describe the presentation of persistent orofacial muscle pain, also commonly referred to as myofascial temporomandibular disorder. METHODS In this practice survey, the authors reviewed the demographic and clinical features of 34 patients who were evaluated and diagnosed personally. RESULTS The majority of the 34 patients were women (82.4%), and their age at consultation averaged 44.6 ± 12.6 (SD) years. The median pain duration was 4.0 years (range: 0.2-34 years). In 97.1% of patients, the pain occurred daily and continuously, and in 51.9% it was unilateral. Chewing or eating made the pain worse in 50% of the patients, and talking in 29.4%. On examination, tightness of the masseter muscle(s) was present in 58.8%, and tenderness in 58.8%. CONCLUSIONS Persistent orofacial muscle pain mostly affects women, generally occurs daily and continuously, and is equally often unilateral and bilateral. Chewing, eating, and talking are the most common aggravating factors, and tightness or tenderness of the masseter muscle(s) is often found on examination.
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Affiliation(s)
- Egilius L H Spierings
- a Department of Neurology and Craniofacial Pain Center , Tufts University Schools of Medicine and Dental Medicine , Boston , MA , USA
| | - Maxim J H L Mulder
- b Department of Neurology , Erasmus Medical Center , Rotterdam , The Netherlands
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12
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Abstract
There are many etiologic factors to consider in a patient who presents with symptoms or sensations of a sore burning mouth. These range from local causes within the oral cavity to underlying systemic disease, including psychologic factors. This paper aims to describe the different clinical presentations and to outline a systematic approach to the evaluation and management of such patients. The clinician will be directed to the relevant diagnosis by following the traditional medical model of taking a focused history, performing a thorough clinical examination, considering the potential differential diagnoses, and requesting pertinent and appropriate investigations. The various differential diagnoses and broad treatment options will also be discussed and outlined. This paper will not, however, discuss burning mouth syndrome (oral dysesthesia), which is a diagnosis of exclusion, whereby the oral mucosa is clinically normal and there are no identifiable medical or dental causes to account for the patient's symptoms.
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Affiliation(s)
- John C Steele
- Department of Oral Medicine, Leeds Dental Institute and School of Dentistry, The Leeds Teaching Hospitals NHS Trust/University of Leeds, Leeds, UK.
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Ching V, Grushka M, Darling M, Su N. Increased prevalence of geographic tongue in burning mouth complaints: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:444-8. [PMID: 22901641 DOI: 10.1016/j.oooo.2012.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 04/09/2012] [Accepted: 04/11/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The objective of this study was to assess the frequency of geographic tongue and fissured tongue (GFT) in patients with burning mouth syndrome (BMS). Our hypothesis was that benign soft tissue changes to the tongue, such as GFT, are associated with BMS. STUDY DESIGN Retrospective review of 161 patients with BMS and 87 TMJ dysfunction cases as control. Frequency of GFT and demographics for both groups was assessed. RESULTS In the BMS group, 26.7% of the subjects were diagnosed with GFT, whereas in the control group, 11.5% had GFT (P < .05). In the subgroup of BMS with GFT, the male-to-female ratio was approximately 1:2, whereas the male-to-female ratio of those with BMS and no GFT was approximately 1:5 (P < .05). CONCLUSIONS Our results demonstrate a higher than expected prevalence of GFT among patients with BMS compared with a control group of patients with TMJ. In males, GFT may be a significant predictor for BMS.
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Affiliation(s)
- Victor Ching
- Department of Nursing, Faculty of Health, York University, Toronto, Ontario, Canada
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16
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Gavrilovic IT, Balagula Y, Rosen AC, Ramaswamy V, Dickler MN, Dunkel IJ, Lacouture ME. Characteristics of oral mucosal events related to bevacizumab treatment. Oncologist 2012; 17:274-8. [PMID: 22282905 DOI: 10.1634/theoncologist.2011-0198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bevacizumab, a monoclonal antibody targeting a vascular endothelial growth factor (VEGF) protein, has been reported to induce mucosal toxicities. However, the clinical characteristics of these particular toxicities have not been well characterized. We aimed at providing a detailed clinical description of signs and symptoms limited to the tongue mucosa in patients treated with bevacizumab. METHODS A retrospective review of medical records and clinical photographs was performed with specific attention to clinical presentation, evolution, associated symptoms, concomitant medications, and treatment methods. RESULTS In total, four patients presented to the dermatology service with clinical findings characterized by multifocal, erythematous circinate and serpiginous erosions on the dorsal tongue surrounded by white hyperkeratotic rims that were temporally related to bevacizumab therapy. Associated increased sensitivity to spicy foods was frequently observed. CONCLUSION These characteristic clinical findings are consistent with geographic tongue. However, large prospective evaluations are necessary to confirm this potential relationship. If bevacizumab is indeed associated with geographic tongue, increased awareness may result in improved reporting and characterization of this particular adverse event.
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Affiliation(s)
- Igor T Gavrilovic
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA
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Ishibashi M, Tojo G, Watanabe M, Tamabuchi T, Masu T, Aiba S. Geographic tongue treated with topical tacrolimus. J Dermatol Case Rep 2011; 4:57-9. [PMID: 21886753 DOI: 10.3315/jdcr.2010.1058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 11/21/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Geographic tongue, or benign migratory glossitis, is usually an asymptomatic inflammatory disorder of the tongue mucosa of unknown etiology. It is characterized by circinate, erythematous, ulcer-like lesions of the dorsum and lateral border of the tongue due to loss of filiform papillae of the tongue epithelium. Symptomatic treatments have not been evaluated rigorously. MAIN OBSERVATION We describe herein two cases of adult patients with persistent and painful geographic tongue successfully treated with topical application of 0.1% tacrolimus ointment. CONCLUSION To our knowledge, this is the first report of successful treatment with topical 0.1% tacrolimus for symptomatic geographic tongue. Clinical trials are needed to confirm the efficacy and the safety of topical tacrolimus in treating geographic tongue.
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Affiliation(s)
- Masaya Ishibashi
- Department of Dermatology, Tohoku University Hospital, Sendai, Japan
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18
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Balasubramaniam R, Klasser GD, Delcanho R. Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma. Aust Dent J 2009; 54:293-9. [DOI: 10.1111/j.1834-7819.2009.01153.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Steele JC, Bruce AJ, Drage LA, Rogers RS. α-Lipoic acid treatment of 31 patients with sore, burning mouth. Oral Dis 2008; 14:529-32. [DOI: 10.1111/j.1601-0825.2007.01414.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klasser GD, Fischer DJ, Epstein JB. Burning Mouth Syndrome: Recognition, Understanding, and Management. Oral Maxillofac Surg Clin North Am 2008; 20:255-71, vii. [DOI: 10.1016/j.coms.2007.12.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maltsman-Tseikhin A, Moricca P, Niv D. Burning Mouth Syndrome: Will Better Understanding Yield Better Management? Pain Pract 2007; 7:151-62. [PMID: 17559486 DOI: 10.1111/j.1533-2500.2007.00124.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
"Burning mouth syndrome" (BMS) refers to a chronic orofacial pain disorder usually unaccompanied by mucosal lesions or other clinical signs of organic disease. BMS is typically characterized by a continuous, spontaneous, and often intense burning sensation as if the mouth or tongue were scalded or on fire. Burning mouth syndrome is a relatively common condition. The estimated prevalence of BMS reported in recent studies ranges between 0.7 and 4.6% of the general population. About 1.3 million American adults, mostly women in the postmenopausal period, are afflicted with BMS. The etiology of this disorder is poorly understood even though new evidence for a possible neuropathic pathogenesis of idiopathic BMS is emerging. Burning mouth syndrome may present as an idiopathic condition (primary BMS type) distinct from the symptom of oral burning that can potentially arise from various local or systemic abnormalities (secondary BMS type), including nutritional deficiencies, hormonal changes associated with menopause, local oral infections, denture-related lesions, xerostomia, hypersensitivity reactions, medications, and systemic diseases including diabetes mellitus. In more than a third of patients, multiple, concurrent causes of BMS may be identified. It is important to note that the diagnosis of BMS should be established only after all other possible causes have been ruled out. Professional delay in diagnosing, referring, and appropriately managing of BMS patients occurs frequently. Treatment should be tailored to each patient and it is recommended to practice the treatment in a multidisciplinary facility. This article discusses our current understanding of the etiology and pathogenesis of BMS. The authors have tried to emphasize new pharmacological approaches to manage this challenging disorder.
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Affiliation(s)
- Alexander Maltsman-Tseikhin
- Center for Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporin administration for persistent benign migratory glossitis. J Dermatol 2007; 34:340-3. [PMID: 17408445 DOI: 10.1111/j.1346-8138.2007.00284.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We herein describe a 54 year-old female patient with a 5-year history of persistent and painful benign migratory glossitis (BMG), which was remarkably improved by systemic administration of cyclosporin. She had noted some white patches leaving smooth denuded red areas with whitish elevated borders on the dorsum of her tongue, and finally felt strong pain. The lesion was refractory to the previous treatment with topical corticosteroid treatment for the last 2 years. Because clinicopathological findings were compatible with BMG, systemic administration of 20 mg/day prednisolone and topical 0.1% dexamethasone application were started, however, she suffered a severe relapse after tapering the dosage of prednisolone to 10 mg/day. Because some investigations have suggested that BMG is an oral manifestation of psoriasis, we introduced cyclosporin administration. The systemic treatment of cyclosporin microemulsion pre-concentrate, 3 mg/kg/day, resulted in a satisfactory improvement. Two months later, we could reduce cyclosporin microemulsion pre-concentrate dosage to 1.5 mg/kg/day for maintenance therapy, and the disease has been well controlled so far.
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Affiliation(s)
- Masatoshi Abe
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Lehman JS, Bruce AJ, Rogers RS. Atrophic Glossitis From Vitamin B12Deficiency: A Case Misdiagnosed as Burning Mouth Disorder. J Periodontol 2006; 77:2090-2. [PMID: 17209796 DOI: 10.1902/jop.2006.060169] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Glossodynia, or painful sensation of the tongue, can have a spectrum of etiologies, such as local infection, trauma, nerve damage, glossitis, or the enigmatic neuropathic pain syndrome, burning mouth disorder (BMD; also known as burning mouth syndrome). Careful history-taking, physical examination, and appropriate laboratory screening can differentiate these causes of glossodynia and direct further therapy. METHODS A 73-year-old woman presented with several months of glossodynia having previously been diagnosed by her primary care physician with primary BMD. Subsequently, she consulted an otolaryngologist, who pursued further diagnostic evaluation. RESULTS Examination revealed the presence of a beefy, red, smooth tongue, and further laboratory evaluation yielded a low serum vitamin B(12) level and macrocytosis. Three months of oral vitamin B(12) supplementation led to partial restoration of serum vitamin B(12) levels and a modest improvement in symptoms. Her final diagnoses were atrophic glossitis and glossodynia secondary to vitamin B(12) deficiency, most likely due to pernicious anemia. CONCLUSIONS The results of this case have important clinical implications for the diagnostic evaluation and management of patients with glossodynia and apparent BMD. Pathogenic mechanisms of nutrient deficiency in atrophic glossitis are discussed.
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Affiliation(s)
- Julia S Lehman
- University of Wisconsin Medical School, Madison, WI, USA
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24
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Affiliation(s)
- Randolph W Evans
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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25
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Abstract
A 73-year-old white male with a 6-month history of glossodynia, unresponsive to clotrimazole troches, cevimeline, triamcinolone dental paste, paroxetine, and lorazepam presented to the dermatology clinic for consultation. Work-up revealed no oral abnormalities and no underlying systemic disorder. He denied symptoms consistent with a psychiatric disorder. A detailed free amnestic assessment by a board certified Geriatric Psychiatrist (John S. Kennedy, MD) found that the patient was oppressed by the pain. He did not meet the criteria for major depression nor did he have any anxiety disorder or delusions. Because of the presence of dysphoria and anticipatory anxiety secondary to glossodynia, the patient was started on olanzapine. Improvement of pain symptoms were noted within 3 days with full resolution of symptoms at 1- and 3-month follow-ups. Dysphoria and anticipatory anxiety remitted fully upon pain relief.
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Affiliation(s)
- Carrie L Gick
- Department of Dermatology, Indiana University School of Medicine, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
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26
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Menni S, Boccardi D, Crosti C. Painful geographic tongue (benign migratory glossitis) in a child. J Eur Acad Dermatol Venereol 2005; 18:737-8. [PMID: 15482313 DOI: 10.1111/j.1468-3083.2004.01032.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lampl Y, Gilad R. Topiramate Effective in the Treatment of Intractable Glossodynia. J Pharm Technol 2004. [DOI: 10.1177/875512250402000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To report effective treatment with topiramate in 2 cases of glossodynia (burning tongue and mouth syndrome). Case Summaries: Two women, 52 and 53 years old, suffered from intractable unilateral burning mouth syndrome. In both cases, the activities of daily living were severely restricted. Previous treatment with diverse medications had failed. Administration of topiramate 200–350 mg/day stopped the attacks completely in one patient and reduced the frequency by 50–60% in the second. Discussion: Glossodynia may present as unilateral intractable pain syndrome with characteristics of neuralgic pain. It is defined as a burning pain in the tongue and mucous membranes of the mouth. There is some research on possible effective medications for treatment, but few data on the beneficial effects of this therapy have been reported. Topiramate has been previously shown to have an antineuralgic effect in trigeminal neuralgia. In the cases of intractable glossodynia presented here, this medication led to significant improvement in the symptoms of this uncommon neuralgic pain. Conclusions: Topiramate has a beneficial effect in intractable burning mouth and tongue syndrome. Taking these positive results into consideration, the practitioner can give hope to disabled patients for returning to acceptable activities of daily living.
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Affiliation(s)
- Yair Lampl
- YAIR LAMPL MD, Deputy Head, Department of Neurology, E Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Ronit Gilad
- RONIT GILAD MD, Staff Physician, Department of Neurology, E Wolfson Medical Center, Sackler Faculty of Medicine
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Friedlander AH, Friedlander IK, Marder SR. Posttraumatic stress disorder: psychopathology, medical management, and dental implications. ACTA ACUST UNITED AC 2004; 97:5-11. [PMID: 14716250 DOI: 10.1016/j.tripleo.2003.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PTSD is a chronic mental illness that may arise after an individual experiences or witnesses a life-threatening event. Symptoms consist of persistent reexperiencing of the event, avoidance of reminders of the event, a numbing of positive emotions, and social withdrawal. A depressed mood and excessive use of alcohol and tobacco may accompany the disorder. PTSD afflicts approximately 5% of men and 11% of women. Dental disease may be extensive because of neglect of oral hygiene compounded by cigarette smoking. Dental treatment includes preventive education, oral cancer screening, and prescribing saliva substitutes or stimulants and anticaries agents to combat medication-induced xerostomia. Precautions must be taken when prescribing or administering certain analgesics, antibiotics, or sedative agents that may adversely interact with the psychiatric medications or when performing surgery because of the long-term effects of alcohol abuse.
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Maier H, Tisch M. [Mouth dryness and burning sensation of the oral mucosa: causes and possibilities for treatment]. HNO 2003; 51:739-47. [PMID: 14504789 DOI: 10.1007/s00106-003-0918-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Both sets of complaints, mouth dryness and a burning sensation of the oral mucosa, can have a variety of causes. Local and regional as well as systemic causes can be responsible for burning mouth syndrome. Diseases of the oral mucosa can have genetic, inflammatory, or neoplastic origins. Autoimmune diseases and allergies as well as different afflictions relating to internal medicine can be accompanied by a burning sensation in the oral mucosa. Neurological and psychiatric illnesses must be clarified during interdisciplinary diagnostics in order to identify idiopathic forms. The causes of mouth dryness are similarly complex. In addition to inadequate fluid intake, particularly in elderly patients, drug side effects or systemic diseases are frequently also responsible. Treatment is directed at the underlying disease; in ambiguous cases, symptomatic therapy can provide relief for medical complaints.
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Affiliation(s)
- H Maier
- Abteilung Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm.
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Abstract
Contact stomatitis is inflammation or pain of the oral mucosa due to both irritant and allergic substances. Irritants include heat, frictional trauma, and chemicals. Oral flavorings, preservatives, and dental materials are common allergens. Simplification of oral care and avoidance of contactants is the primary mode of therapy. Patch testing to a broad series of antigens may be required to identify specific causes of allergic contact stomatitis.
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Affiliation(s)
- Benjamin W LeSueur
- Department of Dermatology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Abstract
Burning mouth syndrome is the occurrence of oral pain in a patient with a normal oral mucosal examination. It can be caused by both organic and psychologic or psychiatric factors, which can be broken down into local, systemic. psychologic or psychiatric, and idiopathic causes. The most frequently associated conditions are psychiatric (depression, anxiety, or cancerphobia); xerostomia; nutritional deficiency; allergic contact dermatitis; candidiasis; denture-related pain: and parafunctional behavior. Multiple different factors contributing to the oral pain are common, and a systematic approach to the evaluation is important. Identification of correctable causes of BMS should be emphasized and psychiatric causes should not be invoked without thorough evaluation of the patient. A directed history and careful oral examination must be completed to exclude local diseases and identify clues to potential causes. Assessment of medications, psychiatric history and background, and selected laboratory and patch tests may help identify the etiologies of these symptoms. Treatment should be tailored to each patient and may best be managed in a multidisciplinary approach with input from dermatologists, dentists, psychiatrists. otorhinolaryngologists, and primary care providers. A thoughtful and structured evaluation of the patient with BMS has been associated with improvement in about 70% of patients. The remaining patients may benefit from empiric therapy with a chronic pain protocol and continued supportive interactions.
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Affiliation(s)
- Lisa A Drage
- Department of Dermatology, Mayo Clinic, 200 First Street SW Rochester MN 55905, USA.
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Abstract
BACKGROUND Major depressive disorder, or MDD, is a psychiatric illness in which mood, thoughts and behavioral patterns are impaired for long periods. The illness distresses the person and impairs his or her social functioning and quality of life. MDD is characterized by marked sadness or a loss of interest or pleasure in daily activities, and is accompanied by weight change, sleep disturbance, fatigue, difficulty concentrating, physical impairment and a high suicide rate. In 2000, the World Health Organization, or WHO, identified MDD as the fourth ranked cause of disability and premature death in the world. WHO projected that by 2020, MDD would rise in disease burden to be second only to ischemic heart disease. The disorder is common in the United States, with a lifetime prevalence rate of 17 percent and a recurrence rate of more than 50 percent. CONCLUSIONS MDD may be associated with extensive dental disease, and people may seek dental treatment before becoming aware of their psychiatric illness. MDD frequently is associated with a disinterest in performing appropriate oral hygiene techniques, a cariogenic diet, diminished salivary flow, rampant dental caries, advanced periodontal disease and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management requires a vigorous dental education program, the use of saliva substitutes and anticaries agents containing fluoride, and special precautions when prescribing or administering analgesics and local anesthetics. CLINICAL IMPLICATIONS Dentists cognizant of these signs and symptoms have an opportunity to recognize patients with occult MDD. After confirmation of the diagnosis and institution of treatment by a mental health practitioner, dentists usually can provide a full range of services that may enhance patients' self-esteem and contribute to the psychotherapeutic aspect of management.
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Affiliation(s)
- A H Friedlander
- Veterans Affairs Greater Los Angeles Healthcare System (14), 11301 Wilshire Blvd., Los Angeles, Calif. 90073, USA.
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