A case of unilateral burning mouth syndrome of neuropathic origin

Risk of Burning Mouth Syndrome in Patients with Migraine: A Nationwide Cohort Study

Migraine is a common neurological disease that causes a variety of symptoms, most notably throbbing, which is described as a pulsing headache on one side of the head. Burning mouth syndrome (BMS) is defined as an intra-oral burning sensation. Currently, no medical or dental cause has been identified for BMS. Interestingly, neuropathic pain is a characteristic feature of BMS; however, it remains unclear whether migraine can cause BMS. We aimed to identify the association of migraine with the risk of developing BMS. We used a representative nationwide cohort sample of approximately 1 million patients from 2002 to 2013 to investigate the prospective association between migraine and BMS. A total of 4157 migraine patients (migraine group) and 16,628 patients without migraine (comparison group) were enrolled after 1:4 propensity score matching. The overall incidence of BMS was significantly higher in the migraine group (0.15 per 1000 person-years) than in the comparison group (0.05 per 1000 person-years). The adjusted HR for patients with migraine who reported BMS events during the 10-year follow-up period was 2.96 (95% confidence interval, 1.02–8.56), after adjusting for other covariates. However, in the subgroup analysis, the adjusted HR for BMS events did not show a significant difference between the migraine and comparison group according to sex, age, and comorbidities. This study suggests that migraine is associated with an increased incidence of BMS. Therefore, clinicians should be attentive to detect BMS at an early stage when treating patients with migraine.

Use of a combination of N-acetylcysteine and clonazepam to treat burning mouth syndrome

OBJECTIVE

This study was intended to evaluate the clinical efficacy of a combination of N-acetylcysteine (NAC) and clonazepam for treatment of burning mouth syndrome (BMS).

STUDY DESIGN

A total of 160 patients with BMS were divided into 3 groups: group 1 received NAC (400 mg/d), group 2 received clonazepam (0.5 mg/d), and group 3 received both NAC and clonazepam. We evaluated symptom relief after 8 weeks of treatment using a visual analog scale (VAS). To assess oral health-related quality of life, we used the validated Korean version of an oral health impact profile (OHIP-14K).

RESULTS

The overall response rates of the 3 groups were 60.3%, 51.3%, and 80.0%, respectively. The mean VAS and OHIP-14K scores significantly decreased in all groups after the 8-week treatments. The VAS score changes were -12.2 ± 19.5, -10.0 ± 14.1, and -21.0 ± 24.6, respectively (P = .001), in the 3 groups and the OHIP-14K changes were -2.3 ± 9.2, -4.4 ± 6.9, and -8.7 ± 10.3, respectively (P = .020). Group 3 showed significantly larger differences in VAS and OHIP-14K scores than group 2, before and after treatment.

CONCLUSIONS

In the treatment of BMS, the NAC/clonazepam combination therapy was more effective than either monotherapy.

Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report

Objectives: To evaluate (1) the effect of a salivary substitute prepared using chamomile (Matricaria chamomilla L.) flower and flax (Linum usitatissimum L.) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect. Subjects: 40 women aging >40 years with diagnosis of primary BMS. Settings/Location: Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil. Design: This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately. Interventions: Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min. Outcome measures: A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively. Results: After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (p < 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects. Conclusion: This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.

Thermal quantitative sensory testing in burning mouth syndrome

OBJECTIVES

Subjects with burning mouth syndrome (BMS) have altered sensitivity and pain thresholds for thermal stimuli compared to a control group.

MATERIALS AND METHODS

Fourteen women and 6 men (average age = 62.60 years, median = 63.50) with BMS and a control group were tested using the method of thermal quantitative sensory testing (tQST) (tip, right, and left lateral border of the tongue, left thumb) to determine their heat/cold detection threshold (WDT/CDT) and heat/cold pain threshold (HPT/CPT).

RESULTS

Only the CPT values at the tip and both lateral border of the tongue show a statistically significant difference: tip of the tongue: sick = 12.0 ± 5.5 °C, median 14.2°C; healthy = 4.5 ± 2.9 °C; median = 6.4 °C; p = 0.000; right lateral border: sick = 8.55 ± 3.34 °C; healthy = 4.46 ± 1.90 °C; median 5.8 °C; p < 0.001; left lateral border: sick = 10.18 ± 3.94 °C¸ healthy = 4.15 ± 2.18 °C; median = 6.0 °C; p < 0.001.

CONCLUSIONS

BMS may be a combination of a dysfunction of free nociceptive nerve endings in the peripheral nervous system and impaired pain processing in the central nervous system.

CLINICAL RELEVANCE

This preliminary study provides hints to other causes of BMS. This offers the possibility of further therapeutic options.

Temporomandibular Disorders and Oral Features in Systemic Lupus Erythematosus Patients: An Observational Study of Symptoms and Signs

Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ2=4,1548 p=0,0415), temple headache (χ2=4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ2=4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ2= 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ2=7,37 p=0,007). Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.

Evidence of Signs and Symptoms of Craniomandibular Disorders in Fibromyalgia Patients

OBJECTIVE

The purpose of this study is to highlight the evidence of signs and symptoms of craniomandibular disorders (CMD) in patients suffering from fibromyalgia.

MATERIALS AND METHOD

The study has been carried out from May 2011 to May 2015, recruiting a sample of fibromyalgia patients at the Department of Neurophysiopathology at the hospital Policlinico in Bari. Among the 150 examined patients, 60 of them have been diagnosed to suffer from fibromyalgia and 27 accepted to be investigated with a gnathologic examination at the Dental School at the University of Bari.

RESULTS

24 patients (88.9%) were women and 3 (11.1%) men; from 26 to 66 years old (average age, 39). 14 patients (51.9%) were affected by primary fibromyalgia, the remaining 13 (48.1%) by secondary fibromyalgia, mainly associated with hypothyroidism (29.6%). VAS average score was about 8 ± 1.85. The frequency of pain was daily in 15 patients (55.6%); twice a week in 10 patients (37.03%) and a few times a month in 2 patients (7.4%). 11 patients (40.7%) attributed the onset of fibromyalgia to a specific instigating event. In addition, from the gnathologic anamnesis, 11 patients (40,7%) reported a painful symptom in the head-neck region, especially in the frontal region, in the neck, in the masseter muscle and ATM. VAS average score was 3.4 ± 2.8, significantly lower than the one referring to the fibromyalgia pain. The gnathological examination found CMD signs and symptoms in 18 patients (66.7%). Concerning the prevalence of CMD, in type I fibromyalgia, myofascial pain was more frequent (5 patients), whereas in type II fibromyalgia, what was more frequent was a dislocation with reduction (3 patients).

CONCLUSION

Based on clinic experience, we can affirm that some patients with CMD report pain in other regions. It is difficult to distinguish the CMD forms directly correlated to fibromyalgia from those engendered by parafunctional activities; hence the need is to resolve the fibromyalgia syndrome adopting a multidisciplinary approach.

Correlation between parodontal indexes and orthodontic retainers: prospective study in a group of 16 patients

PURPOSE

Fixed retainers are used to stabilize dental elements after orthodontic treatment. Being it a permanent treatment, it is necessary to instruct patients about a constant and continuous monitoring of their periodontal conditions and a correct oral hygiene. The aim of this study was to highlight the possible adverse effects of bonded retainers on parameters correlated to the health conditions of periodontal tissues.

MATERIALS AND METHODS

We selected 16 patients, under treatment in the Orthodontics Department of University of Bari Dental School, who had undergone a lingual retainer insertion at the end of the orthodontic treatment. The patients were then divided into two groups (Control Group and Study Group) and monitored for 3 and 36 months, respectively. The following indexes were taken into consideration: gingival index (GI), plaque index (PI) and the presence of calculus (Calculus Index, CI), the probing depth and the presence of gingival recession on the six inferior frontal dental elements.

RESULTS

After the observation was carried out, any of the patients showed periodontal sockets and gingival recession. In the Study Group, only 1 patient had a PI score=3, the 7 left had scores between 0.66 and 2.83. In the Control Group, one patient had score=0, the other ones showed values between 0.5 and 1.66. The mean GI in the Study Group peaked at a score of 2.83, the minimum was 0.66; whereas in the Control Group the maximum value was 2 and the minimum 0.66. The CI in the Group Study was between 1 and 2. In the Control Group it was absent in only 1 patient, whereas in the remaining 7, it had a value between 0.3 and 1. The clinical data were studied by means of the Wilcoxon test. We found a statistically significant difference for what concerns the Plaque Indexes (PI) (P>0.05) and Calculus Indexes (CI) (P>0.1) in both groups, with higher scores in the Study Group, having retainers for 36 months. Any statistically significant difference was calculated for the GI.

CONCLUSIONS

We can therefore conclude that patients with lingual retainers need periodontal hygiene and treatment as to prevent, in the course of time, periodontal damages non-detectable in short-term.

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

Burning mouth syndrome (BMS) is a chronic condition that is characterized by burning symptoms of the oral mucosa without obvious clinical examination findings. This syndrome has complex characteristics, but its cause remains largely enigmatic, making treatment and management of patients with BMS difficult. Despite not being accompanied by evident organic changes, BMS can significantly reduce the quality of life for such patients. Therefore, it is incumbent on dental professionals to diagnose and manage patients with BMS as a part of comprehensive care.

Burning mouth syndrome

Burning mouth syndrome (BMS) is a chronic condition characterized by burning of the oral mucosa, with or without dysgeusia and xerostomia, in the setting of no underlying systemic disease or identifiable abnormalities on physical examination or laboratory testing. BMS disproportionately affects postmenopausal women. The pathophysiology of the disease is unknown; no single treatment has proven universally successful. In light of these shortcomings, having a practical approach to the evaluation and management of patients with BMS can improve both patient quality of life and physician satisfaction.