Burning mouth syndrome

The prevalence and severity of latex allergies have rapidly increased recently. This article presents two cases of patients with rubber latex allergy. The patient in case A was unaware of her sensitivity to latex and presented symptoms of contact dermatitis-stomatitis during endodontic treatment. The patient in case B reported latex allergy before the initiation of the treatment and a different approach was followed. Certain aspects of latex allergy related to the endodontic treatment are discussed. Moreover, a protocol is proposed for treatment of patients with latex hypersensitivity with safety.

There are different types of treatment for head and neck cancer, including: surgery, chemotherapy and radiotherapy. Their use alone or combined can lead to sequelae in the temporomandibular joint, resulting in limited mouth opening. However, there are few studies have been published that evaluated exercise therapy in oncology related trismus, and no standard of care exits. The objective of this study was to verify the influence of a 7-week structured orofacial myofunctional exercise program on increasing the mouth opening in head and neck cancer patients with trismus. The sample consisted of 17 patients aged between 45 and 77 years, 15 men and 2 women with mouth opening less than 40 mm. Postoperative radiotherapy was performed as an adjuvant treatment in all patients in the sample, with the median dose 65Gy. After 7 weeks, the initial mouth opening average went from 25.37 mm to 33.76 mm, demonstrating that these exercises contributed to the treatment of temporomandibular disorders and stomatognathic functions in this group of head and neck cancer patients.

Introduction. -Les stomatodynies sont par définition des douleurs buccales sans cause trouvée à l'interrogatoire ou à l'examen. Une cause allergique est souvent suspectée par le malade ou son médecin. Notre but était d'évaluer l'intérêt des tests épicutanés pour mettre en évidence une cause allergique chez les malades atteints de stomatodynie. Malades et méthodes. -Il s'agissait d'une étude rétrospective monocentrique de malades ayant eu entre 1996 et 2003 des tests épicutanés pour chercher une cause allergique à des douleurs buccales non expliquées par une anomalie visible lors d'un examen réalisé à la consultation de pathologie buccale. Résultats. -Quarante malades ont été inclus (11 hommes, 29 femmes, âgés de 58 ans en moyenne) et 39 ont été exclus. Seize malades ont eu au moins un test positif, avec un total de 35 tests positifs. Par ordre de fréquence décroissante, il s'agissait des métaux, des dérivés mercuriels (sels de nickel : n = 5 ; de chrome : n = 3 ; de palladium : n = 2 ; phenylmercuric acétate : n = 2 ; thiomersal : n = 2 ; de cobalt : n = 1 ; d'or : n = 1 ; mercure : n = 1), et des résines (acrylates : n = 4). La pertinence de ces tests a été jugée comme probable trois fois et possible cinq fois, liée à l'existence de métaux ou de résines en bouche. Le baume du Pérou était positif * Auteur correspondant. Adresse L. Machet et al.

In summary, rosacea-like eruptions may be a dermatological side effect of nilotinib treatment. To date, there have been few clinical reports about the cutaneous adverse effects of nilotinib. Additional case reports and research are needed to determine the mechanism by which nilotinib induces rosacea-like eruptions.

Burning mouth syndrome (BMS) has been defined as a burning pain of the tongue or other oral mucous membranes in an individual who exhibits no clinical signs and no related laboratory findings. Recently this concept has been disputed as being too restrictive; it has been suggested instead that BMS may exist coincidentally with other oral conditions. BMS may be linked to other orofacial pain problems, such as atypical odontalgia (AO), temporomandibular disorder (TMD), and other sensory dysesthesia.

Nested polymerase chain reaction (PCR) was performed to detect the presence of Helicobacter pylori in tongue mucosa in 268 patients divided into four groups according to their diagnosis: 87 with atrophic glossitis, 37 with benign migratory glossitis and 144 with burning mouth syndrome (BMS). The latter group was subdivided according to anatomic site of burning sensation: subgroup A (54 patients) with complaints limited to tongue and subgroup B (90 patients) with burning sensations in other parts of oral mucosa. H. pylori was found in 43 samples (16%). Bacteria were significantly less present in tongue mucosa affected with benign migratory glossitis compared with atrophic glossitis and BMS (Pϭ0.025). This difference was more obvious when compared with atrophic glossitis only (Pϭ 0.006). Mucosal changes in these conditions might make the oral environment more acceptable for H. pylori colonization compared with normal mucosa, and this mechanism may play a role in its oro-oral transmission.

Subgemmal neurogenous plaques, biphasic structures with a neurofibroma and neuroma patterns, are observed in tongue biopsies involving subepithelial areas, being characterized as aggregates of nerve plexus and ganglion cells. Oral burning symptoms, having many possible causes, are commonly observed during oral medicine practice, but the association of subgemmal neurogenous plaque with tongue burning symptoms is very unusual. Reported here are two cases of focal burning sensation in the lateral border of the tongue diagnosed as subgemmal neurogenous plaque through biopsy. Recognizing this entity is important to avoid misdiagnosis of other neural proliferations, especially in cases involving focal tongue burning.

Keywords: electroconvulsive therapy idiopathic burning mouth syndrome major depressive disorder somatic symptom disorder a b s t r a c t Somatic symptom disorders are common causes of disability and suffering, and can pose significant management challenges. Idiopathic burning mouth syndrome is a challenging somatic symptom disorder with relatively high prevalence, particularly among post-menopausal women. Here, we present the case of a woman with severe treatment refractory idiopathic burning mouth syndrome and comorbid major depressive disorder, who was successfully treated with bitemporal electroconvulsive therapy. This case highlights the potential effectiveness of electroconvulsive therapy in idiopathic burning mouth syndrome when other treatment options have been exhausted.

technique that is fundamental in viewing peripheral circulation and in studying microangiopathies. The morphological study of microcirculation is of fundamental importance, mainly because the microvascular bed is directly involved in the etiopathogenesis of autoimmune disorders and acute and chronic inflammatory pathological conditions. The value of capillaroscopic investigation as a diagnostic means in cases of peripheral microcirculation disorders has been confirmed by numerous studies. Other studies used capillaroscopic investigations to evaluate microcirculation damage not as a complication of disease (diabetes), but as its initial stage, and therefore to make a diagnosis. Capillaroscopy is an interesting method of studying microcirculation, because of the possibility of studying small vessels in vivo by means of a microscope. Today, it has become more reliable, thanks to the development of observation tools (photography, videomicroscopy). This review describes in detail various aspects of the microcirculation of the oral mucosa.

Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting mucosal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.

Most clinicians dread seeing the patient presenting with a primary complaint of a burning pain on one or more oral mucosal surfaces. Unlike most other clinical conditions presenting in a dental office, burning mouth syndrome is poorly understood with few evidence based remedies. More recently, advances have been made towards clarifying the possible etiology of the disorder and testing the possible therapeutic modalities available. This article attempts to summarize the "state of the art" today.

Dental practitioners occasionally have patients present clinically with a history or chief complaint of burning and painful sensations in the oral cavity. Often the patient demonstrates clinically normal mucosa, which can make formulating a diagnosis challenging. This scenario, has been referred to as burning mouth syndrome, a multifactorial syndrome.

RESUMEN. Introducción: la enfermedad de Alzheimer es una alteración neurodegenerativa caracterizada por la pérdida de funciones cognitivas. Existe una alta prevalencia de esta enfermedad a nivel mundial, por lo que resulta oportuno tener una mayor comprensión de las necesidades y condiciones de salud bucal de los sujetos con este desorden. El presente estudio se llevó a cabo en una población con mutación E280A para la enfermedad de Alzheimer. El objetivo consistió en describir las características salivares de las personas con enfermedad de Alzheimer familiar precoz, con el fin de detectar cambios en el microbioma bucal que puedan orientar el manejo odontológico de estos pacientes. Métodos: estudio transversal en 37 participantes que habitan el Área Metropolitana de la ciudad de Medellín, con una edad promedio de 53 ± 6 años, en diferentes estadios de la enfermedad: leve: 8, moderada: 7 y grave: 22, evaluados mediante pruebas neuropsicológicas. Se tomaron muestras salivares, se evaluó la tasa de secreción salivar y la capacidad buffer de la saliva y se efectuó un análisis microbiano de las principales especies presentes en boca. Resultados: el 45,9% de los participantes presentaron una tasa disminuida de secreción salivar estimulada; la capacidad buffer salivar estuvo disminuida en el 83,87% de los participantes, con valores promedios de pH luego de la prueba de Ericsson de 3,449 ± 0,89. La capacidad buffer se encontró alterada tanto en los participantes con tasa de secreción disminuida como en aquellos con tasa de secreción salivar no alterada. Se observó alto crecimiento microbiano, principalmente de Streptococcus mutans y Candida albicans. Conclusiones: este estudio sugiere que pueden existir otros factores, además de los farmacológicos, que afectan la tasa de flujo salivar en los pacientes con enfermedad de Alzheimer familiar precoz, como la edad y la severidad de la enfermedad.

Despite the extensive amount of published literature upon burning symptoms in patients with clinically healthy appearance of the oral mucosa, as well as burning mouth syndrome (BMS) itself, they both remain still challenging topics. The aim of this study was to determine the real prevalence of "true" BMS in comparison to other patients with burning symptoms with clinically healthy appearance of the oral mucosa and then to compare "true" BMS patients with healthy controls regarding gastritis and intake of anxiolytics and angiotensin converting enzyme inhibitors. In 150 patients with burning symptoms of clinically healthy oral mucosa, local and systemic investigations were performed and they included detection of candidal infection, salivary flow rate, presence of oral galvanism and parafunctional habits as well as complete blood count, serum ferritin, serum glucose levels, serum antibodies to Helicobacter pylori together with detailed medical history with special ...

Objective: To provide a review on the aetiology and therapeutic options for the management of patients with burning mouth syndrome (BMS). Background: BMS is a chronic disorder that frequently affects women and is characterised by burning symptoms of the oral mucosa without clinical signs. This syndrome has a complex and multifactorial characteristics, but its aetiology remains unknown and this makes it difficult with regard to the treatment and management of such patients. Despite not being accompanied by evident organic changes and not presenting risks to health, BMS can significantly reduce the quality of life for patients. Methods and materials: The article reviews the literature regarding aetiologic factors, clinical implications and treatment of BMS. Conclusion: The involvement of neurological, emotional and hormonal alterations is proposed in BMS aetiology. However the mechanisms of its development are complex and not completely understood. Tricyclic antidepressants, benzodiazepines and antipsychotic drugs are the most accepted options in treatment and show variable results. The correct diagnosis of BMS and the exclusion of possible local or systemic factors that can be associated with the symptoms are fundamental. It is also important to evaluate the quality of life for these patients to recognise the potential impact of this condition on their lives.

Exfoliative cytology of the oral mucosa in burning mouth syndrome: a cytomorphological and cytomorphometric analysis Objective: The aim of this study was to evaluate oral epithelial cells by exfoliative cytology in burning mouth syndrome (BMS). Material and methods: Oral smears were collected from clinically normal-appearing mucosa by liquidbased exfoliative cytology in 40 individuals (20 BMS patients and 20 healthy controls matched for age and gender) and analysed for cytological and cytomorphometric techniques. Results: Mean values of nuclear area (NA) for experimental and control groups were, respectively, 67.52 and 55.64 lm 2 (p < 0.05). Cytoplasmic area (CA) showed the following mean values: 1258.0 (experimental) and 2069.0 lm 2 (control). Nucleus-to-cytoplasm area ratio for the experimental group was 0.07, besides the control group was 0.03 (p < 0.05). Morphologically, oral smears exhibited normal epithelial cells in both experimental and control groups. There was a significant predominance of nucleated cells of the superficial layer in the smears of BMS patients (p = 0.00001). Conclusion: This study revealed that oral mucosa of BMS patients exhibited significant cytomorphometric changes in the oral epithelial cells. These changes probably are associated with epithelial atrophy and a deregulated maturation process that may contribute to the oral symptoms of pain and discomfort in BMS.

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Objective. This randomized, double-blind, placebo-controlled clinical study aimed at evaluating the effect of the systemic use of an herbal compound (Catuama) on the symptoms of burning mouth syndrome (BMS). Study Design. Seventy-two patients with BMS were randomly allocated into test (n ϭ 38) and control (n ϭ 34) groups. Patients were instructed to take 2 capsules each day for 8 weeks. They were reassessed at 4, 8, and 12 weeks after treatment onset using a faces scale (FS) and a visual numeric scale (VNS).

Burning mouth disorder (BMD) is a burning or stinging sensation affecting the oral mucosa, lips, and/or tongue, in the absence of clinically visible mucosal lesions. There is a strong female predilection, with the age of onset being approximately 50 years. The causes of BMD are multifactorial and remain poorly understood. Often BMD patients report, in association, change in taste. In this regards, it is relevant that in central nervous system connections exist between taste and oral pain and that taste normally inhibits oral pain. The working hypothesis of this study considers a possible relationship between burning mouth disorders and alterations of taste. Several conditions or pathologies can be responsible of taste disturbances that might be the cause of oral pain in BMD patients. We have analyzed, retrospectively, 142 cases of BMD with associated taste disturbance. Possible causes that could be responsible for alterations of taste were investigated. Sixty-one subjects revealed t...

Objectives/Hypothesis: In the treatment of burning mouth syndrome (BMS), various approaches have been tried with equivocal results. The aim of the present randomized clinical trial was to determine the efficacy of clonazepam, a GABA agonist designed as an antiepileptic drug that exerts the typical effects of benzodiazepines.

Burning mouth syndrome (BMS) is defined as a burning sensation in the tongue or in any other region of the oral mucosa, in the absence of specific oral lesions. The present study reviews the pharmacological treatments used in the last 10 years to reduce the symptoms of BMS, and assesses the efficacy and safety of pharmacological interventions destined to alleviate the symptoms of BMS. To this effect, searches were made in the following databases: Micromedex®, Cochrane Database® and PubMed®, crossing the following key words: drug, treatment, clinical trial, pain management, and burning mouth syndrome. The searches were limited to articles published in the last 10 years in English or Spanish, and involving human subjects. The searches were conducted in November 2006. The literature contains clinical studies in which BMS has been treated with drugs belonging to different pharmacological groups: antidepressants, antipsychotics, antiepileptic drugs, analgesics and mucosal protectors, among others. Although effective therapies have been identified in concrete cases, a treatment modality offering efficacy in most cases of BMS remains to be established. It is essential to gain further insight to the physiopathological mechanisms of BMS, and to establish differential diagnostic criteria to develop drugs with improved efficacy and safety profiles in the treatment of BMS.

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome.

Burning mouth syndrome (BMS) is often an idiopathic chronic and intractable pain condition, affecting 1.5-5.5% of middle-aged and elderly women. We have studied the heat and capsaicin receptor TRPV1, and its regulator nerve growth factor (NGF), in BMS. Patients with BMS (n = 10) and controls (n = 10) were assessed for baseline and post-topical capsaicin pain scores, and their tongue biopsies immunostained for TRPV1, NGF, and structural nerve markers neurofilament and peripherin. Nerve fibres penetrating the epithelium were less abundant in BMS (p < 0.0001), indicating a small fibre neuropathy. TRPV1-positive fibres were overall significantly increased in BMS (p = 0.0011), as were NGF fibres (p < 0.0001) and basal epithelial cell NGF staining (p < 0.0147). There was a significant correlation between the baseline pain score and TRPV1 (p = 0.0143) and NGF fibres (p = 0.0252). A significant correlation was observed between baseline and post-capsaicin pain (p = 0.0006). Selective TRPV1 and NGF blockers may provide a new therapy for BMS.

This open cross-sectional questionnaire study investigated subjective oral symptoms in hospitalized psychiatric patients,
comparing those taking typical vs. atypical neuroleptic drugs. The present study included 170 hospitalized patients who
were taking psychiatric medications. We observed a significantly higher prevalence of xerostomia in the typical neuroleptic
group (66%) compared with the atypical neuroleptic group (53%, p<0.01). In our study, 28% of women and 17% of men
received professional consultations for dry mouth. Persistent oral pain lasting throughout the day was reported by 46% and
5% of patients in the typical and atypical neuroleptic groups, respectively. The oral pain was predominantly located in the
tongue and buccal mucosa; it was described as a burning sensation by patients in both medication groups. These results
emphasize the need for awareness of oral discomfort and its subsequent effects on quality of life in this challenging patient
group

Objective. This study was conducted to evaluate salivary dehydroepiandrosterone (DHEA) levels, salivary flow rate (SFR), depression, and hopelessness in patients with the complaint of burning mouth (BM). Study design. Thirty female patients with BM and 30 age-matched control women without any complaint of burning mouth were enrolled. After anamnesis and oral examination, the salivary flow rate was determined. Depression and hopelessness were evaluated by the application of inventories. Two saliva samples were collected for DHEA analysis. Results. Dysgeusia (P ϭ .045) and xerostomia (P ϭ .003) were significantly higher in the BM group. The BM patients showed significantly lower salivary flow rate, both under stimulation (P ϭ .001) and at rest (P Ͻ .001). Significant differences between the groups were not found in the depression (P ϭ .416) or hopelessness (P ϭ .597) scores. The BM group revealed significantly lower salivary DHEA levels in the morning samples (P ϭ .003). Conclusion. Patients with BM exhibit decreased morning salivary DHEA as well as dysgeusia and hyposalivation more frequently than control subjects. Additional investigations are needed to clarify this association.

Objective. The objective of this study was to evaluate the anxiety and salivary cortisol levels in patients with burning mouth syndrome. Study design. A case-control ed into 2 groups: BMS, with diagnosis of the syndrome, and control, without any complaint of burning mouth. Anamnesis, oral examination, sialometry, the application anxiety inventory, and 3 saliva samples for cortisol analysis were done in every patient. Results. Statistical difference for subjective xerostomia was found on the BMS group (P ϭ .01), but salivary flow rate was normal in both groups. BMS group presented higher anxiety (P ϭ .001) and salivary cortisol levels (P ϭ .003) when compared with the control group. Conclusion. Higher anxiety and salivary cortisol levels were positively associated with the presence of

Background Voltage gated sodium channels Nav1.7 are involved in nociceptor nerve action potentials and are known to affect pain sensitivity in clinical genetic disorders. Aims and Objectives To study Nav1.7 levels in dental pulpitis pain, an inflammatory condition, and burning mouth syndrome (BMS), considered a neuropathic orofacial pain disorder. Methods Two groups of patients were recruited for this study. One group consisted of patients with dental pulpitis pain (n = 5) and controls (n = 12), and the other patients with BMS (n = 7) and controls (n = 10). BMS patients were diagnosed according to the International Association for the Study of Pain criteria; a pain history was collected, including the visual analogue scale (VAS). Immunohistochemistry with visual intensity and computer image analysis were used to evaluate levels of Nav1.7 in dental pulp tissue samples from the dental pulpitis group, and tongue biopsies from the BMS group. Results There was a significantly increased v...

OBJECTIVE: To assess the occurrence of oral pathological changes and symptoms in patients affected by gastrooesophageal reflux disease (GERD). PATIENTS AND METHODS: 200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft ⁄ hard palate and uvula erythema, tooth wear, xerostomia, oral acid ⁄ burning sensation, subjective halitosis and dental sensitivity. Statistical analysis included chi-squared test, and crude odds ratio with 95% % CI. RESULTS: Univariate analysis showed that xerostomia, oral acid ⁄ burning sensation, subjective halitosis, and soft and hard palate mucosa and uvula erythema were more common in patients with GERD than matched controls (P < 0.05). CONCLUSIONS: This study failed to find any significant association between GERD and dental erosions, whereas some symptoms and other objective oral mucosal changes were found to be significantly associated with GERD.

It has been documented in vitro and in vivo that metal dental appliances release metal ions due to corrosion. Dentists must choose among many dental casting alloys available, often without knowledge of their biological properties and effect on oral mucosa. The aim of this study was to measure metal content of nickel (Ni) and chromium (Cr) in whole saliva of 85 patients with and without metal dental appliances. Unstimulated whole saliva was collected and analyzed by using electrothermal atomic absorption spectrometry. History data, subjective complaints and objective findings on oral mucosa were recorded. The concentration of metal ions was investigated in correlation to burning mouth syndrome, erythema of oral mucosa, pH and smoking habit. Results showed a higher Ni concentration in patients with metal restorations, especially wearers of predominantly base metal appliances. The concentration of Cr showed no difference between patient groups. Although burning mouth syndrome was more ...

Our preliminary observations on a small group of burning mouth syndrome (BMS) patients indicated a change in the non-nociceptive, tactile sensory function in BMS and provided evidence for the hypothesis of a neuropathic etiology of BMS. In the present clinical study on a group of 52 BMS patients, we used quantitative sensory tests (QST) in addition to the blink reflex (BR) recordings in order to gain further insight into the neural mechanisms of BMS pain. Based on electrophysiologic findings, the BMS patients could be grouped into four different categories: (1) The results of the BR were suggestive of brainstem pathology or peripheral trigeminal neuropathy in ten (19%) patients. In most of the cases, the abnormalities in the BR seemed to represent subclinical changes of the trigeminal system. (2) Increased excitability of the BR was found in the form of deficient habituation of the R2 component of the BR in 11 (21%) of the patients. Two of these patients also showed signs of warm allodynia in QST. (3) One or more of the sensory thresholds were abnormal indicating thin fiber dysfunction in altogether 35 patients (76%) out of the 46 tested with QST. Thirty-three of these patients showed signs of hypoesthesia. (4) There were only five patients with normal findings in both tests. The present findings with strong evidence for neuropathic background in BMS will hopefully provide insights for new therapeutic strategies.

The burning mouth syndrome (BMS) is a chronic condition characterized by oral burning pain in the absence of clinical abnormalities and without established therapy. OBJECTIVES: The purpose of this study was to evaluate the effectiveness of alpha lipoic acid (ALA) in the management of BMS symptoms through a randomized double-blind placebo-controlled trial. METHODS: Thirty-eight patients (34 women and four men, median age 62.9 years, range 36-78) were included and 31 completed the study. The patients were randomized into two cycles of treatment: one with alpha lipoic acid and one with placebo both administered in identical capsules. These cycles were separated by a washout period of 20 days. The oral symptoms and the treatment response were assessed using a 100-mm visual analog scale before and after each cycle and the global perceived effect score, using a 5-point scale after each treatment cycle. RESULTS: The level of reduction on burning was significant for both treatments (paired t-test: P < 0.05; rp = 0.011; ral < 0.001). Considering the two cycles together, 22 patients reported at least some improvement after ALA use and 23 patients after placebo. CONCLUSIONS: Comparison of the oral assessment scores of the two cycles failed to demonstrate the effectiveness of ALA over placebo (t-test: P > 0.05; r = 0.75).