Burning Mouth Syndrome: A Therapeutic Approach
Burning Mouth Syndrome: A Therapeutic Approach
The study group was composed of 26 patients (25 women and 1 man) with a mean age of 63.8 ± 12.0 years. The average duration of BMS was 3 years and the range was 1 to 180 months with daily symptoms (Table 1).
All patients had normal oral mucosa in the clinical examination and no changes in their blood analyses. Ten patients (38.5%) had cancer phobia. Twenty-five patients (96.2%) reported systemic changes. Twenty-four patients (92.3%) reported medication use including antihypertensive agents (53.8%) and antidepressants (34.6%). Fourteen patients (53.8%) wore dentures, 7.7% (2/26) of patients reported smoking, and 7.7% (2/26) reported alcohol use (Table 1).
Sixty-five percent of patients reported taste disturbances, especially bitter tastes (47.1%). Other taste perceptions included sensations that could not be classified as bitter, acid, sweet, salty, or spicy. Xerostomia was reported by 80.8% of the patients. Most patients (65.4%) had 3 or more burning sites, and all patients reported a burning sensation in the tongue (Table 1).
With respect to salivary function, the resting and stimulated salivary flow initial rates were 0.4 ± 0.3 mL/minute and 1.2 ± 0.7 mL/minute, respectively (Fig. 2). The resting (Fig. 2A) and stimulated (Fig. 2B) salivary flows were not significantly modified by therapy; no significant differences were found between different time points (P > .05).
(Enlarge Image)
Figure 2.
Resting (A) and stimulated (B) salivary flow in patients with burning mouth syndrome before (day 0) and after (30, 60, and 90 days) mechanical salivary therapy (P > .05 using Friedman test).
The saliva quality parameters of viscosity, turbidity, and staining were not significantly affected by therapy (P > .05) (Table 2). However, an increased number of individuals with normal saliva were observed after therapy when compared with the period before therapy (Table 2).
The clinical evaluations revealed improvements in all evaluated parameters with significant differences before and after treatment. Initially, all patients reported a daily frequency of burning symptoms; after 180 days, 56.7% of patients reported a decrease in the frequency of symptoms (P < .001) (Table 3). Additionally, there was a decrease in the number of burning sites: 65.4% of patients reported three or more sites at the beginning, and 73.1% reported none or one site at the end of therapy (P < .001). The mean score of burning sensation using the VAS before therapy was 9.0 ± 1.6 (5–10), but after 180 days of treatment, 73.1% of patients reported a VAS score ranging from 0 to 3 with a mean score of 2.6 ± 2.6 (0–8) (P < .001). Using the VDS, symptoms were considered moderate to severe for 100% of patients prior to therapy. After 180 days, most of the patients (80.8%) reported an absent or slight burning sensation (P < .001) (Table 3).
Of the 17 patients with taste disturbances, 76.5% reported an improvement (P < .001). Of the 21 patients with subjective oral dryness, 90.5% reported improvement (P < .001) (Table 3).
A significant decrease of total protein levels in the stimulated flow was verified after therapy (P = .01) (Fig. 3A). On the other hand, an increase of TNF-α levels was observed when comparing the beginning and end of therapy (P = .01) (Fig. 3D). No statistical differences were observed in the levels of BDNF (Fig. 3B), IL-10 (Fig. 3C), IL-6 (Fig. 3E), or NGF (Fig. 3F). However, the IL-6 (P = .99) and NGF (P = .069) levels tended to increase from the beginning (8.3 ± 8.0 pg/mg and 44.2 ± 28.0 pg/mg, respectively) to the end (16.2 ± 39.5 pg/mg and 62.9 ± 72.9, respectively) of therapy. For resting flow, no differences were found between the levels of total protein and cytokines in the initial saliva collection at day 0 and the final collection at day 90 (data not shown).
(Enlarge Image)
Figure 3.
Levels of total protein (A), brain-derived neurotrophic factor (BDNF) (B), interleukin (IL)-10 (C), tumor necrosis factor (TNF)-α (D), IL-6 (E), and nerve growth factor (NGF) (F) in the stimulated salivary flow of patients with burning mouth syndrome before (day 0) and after 90 days of mechanical salivary therapy. *P < .05 when comparing with day 0 (Wilcoxon test).
Results
Patients
The study group was composed of 26 patients (25 women and 1 man) with a mean age of 63.8 ± 12.0 years. The average duration of BMS was 3 years and the range was 1 to 180 months with daily symptoms (Table 1).
All patients had normal oral mucosa in the clinical examination and no changes in their blood analyses. Ten patients (38.5%) had cancer phobia. Twenty-five patients (96.2%) reported systemic changes. Twenty-four patients (92.3%) reported medication use including antihypertensive agents (53.8%) and antidepressants (34.6%). Fourteen patients (53.8%) wore dentures, 7.7% (2/26) of patients reported smoking, and 7.7% (2/26) reported alcohol use (Table 1).
Sixty-five percent of patients reported taste disturbances, especially bitter tastes (47.1%). Other taste perceptions included sensations that could not be classified as bitter, acid, sweet, salty, or spicy. Xerostomia was reported by 80.8% of the patients. Most patients (65.4%) had 3 or more burning sites, and all patients reported a burning sensation in the tongue (Table 1).
Effect of Therapy on Salivary Flow and Quality of Saliva
With respect to salivary function, the resting and stimulated salivary flow initial rates were 0.4 ± 0.3 mL/minute and 1.2 ± 0.7 mL/minute, respectively (Fig. 2). The resting (Fig. 2A) and stimulated (Fig. 2B) salivary flows were not significantly modified by therapy; no significant differences were found between different time points (P > .05).
(Enlarge Image)
Figure 2.
Resting (A) and stimulated (B) salivary flow in patients with burning mouth syndrome before (day 0) and after (30, 60, and 90 days) mechanical salivary therapy (P > .05 using Friedman test).
The saliva quality parameters of viscosity, turbidity, and staining were not significantly affected by therapy (P > .05) (Table 2). However, an increased number of individuals with normal saliva were observed after therapy when compared with the period before therapy (Table 2).
Clinical Aspects of Therapy
The clinical evaluations revealed improvements in all evaluated parameters with significant differences before and after treatment. Initially, all patients reported a daily frequency of burning symptoms; after 180 days, 56.7% of patients reported a decrease in the frequency of symptoms (P < .001) (Table 3). Additionally, there was a decrease in the number of burning sites: 65.4% of patients reported three or more sites at the beginning, and 73.1% reported none or one site at the end of therapy (P < .001). The mean score of burning sensation using the VAS before therapy was 9.0 ± 1.6 (5–10), but after 180 days of treatment, 73.1% of patients reported a VAS score ranging from 0 to 3 with a mean score of 2.6 ± 2.6 (0–8) (P < .001). Using the VDS, symptoms were considered moderate to severe for 100% of patients prior to therapy. After 180 days, most of the patients (80.8%) reported an absent or slight burning sensation (P < .001) (Table 3).
Of the 17 patients with taste disturbances, 76.5% reported an improvement (P < .001). Of the 21 patients with subjective oral dryness, 90.5% reported improvement (P < .001) (Table 3).
Impact of Therapy on Salivary Cytokine Levels
A significant decrease of total protein levels in the stimulated flow was verified after therapy (P = .01) (Fig. 3A). On the other hand, an increase of TNF-α levels was observed when comparing the beginning and end of therapy (P = .01) (Fig. 3D). No statistical differences were observed in the levels of BDNF (Fig. 3B), IL-10 (Fig. 3C), IL-6 (Fig. 3E), or NGF (Fig. 3F). However, the IL-6 (P = .99) and NGF (P = .069) levels tended to increase from the beginning (8.3 ± 8.0 pg/mg and 44.2 ± 28.0 pg/mg, respectively) to the end (16.2 ± 39.5 pg/mg and 62.9 ± 72.9, respectively) of therapy. For resting flow, no differences were found between the levels of total protein and cytokines in the initial saliva collection at day 0 and the final collection at day 90 (data not shown).
(Enlarge Image)
Figure 3.
Levels of total protein (A), brain-derived neurotrophic factor (BDNF) (B), interleukin (IL)-10 (C), tumor necrosis factor (TNF)-α (D), IL-6 (E), and nerve growth factor (NGF) (F) in the stimulated salivary flow of patients with burning mouth syndrome before (day 0) and after 90 days of mechanical salivary therapy. *P < .05 when comparing with day 0 (Wilcoxon test).
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