Burning mouth syndrome (BMS) is a major diagnostic and therapeutic problem. Systemic and topical treatments (capsaicin, lidocaine, anti-histamines, sucralfate and benzydiamine) have been tried, but they appear to be inadequate. Topical capsaicin is bitter, may cause burning and has low therapeutic efficacy. We hypothesized that systemic administration of capsaicin could reduce the limitations of topical administration and have better therapeutic efficacy; this hypothesis was tested in a controlled trial.
Systemic oral capsaicin 0.25% was used for patients with BMS, recruited in our single centre. After the diagnosis of BMS, patients were dentally and medically examined. They were alternatively assigned to treatment with capsaicin or to a shape/smell/taste/color matched placebo. The severity of symptoms was scored at trial entry and 30 days thereafter by investigators who were unaware of the assigned intervention. The visual analogical scale (VAS) measure was used to score the severity of pain, and results for the treated and untreated groups were compared by Fisher's exact test. Analysis was performed by intention-to-treat. Statistical significance was considered for values of P < 0.05. Data are expressed as mean +/- SD.
Fifty patients were enrolled (25 assigned to systemic capsaicin and 25 to placebo). The VAS score was significantly lower in treated patients (5.84 +/- 1.17) as compared to the placebo-control group (6.24 +/- 0.96). The use of systemic capsaicin implied significant gastric toxicity (referred gastric pain) with eight cases (32%) documented in the treatment group as compared to zero cases (0%) in the placebo control group.
Systemic capsaicin is therapeutically effective for the short-term treatment of BMS but major gastrointestinal side-effects may threaten its large-scale, long-term use. This preliminary study suggests that more, adequately powered, randomized controlled trials are necessary and worthy to come to a definitive assessment of this matter.
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"L'utilisation de bains de bouche à la capsaïcine (3,5 g/ml) diminue de moitié l'intensité des symptômes, avec 75 % des patients améliorés à 8 semaines sans effet indésirable significatif  . L'administration systémique de capsaïcine semble montrer elle-aussi une certaine efficacité mais le grand nombre d'effets secondaires rencontrés sème le doute quant à la pertinence de cette thérapeutique . "
[Show abstract][Hide abstract] ABSTRACT: La stomatodynie idiopathique (burning mouth syndrome) est caractérisée par une douleur prolongée, spontanée, sans cause organique directe, ressentie au niveau des muqueuses buccales et associée à une altération de la qualité de vie. La prévalence de cette affection dans la population générale est faible (< 1 %) mais augmente avec l’âge et plus particulièrement chez les femmes au moment de la ménopause. Longtemps considérées comme des douleurs psychogènes en raison d’un contexte anxiodépressif fréquemment associé, cette vue a été remise en question par des études psychophysiques et neurophysiologiques qui ont objectivé des altérations sensorielles chez la plupart des patients. Dysgueusie et xérostomie sont souvent associées à la plainte somesthésique suggérant une étiologie complexe et multifactorielle. Les traitements disponibles sont décevants. Cet article passe en revue les différents aspects de l’affection.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Burning Mouth Syndrome (BMS) is a chronic disease characterized by absence of any lesions and burning of the oral mucosa associated to a sensation of dry mouth and/or taste alterations. The purpose of our study is to estimate signs and symptoms of Temporomandibular Disorders (TMD) in patients with BMS and to investigate for the existence of an association between BMS and TMD.
MATERIALS AND METHODS: Forty-four BMS patients were enrolled; BMS subtype was established according to the classification of Lamey. After a gnathological evaluation, according to the protocol of the European Academy of Craniomandibular Disorders, patients were classified by RDC/TMD criteria. The data were compared and analyzed using a chi-square test to describe the existence of an association between BMS and TMD.
RESULTS: 65.9% the BMS patients showed disorders classified as primary signs and symptoms of TMD according to RDC / TMD criteria, and 72.7% showed parafunctional habits. The chi-square test revealed a statistically significant association (p = 0.035) between BMS and TMD.
CONCLUSION: The data suggest that there is a possible relationship not yet well understood between BMS and TMD, may be for neurophatic alterations assumed for BMS that could be also engaged in TMD pathogenesis.
Full-text · Article · Oct 2013 · International journal of medical sciences
"However, it should be noted that there are clear limita¬tions to the use of topical capsaicin, such as limited effect over time and a limited magnitude of improvement (32). Systemic capsaicin has been used (0.25%, three times a day, for 30 days) with a significant reduction in pain intensity compared with a placebo group (33). "
[Show abstract][Hide abstract] ABSTRACT: Burning mouth syndrome (BMS) has been considered an enigmatic condition because the intensity of pain rarely corresponds to the clinical signs of the disease. Various local, systemic and psychological factors are associated with BMS, but its etiology is not fully understood. Also there is no consensus on the diagnosis and classification of BMS. A substantial volume of research has been focused on BMS during the last two decades. Progress has been made but the condition remains a fascinating, yet poorly understood area, in the field of oral medicine. Recently, there has been a resurgence of interest in this disorder with the discovery that the pain of BMS may be neuropathic in origin and originate both centrally and peripherally. The aim of this paper is to explore the condition of BMS with the specific outcome of increasing awareness of the condition.
Key words:Burning mouth syndrome, stomatodynia, oral dysesthesia, pain management.
Full-text · Article · Jul 2012 · Journal of Clinical and Experimental Dentistry