Mineral and trace element analysis of saliva from patients with BMS: a cross-sectional prospective controlled clinical study.

OBJECTIVE: The aim of this study was to investigate salivary markers related to burning mouth syndrome (BMS). STUDY DESIGN: A cross-sectional prospective controlled clinical study of 58 patients (28 BMS and 30 control). The presence of mineral and trace metals in unstimulated whole saliva was analyzed in BMS patients and in control subjects by means of ICP-OES. The parameters analyzed were as follows: oral health-related quality of life (OHIP-14) and the Hospital Anxiety Depression (HAD) scale. A visual analogue scale (VAS) was used to measure the intensity of burning sensation (pain). RESULTS: The mean pain value for patients with BMS was 7.8 ± 2.4. OHIP-14 oral health-related quality of life among BMS patients was found to be affected: total BMS OHIP-14 (16.98 ± 12.29) vs. control (8.53 ± 10.5) with significant difference (P = 0.015). Concentrations of the different elements were slightly higher among BMS patients but without statistically significant differences for any of the elements analyzed (Na, K, Ca, Mg, Fe, Cu, Mn, Zn, B, P, S, Al, Pb, Cd, Cr, Ni, As, Be, Bi, Co, Li, Mo, Sb, Se, Sr, Ti, Tl, V). CONCLUSIONS: This study failed to identify abnormal levels of minerals or trace elements in saliva of patients with BMS.

Group cognitive-behavioral intervention for patients with burning mouth syndrome.

This study was conducted to assess the psychological characteristics of, and determine the effectiveness of group cognitive-behavioral (CB) treatment for, patients with burning mouth syndrome (BMS). The baseline characteristics of 24 female patients (age 69.7 ± 5.9 years) and an identical number of healthy female control subjects (age 69.2 ± 5.5 years) were compared. The patient group had significantly higher anxiety scores (P < 0.05) at baseline. A brief group CB intervention was delivered in a small-group format. Two sessions were planned 6 months apart. A numeric rating scale (NRS) was used to assess pain intensity. Anxiety was evaluated using a state and trait anxiety inventories. Present pain intensity decreased after both the first and second sessions. The session effect was significant (P = 0.02), but no repeat effect was found (P = 0.19). The state anxiety inventory score also decreased after the second session. The session effect was significant (P < 0.01), as was the repeat effect (P < 0.01). The trait anxiety inventory score decreased after the second session, and the session effect was significant (P = 0.013), but the repeat effect was not (P = 0.93). The results suggest that a brief group CB intervention reduces pain intensity and anxiety in patients with BMS.

Orodinia y glosodinia / No disponible

La orodinia y la glosodinia son los nombres aceptados para referirse a las molestias de la boca y de la lengua de origen psíquico. Las causas más frecuentes son estados de ansiedad y trastorno depresivo enmascarado. Los pacientes no suelen ser conscientes de sus trastornos psiquiátricos. La depresión enmascarada se denomina así porque le falta el síntoma principal de los trastornos depresivos, que es la falta de ilusión para vivir. Los trastornos depresivos enmascarados tienden a somatizarse. En este caso, el trastorno psiquiátrico se somatiza en la boca. Se describe el interrogatorio necesario para diagnosticar estados ansiosos y trastornos depresivos, así como el tratamiento adecuado de los mismos (AU)

Oro- and glosodynia are usually terms referring to oral psychogenic disturbing sensations. Anxiety and masked depressive disorder are the habitual causes. Oro- and glosodynia patients are not conscious of their psychiatric disorder. In masked depressive disorders the depressive major symptom, the lost of capacity enjoying own life is lacking. Masked depressive disorders are prone to be somatised. A specific questionnaire for diagnosing both anxiety and depressive disorders is presented. Managing and use of effective psychotropic drugs are discussed (AU)

[Are patients with glossodynia unremarkable? A hard-to-grasp psychodiagnostic disease]. / Sind Patienten mit Glossodynie psychisch unauffällig? - Eine psychodiagnostisch schwer fassbare Erkrankung.

INTRODUCTION: Idiopathic glossodynia is generally considered a disease with profound psychical involvement. Nevertheless, psychodiagnostic studies on this disease have been rare. The patients usually have low emotional self-reference, are focused on their physical complaints and refuse a psychosomatic attribute. Therefore, the doctor-patient relationship is often complicated, which impedes the initiation of an adequate therapy. PATIENTS AND METHODS: Seventeen patients diagnosed to have glossodynia or orofascial pain syndrome were examined within the psychosomatic consultation-liaison service of two dermatological hospitals. The Coping with Skin Disease Questionnaire (CSD) and the Symptom Check List (SCL-90R) were used as test inventory. Patients with glossodynia were compared with other dermatological patients in the consultation-liaison service (n = 356) and with the standard random sample of the SCL-90R. RESULTS: By comparing the test inventories it was found that glossodynia patients appeared particularly "inconspicious" on nearly all dimensions. Compared with the standard random sample of the SCL-90R (n = 1006) higher values were only observed for the scores "somatization" and "anxiety". CONCLUSION: Based on the two psychological test inventories, no indication of depression was found, which is often suspected in glossodynia patients. It appears that psychosomatic (accompanying) symptoms in these individuals are not sufficiently assessed by many psychological test instruments.

[Some aspects of glossodynia]. / Einige Gesichtspunkte zur Glossodynie.

Glossodynia (synonym: burning mouth syndrome) is thought to be a disorder with a wide range of possible causes. Aetiologies may include haematological diseases, vitamin deficiencies, dental work, hormonal factors, or infections. In addition, psychological disorders such as neuroses, depression, or phobias have been reported as playing a significant role in the initiation of burning mouth syndrome. Typically, the oral mucosa is found to be normal in most burning mouth syndrome patients. A multidisciplinary approach appears to be essential for appropriate assessment of this disorder, i.e. the diagnostic procedure should involve dentistry, neurology, and internal medicine. If possible, careful treatment of underlying causes must be undertaken. However, the replacement of suspected but unproven hormonal/nutritional deficiencies should be avoided.

Abordaje interdisciplinario en pacientes con Síndrome de Ardor Bucal / Interdisciplinary shall in patients with Burning Mouth Syndrome

El Síndrome de Ardor Bucal se caracteriza por ardor y dolor crónico en la boca, principalmente en la lengua no revelando la mucosa ningún signo de alteración. Se presenta en el 0.71 por ciento de la población general, siendo el 75 por ciento mujeres postmenopaúsicas. La etiopatogenia es incierta. Es necesario establecer el diagnóstico diferencial con respecto a lesiones que ocasionan ardor en la cavidad bucal como liquen plano, lengua geográfica, candidiasis, etc. En la Sección Patología Bucal del Instituto de Estudios Oncológicos "Fundación Maissa" de la Academia Nacional de Medicina de Buenos Aires, se planteó un abordaje interdisciplinario donde se incluyó la intervención de psiquiatras dadas las dificultades en el manejo clínico de los pacientes por lo tormentoso de los síntomas y la falta de respuesta a múltiples tratamientos. Se describen las características clínicas de veinte pacientes con Síndrome de Ardor Bucal y la experiencia de psicoterapia grupal entre abril y noviembre 1995. Los hallazgos clínicos coinciden con la bibliografía. En ésta no se encontraron trabajos que incluyeran psicoterapia grupal. Se observaron en todos los pacientes situaciones de duelos no elaborados intentándose con psicoterapia y medicación la elaboración de los mismos. Es de esperar que esta modalidad de abordaje interdisciplinario aporte futuros beneficios en la investigación clínica y la mejoría de estos pacientes.

Abordaje interdisciplinario en pacientes con Síndrome de Ardor Bucal / Interdisciplinary shall in patients with Burning Mouth Syndrome

El Síndrome de Ardor Bucal se caracteriza por ardor y dolor crónico en la boca, principalmente en la lengua no revelando la mucosa ningún signo de alteración. Se presenta en el 0.71 por ciento de la población general, siendo el 75 por ciento mujeres postmenopaúsicas. La etiopatogenia es incierta. Es necesario establecer el diagnóstico diferencial con respecto a lesiones que ocasionan ardor en la cavidad bucal como liquen plano, lengua geográfica, candidiasis, etc. En la Sección Patología Bucal del Instituto de Estudios Oncológicos "Fundación Maissa" de la Academia Nacional de Medicina de Buenos Aires, se planteó un abordaje interdisciplinario donde se incluyó la intervención de psiquiatras dadas las dificultades en el manejo clínico de los pacientes por lo tormentoso de los síntomas y la falta de respuesta a múltiples tratamientos. Se describen las características clínicas de veinte pacientes con Síndrome de Ardor Bucal y la experiencia de psicoterapia grupal entre abril y noviembre 1995. Los hallazgos clínicos coinciden con la bibliografía. En ésta no se encontraron trabajos que incluyeran psicoterapia grupal. Se observaron en todos los pacientes situaciones de duelos no elaborados intentándose con psicoterapia y medicación la elaboración de los mismos. Es de esperar que esta modalidad de abordaje interdisciplinario aporte futuros beneficios en la investigación clínica y la mejoría de estos pacientes.(AU)

A psychiatric appraisal of "glossodynia".

"Glossodynia" is a diagnostic rubric that includes patients enduring pain or a burning sensation in the tongue without any oral pathology or systemic disease. Psychiatric profiles of 50 women patients with "glossodynia" were compared with those of control subjects. The patients scored significantly lower on the Extraversion Scale of the Eysenck Personality Questionnaire and higher on the Toronto Alexithymia Scale than the control subjects, whereas there was no significant difference in the mean General Health Questionnaire score. The psychopathology of "glossodynia" may be more markedly associated with personality trait characteristics than with neurotic or depressive symptoms.

Glossodynia: personality characteristics and psychopathology.

BACKGROUND: Glossodynia or burning mouth syndrome has been suggested to be a multifunctional disorder. Etiologic factors that have been reported include hematologic or vitamin deficiencies, denture factors, the climacteric, infections or endocrinological disorders. On the other hand psychological factors, such as anxiety, depression and phobias have been reported to play a significant role at the beginning of this nosological entity. It seems therefore that there are two main categories of glossodynia, one with a detectable organic etiology and another with a psychologic origin. The purpose of this study was to provide further information concerning the personality characteristics and the incidence of psychopathology in patients suffering from glossodynia without an organic etiology. METHODS: Twenty-five patients suffering from glossodynia and 25 control subjects, matched for sex and age, participated in the study. Patients and controls were assessed concerning their psychosomatic morbidity. Both groups were given psychometric instruments (SRSD, STAI, EPQ, HDHQ, SSPS) for the assessment of personality characteristics and psychopathological symptoms. RESULTS: Patients were significantly differentiated from controls with respect to all factors of HDHQ; they exhibited more hostility, either introverted or extroverted, than control subjects. The patients also had significantly higher values in the N (neuroticism) and the L (lie) factors of the EPQ. Concerning the other psychometric measurements there were no significant differences. Patients also had significantly higher rates of psychosomatic morbidity than controls. CONCLUSIONS: Our findings indicate that hostility-especially introverted hostility-neuroticism and possibly depression are important components of the psychological profile of patients suffering from glossodynia.

Detection of psychopathologic trends in glossodynia patients.

Glossodynia affects primarily middle-aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL-90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL-90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL-90 scores and duration of symptoms, prevalence of symptoms per day and patient's condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

Glossodynia--psychodynamic basis and results of psychopathometric investigations.

Between 1985 and 1988, 131 patients suffering from glossodynia were submitted to a careful examination that included a neurological work-up, a detailed psychiatric interview and a number of psychological tests. Particular attention was paid to psychosomatic and psychopathologic disorders. The average age of the patients was 55 yr, and 73% of them were female. In 40% of patients, the psychiatric interview revealed no psychopathological findings, while in most of them, a psychiatrically relevant disorder, usually depression, was found. All patients had an unremarkable neurological status, and the EEG's showed no pathological changes. Psychodynamic considerations in conjunction with the elevated scores for depressive mood, anxiety and tension suggest that glossodynia is an expression of a psychosomatic disorder.

Da avaliaçäo clínico-laboratorial na glossodínia / Glossodynia: clinical evaluation

Trinta e dois pacientes portadores de Glossodínia acompanhados no ambulatório de Estomatologia e Dermatologia da Escola Paulista de Medicina, foram submetidos à avaliaçäo clínico-laboratorial no período de 1986 a 1988. A maior parte dos pacientes constitui-se de mulheres da raça branca no período pós-menopausa. Os dados obtidos deste estudo, sugerem näo haver relaçäo Glossodínia e tabagismo, hábito de ingestäo de álcool, diabete, hiperuricemia ou alteraçöes nos níveis de estrógeno; e evidencia a importância de uma avaliaçäo psicolótica nestes pacientes

[Glossodynia]. / Les glossodynies.

Glossodynias are a build up of painful lingual syndromes with neither a detectable visible lesion, nor of a known organic origin. An obvious discordance between the subjective feelings and the weakness, even absence of an objective lesion support able to explain them, can be observed. Being often considered by physicians to be of a psychological origin, they are always the object of never-ending research for a detectable lesion which would explain their complications. Following consultations with 114 patients in the department of Stomatology, and in collaboration with our neuropsychiatrist colleagues in the same hospital, we took stock of this frequent application which bothers the buccal specialist, who does not know to consider it or how to treat it.

[Stomatodynia and depressive syndrome]. / Stomatodynies et syndrome dépressif.

Stomatodynia is pain localised to the buccal cavity which cannot be explained on an organic basis and where the etiological diagnosis is depression. The particular way in which the patient describes his pain may suggest the diagnosis. Treatment involves prescription of anti-depressants.

The diagnosis and treatment of psychogenic glossodynia.

The symptoms of patients with psychogenic glossodynia are presented and discussed in the context of psychosomatic manifestations of psychiatric illnesses. The majority of patients with psychogenic glossodynia can be treated effectively by focusing on diagnosis and then initiating antidepressant medication or anxiolytics and other psychological treatments as needed.