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RISK FACTORS of BURNING MOUTH SYNDROME: UN UPDATE Cristina Popa, Carmen Stelea, Eugenia Popescu

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RISK FACTORS of BURNING MOUTH SYNDROME: UN UPDATE Cristina Popa, Carmen Stelea, Eugenia Popescu Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 RISK FACTORS OF BURNING MOUTH SYNDROME: UN UPDATE Cristina Popa, Carmen Stelea, Eugenia Popescu Department of Oral and Maxilo-facial Surgery Abstract: Burning mouth syndrome has never been associated with a specific medical conditions, although associations were reported with a wide variety of health and chronic pain conditions. The painful mouth syndrome revealed the lack of specific criteria for diagnosis. Stomatodynia is characterized by the existence or coexistence of local, general and psychological etiologic factors. Local factors, the most frequently involved was candidiasis, incorrectly adjusted dentures, contact allergies and oral parafunctions. Among the general factors that recordered a higher frequency, we mention : menopause, diabetes, previous medications and iron deficiency anemia. Regarding the psychological factors, there were identified: stress, anxiety, depression, mental lability and mental disorders. Key words: burning mouth syndrome, tongue pain, glossodynia, menopause, dry mouth. INTRODUCTION and pain in other areas. (2) Taste and pain Burning mouth syndrome(BMS) is are mediated by small diameter fibers, manifested in some patients gradually with while salivary stimulation is controlled increasing intensity of pain and other sympathetic and parasympathetic nervous symptoms over time, and in others the system. An interesting aspect is that, while onset is sudden and precipitate. Most burning sensation and altered taste are patients can not identify a cause of disease reduced by food, rinse with an anesthetic and attributed the apparent onset of a solution increases oral pain and decreases previous dental procedures, systemic changes of taste. (6) diseases or treatment with antibiotics. Personality characteristics, including Thus, for some patients, neurological depression and anxiety are frequently changes that are possible causative factor reported in patients with BMS and may subsequent to viral infection, or a influence pain or may be secondary to neurotoxic effect of local anesthetics. (1) chronic pain. The significance of diurnal Due to difficulties in understanding the variation of pain is unknown, but may be long-term pain induced by painful mouth associated with postural changes in blood syndrome and its complex clinical picture, flow or changes in the central nervous there were suggested a large number of system (CNS) during sleep. (4,7) etiologies. Most studies suggest that oral Although most patients can not burning is frequently accompanied by dry identify an apparent cause of the disease mouth and thirst (despite lack of evidence onset, approximately 37% of patients, of decreased salivary flow in most related symptoms to previous dental patients), altered taste and additional procedures, or treatments with antibiotics. allegations of pain, including facial pain Thus, for some patients, there is the 58 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 possibility that neurological changes can of this syndrome prevalence between 0.7% be the etiological factor, by virtue of viral and 15% . It should be noted that infection, or the neurotoxic effect of local numerous patients studies refers to BMS anesthetics. (5) symptoms rather than painful mouth Interestingly, there is a large syndrome itself. (3,9) discrepancy between the severity and the patient accused disorders (painful MATERIAL AND METHODS subjective complaints) and the absence of A group of 339 patients were clinical changes of oral mucosa. examined and diagnosed with acute pain Regarding the epidemiology of of the oral cavity, between 2008 2010. burning mouth syndrome is found that the Evolution on the number of these patients epidemiological data are limited, which was as follows : in 2008 we had a total of leads to lack of specific criteria for 142 patients, in 2009 were a total of 77 diagnosis. (8) However, the studies of patients examined and in 2010 a total of population groups highlights the existence 120. (fig. 1) 120 77 142 Fig.1 In the group of patients analyzed, we identified the existence of 12 diseases of the oral mucosa . (fig.2) 59 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 70 pemfigus 60 ulcerations geographic tongue 50 hairy tongue 40 herpes lichen planus 30 leukoplakia 20 oral thrush candidiasis 10 allergia 0 gingivitis 1 2 Fig.2 Within the study group of 339 patients, painful mouth syndrome was observed in a number of 118, representing a 34.80% share of the total. (fig.3) Fig.3 For a more complete picture of areas being represented by the difference. people diagnosed with BMS was necessary This high proportion of urban patients to know the place of residence , age show greater concern for their oral hygiene distribution, sex, occupation, etc.. and treatment of such diseases. (fig.4) Patients diagnosed with painful mouth syndrome are in a 89% urban, rural 60 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 Fig.4 The sex distribution is significant, in be said that BMS affects, in particular in terms of prevalence for stomatodynia, in post-menopausal women. That conclusion females . Thus, from the total number of is part of the general conclusions drawn 118 patients, BMS has affected 84 women from clinical trials specialist. (fig.6) and 33 men, which implies a distribution In our study, we found that patients of 28% men and 72% women. It concludes complained of pain in multiple areas of the that BMS affected more women than men. oral cavity: the back of the tongue, lower (fig.5) Age distribution of patients lip, palate, oral mucosa, third front and diagnosed with BMS is characterized by a edges of the tongue, upper and lower concentration in people over 50 years, at a buccal vestibule. Of these, the most rate of 72.9% of the total. Our study frequently affected by painful mouth confirmed the views of experts on the syndrome (93%), are the top and edges of disease prevalence for females and people the tongue, followed by the back of the aged over 50 years. By correlating the tongue - 3%. (fig. 7) distribution by sex and age structure, it can Fig.5 61 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 RESULTS AND DISCUSSION mouth syndrome, numerous etiologies can Due to difficulties in understanding now be considered part of a the long-term pain induced by BMS and comprehensive model of the disease. BMS complex clinical picture, there were has never been associated with a specific suggested a large number of etiologies. medical conditions, although associations Each of these postulated causes of pain were reported with a wide variety of health was explained only for a small groups of conditions and chronic pain conditions, patients. With the growing understanding including headache. Patients with BMS of the profound role that taste damage often have high blood glucose levels, but plays in the pathogenesis of burning showed no consistent or causal 62 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 relationship. Despite reports suggesting a Maxillofacial - Surgery Iasi, patients significant relationship between painful reported that the onset of disease was mouth syndrome and ulcerative or erosive generally slow (59% of them), the mucosal lesions, periodontal and symptoms gradually evolved and in 41% geographic tongue, most studies have of them disease was installed suddenly as a reported no significant changes in the result of previous dental maneuver, mental intraoral soft or hard tissue. Similarly, stress or shock. In terms of symptoms, chemical irritation and allergic reactions to patients accused pain, tingling, burning, dental materials and galvanic currents numbness, swelling, and stinging. between dissimilar metals have been Approximately half of the patients identified as major causes painful mouth complained pain continuing character, and syndrome. (3,10) the other half, pain intermittent nature. In the initial consultations carried (fig.8) out in the Ambulatory of Oral and Fig.8 Regarding local factors ,in the 97 floor of the mouth; 11% with contact patients( 82.2% of total), we encountered: allergy at methyl methacrylate, epoxy or 35.6% with chronic candidiasis generated other resins, such as new dentures and or contributed to diabetes mellitus, prosthetic field applied; 6.8% with oral xerostomia, corticosteroids, pernicious parafunctions like motor tics of language anemia: 26, 3% with dentures ,mainly (rubbing, rolling, rotation) or bruxism those removable. The pain headquarters caused by prosthetics that led to the was located at the gums of maxillary burning sensation of oral mucosa; 2.5% alveolar process and hard palate and on the with migratory glossitis which determines 63 Romanian Journal of Oral Rehabilitation Vol. 3, No. 3, July 2011 the phase of exacerbation depapillation exacerbated during periods of stress. and burning sensation on the tongue, (Fig.9) Fig.9 General factors were found in 83 another important issues in the emergence patients(70.3%), except that the 38 patients of glossodynia (16.1%); Anemia was displayed the presence of two or more found in 11.4%. The most common forms concomitant factors. In the target group in the present study were iron deficiency was found the following general anemia (which is due to iron deficiency etiological factors: Menopause - 53.4% of from the reactions of the stomach or the total. It is recognized as the most repeated bleeding) and pernicious anemia frequent factor in the genesis of (released as a result of vitamin B12 nonspecific oral pain in females. This malabsorption syndrome). (fig.10) factor in conjunction with the general Regarding psychological factors vasomotor phenomena, psychological involved in the etiology of stomatodynias symptoms or other disorders that can for a total of 29 patients( 24.8% of the accompany the events around menopause, total) were found: the states of stress can causes oral discomfort and symptoms 1,8%, mental lability 5,1%, psychiatric like burning sensation, altered taste, disorders (sometimes hidden or swelling, tingling, etc. undiagnosed) -17%. (fig.11) Diabetes mellitus was present in Patients diagnosed with BMS have 18.6%.
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