Efficacy of cranial electrotherapy stimulation in patients with burning mouth syndrome: a randomized, controlled, double-blind pilot study.

Background: The Burning mouth syndrome (BMS) is a chronic pain syndrome characterized by a burning sensation in the oral mucous membranes. The etiology and pathophysiology of BMS is largely unexplained. To date, there is no evidence-based treatment strategy for BMS. Cranial electrical stimulation (CES) represents a non-invasive treatment option with a low side effect profile that is approved for the treatment of pain, depression, anxiety disorder and insomnia. It has shown efficacy in studies for chronic pain such as fibromyalgia and neuropathic pain after spinal cord injury. This study aimed to investigate the therapeutic effectiveness of CES in combination with local transcutaneous electrical nerve stimulation (TENS) as an adjunct therapy in patients with BMS compared to sham stimulation. Methods: This randomized, double-blind, sham-controlled pilot study enrolled 22 patients, aged 18 years and over, with the diagnosis of BMS meeting the ICHD-3 criteria from August 2020 to June 2021. The study duration was 4 weeks (28 days) per participant. After randomization, the active group participants (n = 11) received a 100 µA CES treatment for 60 min a day whereas the devices in the Sham group did not emit electricity. Simple linear regression was used to determine whether the interventions promoted significant differences in pain intensity. Results: The linear regression showed that the period of stimulation significantly predicted decrease in the intensity of pain in the active group [ß = -0.036; t(26) = -7.219; p < 0.001] as in the sham group [ß = -0.026; t(26) = -2.56; p < 0.017]. With the applied cutoff of 30% pain reduction within the stimulation period, both the active and sham groups had 36% responders (n = 4) (Fisher's exact test, p = 1.00). In both groups (active stimulation and sham group), a significant decrease in the intensity of pain, somatic symptoms and an improvement in sleep quality over the study period was observed. Subjects reported no adverse events during the study. Conclusion: Although CES is an easily applicable and safe therapeutic option for chronic facial pain, active stimulation was not superior to sham stimulation. Among other reasons, this could be due to the short double-blinded treatment period, duration of the daily stimulation session or the small sample size.

An Unusual Case of Burning Mouth Syndrome in an Adult Male: A Case Report.

Burning mouth syndrome (BMS) is a rare disorder primarily affecting the oral mucosa and characterized by a chronic burning sensation without specific oral mucosal lesions. This paper presents a case of a 54-year-old adult male patient who complained of chronic burning mouth pain. The clinical diagnosis was made after excluding various differentials, including oral candidiasis, hairy oral leukoplakia, gastroesophageal reflux disease, oral lichen planus, local infective processes, and nutritional deficiencies. Physical examination did not reveal specific signs or lesions related to BMS; however, considering the patient's signs, symptoms, and the exclusion of other possibilities, a possible diagnosis of BMS was considered. The patient was evaluated in an outpatient setting, and management was conducted in this setting to reduce patient costs. This presentation is considered rare, as the disorder predominantly affects postmenopausal females, and most proposed theories behind its pathophysiology revolve around estrogen-mediated modulation of pain receptors. Currently, diagnostic and management criteria for BMS may vary and continue to evolve. The management of this patient focuses on patient education and routine follow-up. This case report presents the management of this particular case, along with a review of other proposed management options.

Síndrome de boca ardiente, abordaje otorrinolaringológico. Revisión bibliográfica sistemática / Burning mouth syndrome, otorhinolaryngological approach. Systematic literature review

Introducción y objetivo: El síndrome de boca ardiente (SBA) es una afección crónica, que cursa con quemazón o dolor de la mucosa bucal, afectando predominantemente a mujeres de edad media. Puede aparecer como cuadro primario o bien de forma secundaria. La fisiopatología de esta entidad es bastante desconocida. Existe un amplio abanico terapéutico, pero por lo general precisa de un abordaje multidisciplinar. Nuestra intención es realizar una puesta al día de la enfermedad para poder hacerla frente en la consulta de otorrinolaringología. Método: Revisión bibliográfica de la literatura. Fecha de publicación limitada de 2012 a 2022. Resultados: El SBA presenta una etiopatogenia de carácter multifactorial. Para su diagnóstico es necesario realizar una exhaustiva anamnesis y exploración. Se diferencian 3 tipos distintos de SBA, siendo el tipo II el más frecuente y el más refractario a la terapia. El adecuado tratamiento se fundamenta en un correcto diagnóstico y debe ser multidisciplinar. Discusión: Es importante resaltar que es una entidad benigna. Los tratamientos son variados y no hay ninguno que destaque sobre el resto, lo que dificulta el manejo de estos pacientes. Aunque la bibliografía sobre este síndrome es abundante, no se han producido en los últimos años, importantes innovaciones en cuanto a la etiología y tratamiento. Conclusiones: La anamnesis y los estudios de laboratorio son fundamentales para descartar casusas secundarias de la enfermedad. La terapia es diversa y debe incluir derivación a salud mental como parte del manejo multidisciplinar. (AU)

Introduction and objective: Burning mouth syndrome (BMS) is a chronic condition that causes burning or pain of the oral mucosa, predominantly affecting middle-aged women. It can appear as a primary box or secondary. The pathophysiology of this entity is quite unknown. There is a varied therapeutic range, but it generally requires a multidisciplinary approach. Our intention is to update the disease in order to deal with it in the otorhinolaryngology consultation. Method: Bibliographic review of the literature. Limited release date from 2012 to 2022. Results: BMS has a multifactorial etiopathogenesis. For its diagnosis it is necessary to carry out an exhaustive anamnesis and examination. There are 3 different types of BMS, type II being the most frequent and the most refractory to therapy. Adequate treatment is based on a correct diagnosis and must be multidisciplinary. Discussion: It is important to emphasize that it is a benign entity. The treatments are varied and there is none that stands out above the rest, which makes it difficult to manage these patients. Although the bibliography on this syndrome is abundant, important innovations in terms of etiology and treatment have not been produced in recent years. Conclusions: Anamnesis and laboratory studies are essential to rule out secondary causes of the disease. Therapy is varied and should include referral to mental health as part of multidisciplinary management. (AU)

The association of sleep disturbances with burning mouth syndrome: An overlooked relationship-A qualitative systematic review.

OBJECTIVES: To review the relevant literature to assess whether patients with burning mouth syndrome (BMS) are more prone to have sleep disturbances than general population. METHODS: The literature search for relevant articles was from July 2020 to March 2021. A systematic search of PubMed, Embase, Google Scholar, Cochrane library, Dentistry & Oral Sciences Source, and Scopus was conducted to search for relevant studies. The quality of studies was assessed in accordance with the Joanna Briggs Institute's guidelines and using the software SUMARI-The System for the Unified Management, Assessment and Review of Information. Confidence in the findings was assessed using the GRADE-CERQual approach. RESULTS: A total of 1064 studies were initially identified from the search; six studies, two cross-sectional and four case-control, met the inclusion criteria and were selected for this systematic review. Sleep disturbances were a required outcome measured in selected studies evaluating symptoms of BMS. For studies that were included in the final analyses, BMS was found to relate to several dimensions of sleep including sleep disturbance and duration (n = 6), sleep affecting daytime function (n = 4), sleep quality (n = 6), sleep efficiency (n = 4), and ability to fall asleep (n = 4). Consistent evidence of moderate confidence found that BMS was associated with greater sleep disturbance, reduced sleep quality, increased time taken to fall asleep, reduced sleep efficiency, and poor daytime function, whereas evidence of low confidence was found regarding the association of BMS with reduced sleep duration. CONCLUSIONS: Although the presented studies could not establish a direct causal relationship between BMS and sleep disturbances, it supports the evidence that sleep disturbance is associated with symptoms of BMS. Management strategies to improve sleep may be considered in future research for managing BMS patients.

Prevalencia de glosodinia. Síndrome de boca ardiente y factores de riesgo asociados en la población de Ciudad Real / Prevalence of glossodynia. Burning mouth syndrome and associated risk factors in the population of Ciudad Real

Objetivo: Conocer la prevalencia real del síndrome de boca ardiente (SBA) y los posibles factores de riesgo asociados.Material y métodos: Estudio observacional descriptivo transversal, de base poblacional con selección aleatoria simple en mayores de 24 años. Tras muestreo aleatorio, el año 2015 se contactó telefónicamente identificando pacientes que cumplían criterios de inclusión. A estos se les realizó entrevista presencial, descartando presencia de lesiones orales, se realizó test de ansiedad, depresión y analítica. Se agregó una cohorte de pacientes ya diagnosticados de base de datos del Hospital de Ciudad Real de Dermatología, para analizar los posibles factores de riesgo asociados comparando con un grupo control. Las características de los pacientes con SBA y los controles sin SBA se analizaron estadísticamente con el SPSS v 21 y se utilizaron la prueba de Chi cuadrado y el Odds Ratio (OR) para evaluar las diferencias en las características de losgrupos. La significación estadística se fijó en p < 0,05.Resultados: La prevalencia fue de 0,84 % (IC 95 %: 0,28-1,4). Los factores que alcanzaron significación estadística en el desarrollo de SBA fueron los siguientes: el sexo femenino p < 0,05 (IC 1,43-2,20), antecedentes de ansiedad p < 0,05 (IC 6,4-72,47), depresión p < 0,05 (IC 3,59-34,40 ), de candidiasis oral p < 0,05 (IC 1,44-16,27), de déficit nutricional p < 0,05 (IC 4,1-100,05), miedo al cáncer p < 0,05 (IC 1-1,36), hipotiroidismo p < 0,005 (IC 1,06-31,48) y uso de prótesis dentales p < 0,05 (IC 1,06-32,48). La toma de antidepresivos p < 0,05 (IC 7,28-177,86) y ansiolíticos p < 0,05 (IC 7,56-99,67). La presencia de sequedad bucal subjetiva p < 0,05 (IC 1,81-17,94) y objetiva p < 0,05 (IC 1,47-14,57). Tener alterados los cuestionario de ansiedad p < 0,05 (IC 10,64-183,29) y depresión p < 0,05 (IC: 5,48-132,92).(AU)

Objective: To know the real prevalence of burning mouth syndrome (BAS) and the possible associated risk factors.Material and methods: Observational, descriptive, cross-sectional, population-based study with simple random selection in people over 24 years of age. After showing up randomly, in 2015 a telephone call was made to identify patients who met the inclusion criteria. They underwent a face-to-face interview, ruling out the presence of oral lesions, anxiety, depression and analytical tests were performed. A cohort of patients already diagnosed from the Ciudad Real Dermatology Hospital database was added to analyze the possible associated risk factors compared with a control group. Characteristics of BMS patients and non-ABS controls were statistically analyzed with SPSS v 21 and chi-square test and Odds Ratio (OR) were used to assess differences in group characteristics. Significance statistic was set at p < 0.05.Results: The prevalence was 0.84 % (95 % CI 0.28-1.4). The factors that reached statistical significance in the development of BMS were the following: female sex p < 0.05 (CI 1.43-2.20), history of anxiety p < 0.05 (CI 6.4-72.47) depression p < 0.05 (CI 3.-34.40), oral candidiasis p < 0.05 (CI 1.44-16.27); and nutritional deficit p < 0.05 (CI 4.1-100.05); fear of cancer p < 0.05 (CI 1-1.36); hypothyroidism p < 0.05 (CI 1.06-31.48) and use of dental prostheses p < 0.05 (CI 1.06-32,48). Taking antidepressants p < 0.05 CI (7.28-177.86) and anxiolytics p < 0.05 (CI 7.56-99.67). The presence of subjective dry mouth p < 0.05 (IC 1.81-17,94) and objective p < 0.05 (IC 1.47-14.57). Having altered the Anxiety Questionnaire p < 0.05 (CI 10.64-183.29); and depression p < 0.05 (CI: 5.48-132.92).(AU)

[Clinical aspects of diagnosis and treatment of glossodynia in elderly and senile people.]

Glossodynia is a disease that is difficult to diagnose and treat. Persons of older age groups are in the most risk of its occurrence. This is due to the fact that its etiological factors are: age-related changes, general somatic diseases, usage of some pharmacological drugs, changes in the psycho-emotional background. Due to the similarity of the clinical picture of glossodynia with other diseases of the oral cavity, the doctor is required to be thoughtful when diagnosing and differentiating glossodynia. Clinical methods of examination are used, paying most attention to the anamnesis of life and disease, assessment of the personal and emotional sphere of the patient. Clinico-functional, clinico-instrumental, and laboratory methods of examination are also used. In the treatment of glossodynia, attention should be paid not only to the elimination of symptoms, but also to its prevention. The main efforts should be aimed at combating the main links of pathogenesis. Treatment should be comprehensive, differentiated and personalized. As a result of many researchers work, certain principles of diagnostics and treatment of glossodynia have been developed, which will be considered in our work.

Candidiasis and Other Bacterial Infections among Patients Diagnosed with Burning Mouth Syndrome.

Background and Objectives: Burning mouth syndrome (BMS) is a state in which a patient experiences intraoral burning or a dysesthetic sensation without clinically evident causative lesions in the oropharyngeal area. The disorder is linked to a variety of conditions, including dry mouth, Candida, and bacterial infections. The aim of this study was to determine the incidence of oral Candida and/or bacterial infections among patients with BMS and whether they have an effect on pain/burning and salivary flow levels. Objectives: (1) Gather patient data regarding the presence of oral infections, dry mouth, and pain levels in the morning, afternoon, and evening periods; (2) data analysis and assessment to determine medians, means, frequencies, correlations, and statistically significant differences between patient groups. Materials and Methods: Overall, 173 patients (23 males and 150 females) with BMS and 13 controls (five males and eight females) took part in the study. We measured pain/burning levels, unstimulated and stimulated salivary flow, the percentage of patients infected with Candida species and/or bacterial species, and the said species growth in Petri dishes. Results: Candida albicans was the most commonly found infection among patients with BMS (n = 28, 16.2%). Overall, 21.4% patients with BMS were diagnosed with either C. albicans or another Candida species. Enterobacter had the richest growth among patients with BMS (7.5% out of the infected 10.4% BMS patients). No statistical significance could be noted between the existence of either Candida species or bacterial species infections and changes in pain/burning and salivary flow levels. Negative correlations were noted between age and unstimulated and stimulated salivary flow, and positive correlations were noted between age and Candida andspecific bacteria species' growth levels. Conclusions: Although patients with present bacterial or Candida infections showed a marginal increase in pain/burning levels, no direct statistically significant associations could be made between the presence of Candida species or other bacteria and the symptoms among patients with BMS.

Síndrome de la boca ardiente: revisión de la literatura / Burning mouth syndrome: literature review

Resumen El síndrome de la boca ardiente (SBA) es una condición de dolor crónico en la cavidad oral, que se presenta mayoritariamente en mujeres de edad media. Diversas causas locales y sistémicas pueden producirlo en forma secundaria, o bien, puede representar un cuadro primario, sin etiología específica identificable. Su etiopatogenia y evolución clínica es poco comprendida. Las opciones terapéuticas son variadas y en general es necesario un tratamiento multidisciplinario. A continuación, se presenta una revisión de la literatura respecto a esta patología para difusión en nuestro medio.

Abstract Burning mouth syndrome (BMS) is a chronic pain condition of the oral cavity, which occurs more frequently in middle-aged women. It can be secondary to different local and systemic causes, or represent a primary condition, with no specific identifiable etiology. Its etiopathogenesis and clinical evolution are poorly understood. Therapeutic options are multiple and a multidisciplinary treatment is necessary. We present a review of the literature regarding BMS, to provide information relevant to our area of expertise.

A systematic review of treatment for patients with burning mouth syndrome.

BACKGROUND: Burning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments. AIM: This review aimed to study the short- (≤3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects. MATERIALS AND METHODS: Randomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020). RESULTS: Twenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment. CONCLUSION: A more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.Registration International Prospective Register of Systematic Reviews (PROSPERO):Protocol ID - CRD42020160892.

Vitamin B and Zinc Supplements and Capsaicin Oral Rinse Treatment Options for Burning Mouth Syndrome.

Background and Objectives: Burning mouth syndrome (BMS) is an enigmatic, idiopathic, chronic, often painful clinical entity, where patients experience oral burning without clear clinical changes on the oral mucosa. There are yet to be well established standardized and validated definitions, diagnostic criteria or classifications for burning mouth syndrome. The aim of this study is to determine whether vitamin B complex and zinc supplements or 0.02% topical capsaicin rinse, can help alleviate BMS pain/burning levels. The objectives: (1) Gather data before and after treatment with vitamin B complex and zinc supplements (2) After the vitamin B complex and zinc protocol gather data before and after treatment with 0.02% topical capsaicin rinse (3) Data analysis and assessment for both treatment methods. Materials and Methods: 89 patients took part in the vitamin B and zinc supplement treatment regimen, out of those 20 patients took part in the capsaicin rinse treatment regimen. Before and after each treatment pain/burning levels were determined using the Visual analogue scale, salivary flow was also determined. Results: Both treatment methods showed statistically significant data in reducing pain/burning levels. There were no statistically significant changes in the salivary flow after any treatment. Conclusion: vitamin B and zinc supplement therapy and topical capsaicin rinse therapy can be an effective way to decrease pain/burning sensation levels in patients with BMS. More research should be conducted to determine the benefit of either vitamin B and zinc supplement therapy or topical capsaicin rinse therapy, so that BMS patients have treatment options, that have as few side-effects as possible.

Developing a research diagnostic criteria for burning mouth syndrome: Results from an international Delphi process.

OBJECTIVE: To develop a beta version of a preliminary set of empirically derived research diagnostic criteria (RDC) for burning mouth syndrome (BMS) through expert consensus, which can then be taken into a test period before publication of a final RDC/BMS. DESIGN: A 6 round Delphi process with twelve experts in the field of BMS was used. The first round formed a focus group during which the purpose of the RDC and the definition of BMS was agreed upon, as well as the structure and contents. The remaining rounds were carried out virtually via email to achieve a consensus of the beta version of the RDC/BMS. RESULTS: The definition of BMS was agreed to be 'an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without evident causative lesions on clinical examination and investigation'. The RDC was based upon the already developed and validated RDC/TMD and formed three main parts: patient self-report; examination; and psychosocial self-report. A fourth additional part was also developed listing aspirational biomarkers which could be used as part of the BMS diagnosis where available, or to inform future research. CONCLUSION: This Delphi process has created a beta version of an RDC for use with BMS. This will allow future clinical research within BMS to be carried out to a higher standard, ensuring only patients with true BMS are included. Further validation studies will be required alongside refinement of the RDC as trialling progresses.

Fibromyalgia: practical considerations for oral health care providers.

Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia. This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.

Burning Mouth Syndrome.

Burning mouth syndrome is a chronic condition characterized by an intraoral burning sensation in the absence of a local or systemic cause.

Neuropathic Pain and Burning Mouth Syndrome: An Overview and Current Update.

Burning mouth syndrome/glossodynia and trigeminal neuropathic conditions can have serious negative impact on a patient's overall quality of life. These conditions are often hard to diagnose and even harder to fully treat and manage, but it is important for dentists/oral and maxillofacial surgeons to be aware of these conditions and modalities of their treatment. Often the only method for arriving at the proper diagnosis is for patients to undergo traditional approaches for treatment of presenting signs and symptoms, and it is the unexpected failure of interventional therapies that leads ultimately to a proper diagnosis.

[Current advances in research of burning mouth syndrome: biological nerve and social psychology patterns].

Burning mouth syndrome (BMS) is a complex chronic disorder characterized symptomatically by burning sensation mainly localized in the tongue with no specific lesions. Its etiology is not fully understood. Due to the persistent pain and unsatisfactory outcome of treatment, patients with high expectation when seeking medical advice easily feel discontent after treatment, which might cause medical dispute. This review introduces the epidemiology, manifestations, etiology, diagnosis, classification and treatment of BMS. The authors hope the current advances about BMS, mainly focus on the etiology of biological nerve and social psychology, may help the clinicians in treatment of BMS.

Current advances in research of burning mouth syndrome: biological nerve and social psychology patterns / 中华口腔医学杂志

Burning mouth syndrome (BMS) is a complex chronic disorder characterized symptomatically by burning sensation mainly localized in the tongue with no specific lesions. Its etiology is not fully understood. Due to the persistent pain and unsatisfactory outcome of treatment, patients with high expectation when seeking medical advice easily feel discontent after treatment, which might cause medical dispute. This review introduces the epidemiology, manifestations, etiology, diagnosis, classification and treatment of BMS. The authors hope the current advances about BMS, mainly focus on the etiology of biological nerve and social psychology, may help the clinicians in treatment of BMS.

[Lingual necrosis as a form of presentation of temporary arteritis]. / Necrosis lingual como forma de presentación de arteritis temporal.

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.

La arteritis de células gigantes es una vasculitis sistémica que compromete arterias de mediano y gran calibre, principalmente la arteria aorta y sus ramas. Su prevalencia es mayor en mujeres a partir de los 50 años, típicamente se manifiesta con fiebre, claudicación mandibular, cefalea, hiperestesia del cuero cabelludo y pérdida de la visión con neuropatía óptica isquémica anterior, en una minoría de casos aparecen síntomas menos frecuentes que dificultan y retrasan el diagnóstico. Se presenta el caso de una mujer de 76 años que consultó por dolor en la cavidad bucal con edema lingual y en cuello de 48 horas de evolución asociado a cefalea el mes previo. En el examen físico presentaba signos clínicos de isquemia lingual, por lo que se consideró como diagnóstico presuntivo compromiso isquémico por arteritis de células gigantes, e inició tratamiento con corticoides sistémicos realizándose una biopsia de arteria temporal que evidenció infiltrado linfocitario panparietal con engrosamiento de la túnica íntima y hallazgos compatibles con panarteritis. La arteritis de células gigantes debe ser sospechada en pacientes con manifestaciones de isquemia lingual, iniciándose en forma precoz el tratamiento para evitar complicaciones irreversibles.

Presencia de lesiones orales en pacientes con afecciones psicológicas, atendidos en una institución de salud / Presence of oral lesions in a group of patients with psychological disorders attending a health institution

Introducción: El liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente constituyen entidades patológicas bucales que presentan relación con afecciones psicológicas. Objetivo: Describir la presencia de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca urente en pacientes con afecciones psicológicas atendidos en una institución de salud. Métodos: Se realizó un estudio descriptivo de corte transversal, obteniéndose una población de 35 pacientes seleccionados mediante un muestreo no probabilístico por criterio de 26 pacientes aquellos que fueron remitidos del área de psicología (bajo un test de diagnóstico psicológico) al servicio de estomatología, con lesiones orales antes descritas. Bajo la firma de un consentimiento informado fueron tratadas y evolucionadas en un periodo de 16 meses. Se tuvieron en cuenta las consideraciones éticas basadas en la resolución 008430 de 1993, tratado de Helsinki. Resultados: En cuanto a la frecuencia, la lesión bucal que más se presentó fue la estomatitis aftosa recurrente en un 65,3 por ciento, las aftas mayores en un 38,4 por ciento, seguido de un tipo aftas menores en un 26,9 por ciento, entre otras lesiones en menor frecuencia. Los diagnósticos psicológicos evidenciados fueron estrés, depresión y ansiedad, en diferentes proporciones, mostrándose como lesión más frecuente dentro de estas entidades psicológicas, la estomatitis aftosa recurrente. No existió asociación estadística entre las variables orales y las psicológicas por mostrar valores de p >0,005. Conclusiones: Existió la presencia de liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente en alteraciones psicológicas como estrés, ansiedad y depresión, con mayor frecuencia la estomatitis aftosa recurrente(AU)

Introduction: Oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome are oral conditions related to psychological disorders. Objective: Describe the presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome in patients with psychological disorders attending a health institution. Methods: A descriptive cross-sectional study was conducted of a population of 35 patients, of whom 26 were selected by criterion nonprobability sampling and referred from the psychology service (based on a psychological diagnosis test) to the dental care service due to the presence of the aforementioned oral lesions. Upon granting their informed consent, the patients were treated and followed up for 16 months. Ethical provisions from Resolution 008430 of 1993, the Helsinki Declaration, were complied with. Results: In terms of frequency, the most common oral lesion was recurrent aphthous stomatitis with 65.3 percent. Major aphthas represented 38.4 percent. and aphthas of a minor type 26.9 percent.; other lesions had a lower frequency. The psychological diagnoses achieved were stress, depression and anxiety to various degrees, and the most common lesion for these psychological disorders was recurrent aphthous stomatitis. No statistical association was found between oral and psychological variables, for they showed values of p >0.005. Conclusions: The presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome was determined in psychological disorders such as stress, anxiety and depression. Of these oral lesions, recurrent aphthous stomatitis was the most common(AU)

Necrosis lingual como forma de presentación de arteritis temporal / Lingual necrosis as a form of presentation of temporary arteritis

La arteritis de células gigantes es una vasculitis sistémica que compromete arterias de mediano y gran calibre, principalmente la arteria aorta y sus ramas. Su prevalencia es mayor en mujeres a partir de los 50 años, típicamente se manifiesta con fiebre, claudicación mandibular, cefalea, hiperestesia del cuero cabelludo y pérdida de la visión con neuropatía óptica isquémica anterior, en una minoría de casos aparecen síntomas menos frecuentes que dificultan y retrasan el diagnóstico. Se presenta el caso de una mujer de 76 años que consultó por dolor en la cavidad bucal con edema lingual y en cuello de 48 horas de evolución asociado a cefalea el mes previo. En el examen físico presentaba signos clínicos de isquemia lingual, por lo que se consideró como diagnóstico presuntivo compromiso isquémico por arteritis de células gigantes, e inició tratamiento con corticoides sistémicos realizándose una biopsia de arteria temporal que evidenció infiltrado linfocitario panparietal con engrosamiento de la túnica íntima y hallazgos compatibles con panarteritis. La arteritis de células gigantes debe ser sospechada en pacientes con manifestaciones de isquemia lingual, iniciándose en forma precoz el tratamiento para evitar complicaciones irreversibles.

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.