Is Burning Mouth Syndrome a Neuropathic Pain Disorder? A Systematic Review.

AIMS: To conduct a systematic review compiling an update on the pathophysiology of burning mouth syndrome (BMS) by reviewing the theories and studies published in the last 5 years that consider BMS a neuropathic disease. METHODS: A literature review was carried out in April 2020 on the PubMed database by using the following MeSH terms: "(burning mouth OR burning mouth syndrome OR burning mouth pain OR sore mouth OR burning tongue OR oral neuropathic pain OR glossodynia OR stomatopyrosis) AND (etiopathogenesis OR etiopathological factors OR etiology)." RESULTS: The research carried out according to the methodology found 19 case-control studies (1 of which was in vivo) and 1 RCT. Of the 19 included studies, 8 showed an evidence score of 2-; 8 showed 2+; another 2 showed 2++; and 1 showed 1+. Quality studies on this topic are insufficient and heterogenous. CONCLUSION: In the pathogenesis of BMS, both peripheral and central neuropathies appear to play a pivotal role. Nevertheless, the balance between them varies from case to case and tends to overlap. BMS does not seem to be a result of direct damage to the somatosensory nervous system, but a dysfunction in it and in the brain network.

Low-level laser therapy in patients with Burning Mouth Syndrome: A double-blind, randomized, controlled clinical trial.

BACKGROUND: Evaluate the effect of LLLT in the treatment of burning mouth syndrome (BMS). MATERIAL AND METHODS: Twenty-one BMS patients were randomly assigned to two groups: 12 in the laser group (LG) and 9 in the control group (CG). Patients in the LG underwent 2-week sessions of LLLT for 4 weeks. The spot tip area of this tool is 0.088cm2, semi-conductor GaAlAs, with a wavelength of 808nm ±5nm (infrared), 200 mW output power, 1.97W/cm2 of power density, 3 J energy per point and application time 15 seconds per point. LLLT was applied punctually, in continuous emissions, on each of the sites where there was a symptom. Symptoms were evaluated with a visual analogue scale (VAS) and patient psychological profiles were assessed using the Hospital Anxiety-Depression Scale. No side effects were recorded. Statistical analysis was carried out via ANOVA and logistic regression analysis. RESULTS: The initial VAS score mean was 8.9 for the LG and 8.3 for the CG (p >0.05). After the eighth session the VAS score was 5.5 and 5.8 respectively, and at two months it was 4.7 and 5.1 respectively. Improvement variables were established by dichotomizing the pain scales. We obtained levels of significance for the improvement variable for the LG at the two-month follow-up (p=0.0038) and for the univariate analysis of the treatment. The improvement was marginally significant in the multivariant analysis of: dry mouth, dysgeusia, pain and the treatment (p=0.0538). CONCLUSIONS: LLLT may be an alternative treatment for the relief of oral burning in patients with BMS. Key words:Burning mouth syndrome, oral pain, laser dentistry, laser therapy, low intensity laser therapy.

Burning Mouth Syndrome: update.

Burning Mouth Syndrome (BMS) is a chronic disorder that predominately affects middle-aged women in the postmenopausal period. The condition is distinguished by burning symptoms of the oral mucosa and the absence of any clinical signs. The etiology of BMS is complex and it includes a variety of factors. Local, systemic and psychological factors such as stress, anxiety and depression are listed among the possible causes of BMS. BMS may sometimes be classified as BMS Type I, II or III. Although this syndrome is not accompanied by evident organic alterations and it does not present health risks, it can significantly reduce the patient's quality of life. This study analyzes the available literature related to BMS, and makes special reference to its therapeutic management. The pages that follow will also discuss the diagnostic criteria that should be respected, etiological factors, and clinical aspects. We used the PubMed database and searched it by using the keywords "burning mouth syndrome", "BMS and review", and "burning mouth and review", in the title or abstract of the publication. BMS treatment usually steers towards the management of the symptoms; however, the specific local factors that could play a significant role in worsening the oral burning sensation should be eradicated. The most widely accepted treatment options that show variable results include tricyclic antidepressants, benzodiazepines and antipsychotic drugs; nevertheless there are other therapies that can also be carried out. Professionals that work in the field of dentistry should formulate standardized symptomatic and diagnostic criteria in order to more easily identify the most effective and reliable strategies in BMS treatment through multidisciplinary research.

Evaluation of the response to treatment and clinical evolution in patients with burning mouth syndrome.

OBJECTIVE: the aim of this study is to investigate the clinical evolution, the spontaneous remission of the symptomatology and the response to different treatments in a group of burning mouth syndrome patients. STUDY DESIGN: the sample was formed by a group of patients that were visited in the Unit of Oral Medicine of the Dentistry Clinic of the University of Barcelona, from the year 2000 to 2011. After revising the clinical records of all the patients that had been under control for a period of time of 18 months or longer, they were contacted by telephone. In the telephone interview, they were questioned about the symptomatology evolution and the response to the treatments received, noting down the data in a questionnaire previously performed. RESULTS: the average duration of the symptoms was 6.5 years (+/-2.5 years). The most frequent treatments were: chlorhexidine mouthrinses, oral benzodiazepines, topical clonazepam, antiinflamatory drugs, antidepressants, antifungicals, vitamins, psycotherapy, salivary substitutes and topical corticoids. The specialists that were consulted with a higher frequency were: dermatologists (30%), othorrynolaringologists (10%) and psychiatrists (3%). In 41 patients the oral symptoms did not improve, 35 reported partial improvements, 12 patients worsened, and only in 3 patients the symptoms remitted. CONCLUSIONS: In three of the 91 patients studied the symptoms remitted spontaneously within the five years of treatment. Only 42% of the study population had improved the symptomatology significantly, and this improvement would reach 60% if clonazepam were associated to psychotherapy.

Materiales de relleno en el área orofacial / No disponible

Existe hoy en día una gran demanda de estética por parte de la población. Los materiales de relleno se utilizan para restaurar y remodelar el volumen facial. Deben ser fáciles de implantar, duraderos y con mínimos efectos adversos para el huésped. Los materiales de relleno se clasifican, clásicamente según su permanencia en el tejido en: reabsorbibles de corta duración (entre 3 meses y 1 año),semipermanentes (más de 18 meses) y permanentes. La elección del material adecuado depende del área donde se quiera implantar, del defecto que se pretende tratar, y de la experiencia del profesional (AU)

Nowadays there is a high demand on esthetic treatments. Filling materials are used for restoring and restructuring the facial volume. Such materials must be easy to implant, durable and with the minimum side effects. Filling materials are classified depending on their permanence on the tissue in: materials that reabsorb in a short time period (between 3 months and 1 year), semipermanents (more than 18 months) and permanents. The adequate material choice depends on the area where it wants to be implanted, on the defect wanted to be treated and on the physician’s experience (AU)

Esclerosis tuberosa y manifestaciones orales. Caso clínico / Tuberous sclerosis and its oral manifestations. A clinical case

La esclerosis tuberosa (ET) es una anomalía congénita del desarrollo embrionario que se transmite de forma autosómica dominante y tiene diferentes formas de expresión clínica. Se clasifica dentro de las denominadas facomatosis (phakos "mancha" y oma "tumor"), que son anomalías del desarrollo, susceptibles de originar tumores y/o hamartomas del sistema nervioso. Es importante destacar que las lesiones del sistema nervioso se acompañan, prácticamente siempre, de anomalías cutáneas. En este trabajo presentamos el caso de una paciente de 55 años de edad, diagnosticada desde hace años de esclerosis tuberosa, que cursa con lesiones intraorales compatibles clínicamente con fibromas. Estas lesiones de aspecto fibromatoso se presentan sobre todo en el labio inferior y en ambas mucosas yugales, localización poco referenciada para esta manifestación en la enfermedad de base que nos ocupa. La anatomía patológica sugiere lesiones compatibles con angiomiolipoma. También repasamos los datos referentes a la ET, se describen las implicaciones orales de la misma y en base al resultado histopatológico obtenido se revisa el significado del término angiomiolipoma (AU)

Tuberous sclerosis (TS) is a congenital anomaly in the development of the embryo which is transmitted through the autosomal dominant gene. It has various forms of clinical expression. It is classified as one of what are known as Phacomatoses (phakos stain and oma tumour), which are development anomalies that can originate tumours and/or hamartomas in the nervous system. Lesions in the nervous system are nearly always accompanied by cutaneous anomalies. In this study we introduce the case of a woman patient aged 55, diagnosed several years earlier with Tuberous Sclerosis, who attended for intraoral lesions which were clinically compatible with fibromata. These lesions of fibrous appearance occurred above all on the lower lip and in both cheeks' mucous membra-nes, little mentioned in the literature as a site for such a manifestation of TS. The pathological anatomy suggested lesions compatible with Angiomyolipoma.In addition, the data referring to TS are reviewed; its implications for the mouth are described; and histopathological results are used to examine the significance of the word Angiomyolipoma (AU)

Tuberous sclerosis and its oral manifestations. A clinical case.

Tuberous sclerosis (TS) is a congenital anomaly in the development of the embryo which is transmitted through the autosomal dominant gene. It has various forms of clinical expression. It is classified as one of what are known as Phacomatoses (phakos stain and oma tumour), which are development anomalies that can originate tumours and/or hamartomas in the nervous system. Lesions in the nervous system are nearly always accompanied by cutaneous anomalies. In this study we introduce the case of a woman patient aged 55, diagnosed several years earlier with Tuberous Sclerosis, who attended for intraoral lesions which were clinically compatible with fibromata. These lesions of fibrous appearance occurred above all on the lower lip and in both cheeks' mucous membranes, little mentioned in the literature as a site for such a manifestation of TS. The pathological anatomy suggested lesions compatible with Angiomyolipoma. In addition, the data referring to TS are reviewed; its implications for the mouth are described; and histopathological results are used to examine the significance of the word Angiomyolipoma.

Kindler syndrome: a clinical case.

Kindler's syndrome is a congenital disorder with simultaneous clinical characteristics of two congenital diseases: dystrophic epidermolysis bullosa and congenital poikiloderma. A review is made of the literature, with the presentation of the case of a 51-year-old woman who after a number of years of implant therapy for oral rehabilitation (total upper and partial lower arch edentulous status) developed xerostomia and a series of whitish and hyperkeratotic lesions associated with other atrophic erythematous lesions lining the entire oral mucosa. The clinical case and treatment are described, with the recommendation to ensure the follow-up of such patients, in order to avoid possible degenerative transformations of the disease, in view of its chronic nature.

Síndrome de Kindler: presentación de un caso / Kindler syndrome: a clinical case

El síndrome de Kindler es una patología congénita, que reúne características clínicas de dos enfermedades congénitas simultáneamente, la epidermolisis ampollar distrófica y la poiquilodermia congénita. En este trabajo se revisa la bibliografía y se presenta el caso de una paciente de 51 años de edad, quien, tras algunos años de haber sido tratada con implantes para rehabilitar su boca, desdentada total en la arcada superior y desdentada parcial en la arcada inferior, presentaba xerostomía y varias lesiones, blanquecinas e hiperqueratósicas unas, eritematosas atróficas otras, de aspecto liquenoide, tapizando toda la mucosa bucal. Se describe el caso clínico y su tratamiento, recomendando asimismo el seguimiento de estos pacientes, para evitar posibles transformaciones degenerativas de esta patología, dado su carácter crónico (AU)

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