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Burning mouth syndrome (BMS) is a chronic intraoral pain condition unaccompanied by clinical lesions or systemic diseases. Its aetiology is unknown. Several recent studies suggest that BMS may be a neuropathic condition, though it is still uncertain whether it is a peripheral and/or a central neurogenic dysfunction. Research indicates that BMS includes psychological components such as anxiety, depression, cancerophobia. Professional delay in diagnosing, referring and managing BMS patients occurs commonly. The treatment of BMS is possible but not yet satisfactory. This review, examines recent data on the aetiology, pathogenesis and clinical management of the syndrome.
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PMID:An up-to-date view on burning mouth syndrome. 1762 90

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.
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PMID:Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of Candida species. 1827 6

Stomatopyrosis of 'burning mouth' syndrome, in a narrower sense of definition, is a condition characterized by sensation of burning and heating in mouth, despite its normal mucosa. This research has been directed towards treatment of stomatopyrosis, putting emphasis on the implementation of psychopharmacotherapy and psychotherapy. The research was conducted on altogether 120 respondents suffering from stomatopyrosis. The respondents were divided into two equal groups: each one comprising 60 members. All the respondents were treated by means of a standard topical therapy. All the patients were assessed clinically and by means of psychological tests measuring depression and anxiety four times: once before the treatment, after one month, after two months and after four months since the beginning of the treatment. The acquired data were afterwards statistically processed. Our research led to the conclusion that stomatopyrosis occurs with elderly people, primarily women. Regarding their occupation, majority of the respondents were clerks, followed by retirees. The burning sensation in mouth was present with all the respondents, the dominating site being the lips, while the nature of sensation was reported as mostly unbearable. Anxiety, tension and stress tend to aggravate the symptoms. When grading the symptoms on VAS, i.e. visual analogous scale, the subjective assessment of symptoms was marked as 7-8 cm, which shows a high degree of burning sensation. According to our study, the quantity of saliva, which was at the beginning of the research slightly decreased, normalized after the treatment. Apart from the clinical investigation of stomatopyrosis, we applied Depression and Anxiety questionnaires. During the therapy, the results of the depression test have shown a decrease in depression (from 56.7% to 0.00%), which is particularly apparent in the group treated by autogenic training and in the first group of respondents, i.e. the one treated with antidepressants. The Anxiety tests have shown a higher percentage and intensity of anxiety with men (62.5%, as opposed to women - 32.5%) in the beginning, which has dropped to 7.5% with men during the treatment and 8.8% with women. Clinical presentation of stomatopyrosis has also apparently improved. This improvement in clinical symptoms and psychological condition of patients is statistically significant. On the basis of our research, we have concluded the following: the comorbidity of stomatopyrosis with the phenomena of anxiety and depression proves that, among other factors, there is a psychogenic aetiology of this disease. Further research should provide answers to the questions whether stomatopyrosis is a psychosomatic or a conversive disorder Antidepressants and anxiolytics have an important role in the therapy of stomatopyrosis. Autogenic training, which is a psychotherapeutic anxiolytic technique, is a therapy of choice for stomatopyrosis, which contributes not only to the elimination of oral complaints, but to the emotional rehabilitation of the patients as well.
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PMID:Regression analysis of the symptoms. 1940 18

Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.
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PMID:Burning mouth syndrome and psychological disorders. 1947 48

Stomatopyrosis of 'burning mouth' syndrome, in a narrower sense of definition, is a condition characterized by sensation of burning and heating in mouth, despite its normal mucosa. This research has been directed towards treatment of stomatopyrosis, putting emphasis on the implementation of psychopharmacotherapy and psychotherapy. The research was conducted on altogether 120 respondents suffering from stomatopyrosis. The respondents were divided into two equal groups: each one comprising 60 members. All the respondents were treated by means of a standard topical therapy. All the patients were assessed clinically and by means of psychological tests measuring depression and anxiety four times: once before the treatment, after one month, after two months and after four months since the beginning of the treatment. The acquired data were afterwards statistically processed. When grading the symptoms on VAS, i.e. visual analogous scale, the subjective assessment of symptoms was marked as 7-8 cm, which shows a high degree of burning sensation. According to our study, the quantity of saliva, which was at the beginning of the research slightly decreased, normalized after the treatment. Apart from the clinical investigation of stomatopyrosis, we applied Depression and Anxiety questionnaires. On the basis of our research, we have concluded the following: the comorbidity of stomatopyrosis with the phenomena of anxiety and depression proves that, among other factors, there is a psychogenic aetiology of this disease. Autogenic training, which is a psychotherapeutic anxiolytic technique, is a therapy of choice for stomatopyrosis, which contributes not only to the elimination of oral complaints, but to the emotional rehabilitation of the patients as well, and to the reduction of dryness in the mouth.
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PMID:Salivation quantum--stomatopyrosis--autogenic training. 1986 Jan 17

Burning mouth syndrome (stomatodynia) is associated with changes of a neuropathic nature the main location of which, peripheral or central, remains unknown. A randomised, double-blind crossover design was used to investigate the effects of lingual nerve block on spontaneous burning pain and a possible correlation with the effects of topical clonazepam, the patient's response to a psychological questionnaire, and the taste and heat thresholds. The spontaneous burning was measured with a visual analogue scale (VAS) just before and 15 min after injection. The decreases in VAS score after lidocaine or saline injection were not significantly different (2.7+/-3.9 and 2.0+/-2.6, respectively; n=20). However, two groups of patients could be identified: in a "peripheral group" (n=10) the VAS decrease due to lingual nerve injection was 4.3+/-3.1cm after lidocaine and 0.9+/-0.3 cm after saline (p=0.02). In a "central group" (n=7), there were an increase in pain intensity score (-0.8+/-2.6 cm) after lidocaine and a decrease (1.5+/-3.0 cm) after saline (p=0.15). An increase in the hospital anxiety and depression (HAD) score and a decreased taste sensitivity and heat pain threshold of painful oral area were seen in patients compared with age-and-sex-matched controls (p<0.05). Topical clonazepam treatment tended to be more effective (p=0.07) and HAD score lower (p<0.03) in the peripheral than in the central group. These results suggest that the neuropathic disorder associated with stomatodynia may be predominantly peripheral, central or mixed depending on the individual. Topical application of clonazepam and HAD may serve as indicators of which mechanism is dominating.
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PMID:Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial. 2014 36

Stomatopyrosis is commonly associated with stressful situations, which implies the importance of psychological conditions of the patients with this symptom. Patients suffering from burning mouth syndrome suffered from some psychical disturbances as well. The fact that depression and anxiety are closely connected with stomatopyrosis has been scientifically confirmed. The data which systematically led to this conclusion suggest the possibility of the existence of a psychogenic disturbance as an aetiological factor which leads to stomatopyrosis. Research which might be conducted in order to relate psychogenic disturbances with stomatopyrosis by means of various drugs and procedures, might provide an insight into the relatedness of these factors, which would enable us to treat the cause and not the consequence. This research has been directed towards establishing this "relatedness" by means of psychopharmatics and psychotherapy, and has been confirmed by means of psychological depression and anxiety tests. The research has been conducted on 120 respondents suffering from stomatopyrosis, who were also, as previously diagnosed, suffering from a psychical disturbance. The respondents were divided into 4 groups. Each group contained 30 respondents suffering from stomatopyrosis as the basic symptom, but with different psychogenic disturbances. These groups were: 1) antidepressants, 2) anxiolytics, 3) autogenic training and 4) control group. A detailed clinical and psychiatric check-up was conducted before the treatment started, and was repeated several times in different intervals: after a month, after two months and after four months. Respondents are still undergoing a therapy. Subjective assessment of the intensity of the burning sensation was obtained according to Visual analogue scale and two psychological questionnaires (depression test and anxiety test). Conclusion is: 1) Antidepressants and anxiolytic drugs have a prominent role in the treatment of stomatopyrosis. Psychological tests conducted after a four-month period have shown improvement--there was a decrease in anxiety--7.5%-8.8%, while depression has in some of the tested groups completely disappeared. At the same time, subjective evaluation of the intensity of the symptom has, according to VAS, showed a fall from 6.93-7.8 cm to 2.13-3.0 cm. At the beginning of the treatment, symptoms were described as "pretty often" with 36.7%-76.7% respondents, and as "permanent" with 23.3%-63.3% respondents. At the end of the treatment, the most frequent description regarding the frequency of the symptoms was "very rarely". 2) Autogenic training--psychotherapeutic anxiolytic technique--is the therapy of choice as far as stomatopyrosis is concerned, as it both eliminates the problems and emotionally rehabilitates the patient. 3) As far as the therapeutic progress is concerned, it can be taken as the "progress" of the time when the symptoms appear: during the treatment, the frequency and the duration of the symptoms have been shortened at night, while their occurrence during the day has been reported as relatively more frequent.
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PMID:The impact of psychological testing on the patients suffering from stomatopyrosis. 2239 55

Burning mouth syndrome (BMS) is a debilitating, idiopathic chronic pain condition. For many BMS patients, burning oral pain begins in late morning and becomes more intense throughout the day, peaking by late afternoon or evening. We investigated brain gray matter volume (GMV) with voxel-based morphometry (VBM), white matter fractional anisotropy (FA) with diffusion tensor imaging (DTI), and functional connectivity in resting state functional MRI (rsfMRI) in a tightly screened, homogeneous sample of 9 female, postmenopausal/perimenopausal BMS patients and 9 matched healthy control subjects. Patients underwent 2 scanning sessions in the same day: in the morning, when ongoing pain/burning was low, and in the afternoon, when pain/burning was significantly higher. Patients had increased GMV and lower FA in the hippocampus (Hc), and decreased GMV in the medial prefrontal cortex (mPFC). rsfMRI revealed altered connectivity patterns in different states of pain/burning, with increased connectivity between mPFC (a node in the default mode network) and anterior cingulate cortex, occipital cortex, ventromedial PFC, and bilateral Hc/amygdala in the afternoon compared with the morning session. Furthermore, mPFC-Hc connectivity was higher in BMS patients than control subjects for the afternoon but not the morning session. mPFC-Hc connectivity was related to Beck depression inventory scores both between groups and between burning states within patients, suggesting that depression and anxiety partially explain pain-related brain dysfunction in BMS. Overall, we provide multiple lines of evidence supporting aberrant structure and function in the mPFC and Hc, and implicate a circuit involving the mPFC and Hc in regulating mood and depressive symptoms in BMS.
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PMID:Altered structure and function in the hippocampus and medial prefrontal cortex in patients with burning mouth syndrome. 2486 84

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.
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PMID:Burning Mouth Syndrome: update. 2498 58

Burning mouth syndrome (BMS) is a chronic pain condition characterized by pain, burning sensations and dryness within an oral mucosa, without any clinical changes of the latter. It occurs approximately seven times more frequently in women, mostly in perimenopausal age. The psychiatric aspect of BMS is significant: the most frequent co-morbidities are depression and anxiety disorders, and a number of psychotropic drugs play an essential role in its treatment. In the present review, the most important pathogenic and treatment concepts of BMS have been discussed. The BMS may be similar to neuropathic pain and has some related pathogenic elements with fibromyalgia and the restless leg syndrome. In primary BMS, the features of presynaptic dysfunction of dopaminergic neurons and deficiency of endogenous dopamine levels have been demonstrated. Other neurotransmitters such as serotonin, noradrenaline, histamine as well as hormonal and inflammatory factors may also play a role in the pathogenesis of BMS. In the pharmacological treatment of BMS a variety of drugs have been used including benzodiazepines, anticonvulsants, antidepressants and atypical antipsychotic drugs. In the final part of the paper, the possibility of using atypical antipsychotic drug, olanzapine, in the treatment of BMS has been discussed. In the context of the recent studies on this topic, a case of female patient with the BMS lasting more than ten years has been mentioned, in whom the treatment with olanzapine brought about a rapid and significant reduction of symptoms. The probable mechanism of the therapeutic effect of olanzapine in BMS can include its effect on dopaminergic receptors and probably also on histaminergic, noradrenergic and serotonergic ones.
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PMID:[Burning mouth syndrome: pathogenic and therapeutic concepts]. 2500 31


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