Article

Causative or precipitating aspects of burning mouth syndrome: A case-control study

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  • Università degli studi di Milano
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Abstract

On causative or precipitating causes of burning mouth syndrome (BMS), there is a lack of consensus. In this prospective case-control study, we compared clinical features and laboratory aspects to evaluate the association of the proposed causative/precipitating factors of BMS. A total of 61 BMS patients and 54 control subjects underwent several evaluations: rest and stimulated salivary flow rates measurements, laboratory tests, isolation of Candida species, assessment of parafunctional activities, detection of anxiety and depression by means of the Hospital Anxiety and Depression Scale. Odds ratio and 95% confidence interval were calculated to compare the variables. No statistically significant differences were found with regard to the tested variables except for anxiety and depression. The results of this study seem not to support a role for the usually reported causative or precipitating factors of BMS and efforts should be addressed towards different aetiologies including possible neuropathic mechanisms of BMS.

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... In this context, it has been proposed that psychiatric disorders could explain the occurrence of BMS [15][16][17][18][19][20] . Several studies have reported elevated psychiatric morbidity in BMS, mainly depression, anxiety and hypochondriasis [15][16][17]21] . ...
... In this context, it has been proposed that psychiatric disorders could explain the occurrence of BMS [15][16][17][18][19][20] . Several studies have reported elevated psychiatric morbidity in BMS, mainly depression, anxiety and hypochondriasis [15][16][17]21] . Depression is the most prevalent psychiatric disorder in patients with BMS [15][16][17]20] . ...
... Several studies have reported elevated psychiatric morbidity in BMS, mainly depression, anxiety and hypochondriasis [15][16][17]21] . Depression is the most prevalent psychiatric disorder in patients with BMS [15][16][17]20] . Furthermore, personality traits such as neuroticism, extraversion, openness and conscientiousness seem to differentiate BMS patients from controls [17] . ...
Article
Background: Burning mouth syndrome (BMS) is a chronic disorder defined as a burning sensation in the oral mucosa without evidence of pathological findings. Its pathophysiology is largely unknown, but psychiatric disorders and personality traits have been implicated. Objective: This study investigated whether there is any association between salivary biomarkers and personality traits in BMS patients. Methods: It was a cross-sectional, controlled study that evaluated 30 individuals with BMS and 32 controls. All subjects were assessed with a structured psychiatric interview (Mini International Neuropsychiatric Interview) and the Big Five inventory. Salivary levels of brain-derived neurotrophic factor (BDNF), neural growth factor, tumor necrosis factor-α, interleukin (IL)-6, IL-10 and cortisol were determined. Results: We found that BMS patients exhibited more traits of neuroticism and lower openness than controls. Openness showed a moderate and negative correlation with cortisol, BDNF and IL-6. Conclusion: Personality traits are associated with salivary biomarkers in BMS.
... Burning mouth syndrome (BMS) is a chronic and complex disorder mainly found in middle aged or elderly women, and is characterized by burning or itching sensation or other oral dysesthesias such as gritty sensation or bothersome mucosity on the oral mucosa. However, clinical examination reveals no anomalies, and the syndrome is not accompanied by laboratory test alterations [1]. According to the criteria established by the International Headache Society (ICHD-II), BMS is classified among the central causes of facial pain, and is defined as a spontaneous burning and painful sensation manifesting on the oral mucosa in the absence of exploratory findings or other identifiable local or systemic causes [2]. ...
... The main symptom (burning sensation) is typically continuous, non-paroxysmal and located on both sides of the tongue (tip and edges) -though the lips, palate, cheek mucosa or entire mouth can also be affected [1,5,6]. ...
... The spontaneous resolution of the symptoms of BMS is rarely observed (perhaps in less than 20% of the cases) [1]. Regarding treatment efficacy, older patients or individuals with longer evolving BMS are more refractory and difficult to treat [50]. ...
... Burning mouth syndrome (BMS) is a chronic and complex disorder mainly found in middle aged or elderly women, and is characterized by burning or itching sensation or other oral dysesthesias such as gritty sensation or bothersome mucosity on the oral mucosa. However, clinical examination reveals no anomalies, and the syndrome is not accompanied by laboratory test alterations [1]. According to the criteria established by the International Headache Society (ICHD-II), BMS is classified among the central causes of facial pain, and is defined as a spontaneous burning and painful sensation manifesting on the oral mucosa in the absence of exploratory findings or other identifiable local or systemic causes [2]. ...
... The main symptom (burning sensation) is typically continuous, non-paroxysmal and located on both sides of the tongue (tip and edges) -though the lips, palate, cheek mucosa or entire mouth can also be affected [1,5,6]. ...
... The spontaneous resolution of the symptoms of BMS is rarely observed (perhaps in less than 20% of the cases) [1]. Regarding treatment efficacy, older patients or individuals with longer evolving BMS are more refractory and difficult to treat [50]. ...
Article
Burning mouth syndrome (BMS) is mainly found in middle aged or elderly women and is characterized by intense burning or itching sensation of the tongue or other regions of the oral mucosa. It can be accompanied by xerostomia and dysgeusia. The syndrome generally manifests spontaneously, and the discomfort is typically of a continuous nature but increases in intensity during the evening and at night. Although BMS classically has been attributed to a range of factors, in recent years evidence has been obtained relating it peripheral (sensory C and/or trigeminal nerve fibers) or central neuropathic disturbances (involving the nigrostriatal dopaminergic system). The differential diagnosis requires the exclusion of oral mucosal lesions or blood test alterations that can produce burning mouth sensation. Patient management is based on the avoidance of causes of oral irritation and the provision of psychological support. Drug treatment for burning sensation in primary BMS of peripheral origin can consist of topical clonazepam, while central type BMS appears to improve with the use of antidepressants such as duloxetine, antiseizure drugs such as gabapentin, or amisulpride.
... [1,2] BMS is an interesting condition as its etiology is multifactorial. [1][2][3][4][5][6][7][8][9][10][11][12][13] The estimated prevalence of BMS reported in recent studies ranges between 0.7% and 15% in the general population, while it made up 10% of the outpatients of oral medicine clinics. [3,5,7,12] The vast majority of affected persons are older than 50 years and there is a preponderance of women (male-to-female ratio between 1 and 4) that were postmenopausal or had experienced sex hormonal change. ...
... [3,[9][10][11][12] Most patients experience burning sensations of moderate-to-severe intensity with mean severity of about 4.6-8 cm on a 0-10 cm visual analog scale. [1,8,[14][15][16] The tongue is the most common site of the complaint, though it may be accompanied by other parts of the mouth. [5,6,8,9,16] This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ...
... [1,8,[14][15][16] The tongue is the most common site of the complaint, though it may be accompanied by other parts of the mouth. [5,6,8,9,16] This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ...
Article
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Background and Aim Burning mouth syndrome (BMS) may be defined as a burning sensation in the oral mucosa usually unaccompanied by clinical signs. Multiple conditions have been attributed to a burning sensation. The aim of this study was to determine the role of age and sex in BMS. Materials and Methods A total of 195 consecutive patients with BMS and 95 healthy patients without burning sensation were recruited in this study. Patients with BMS had experienced oral, burning sensations for at least 6 months without oral clinical signs, and with a normal blood count. Multiple logistic regression analyses were utilized to define the main predictors. Results Menopause, candidiasis, psychological disorders, job status, denture, and dry mouth were significantly frequent in BMS patients. Multivariate logistic regression indicated age (odds ratio (OR) =1.12, 95% confidence interval (CI): 1.08–1.15, P < 0.0001) and sex (OR = 3.14, 95% CI: 1.4–6.7, P < 0.002) significantly increase the odds of BMS. Psychological disorders (OR = 3.39, 95% CI: 1.2–9.5, P < 0.02) and candidiasis remain as predictive factors. Ultimately, age was defined as a critical predictor. Moreover, we can therefore predict that a 60-year-old woman with psychological disorders is 25 times more likely to suffer from BMS than a man 10 years younger who has no psychological disorder. Conclusion Age and sex were the main predictors in BMS. Psychological disorders and candidiasis were significantly associated with the occurrence of BMS.
... Reports of Candida oral carriage rates among BMS patients range from 25% to 93.7% within the published literature [14][15][16][18][19][20][21][22][23] . Three independent studies have shown no statistically significant difference in the rate of Candida carriage between BMS and control subjects 18,19,23 . ...
... Reports of Candida oral carriage rates among BMS patients range from 25% to 93.7% within the published literature [14][15][16][18][19][20][21][22][23] . Three independent studies have shown no statistically significant difference in the rate of Candida carriage between BMS and control subjects 18,19,23 . A recent Japanese study found no significant difference between the oral carriage of Candida among BMS patients compared with xerostomia or dysgeusia 18 . ...
... The lack of a healthy control group for comparison within this study is a weakness that may be counteracted by a strong body of existing research that refutes the presence of a significant difference between Candida carriage among BMS versus control patients 18,19,23 . The data presented confirms previous findings that the existence of xerostomia is associated with increased ...
Article
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Objectives: Oral dysesthesia (burning mouth syndrome) is characterised by a burning-like sensation of the oral mucosa. The aetiology of this disorder is still unknown, however associations with oral fungal carriage have been proposed and applied clinically. The aim of the this study was to compare oral Candida carriage in patients with oral dysesthesia with Candida carriage in patients with other commonly diagnosed oral diseases to clarify the relationship between Candida and oral dysesthesia. Subjects and methods: 441 patients in total including 79 patients diagnosed with oral dysesthesia were included in this study. A retrospective analysis of mycological investigations undertaken in patients with clinically diagnosed oral dysesthesia compared with other oral conditions was undertaken. Results: Oral carriage of Candida was found in 63.3% (50 of 79) of patients with oral dysesthesia. The frequency of carriage, and oral load of Candida were not significantly increased in patients with oral dysesthesia relative to the other conditions assessed. Patients with clinical signs of fungal infection or xerostomia presented with increased carriage of Candida. Conclusion: There is no association between oral dysesthesia and the presence or load of oral Candida. This article is protected by copyright. All rights reserved.
... These uncertainties in BMS patients can often worsen their anxiety. Several BMS patients experience cancer phobia [23][24][25] and 26-53% of the patients with present high-level anxiety [23,24]. Patients with high IU often perceive uncertain situations as threats [13], which can lead to high levels of dissatisfaction. ...
... These uncertainties in BMS patients can often worsen their anxiety. Several BMS patients experience cancer phobia [23][24][25] and 26-53% of the patients with present high-level anxiety [23,24]. Patients with high IU often perceive uncertain situations as threats [13], which can lead to high levels of dissatisfaction. ...
Article
Full-text available
Objective Intolerance of uncertainty (IU) is thought to be involved with the psychological factors that influence the symptoms in patients with burning mouth syndrome (BMS) and affect their limited satisfaction with the treatments provided. However, the influence of IU on satisfaction has not been explored in detail. Therefore, the purpose of this study was to investigate whether IU can affect the satisfaction of patients with BMS. Methods A total of 34 patients with BMS and 100 patients without the disease who visited the general dental clinic were included in the study. They were required to complete a questionnaire measuring the subjective severity of their symptoms and satisfaction with their oral state, and a short IU scale. The BMS patients were separated from the control patients based on the IU score. The coefficients between the severity of symptoms and satisfaction were calculated to examine the influence of IU on the relationship between the two variables. Results The relationship between satisfaction and severity of symptoms was significant in BMS patients with high IU, but not in control patients with low IU. Conclusion This study demonstrated that IU in BMS patients influences the relationship between the severity of symptoms and the satisfaction, thus indicating that the dissatisfaction in BMS patients with high IU might be prevented by decreasing the IU. Clinical relevance Limited satisfaction experienced by BMS patients can influence the patient-doctor relationship. This study provides suggestions for building a good patient-doctor relationship.
... tipo primário constitui a SBA idiopática, sem causa aparente. A SBA do tipo secundário está associada a etiologias iatrogénicas relacionadas com terapêuticas e drogas (4,23) , e a factores psicogénicos (2,3,10,13,14,21,23,24,32,33,34) . ...
... Estes podem afectar a sensação de dor ou serem um efeito secundário á dor crónica (29) . Por isso, alguns autores consideram a SBA como uma doença psicossomática (1, 2, 3, 4, 10,12,13,14,21,34,36) . ...
... Only one study reported no evidence (according to mean of STAI scores) for the involvement of psychological factors in BMS (39), although this study focussed primarily on neurophysiological factors. The STAI and the HADS were the most commonly used tests (three studies each): trait and state anxiety was more prevalent in those with BMS than in healthy controls in two studies (28,34), and BMS patients met the criteria for pathological anxiety and depression (30,32,33) in all of the reviewed studies. Another study found that state and trait anxiety was associated with BMS according to mean scores on the Cattell's Anxiety Test (40). ...
... In terms of personality, we reviewed five studies using five different instruments (NEO Personality Inventory-Revised, SCID-II, MMPI-2, BFI, TCI) to assess personality: One did not find any differences between those with BMS and healthy controls (39), and the other four found higher levels of neuroticism (38,27) and harm-avoidance (11), lower levels of novelty seeking and self-directedness, and a greater prevalence of personality disorders (particularly obsessive-compulsive and schizotypal) in patients with BMS than in controls (37). Two studies reported the presence of cancerophobia in BMS patients with contrasting findings (33,28). ...
Article
Full-text available
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.
... In the regression analysis, bruxofacets were, however, not contributing to the model. Previous studies have reported contradictory results regarding the frequencies of teeth grinding/clenching and/or tongue thrusting [10,42,43]. However, most of these earlier studies have based their conclusions on subjective reports of parafunction, in contrast to this study in which the focus is on clinically visible active bruxofacets, which we believe allows a more accurate assessment of current parafunction. ...
Article
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.
... Les plaintes somatiques et la dépression, pour une part au moins des stomatodynies, peuvent être la conséquence de la douleur persistante. Il est intéressant de noter en ce sens que la corrélation entre les facteurs psychologiques et le BMS n'est pas plus prononcée que pour d'autres affections douloureuses, y compris d'autres douleurs orofaciales [39, [64][65][66]. ...
Article
Introduction : La stomatodynie primaire est une affection énigmatique dont l'étiopathogénie reste largement inconnue et le traitement insatisfaisant. Elle est souvent considérée comme d'origine « psychique », et notamment dans la littérature médicale française. Corpus : Cette revue narrative examine les arguments soutenant ce point de vue, dans ses aspects historiques, cliniques, et thérapeutiques afin d'éclairer la réflexion clinique nécessaire à la prise en charge la plus satisfaisante de l'affection pour le patient. Conclusion :l'incertitude étiopathogénique impose de ne pas enfermer le patient dans une conception erronée de l'affection.
... 105 In contrast to patients with SS who have stomatodynia, patients with BMS are not more prone to oral candidiasis compared with healthy individuals. 176 In BMS, the onset of pain may occur suddenly, and patients often report a specific event that they associate with the first occurrence of pain. 10 The pain in BMS is usually bilateral and involves the tongue predominately but may also be widespread throughout the oral cavity. 9 Discomfort is typically mild and persists throughout the day, although some patients experience moderate or even severe pain. ...
Article
Sjögren’s Syndrome (SS) and Burning Mouth Syndrome (BMS) typically present in post-menopausal 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.
... This shows that although anxiety and depression are frequently encountered in this population, they are by no means present in all cases. The correlation between psychological factors and BMS is no more pronounced than it is in any other chronic pain entities, including other idiopathic orofacial pain (22,31,51,(65)(66)(67)(68)(69)(70). Kim et al. (71) observed no difference in the psychological profiles between male, young premenopausal women and older postmenopausal women with BMS, although they observed significant symptom differences between these subgroups. ...
Article
Objective To review the clinical entity of primary burning mouth syndrome (BMS), its pathophysiological mechanisms, accurate new diagnostic methods and evidence-based treatment options, and to describe novel lines for future research regarding aetiology, pathophysiology, and new therapeutic strategies. Description Primary BMS is a chronic neuropathic intraoral pain condition that despite typical symptoms lacks clear clinical signs of neuropathic involvement. With advanced diagnostic methods, such as quantitative sensory testing of small somatosensory and taste afferents, neurophysiological recordings of the trigeminal system, and peripheral nerve blocks, most BMS patients can be classified into the peripheral or central type of neuropathic pain. These two types differ regarding pathophysiological mechanisms, efficacy of available treatments, and psychiatric comorbidity. The two types may overlap in individual patients. BMS is most frequent in postmenopausal women, with general population prevalence of around 1%. Treatment of BMS is difficult; best evidence exists for efficacy of topical and systemic clonazepam. Hormonal substitution, dopaminergic medications, and therapeutic non-invasive neuromodulation may provide efficient mechanism-based treatments for BMS in the future. Conclusion We present a novel comprehensive hypothesis of primary BMS, gathering the hormonal, neuropathic, and genetic factors presumably required in the genesis of the condition. This will aid in future research on pathophysiology and risk factors of BMS, and boost treatment trials taking into account individual mechanism profiles and subgroup-clusters.
... Local erythema is observed in patients with ill-fitting dentures, but there is no support on the fact that mechanical trauma causes BMS (21). Oral parafunctional habits such as bruxism are chiefly associated with anxiety; but to this point of time, there are no studies that support the fact that these habits can cause BMS (22). Only 2% of the studied population had burning pain that was due to oral dryness as a result of a local complication in the salivary glands and 4.4% due to xerostomia as a result of a systemic diseases. ...
Article
Background: Burning Mouth Syndrome (BMS) is a burning sensation of the oral mucosa without any sign of mucosal abnormality for which no medical or dental cause can be detected. However, this syndrome belongs to a broader category of patients whose main complaint is mouth burning and, so, their etiologies can largely vary. Objectives: This study investigates the prevalence of burningmouthsymptomfor the first time in an institutional group of patients in Shiraz, Iran, among whom some were found to have BMS through excluding the recognizable physical or biochemical causes of mouth burning. Methods: In this cross sectional study, from the existing records of 2 533 patients who referred to Shiraz Dental School since 2007 To 2015, a total number of 298 patients with the chief complaint of oral burning sensation were chosen. For each patient age, sex, etiology, and site of pain were recorded. Results: Analysis revealed that amongst 298 individuals who suffered from burning sensation of the oral mucosa, the female/male ratio was 3 to 1; and local factors were found as the primary cause for the symptom development in a large proportion of the patients (63.5%). Followed by systemic diseases with amuch less contribution to cause the symptom (22.8%). A number of 8.4% of the patients were idiopathic and 5.4% suffered from psychological disorders. Tongue was the most frequent location of burning (37.2%). Overall, only 25 patients (< 1%) who were mostly elderly (P < 0.001) had idiopathic BMS. The burning localization in the idiopathic cases was more likely to be reported as generalized than that in the cases with recognizable causes (P < 0.001). Conclusions: The results of this study show that oral burning is mostly caused by the factors recognized during examination and that the idiopathic form or BMS known as a neuropathic pain is uncommon. Understanding the prevalence of the etiologic factors in certain populations would lead to a better diagnostic approach to BMS through the exclusion of those factors.
... Les plaintes somatiques et la dépression, pour une part au moins des stomatodynies, peuvent être la conséquence de la douleur persistante. Il est intéressant de noter en ce sens que la corrélation entre les facteurs psychologiques et le BMS n'est pas plus prononcée que pour d'autres affections douloureuses, y compris d'autres douleurs orofaciales [39,[64][65][66]. ...
... DSM-IV'e göre YAS; Somatoform Bozukluk içinde yer alan "Ağrı bozukluğu" başlığı altında sınıflandırılmaktadır [10]. Somatoform bozukluğun tanımlayıcı özellikleri; fizyolojik mekanizmalarla açıklanmayan gösterilebilir organik bulguların olmaması, belirtilerin psikolojik 134 çatışma ve etmenlerle ilişkili olmasıdır (20). Bu hastanın yakınmaları ile ilgili organik bir neden tespit edilememiştir. ...
Article
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Burning Mouth Syndrome, is a chronic disease characterized by burning and tingling sensation in mouth without any systemic and local reason. The etiopathology has not been cleared up yet. In addition to hypothesis about the psychological factors may have a role for constitution of the disease, it was shown that comorbid psychiatric conditions are high in these patients.A forty nine-year old - married woman was referred from the periodontology clinic to the Psychiatry clinic because of oral burning complaint without any detected cause. Her complaints began five years ago after she had a biopsy for a lip swelling. Burning, tingling and burning sensation continued progressively on the mouth, especially on the tongue and inner surface of the lips. In mental state examination, affect was depressed, somatic symptoms and hypochondriac preoccupation was noticed. She was consultated to the Dermatology clinic, there wasn’t any detected pathological finding at the dermatological physical examination of the oral mucosa. She was accepted as burning mouth syndrome.In this case, repetitive somatic symptoms and recurrent medical references may indicate somatization. Burning mouth sydrome, which is in the classification of “Psychocutaneous diseases” according to DSM-IV will be discussed in terms of diagnosis by this case. This case report will shed on light for further studies working on etiopathology of burning mouth syndrome.
... Another factor is associated to deleterious habits such as clenching, bruxism, tongue thrusting, lip biting, compulsive movements of the tongue, and continuous prostheses friction. [27] BMS holders have more nonspecific complaints of health and more severe symptoms of menopause compared to healthy subjects. [21] The estrogen replacement therapy may not relieve symptoms of pain or burning, leading the authors to conclude that estrogen deficiency has no direct effect on the oral symptoms. ...
Article
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The burning mouth syndrome (BMS) is a chronic orofacial disease characterized by symptoms of burning or burning in the oral mucosa without being able to detect lesions or clinical change. Its etiology is multifactorial and affects mainly women in the postmenopausal periods. Treatment should be multidisciplinary , but the complexity of the etiology knowledge hinders the establishment of the most appropriate treatment. Therefore, this study evaluated the use of acupuncture in the treatment of BMS. Through literature review, it can be noticed that the union of the concepts with the teachings of traditional Chinese medicine can provide a new perspective for the treatment of pain/oral burning as acupuncture treats the individual as a whole, in an attempt to restore the balance between the organs. Thus, various pharmacological effects can be achieved, such as analgesic, muscle relaxing, sedative, antidepressant, anti-inflammatory, repair stimulating, and immunity promoter, which might have a great efficacy in the treatment of BMS.
... 11,12,26,29,30) The only significant differences were found in self-reported depression and anxiety in case control study. 31) Hakeberg et al. 26) proved that the appearance of the BMS was preceded by an acutely stressful event. Most of these literatures, however, were anecdotal, and only a few studies used objective psychometric methods to assess the patient's psychological status. ...
Article
The etiopathogenesis of burning mouth syndrome (BMS) seems to be complex and many patients probably involves interactions among local, systemic, and/or psychological factors in the pathophysiologic mechanism. Although there are controversies over whether the psychological factor is a cause or a result of BMS, several studies have supported strong relationships between psychological factors and chronic pain. It has been suggested that somatic complaints from unfavorable life experiences may influence both individual personality and mood changes; however, initiation of BMS symptoms is not necessarily correlated with stressful life events despite their elevated psychological stress. If the psychological distress is not a causal factor of BMS, it seems that BMS patients may be particularly vulnerable to psychological problems, primarily depression, anxiety, and hostility due to the characteristic entities of BMS such as chronic persistent pain itself. It seems likely that both physiological and psychological factors play a role in causing, perpetuating and/or exacerbating BMS; therefore, both two components of the patient`s symptoms must be addressed. The acceptance of psychological factors by the patient is often an important element of BMS, management. The evaluation of psychological and emotional status of BMS patient enables clinicians to recognize prolonged negative and subclinical factors which can complicate the management of pain or indirectly perpetuate other physical factors. This evaluation improves the doctor-patient relationships, motivation, and compliance through a correct understanding of the clinical problem. Appropriate emotional and psychological evaluation may be required prior to developing a treatment plan in order to gain the successful treatment outcome.
... Somatic complaints and depression, for at least a part of stomatodynia, may be the consequence of persistent pain. It is interesting to note that the association between psychological factors and BMS is not more pronounced than that for other painful conditions, including orofacial pain [39,[64][65][66]. ...
Article
Full-text available
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.
... A total of 63 patients with burning or pain symptoms were examined in the Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University in Istanbul, Turkey. The diagnosis of BMS was based on established diagnostic criteria 7,12,20,21,24,27,31 : (1) Patients were initially interviewed for complaints of dysgesia, xerostomia, burning, and/or painful sensations in the oral cavity; (2) All patients underwent a thorough clinical examination of the head and neck region to the oral cavity and dental status. If dentures were worn then their design and condition were assessed; (3) All patients underwent radiographic examination including panoramic radiographs and additional radiographs as necessary to exclude organic findings; (4) Laboratory evaluation included fasting blood glucose, haemoglobin, haematocrit, levels of vitamin B12, serum iron, total iron binding capacity, folic acid; (5) Non-stimulated whole salivary flow rate (UWSFR) was determined in all patients; 6. Patients suffering from systemic or local conditions, such as diabetes mellitus, lichen planus, neuralgia, chronic pain conditions in other regions and geographic tongue were excluded from the study; (7) Patients were interviewed if the complaints could be relieved by eating or drinking; (8) History of regularity of BMS over the last 6 months or longer; (9) Type of the BMS was recorded -in Type 1 BMS, patients suffer no symptoms on waking, but the burning begins and increases in severity as the day goes on; in Type 2 BMS, patients suffer from burning on waking and it persists throughout the day; in Type 3 BMS, patients have symptoms-free days. ...
Article
Full-text available
Objectives: The purpose of this study was to investigate and compare age, gender, menopause, duration of symptoms, laboratory results, location of burning symptoms, type of denture and the psychological aspects according to the type of burning mouth syndrome (BMS) in a sample of Turkish population. Methods: 63 patients complaining of burning, pain and xerostomia over the last 6 months or longer were examined clinically and radiographi-cally; laboratory evaluation was performed as well. Non-stimulated whole salivary flow rate was determined. Psychological disturbances were evaluated by the Speilberger State-Trait Anxiety Inventory for anxiety and Zung Self-Rating Depression Scale for depression. Results: Of the total of 63 cases, 50 (79.4%) were females and 13 (20.6%) were males. 34 of these subjects were Type 1 and 29 were Type 2 BMS. There was no statistically significant difference for age, gender, menopause , location of burning symptoms and type of denture between Type 1 and Type 2 groups (p>0.05). Non-stimulated whole salivary flow rate and all data were within normal ranges for both groups. For anxiety and depression , there were no statistically significant differences between Type 1 and Type 2 BMS patients (p>0.05), but anxiety scores (SAI and TAI) of both groups were found to be significantly higher than normal ranges. How ever, Zung Depression Scores for both groups were within normal ranges. All patients had cancer-phobia, and the mean VAS scores were 3.32±0.91 and 3.55±0.95 for Type 1 and Type 2 BMS patients, respectively. Conclusion: The psychological element has been an important aspect of the pathological picture for BMS, and anxiety is the most important factor in both types of BMS.
... En un estudio prospectivo de casos y controles realizado por Sardella y cols. 31 , compararon las características clínicas y de laboratorio, aspectos para evaluar la asociación causal de la propuesta de los factores de precipitación del SBA. ...
Article
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Literature review Psychological aspects of burning mouth syndrome. Literature review Abstract The burning mouth syndrome (BMS) is a relevant pathology, defined as a chronic pain of difficult diagnosis and treatment, perceived as burning in the mucous membranes, tongue and lips. Its etiology is considered controversial and it becomes difficult to establish a clear diagnosis, so the BMS etiopathogenesis is complex and is probably due to interactions between local, systemic and psychological factors. Due to disputes about whether the psychological factor is a cause or a consequence of BMS several studies support the relationship between psychological factors and chronic pain, suggesting that the disease somatizes unfavorable experiences of life, which can influence both changes in mood as the personality of patients; however, the onset of symptoms of the BMS are not necessarily related to stressful life events, despite its high psychological stress. BMS patients may be particularly vulnerable to psychological problems such as depression, anxiety, hostility, due to characteristics of the BMS entities such as chronic persistent pain. The physiological and psychological factors perpetuate and exacerbate the BMS; therefore, both components must be addressed. Acceptance of psychological factors by the patient, often is a significant element in the BMS. This review is important because in assessing the psychological and emotional state of patients with BMS, allows us to recognize clinical and subclinical, and other factors that may complicate the management of pain or indirectly link with other physical factors. This assessment helps improve doctor-patient relationships, motivation and compliance through a correct view of the problem, adequate emotional and psychological management, necessary for good treatment. Key words: Burning mouth syndrome, chronic pain, psychological factors.
... Similarly, our current data showed a more significant portion of patients with vitamin B12 and the folic acid deficiency (17.6%). An Italian study showed 11% of vitamin B12 and 12.5% of folic acid deficiency in patients with burning mouth syndrome (20). There are apparent geographic differences in the prevalence of each deficiency. ...
Article
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Introduction: Oral manifestations of deficiency of iron, vitamin B12 and folic acid are thought to be common. Prevalence of these deficiencies among patients with compatible symptoms is not well known. The goal of this study was to summarize evidence from a dental practice of iron, vitamin B12 and folic acid deficiency in patients presenting with compatible oral manifestations. Methods: 250 patients who presented with burning mouth syndrome, angular cheilitis, recurrent aphthous stomatitis, papillar atrophy of the tongue dorsum or mucosal erythema were identified. Patients underwent clinical examination, and the blood samples were taken. Results: 250 patients (208 females; 42 males, mean age 44.1 years) with at least one corresponding symptom or sign were identified. The nutritional deficiency of one or more nutrients was found in 119 patients (47.6%). Seven times more females than males were noted to have one type of deficiency (104 females, 15 males). Iron deficiency as defined was diagnosed in 62 patients (24.8%), vitamin B12 or folic acid deficiency in 44 patients (17.6%) and both deficiencies (iron + vitamin B12/folic acid) in 13 patients (5.2%). The only predictive factor was gender and only for iron deficiency. The presence of more than one deficiency was noted in 10 patients (4.9%). Conclusion: The most commonly observed deficiency in dental practice over the course of 11 years was an iron deficiency in the female population. Age, diet and reported co-morbidities did not show statistically significant predictable value in recognizing these deficiencies.
... 46e49 Based on the above results and the concept that oral Candida is a common oral flora, most scientists still think that oral candidiasis is just a coincidence in BMS patients. 46,49 Approximately 45%e48% of the oral dysesthesia patients in our study showed pain relief after oral nystatin treatment, irrespective of their culture results. Moreover, for the evaluation of NRS reduction after oral nystatin treatment, oral dysesthesia patients in the three different groups all presented a significant reduction in the oral pain level after oral nystatin treatment. ...
Article
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Background/purpose Previous studies have shown that some of the patients with oral mucosal dysesthesia but without objective oral mucosal manifestations (so-called oral dysesthesia patients in this study) may have good responses to oral nystatin treatment. This study evaluated the efficacy of oral nystatin treatment for oral dysesthesia patients and the necessity of Candida culture test before oral nystatin treatment. Materials and methods The 147 oral dysesthesia patients were divided into 3 groups: Candida culture (+) group (n = 29), Candida culture (−) group (n = 34), and without Candida culture test group (n = 84), and treated with oral nystatin. The pain improvement was evaluated by the reduction of numeric pain rating scale (NRS) and global perceived effects (GPE). We defined the GPE score ≥4 points as a great improvement. Results We found that 44.8% of 29 patients in the Candida culture (+) group, 47.1% of 34 patients in the Candida culture (−) group, and 47.6% of 84 patients in the without Candida culture test group showed a significant reduction in the NRS score and achieved a great improvement after oral nystatin treatment for 1–4 weeks. Moreover, 72.4% of our 29 patients with Candida culture test achieved a great improvement within one week, and all the 29 patients achieved a great improvement within 4 weeks of oral nystatin treatment. Conclusion A portion of our oral dysesthesia patients are infected by Candida and it is beneficial to our patients to use oral nystatin treatment before the Candida culture test.
... However, more recent studies were not able to find a significant correlation between the presence of Candida spp. and the onset of primary BMS [69,70]. Indeed, Farah et al. [71] did not observe a statistically significant difference in the presence of Candida species in patients with BMS when compared with other oral diseases [71]. ...
Article
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Burning mouth syndrome (BMS) is defined as “idiopathic orofacial pain with intraoral burning or dysesthesia recurring daily for more than 2 hours per day and more than 3 months, without any identifiable causative lesions, with or without somatosensory changes” in International Classification of Orofacial Pain, 2020. Worldwide prevalence of BMS was estimated to be 1.73% in population-based studies, while female and elderly are at higher risk of BMS. The aim of this narrative review is to clarify the main etiopathogenetic factors of BMS investigated so far in the scientific literature. There is growing evidence of an important role of peripheral neuropathology in BMS, supported by immunohistochemical studies which have demonstrated a significant loss of epithelial and subepithelial nerve fibers. Other possible etiopathogenetic factors emerging from literature are laryngopharyngeal reflux and hormonal and salivary changes related to aging and menopause. Finally, the role of the oral microbiota in BMS has not yet been thoroughly investigated. Further studies are necessary to investigate the probably multifactorial etiopathogenesis of primary BMS, a pathology which has a serious impact on the quality of life of our patients, a disease we find ourselves treating without the adequate therapy and the necessary knowledge.
... The clinical examination can reveal atrophy of the papillae of the dorsum tongue. In advanced cases, the tongue may have a smooth, bright red surface, as reported in a single case report [17]. ...
Article
This research gives a scientific framework for burning mouth syndrome(BMS) etiology and diagnostic approach in clinical dental and medical practice. BMS-like symptoms can be induced by systemic diseases such as diabetes, gastrointestinal, endocrine disorders, allergy etc. or by local oral cavity conditions as candidiasis or geographic tongue or odontogenic causes. Because the etiology of BMS is multifactorial, treatment can only be distinctive, and is aimed at relieving symptoms. The complexity of BMS symptoms and associated psychosocial infirmities, anxiety and depression raise the need for a multidisciplinary and individualised approach.
... Примечательно, что вышеперечисленными двигательными реакциями проявляется тревожное расстройство. Хотя на сегодняшний день нет однозначного мнения о том, что парафункциональные привычки могут вызывать СГР, тем не менее на их наличие стоит обращать внимание при сборе анамнеза [16]. При осмотре могут выявляться стертые зубы, повреждения языка и/или слизистых. ...
Article
The article presents data on the prevalence, classification, diagnosis, and treatment of burning mouth syndrome (BMS). Given the variety of etiological factors, special attention is paid to the differential diagnosis of idiopathic (primary) and secondary BMS. The article also examines topical and systemic causes of burning tongue, which should be excluded when examining patients with complaints specifically attributed to BMS. The information presented in the article allows physicians of various specialties to make an individual plan of diagnostic measures for each patient, taking into account the comorbid background and anamnestic data. The main cause of treatment difficulties in BMS is a complex, not fully investigated etiopathogenesis. Due to the fact that the multifactorial nature of this disorder is most likely to involve topical, systemic and psychogenic causes, a multidisciplinary method involving physicians of various specialties (neurologist, dentist, therapist, psychiatrist) is optimal in the patient management with BMS. KEYWORDS: burning mouth syndrome, burning tongue, differential diagnosis, neuropathic pain, treatment. FOR CITATION: Parkhomenko E.V., Lunev K.V., Sorokina E.A. Burning mouth syndrome. Difficulties in diagnosis. Russian Medical Inquiry. 2020;4(9):560–565. DOI: 10.32364/2587-6821-2020-4-9-560-565.
... Se ha observado que la desaparición espontánea de los síntomas ocurre en muy pocos casos, de 5 a 20%, y en promedio, sólo el 40% de los pacientes se benefician de los medicamentos para el dolor neuropático. 22,23 En caso de ser comprobable una afección local o sistémica, el tratamiento debe ir enfocado es esto, sin embargo, no existiendo una alteración comprobable, ya sea mediante la inspección oral o por medio de exámenes, debiese manejarse como un SBU primario. 24 Además, habiéndose descartado la causa secundaria, también se debe considerar la prevención de posibles factores irritativos y traumáticos sobre la mucosa oral. ...
Article
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El Síndrome de Boca Urente (SBU) clásicamente se define como un dolor oral quemante sin hallazgos en el examen físico o de laboratorio. Muchas veces puede ser asociado a procedimientos dentales o alteraciones psiquiátricas pero en En la gran mayoría de los casos, no existe un fenómeno relacionado. Sin embargo, no existe consenso en su evaluación clínica, lo que se refleja en lo heterogéneo de los estudios de prevalencia, patogenia y tratamiento. Es por esto que muchas veces, representa un desafío el diagnóstico y tratamiento, especialmente cuando especialmente cuando existe un serio deterioro de la calidad de vida, sin una causa identificable. Este artículo tiene como objetivo contribuir en la identificación de causas y en la definición de pautas para el diagnostico y manejo clínico del SBU, proponiendo un esquema de estudio y manejo en base a la revisión de la literatura y la experiencia clínica.
... Although few studies on BMS have used pure personality scales, studies have measured negative emotional symptoms, e.g. symptoms of anxiety and depression, by Hospital Anxiety Depression Scale (HADS) [7,40,41], Montgomery-Åsberg Depression Rating Scale (MADRS) [42], Symptom Checklist-90-Revised (SCL-90-R) [43], Beck Anxiety Inventory (BAI) [44], Beck Depression Inventory (BDI) [45,46], Cattels Anxiety Scale [47], and State and Trait Anxiety (STAI) [43,45,48]. Results from earlier studies show that the role of psychological factors in BMS are substantial. ...
Article
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.
... Thus initially, an idiopathic primary BMS was identified, as well as a secondary BMS associated with local or systemic etiopathogenic factors (6,7). This approach made management of these patients rather complex since they required different complementary tests, some of which were rather complex, as well as a detailed analysis of all the possible factors which could condition the appearance of the painful oral symptomatology (6,8). Due to the neuropathic nature of the disorder and the lack of clinical evidence of the participation of local and/or systemic factors in the genesis of BMS, it was decided in the third classification of the International Headache Society (IHS) (1) that BMS be considered to be a primary process which did not require the ruling out of etiopathogenic factors for its diagnosis; this approach was, nevertheless, not shared by the International Association for the Study of Pain (IASP) (9). ...
Article
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Background: To analyze the presence of burning mouth syndrome (BMS) in a group of patients diagnosed with oral lichenoid disease (OLD). Material and methods: A retrospective study of 217 patients diagnosed with OLD; 158 (72,8%) women and 59 (27,2%) men, with an average age upon diagnosis of 56,4 years (SD 11,88). We carried out a detailed and complete characterization of symptoms, with special emphasis on BMS diagnostic data specified by the International Headache Society. Results: Four patients (1.8%) presented with long-term clinical symptoms of burning mouth, indicative of BMS and they fulfilled the IHS 2018 criteria, except for criterion D, i.e."Oral mucosa is of normal appearance". The observed lichenoid mucosal lesions were not considered to be able to account for the reported intraoral pain in any of our patients. Thus neither diagnosis was considered to be exclusive. Conclusions: Patients diagnosed with OLD, and who simultaneously present clinical characteristics of BMS should be studied in detail, in order to evaluate the possibility of both diagnoses concurring.
... The most common age of onset for this syndrome is the fifth to seventh decades of life. It often occurs in post-menopausal women (Hakeberg et al., 1997;Sardella et al., 2006;Woda et al., 2009). The etiology of this syndrome is still unknown, but central nervous system disorders and peripheral neuropathy are known as a common cause (Borelli et al., 2010;Forssell et al., 2002;Lauria et al., 2005). ...
Article
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.
... However, Cavalcanti et al. [47] in their randomized, double-blind, placebo-controlled trial of 38 patients, did not find effectiveness of alpha lipoic acid, in comparison with the control group given placebo, in the management of BMS [48]. Recent randomized double blind placebo controlled trial by Lopez D et al. [42,49]showed that use of gabapentin alone [300 mg daily] or in combination with ALA [600 mg daily] was beneficial in reducing symptoms in 50% and 70% of patients with BMS, respectively, compared to placebo [15%] [50,51]. ...
Article
Full-text available
Burning mouth syndrome [BMS] is a chronic pain condition, characterized by an intraoral burning sensation in the absence of any organic disorders of the oral cavity or clinical or laboratory findings, affecting predominantly postmenopausal middle‐aged females. This condition is probably of multifactorial origin, involving various local, systemic, and/or psychogenic causes, often idiopathic and its exact etiopathogenesis remains unclear. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS as it is a disease of exclusion. With its management still remaining to be a challenge, In this article we discuss current management strategies from the use of pharmacological modalities to applying non-pharmacological modalities including cognitive behavioral therapy and complementary and alternative medicine [CAM], emphasizing the important role of patient education and anxiety management to improve the patients’ quality of life.
Article
Objectives To investigate the quality of sleep of patients with primary burning mouth syndrome (BMS) compared with a control group.MethodsA total of 70 patients with primary BMS and 70 control subjects were enrolled in the study. The severity of pain was evaluated with a Visual Analogue Scale (VAS). Four validated questionnaires were used to investigate the psychological profile of each patient: the Hospital Anxiety and Depression Scale, the Oral Health Impact Profile-14 (OHIP-14), the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (EES).ResultsPoor sleep quality was present in 67.1% patients with BMS vs. 17.1% in control subjects (P ≤ 0.001). For patients with BMS, total data resulting from the PSQI correlated with results obtained by the EES (P ≤ 0.001), VAS pain (P ≤ 0.001), localization (P = 0.01), HAD-A (P = 0.001) and HAD-D (P = 0.001). Logistic regression analysis showed that an increase of one point in each depression score (HAD-D) made the chances of PSQI 1.26 times more likely, with a 95% confidence interval (CI = 1.03–1.55).Conclusions Patients with primary BMS exhibited significant decreases in sleep quality compared with the control group.
Article
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. 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. 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). 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. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
Background Burning mouth syndrome is a syndrome with tongue as the main affected site and burning pain as the main complaint. Although a variety of therapies have been reported to treat BMS, there is a lack of widely recognized therapies and it is still a dilemma for clinicians to treat BMS. Objective To develop the position paper and provide the references for clinical practice of BMS in China. Methods Under the guidance of WHO (World Health Organization) Handbook for Guideline Development, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach as a tool to develop this position paper in the following steps: setting up the groups, formulating the clinical questions and choosing the outcomes, retrieving and synthesizing of evidence, assessing the evidence, investigating the patients' values and preferences, developing the recommendations, reviewing the recommendations and writing the position paper. Results The 27 recommendations were formed from the following 7 aspects: pre‐treatment examination, removal of stimuli, medication, physical therapy, psychological therapy and antipsychotics. There are 3 strong recommendations and 12 weak recommendations in pre‐treatment examination and removal of stimuli, as well as 12 weak recommendations in therapies. Conclusion The Chinese position paper for management of BMS has been developed, which could provide the references for clinical practice of BMS in China. 27 recommendations were formed based on consensus of experts on the balance of benefits versus side effects, evidence, cost and patients’ values and preferences, although the quality of evidence is relatively low.
Chapter
Chronic orofacial pain may be musculoskeletal, neuropathic, or neurovascular in origin and can impact diet intake and nutrition status Treatment of chronic orofacial pain requires diagnosis of the underlying cause and individualized treatment for each pain diagnosis Primary aims of treatment focus on decreasing pain, restoring function, and maintaining high quality of life and activities of daily living Medications used to manage chronic orofacial pain may have associated systemic, oral, and nutritional sequallae which require management Motor and sensory function in patients with chronic orofacial pain conditions requires an interprofessional approach to support oral function, diet, and nutrition
Article
Objective: To test the association between pain severity and anxiety, depression, and somatoform symptoms in burning sleep syndrome (BMS). Material and methods: The study included 36 patients (33 women, 3 men), mean age 58.0±14.8 years. Psychopathological, clinical-dermatological, parametric, statistical methods were used. Psychometric examination included the Visual Analogue Scale (VAS) for assessment of pain (severity of glossalgia), PHQ-4 for self-assessment of severity of anxiety (GAD-2) and depression (PHQ-2), the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Pittsburgh Sleep Quality Index (PSQI), the EQ-5D-5L quality of life assessment scale. Results and conclusion: Insomnia in chronic pain is very common. On the one hand, studies show that sleep deprivation can enhance pain perception. On the other hand, chronic pain can trigger a variety of sleep disorders. One of the localizations of chronic pain syndrome is the oral mucosa. Somatoform pain disorder related to oral mucosa called «glossalgia» or «burning mouth syndrome» (BMS). The prevalence of insomnia in the study sample was 61.1%. The statistically significant positive correlation was found between the severity of insomnia (PSQI) and the severity of anxiety on both GAD-2 and HADS, while insomnia showed no correlation with depression and pain severity. At the same time, the severity of anxiety showed statistically significant positive correlation with the severity of pain assessed by VAS.
Chapter
Burning mouth disease (BMD), also referred to as burning mouth syndrome, is largely a diagnosis by exclusion of evident causative local (mucosal) lesions or causative nonlocal diseases, including side effects of drugs. In the present chapter attention will be paid to a number of benign, potentially malignant and malignant mucosal lesions that may cause burning sensations or dysaesthetic sensations, somewhat mimicking the symptoms of BMD. The majority of these mucosal lesions can be diagnosed clinically. Furthermore, BMD-like symptoms may be of odontogenic origin, e.g. related to ill-fitting dentures or sensitivity to compounds in the dentures. In rare instances, BMD-like symptoms are caused by hypersensitivity to mercury of amalgam fillings. Oral parafunctional habits, like tongue thrusting or tooth clenching, may be another cause of BMD-like symptoms, although contradictory results on this subject have been published. Smoking and the use of alcohol do not seem to play an important role in the aetiology of BMD.
Article
Aim: To evaluate the prevalence of Burning mouth syndrome (BMS) and to determine local and systemic factors associated with its presence. Patients and methods: 314 patients were divided in BMS group (n = 164) and control group (n = 150). Research was conducted using a questionnaire assaying the prevalence of local and systemic factors associated with BMS between BMS group and control group. The questionnaire involved 14 enquires: demographic data, drugs, allergies, systemic illness or disorders that may be in the background of BMS, smoking and local factors. Total salivary flow rates were determined, smears to identify the presence of Candida were taken, oral galvanism was measured and the presence of parafunctional habits was determined. Comparative statistical analyses of scanned factors among groups were performed using Hi square test, Fischer's exact test or t-test for the difference between proportions. Results: Significantly higher prevalence in the SPU group was found for: allergies, postmenopause, positive finding of H. pylori / GERD / gastritis, local nerve trauma or neurologic disease, parafunctional habits, xerostomia, candidiasis, galvanism and antihypertensive therapy. Smoking was significantly more common in control group. Conclusions: Treating the patients with secondary BMS dentists should pay special attention to the presence of candidyasis, galvanism, parafunctional habits and gastroenterological problems.
Chapter
Burning mouth disease (BMD), also referred to as burning mouth syndrome, is largely a diagnosis by exclusion of evident causative local (mucosal) lesions or causative nonlocal diseases, including allergies and side effects of drugs. In the present chapter, attention will be paid to a number of diseases that may cause BMD-like symptoms. A much debated issue concerns the possible role of iron-deficiency anaemia and pernicious anaemia caused by lack of vitamin B12. Diabetes mellitus is another example of a systemic disease that has been discussed in relation to BMD. Because of the strong predilection of BMD for menopausal and postmenopausal women attention has been paid to a possible role of gonadal hormones in the aetiology of BMD. However, the results of hormonal therapy have not been very convincing. Another cause of BMD-like symptoms is related to side effects of certain drugs e.g. certain classes of hypertensive drugs.
Article
Burning mouth syndrome (BMS) is an enigmatic, misunderstood, and under-recognized painful condition. Symptoms associated with BMS can be varied, thereby providing a challenge for practitioners and having a negative impact on oral health–related quality of life for patients. Management also remains a challenge for practitioners because it is currently only targeted for symptom relief without a definitive cure. There is an urgent need for further investigations to determine the efficacy of different therapies because this is the only way viable therapeutic options can be established for patients with this chronic and painful syndrome.
Thesis
L'établissement d'un état des lieux le plus exhaustif possible des connaissancesactuelles s'agissant des stomatodynies (ou Burning Mouth Syndrome) présente unintérêt certain du point de vue de la pratique. Pour ce faire, et avant tout autre chose, une description de la stomatodynie permet de cerner cette notion et d'en favoriser la compréhension, notamment en la classifiant en stomatodynies dites primaires (SP) et secondaires, ceci afin de permettre aux praticiens d'en faire le diagnostic le cas échéant. Postérieurement au diagnostic différentiel des stomatodynies primaires, une analyse de la littérature sur les avancées des recherches dans l'étiopathogénie des SP permet de mieux comprendre les différents traitements (traitements systémiques, topiques...) expérimentés par les équipes de chercheurs. Toutes ces recherches ont pour but d'améliorer la compréhension de cette pathologie encore méconnue qui retentit négativement sur la qualité de vie de nos patients.
Article
Background:. There are an increasing number of patients with oral sensory complaints (OSCs) presenting to our dental clinic. For most dentists, it is difficult to distinguish burning mouth syndrome (BMS) from other oral mucosal diseases that may cause symptoms such as burning mouth. It is beneficial to effectively distinguish OSC patients to reduce misdiagnosis and eliminate burning symptoms as much as possible. Methods:. Patients with oral burning sensations in the oral mucosal disease clinic were collected from the Peking University Hospital of Stomatology between September 1, 2014 and December 31, 2018. After excluding oral candidiasis, anemic stomatitis, dental material allergy, and other diseases from patients with oral sensory complaints, basic conditions such as gender, age, education level, job status, hyperglycemia, hypertension, hyperlipidemia, history of brain abnormalities, history of cervical spondylitis, history of thyroid disease, history of thyroid disease and insomnia were obtained. The BMS patients were compared with the control group. The t test and Chi-square test were used for statistical analysis to compare the clinical symptoms of these diseases and explore the risk factors for BMS. Results:. In this case-control study, 395 patients (321 females and 74 males, mean age 55.26 ± 10.51 years) with oral sensory complaints and 391 healthy controls (281 females and 110 males, mean age 47.11 ± 13.10 years) were enrolled, among which, 8.4% (33/395) had oral candidiasis, 1.3% (5/395) had dental material allergy, 0.8% (3/395) had anemic stomatitis and 0.5% (2/395) had lichen planus. A total of 352 patients were eventually diagnosed with BMS. Anxiety and depression were more severe in BMS patients, as were the incidences of sleep disorders and brain abnormalities. Logistic regression analysis showed that age (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.61–4.83, P
Chapter
Oral and labial lesions are usually the result of local disease but may be the early signs of systemic disease, including dermatological disorders, and in some instances may cause the main symptoms. This chapter mainly discusses disorders of the periodontal and mucosal tissues that may be related to skin disease and that may present at a dermatology clinic. It should be borne in mind that the professionals most competent in diagnosing and treating oral diseases are those with formal dental training and who are therefore in a position to understand the full complexities of the region. This chapter is divided into a brief discussion of the biology of the mouth, an overview of the more common signs and symptoms affecting specific oral tissues, discussion of the disorders of the oral mucosa of most relevance to dermatology and a tabulated review of oral manifestations of systemic diseases. Only the more classic oral lesions are illustrated. For reasons of space restrictions, diseases affecting the teeth, salivary glands, jaws or temporomandibular joints are not discussed in any depth.
Article
Background: Burning mouth syndrome (BMS) is a disorder characterized by chronic mouth pain in the absence of objective clinical abnormalities. Vitamin or mineral deficiencies may have a role in BMS, but data regarding the prevalence and relevance of hematinic deficiencies are conflicting. We aimed to determine the frequency of specific laboratory abnormalities in patients with BMS. Methods: We retrospectively reviewed the results of screening blood tests in patients with BMS at our institution between January 2003 and December 2013. Results: Among 659 patients with BMS, the most common decreased values or deficiencies were vitamin D3 (15%), vitamin B2 (15%), vitamin B6 (5.7%), zinc (5.7%), vitamin B1 (5.3%), thyrotropin (TSH) (3.2%), vitamin B12 (0.8%), and folic acid (0.7%). Laboratory values for fasting blood glucose and TSH were increased in 23.7% and 5.2%, respectively. Conclusions: In patients with symptoms of BMS, our results suggest it is reasonable to screen for fasting blood glucose, vitamin D (D2 and D3 ), vitamin B6 , zinc, vitamin B1 , and TSH. Deficiencies of vitamin B12 and folic acid were rare (<1% abnormal).
Article
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p>Burning Mouth Syndrome (BMS) is characterized by chronic oro-facial pain in the absence of specific oral lesions & clinically apparent mucosal alterations. It is more commonly observed in middle aged patients & postmenopausal women. It often affects tongue, cheek, lip, hard & soft palate. Usually symptoms are better observed in morning, worsen during the day and typically subside at night. The condition is multifactorial origin, often idiopathic and its etiopathogenesis remain largely enigmatic. Associated medical conditions may include neurologic and metabolic disorder, gastrointestinal, urogenital as well as drug reactions. BMS are of two types, primary & secondary. Primary BMS is essential or idiopathic where secondary BMS is caused by local, systemic and/or psychological factors. Clinical diagnosis depends on the careful history taking, physical examinations and laboratory findings. Vitamin, Zinc or Hormone replacement therapy has been found to be effective with deficiency of the corresponding factors. The drug therapy with alpha-lipoic acid, capsaicin, clonazepam, benzodiazepines, tricyclic antidepressants, anticonvulsants may be effective in symptomatic treatment of BMS. But the treatment is still unsatisfactory and there is no definitive cure. J Bangladesh Coll Phys Surg 2016; 34(3): 151-159</p
Article
The burning mouth syndrome (BMS) is characterized by the presence of chronic symptoms of burning or pain in clinically normal oral mucosa. This syndrome primarily affects peri and postmenopausal women. The cause is unknown, but the relationship between the BMS and a complex association of biological and psychological factors suggest a multifactorial etiology. Although some treatments have been found effective in particular cases, the clinical searchers are still looking for a treatment that can be effective in most cases. This review makes particular reference to the etiological factors and the treatment of the syndrome.
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Burning mouth syndrome (BMS) is a chronic condition characterized by burning sensation on a clinic normal oral mucosa. BMS is not a rare condition, however, mechanisms involved in their development remains poorly understood. The aim of this paper was to carry out a review of literature about this syndrome, highlighting the main etiological factors as an approach to the management of this condition.
Article
The purpose of this study was to explore the relationship between symptoms on burning mouth syndrome and health anxiety and compare patients diagnosed as burning mouth syndrome with general patients in dental clinic from the perspective the influence of health anxiety on affective conditions. Thirty-eight patients with burning mouth syndrome and 100 general patients in dental clinic were assessed by questionnaire consisted of pain intensity, oral dryness, Japanese version of Oral Health Impact profile-14(OHIP-14),the subscale of depression-dejection, tension-anxiety in Japanese version of Profile of Mood State-Brief (POMS-B),Short Health Anxiety Inventory(SHAI). The results of this study showed that health anxiety was not related with pain intensity, oral dryness, and oral health-related QOL, and was related with anxiety and depression.
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Burning Mouth Syndrome (BMS) is characterised by a continuous, painful burning sensation in a clinically normal appearing oral mucosa. The etiology of BMS remains unknown, although a number of local, systemic and psychological factors have been proposed as being of etiopathogenic importance. Numerous studies indicate that the pathological picture includes both somatic and psychological components. In the dental clinic, the patients' descriptions of the nature of pain and the location of the burning pain appear to be unambiguous and remarkably consistent. Several recent studies indicate that BMS is a neuropathic pain condition, but it is still uncertain whether it is a peripheral and/or a central neurogenic dysfunction. In the psychology clinic, too, BMS patients exhibit unambiguous patterns regarding their reactions to the percep-tion of pain. The reaction is reflected in difficulties in distinguishing between the somatic pain and potential psychological phenomena originating from other life events. These difficulties make it pertinent to identify psychological aspects by a parallel psychological assessment in addition to the somatic one. BMS is an example of a chronic orofacial pain condition that creates major diagnostic and therapeutic problems in the dental clinic. Conclusions: Today we know that multidisciplinary cooperation is required in this field. An interdisciplinary and transscientific pain clinic would be a relevant forum for assessment and treatment of these patients. From a scientific point of view this would enable us to achieve a greater understanding of the basic etiological mechanisms behind BMS and ultimately to achieve an evidence-based treatment approach.
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Methods for collection and stimulation of whole mouth saliva were compared. Resting salivary flow values were roughly equivalent for draining, spitting, suction, and swab collection techniques, but the swab technique was less reliable. Gustatory and masticatory stimuli induced significantly higher salivary flow compared to resting levels, but the between- and within-subject variances were also higher. Stimulation produced a fairly constant addition of saliva whether individual resting flow levels were low or high.
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The measurement of pain threshold (PT) and the assessment of trigeminal somatosensory evoked potentials (TSEPs) were performed. These experiments indicated the pathological conditions of nerve afferent and efferent pathways in patients with burning mouth syndrome (BMS). This study also explored the probable pathophysiological mechanisms in BMS. The dorsum linguae of 38 samples in 19 subjects (22 BMS with pain, 10 BMS with numbness, and 6 controls) were stimulated by electroneuromyography. PT was measured as the lowest stimulation intensity the subjects could detect. N3, P4 latency, and spike potential latency of TSEP were recorded by stimulating the lingual nerve. Pain thresholds were significantly lower, N3, P4 latencies were significantly shorter, and the spike potential appeared earlier in the BMS with pain group (P < 0.01). The opposite tendency of these values presented in the BMS with numbness group (P > 0.05). The results indicated that the nerve sensitivity was elevated in the BMS with pain group, and that these patients were easily affected by etiological factors. In the BMS with numbness group, partial or complete nerve blockage may have been indicated. This study suggested that selfreports of BMS pain appeared to be of value, and that there were pathological conditions in nerve transmission. It supported the theory that peripheral or central nervous system involvement might play an important role in BMS. It was possible to show the pathogenesis of BMS. All of these objectively explain the clinical understanding of BMS, and may be of assistance in the treatment of BMS.
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The aim of our investigation was to evaluate possible connection between burning mouth syndrome and hematinic deficiencies, a hypothesis previously reported in the literature with contradictory results. Serum levels of iron, vitamin B12, folic acid, calcium and magnesium were determined in 41 (aged 31-87 years, mean 68,7 yrs) patients with burning mouth syndrome and 35 matched controls (35-83, mean 63 yrs). Serum iron levels were determined according to Fairbanks and Klee. Levels of vitamin B12 and folic acid were determined on commercially available kits (Imx12 and Imx folate assay, Abbot Park lab, IL, USA) on Imx analyser. Calcium and magnesium levels were determined using atomic absorption spectrophotometry. No statistically significant differences in serum levels of iron, folic acid, calcium and magnesium were found between patients with burning mouth syndrome and controls. Statistically significant lowered vitamin B12 levels were found in patients with burning mouth syndrome. Our results suggest that serum deficiencies of iron, folic acid, calcium and magnesium are not etiological factor in patients with burning mouth syndrome.
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Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting muco-sal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.
Article
Abstract The aim of the present study was to examine pain threshold and pain recovery in patients with burning mouth syndrome (BMS) and matched no-pain controls. Twenty female patients diagnosed with BMS without organic gross changes were enrolled in the study. Twenty control subjects were chosen from age-matched healthy female volunteers. We compared the thermal pain threshold using heat beam dolorimeter on the finger and tongue between patients and controls. Warm (at 50°C for 5 s), cold (at 0°C for 30 s) and mechanical (stimulation by electric tooth brush for 15 s) stimulation was applied to the tongue for both groups. Participants were asked to rate the subjective pain using a visual analogue scale (VAS). Although there was no significant differences between patients and controls in terms of the threshold on the finger, the threshold on the tongue was significantly higher in patients than in controls. We suggest there were peripheral dysfunction at the tongue, and/or central dysfunction in patients with BMS. Among the three types of stimulation, the patients perceived significantly the highest pain from the mechanical stimulation for the first 5 min after the stimulation. Furthermore, when patients with BMS perceived some pain, they continued to complain of the pain longer and more intricately than the controls. This indicates that the pain of the patients is strongly affected not only at a sensory component but also at an affective/motivational component than the controls. However, we should be cautious of simply advancing psychogenic theory in this etiology.
Article
Burning mouth syndrome (BMS) is characterized by a burning sensation in the oral cavity although the oral mucosa is clinically normal. The syndrome mostly affects middle-aged women. Various local, systemic and psychological factors have been found to be associated with BMS, but its etiology is not fully understood. Oral complaints and salivary flow were surveyed in 669 men and 758 women randomly selected from 48,500 individuals between the ages 20 and 69 years. Fifty-three individuals (3.7%), 11 men (1.6%) and 42 women (5.5%), were classified as having BMS. In men, no BMS was found before the age group 40 to 49 years where the prevalence was 0.7%, which increased to 3.6% in the oldest age group. In women, no BMS was found in the youngest age group, but in the age group 30 to 39 years the prevalence was 0.6% and increased to 12.2% in the oldest age group. Subjective oral dryness, age, medication, taste disturbances, intake of L-thyroxines, illness, stimulated salivary flow rate, depression and anxiety were factors associated with BMS. In individuals with BMS, the most prevalent site with burning sensations was the tongue (67.9%). The intensity of the burning sensation was estimated to be 4.6 on a visual analogue scale. There were no increased levels of depression, anxiety or stress among individuals with more pain compared to those with less pain. It was concluded that BMS should be seen as a marker of illness and/or distress, and the complex etiology of BMS demands specialist treatment.
Article
To our knowledge, this is the first report on pain-related abnormalities of the eye blink reflex (BR) in a clinical pain patient population. The objective of this study was to evaluate the possible neuropathic mechanisms underlying the burning mouth syndrome (BMS), by means of objective electrophysiological examination of the trigemino-facial system. We studied the BR with stimulation of the supraorbital nerve (SON) with particular emphasis on the occurrence of the pain-related ultralate R3 components, and the habituation response of the R2 components. The subjects consisted of eleven BMS patients and 10 healthy control subjects. All patients underwent thorough clinical oral and neurological examinations. The motor function of the trigeminal nerve was assessed with a jaw reflex recording, and a needle-EMG examination of the facial and masticatory muscles was performed in the patients with abnormalities in the BR recordings. The jaw reflexes, the latencies of the BR components, and the needle-EMG examinations were normal in all patients. As a group, the BMS patients had statistically significantly higher stimulus thresholds for the tactile R1 components of the BR compared with the control subjects. With non-noxious stimulation, the BMS patients showed more frequently pain-related R3 components (11/22 SONs) compared with the controls (3/20 SONs). In addition, four BMS patients had abnormal habituation of the R2 components. In two of these patients, the findings were segmental (i.e., unilateral), coinciding with the side of the subjective BM symptoms. The abnormalities of the BR tests appeared to be related to longer disease duration. Our results suggest a possible pathologic involvement of the nervous system in chronic BMS.
Article
The spinal cord of a patient had been completely and cleanly cut across at the Th3 segment except for part of one anterolateral quadrant. The extent of the lesion was clearly verified at an open surgical inspection. There was complete paralysis below the level of the lesion. The classical expectations of her sensory status were confirmed in only 2 ways:(1) Temperature could be identified only on the side opposite the intact quadrant.(2) Pin prick could be only identified on this contralateral side.Against classical expectations were the following findings:(1) Localisation of touch and pressure stimuli was reasonably accurate on both sides.(2) Passive movement could be detected on the homolateral side.(3) Pain could be evoked by stimulation of both sides.(4) Von Frey hair stimuli could be identified on both sides.(5) Repeated sub threshold stimulation markedly lowered the threshold for detecting von Frey hairs.This case implies that there must be a revision of the traditional labelling of the function of the spinal cord afferent systems.
The increase in incidence of oral discomfort among women in a menopause is probably due to hormone modifications. This study evaluated the efficacy of hormone replacement therapy in 27 postmenopausal patients, aged 48 to 58 years, with oral discomfort and no local irritants and in 47 postmenopausal women with no oral discomfort. Patients were treated with conjugated estrogens for 21 days and medroxyprogesterone acetate from day 12 through day 21. Hormone-replacement therapy had no effect on oral cytology in the 40 symptom-free postmenopausal women compared with a group of 47 postmenopausal women who had no oral symptoms and were not treated. Hormone-replacement therapy relieved symptoms and improved oral cytohormonal features in 15 of 27 patients with symptoms. Nuclear estrogen receptors were found by immunohistochemical assay in 8 of 10 randomly selected patients with symptoms who responded to hormone-replacement therapy, but not in 2 patients who did not benefit from hormone-replacement therapy. Estrogen receptors were also found in 6 of 10 fertile women with no oral disease. Our results suggest that oral discomfort may be related to steroid hormone withdrawal only in some postmenopausal women and that replacement therapy may improve the clinical picture and cytologic features in this group of patients. Immunohistochemical identification of estrogen receptors may help to identify patients for whom hormone-replacement therapy may be beneficial.
Article
The oral carriage of Candida species and coliforms in a healthy adult population and a group of patients with burning mouth syndrome (BMS) was investigated. The intra-oral prevalence of Candida species and coliforms was higher in the BMS group compared with the controls. The most frequent yeast isolated from the BMS group was Candida albicans while Enterobacter and Klebsiella species were the most prevalent coliforms. The possible reasons and the significance of the above findings are discussed.
A recent index of anxiety and depression (Hospital Anxiety and Depression Scale) was applied to 74 patients with burning mouth syndrome. The scale pointed to anxiety, more than depression, being a feature of burning mouth syndrome. The validity and clinical application of this scale to assess anxiety and depression in such patients are discussed.
Article
A prospective study of 150 consecutive patients with burning mouth syndrome and with a minimum follow up period of 18 months is reported. Factors related to dentures, to vitamin B complex deficiency, and to psychological abnormalities were found to be important, and undiagnosed diabetes mellitus, reduced salivary gland function, haematological deficiencies, candidal infection, parafunctional habits, and allergy might also play a part. Given a protocol for management which takes all these factors into account, some two thirds of patients can be cured or have their symptoms improved.
A study was carried out to compare the clinical features of 102 subjects suffering from burning mouth syndrome (BMS) and 43 age- and sex-matched control subjects. In comparison with those in the control group, the BMS subjects reported a significantly higher prevalence of dry mouth, thirst, taste and sleep disturbances, headaches, nonspecific health problems, pain complaints, and severe menopausal symptoms, but no significant differences in other oral or dental features or in the prevalence of candidiasis infection. In addition, there was no hematologic evidence of a nutritional disturbance in more than 90% of the BMS subjects tested, but immunologic abnormalities and an elevation of the erythrocyte sedimentation rate were found in more than 58% and 63% of the BMS subjects, respectively. These findings demonstrate those features which distinguish BMS subjects from age- and sex-matched control subjects but provide no confirmatory evidence for many of the etiologic factors frequently suggested for BMS.
Twenty-five patients with a diagnosis of nonorganic burning mouth syndrome were matched for age and sex with twenty-five patients with organically based painful disorders of the mouth. All patients were interviewed by a psychiatrist and completed the General Health Questionnaire to screen for psychiatric disorders. A diagnosis of psychiatric disorder based on clinical examination findings was made in 44% (11/25) of the patients with burning mouth syndrome and in 16% (4/25) of the controls.
Article
Research now requires instruments capable of a better distinction between depressive and anxiety disorders. The study is concerned with two relatively recent clinician-rated scales, the Montgomery-Asberg Depression Rating Scale and the Clinical Anxiety Scale together with two recent self-assessment scales, the Irritability-Depression-Anxiety Scale and the Hospital Anxiety and Depression Scale. The concurrent validity of these scales as measures of the separate concepts of anxiety and depression is examined.
Analyses of whole and parotid saliva were performed in ten patients with subjective symptoms resembling galvanic pain and in their eight asymptomatic counterparts. Salivary flow rates, protein, IgA, lysozyme, sodium, potassium, chloride, calcium phosphate, copper, and magnesium contents were measured. The concentrations of protein, sodium, chloride, and phosphate in the whole saliva of the patients with symptoms were significantly higher, but concentrations of calcium, magnesium, and IgA were lower than in the asymptomatic controls. In parotid saliva, too, protein, lysozyme, and calcium concentrations were significantly altered in patients with oral symptoms. The analysis of free amino acids serine, proline, glutamic acid + glutamine, and glycine in the whole saliva did not show any significant differences between the two groups studied. The results suggest the importance of salivary contents in the development of oral soreness. Such changes in the salivary constituents could modulate the amount and character of the salivary macromolecules absorbed onto the teeth. This could lead to passivation or activation of the surfaces in metallic restorations and consequently to the onset of the intraoral electric currents.
Article
The effect of cognitive therapy (CT) on resistant burning mouth syndrome (BMS) was studied. Thirty patients with resistant BMS after odontological and medical treatment were randomly divided into two equal groups; a therapy group (TG) was treated with CT and an attention/placebo group (APG) served as a control group. The intensity of BMS, which was estimated by the use of a visual analogue scale, was significantly reduced in the TG directly after CT was completed and was further reduced in a 6-month follow-up. The APG did not show any decrease in intensity of BMS. The results of this study indicate that, in some cases, resistant BMS probably is of psychological origin.
Article
Psychophysical assessments of orofacial sensory function were performed in order to investigate neurophysiological aspects of the burning mouth syndrome (BMS). Sensory and pain thresholds to brief argon laser stimulation were determined on six test regions, which included the tip of tongue, the lower lip mucosa and skin, the buccal mucosa, the anterior hard palate, and the dorsum of the hand. The experimental examination was performed at the Pain Clinic Unit at the Royal Dental College. Twenty-three elderly denture-wearing patients diagnosed as suffering from BMS were studied, and a control group included 23 age-, sex-, and denture-matched subjects. The obtained thresholds were compared between groups. Sensory thresholds were significantly higher and ratios between pain and sensory thresholds significantly lower in patients with BMS on all the tested regions. Pain thresholds were significantly elevated on the lower lip skin, the anterior hard palate, and the hand in patients with BMS. At sensory threshold level, a faint pinprick perception was often reported by patients with BMS contrary to a perception of warmth described by control subjects. The intraregional variations in sensory and pain thresholds on the hard palate, the lower lip mucosa, and on the skin were similar in both groups, but differences occurred in sensory thresholds on the tongue in patients with BMS. The presence of abnormal prepain perceptions and disturbances in the perception of nonnociceptive and nociceptive thermal stimuli applied on both pain-affected and normal regions suggest a perceptual deficit unrelated to specific pathophysiological mechanisms in BMS. However, it appears that a psychological explanation of BMS should be used cautiously, as the present results suggest alterations in sensory function.
The relationship between burning mouth syndrome and 48 variables was investigated in 241 patients, 45 years old and older, who had attended the Oral Medicine Clinic of the Faculty of Dentistry, University of Stellenbosch during a period of 4 years. A total of 85 cases of burning mouth syndrome were diagnosed in 65 women and 20 men. Statistically significant relationships (p < 0.05) were found with self-medication, xerostomia, and other salivary disturbances in both men and women with burning mouth syndrome when compared with their respective controls. Among the women with BMS, significant relationships were also found with anemia, inadequate diet, chronic infection, hormone therapy, ulcerative/erosive lesions, and atrophy. In contrast men with BMS showed statistically significant relationships between taking prescribed medication, central nervous system disturbances, gingivitis, and denture-related problems. In addition, significant associations were related to variables such as psychogenic factors, regurgitation, flatulence, and periodontitis.
Article
Xerostomia (dry mouth) is an uncomfortable and potentially harmful oral symptom which is usually caused by a decrease in the secretion rate of saliva (salivary gland hypofunction, or SGH). It is more prevalent in the elderly population, primarily due to their increased use of drugs and their susceptibility to disease. Many drugs and drug classes have been linked to xerostomia; the xerogenic effect increases when many drugs are taken concurrently. This Reference Guide to Drugs and Dry Mouth is designed to allow the reader to rapidly identify those pharmacologic agents which have the capacity to induce xerostomia and SGH. Xerogenic drugs can be found in 42 drug categories and 56 sub-categories. A guide to the management of drug-induced SGH and xerostomia is also provided.
Article
The goal of this study was to evaluate the prevalence and type of psychiatric disorders coexisting with burning mouth syndrome (BMS), to compare the clinical features of patients with BMS alone with patients with multiple diagnoses, and to investigate the number and severity of life events that occur before the onset of BMS. There were 102 patients with BMS, with no possible local or systemic causes, who were evaluated according to the diagnostic criteria of DSM-IV. All axis I diagnoses for which the patients met criteria at intake or lifetime were determined. Life events were evaluated for a period of 6 months before the onset of BMS. A statistical comparison between patients and a matched control group was performed first; moreover, patients with BMS alone were compared with patients with comorbid BMS. Although 29 (28.4%) BMS patients were not given any other lifetime psychiatric diagnosis, high rates of comorbid psychiatric diagnoses were found. The most prevalent concurrent diagnoses were depressive disorders and generalized anxiety disorder. No significant differences emerged in clinical features between patients with and without other current psychiatric disorders. The severity of life events, rather than in their number, was significantly associated with BMS. BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnoses.
Article
The aim of this study was to evaluate the yield of objective electrophysiological testing of the trigeminofacial system in atypical facial pain (AFP). In addition to the clinical neurological examination, two brainstem reflexes covering both the peripheral parts and the central connections of the trigeminal and the facial nerves, the blink and jaw reflexes (BR and JR), were recorded in 17 AFP patients. The control group consisted of 18 healthy volunteers with no history of facial pain or chronic headache. The AFP patients could be divided into three distinct groups on the basis of the clinical and electrophysiological findings. (1) Major trigeminal neuropathy. Four patients had clinical and electrophysiological signs of trigeminal neuropathy (three patients with an afferent pattern of abnormal BR, and one with absent JR on the clinically affected side) despite normal findings in the MRI-scans of the brain. Thus, electrophysiological testing may be more sensitive than MRI in demonstrating pathology in some of the AFP patients. (2) Minor trigeminal neuropathy. Seven patients had signs of increased excitability of the BR in the form of uni- or bilaterally abnormal (diminished or absent) habituation of the R2 component of the BR; two of these patients also showed clinical signs of trigeminal dysfunction, but the MRI-scans were all normal. This deficient habituation of the BR indicates increased excitability of the BR at brainstem level in nearly 50% of our AFP patients. (3) 'Idiopathic', no signs of trigeminal neuropathy. Five patients had normal findings both in the brainstem reflex recordings and in the clinical examinations. Additionally, one patient had abnormal BAEP and EEG recordings. On the group level, the AFP patients had significantly higher thresholds of the tactile R1 component of the BR than the control subjects. Electrophysiological testing may offer a valuable tool for both the clinical evaluation, and the scientific study of AFP.
Article
The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnaire was administered twice to 197 breast cancer patients randomised in a phase III adjuvant clinical trial: before the start of chemotherapy and at the first follow-up visit. The presence of psychiatric disorders was evaluated at the follow-up visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factors. Crohnbach's alpha for the anxiety and depression scales ranged between 0.80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-III-R diagnosis, in most cases adjustment disorders (24%) or major depressive disorder (10%). Receiver operating characteristics (ROC) analysis was used to test the discriminant validity for both anxiety and depressive disorders. The comparison of the areas under the curve (AUC) between the two scales did not show any difference in identifying either anxiety (P = 0.855) or depressive disorders (P = 0.357). The 14-item total scale showed a high internal consistency (alpha = 0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC = 0.89; 95% CI = 0.83-0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These results suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifier' or as an outcome measure should be considered with caution.
Article
An 8-week parallel, placebo-controlled, double-blind trial evaluated the efficacy of the antidepressant trazodone in the treatment of chronic burning mouth pain. Thirty-seven carefully selected women aged 39 to 71 (mean 58.6 years) were randomized to receive either 200 mg of trazodone or a placebo in a similar manner. Pain and pain-related symptoms were evaluated on a visual analogue scale and other measures at 0, 2, 4, and 8 weeks. There were no significant differences between the groups in treatment effects for pain or pain-related symptoms. Seven patients in the trazodone group and 2 in the placebo group failed to complete the trial because of side effects. The most common side effects were dizziness and drowsiness. In this controlled trial, trazodone failed to relieve burning mouth pain.
Article
The purpose of this study was to evaluate the efficacy of the topical use of benzydamine hydrochloride 0.15% oral mouthwashes in the control of burning mouth syndrome symptoms. In this double-blind, randomized, longitudinal investigation, each of 30 patients with burning mouth syndrome was assigned to one of 3 management modalities. Those in group A received an oral rinse solution of benzydamine hydrochloride 0.15% 3 times a day for 4 weeks, those in group B received a placebo 3 times a day for 4 weeks, and those in group C did not receive any kind of treatment. A visual analog scale was used for evaluation of the symptoms; a Kruskal-Wallis analysis of variance exact test was performed on the resulting data. The findings of this investigation failed to reveal significant differences among the groups. The clinical application of benzydamine hydrochloride oral rinses in the treatment of patients with burning mouth syndrome did not demonstrate significative efficacy in comparison with use of a placebo solution.
Article
The main features of atypical facial pain, stomatodynia, atypical odontalgia, and masticatory muscle and temporomandibular joint (TMJ) disorders are compared in this article, which included a search of articles indexed in MEDLINE. The fact that their terminology has been the subject of many debates can be considered a consequence of taxonomic difficulties and uncertainties. Epidemiologic studies indicate marked female predominance for all types of idiopathic orofacial pain. There is also a difference in the age of maximal prevalence between masticatory muscle and TMJ disorders and the other entities. The clinical presentations display several symptoms in common. Pain is oral, perioral, or facial and does not follow a nervous pathway. It has been present for the last 4 to 6 months or has returned periodically in the same form over a period of several months or years. The pain is continuous, has no major paroxysmal character, and is present throughout all or part of the day. It is generally absent during sleep. Clinical, radiographic, or laboratory examination does not reveal any obvious organic cause of pain. There is also a frequent presence of certain psychologic factors, personality traits, or life events. Based on these shared characteristics, a unified concept is proposed. Each of these entities belongs to a group of idiopathic orofacial pain and could be expressed in either the jaws, the buccal mucosa, the teeth, the masticatory muscles, or the TMJ.
Article
The pathophysiology of burning mouth syndrome (BMS) is largely unknown. Thus, the aim was to study oral mucosal blood flow in BMS-patients using laser Doppler flowmetry (LDF). Thirteen BMS patients (11 female, two male; mean age+/-SD 64.3+/-7.9 years, mean disease duration 18.9+/-6.2 months) and 13 healthy non-smoking controls matched for age and gender (11 female, two male; mean age 64.7+/-8.1 years) were investigated. Using the LDF technique mucosal blood flow (mBF) was measured at the hard palate, the tip of the tongue, on the midline of the oral vestibule, and on the lip. Measurements were made at rest and over 2 min following dry ice application of 10 s duration using a pencil shaped apparatus. In addition, blood pressure (BP), heart rate (HR), peripheral cutaneous blood flow, and transcutaneous pCO(2) were continuously recorded. Mucosal blood flow (mBF) increased at all measurement sites in response to dry ice application (P<0.001) with peak flow at 0.5--1.5 min after stimulation onset. During the following 1.5--2 min, blood flow decreased at all sites with a tendency to return to baseline towards the end of the observation period. Except for BP and peripheral blood flow, all of the cardiovascular changes exhibited significant changes during the observation period; no differences between groups were detected. When compared to healthy controls BMS patients generally exhibited larger changes in mBF. These changes were significant for recordings made on the hard palate (F[1,24]=13.9, P<0.001). Dry ice stimulation appears to be an effective, non-invasive and reasonably tolerable means to investigate mucosal blood flow at different mucosal sites. In general, vasoreactivity in BMS patients was higher than in healthy controls. BMS patients exhibited a higher response on the hard palate compared to controls. These changes in oral blood flow appear to be specifically related to BMS symptoms indicating a disturbed vasoreactivity.
Article
Recent data from animal experiments suggest an important role for the basal ganglia in the processing and sensorimotor gating of nociceptive information. However, very little is known about their possible participation in human pain. Because of our previous finding of increased excitability of the blink reflex (a brainstem reflex under dopaminergic inhibitory control) in some burning mouth syndrome (BMS) patients, we have studied the dopaminergic function of the striatum (putamen and caudatus) of BMS patients with positron emission tomography (PET). 6-[(18)F]fluorodopa (FDOPA) PET scans were done on ten BMS patients and 14 healthy control subjects. The presynaptic dopaminergic function was significantly decreased in the right putamen (20%, P=0.04) of the BMS patients compared to control subjects. On the left side, the FDOPA uptake was decreased by 17% (P=0.08). The mean FDOPA uptake was not significantly changed in the caudate nucleus of the patients. The finding of decreased striatal FDOPA uptake in the putamen supports our previous neurophysiological observations indicating decreased dopaminergic inhibition in BMS patients. The present result provides direct evidence of the involvement of the nigrostriatal dopaminergic system in pain for the first time in a clinical pain condition.
Article
To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
Article
Epidemiologists benefit greatly from having case-control study designs in their research armamentarium. Case-control studies can yield important scientific findings with relatively little time, money, and effort compared with other study designs. This seemingly quick road to research results entices many newly trained epidemiologists. Indeed, investigators implement case-control studies more frequently than any other analytical epidemiological study. Unfortunately, case-control designs also tend to be more susceptible to biases than other comparative studies. Although easier to do, they are also easier to do wrong. Five main notions guide investigators who do, or readers who assess, case-control studies. First, investigators must explicitly define the criteria for diagnosis of a case and any eligibility criteria used for selection. Second, controls should come from the same population as the cases, and their selection should be independent of the exposures of interest. Third, investigators should blind the data gatherers to the case or control status of participants or, if impossible, at least blind them to the main hypothesis of the study. Fourth, data gatherers need to be thoroughly trained to elicit exposure in a similar manner from cases and controls; they should use memory aids to facilitate and balance recall between cases and controls. Finally, investigators should address confounding in case-control studies, either in the design stage or with analytical techniques. Devotion of meticulous attention to these points enhances the validity of the results and bolsters the reader's confidence in the findings.
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Burning mouth syndrome is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory findings. Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. Burning mouth complaints are reported more often in women, especially after menopause. Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as non-insulin-dependent diabetes) and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms. Recent studies have pointed to dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth syndrome. Given in low dosages, benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective in patients with burning mouth syndrome. Topical capsaicin has been used in some patients.
Article
Burning mouth syndrome (BMS) has features of a neuropathy and could be related to the production of the toxic free radicals that are released in stress situations. Alpha-lipoic acid is an antioxidant able to increase the levels of intracellular glutathione and eliminate free radicals. This study aimed to examine the effectiveness of alpha-lipoic acid in the therapy of BMS. This was a double blind, controlled study conducted for two months on 60 patients with constant BMS. Comparing alpha-lipoic acid (test) with cellulose starch (placebo), there was no laboratory evidence of deficiencies in iron, vitamins or thyroid function and no hyperglycaemia. Following treatment with alpha-lipoic acid, there was a significant symptomatic improvement, compared with placebo, with the majority showing at least some improvement after 2 months, thus supporting the hypothesis that burning mouth syndrome is a neuropathy. This improvement was maintained in over 70% of patients at the 1 year follow-up.
Article
Our preliminary observations on a small group of burning mouth syndrome (BMS) patients indicated a change in the non-nociceptive, tactile sensory function in BMS and provided evidence for the hypothesis of a neuropathic etiology of BMS. In the present clinical study on a group of 52 BMS patients, we used quantitative sensory tests (QST) in addition to the blink reflex (BR) recordings in order to gain further insight into the neural mechanisms of BMS pain. Based on electrophysiologic findings, the BMS patients could be grouped into four different categories: (1) The results of the BR were suggestive of brainstem pathology or peripheral trigeminal neuropathy in ten (19%) patients. In most of the cases, the abnormalities in the BR seemed to represent subclinical changes of the trigeminal system. (2) Increased excitability of the BR was found in the form of deficient habituation of the R2 component of the BR in 11 (21%) of the patients. Two of these patients also showed signs of warm allodynia in QST. (3) One or more of the sensory thresholds were abnormal indicating thin fiber dysfunction in altogether 35 patients (76%) out of the 46 tested with QST. Thirty-three of these patients showed signs of hypoesthesia. (4) There were only five patients with normal findings in both tests. The present findings with strong evidence for neuropathic background in BMS will hopefully provide insights for new therapeutic strategies.
Article
Burning mouth syndrome (BMS) primarily affects postmenopausal women and is often difficult to treat successfully. Treatment outcomes have been problematic because of failure to distinguish between patients with BMS and patients presenting with oral burning (OB) resulting from other clinical abnormalities. The purpose of this study was to determine characteristics that might uniquely identify BMS patients from patients with OB and to determine whether proper classification influences treatment outcome. The clinical sample consisted of 69 patients (83% female) with an average age of 62 years, pain duration of 2.45 years, and visual analog scale pain rating of 49 mm (rated from 0 to 100 mm). All patients underwent a clinical exam and completed the Multidimensional Pain Inventory and Symptom Checklist 90-Revised. There were no differences between the BMS and OB groups with respect to age, pain duration, pain intensity, life interference, and levels of psychologic distress. Patients with OB demonstrated more clinical abnormalities than BMS patients. Hyposalivation and greater use of prescription medications, most notably hormone replacement therapy, were more common in the OB group compared with the BMS group. When treatment was provided that corrected an identifiable abnormality, significantly more OB than BMS patients reported greater than 50% relief from baseline pain rating. These data indicate that while BMS and OB groups may initially present with similar clinical and psychosocial features, they are distinguishable with careful diagnosis that often enables successful management of symptoms for each group.