Somatosensory Profiling of Patients with Burning Mouth Syndrome and Correlations with Psychologic Factors Guangju Yang,* PhD Aims: To compare somatosensory function profiles and psychologic factors in Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and patients with primary burning mouth syndrome (BMS) and healthy controls and to Research, Peking University School and evaluate correlations of subjective pain ratings with somatosensory and psychologic Hospital of Stomatology Methods: National Engineering Laboratory for Digital parameters. A quantitative sensory testing (QST) protocol—including and Material Technology of Stomatology cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory Key Laboratory of Digital Stomatology Beijing, China limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR), and Sha Su,* DDS Department of Oral Medicine, Peking pressure pain threshold (PPT)—was performed at the oral mucosa of the tongue, University School and Hospital of buccal, and palatal sites in 30 Chinese patients (25 women and 5 men, mean age Stomatology, Beijing, China 50.9 ± 9.2 years) with primary BMS and in 18 age- and gender-matched healthy Huifei Jie, PhD Department of Prosthodontics and Center for controls (15 women and 3 men, mean age 53.2 ± 7.0 years). For each BMS patient, Oral Functional Diagnosis, Treatment and z scores and loss/gain scores were computed. Psychologic status was evaluated Research, Peking University School and Hospital of Stomatology, Beijing, China in both groups using the Self-Rating Anxiety Scale and Self-Rating Depression Scale. Correlations of BMS patients’ subjective pain ratings with somatosensory Lene Baad-Hansen, PhD Section of Orofacial Pain and Jaw Function and psychologic profiles were assessed with the use of Pearson or Spearman Department of Dentistry correlations and multiple linear regression. Results: In BMS patients, 53.3% Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial had somatosensory abnormalities according to z scores vs 22.2% of healthy Neurosciences controls (P = .033). The abnormalities in BMS patients were somatosensory loss Kelun Wang, PhD to thermal nonnoxious stimuli (TSL = 20.0%, CDT = 13.3%, WDT = 13.3%), Center for Sensory-Motor Interaction Department of Health Science and mechanical pressure stimuli (PPT = 16.7%), pinprick stimuli (MPT = 6.7%), and Technology, Aalborg University thermal pain stimuli (CPT = 3.3%), and somatosensory gain to repetitive pinprick Aalborg, Denmark stimuli (WUR = 6.7%), pressure stimuli (PPT = 6.7%), and thermal pain stimuli Shudong Yan, DDS (HPT = 3.3%). The most frequent loss/gain score was 13.3% for loss of thermal Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and somatosensory function with no somatosensory gain; 13.3% for loss of thermal Research, Peking University School and and mechanical somatosensory function with no somatosensory gain; and 13.3% Hospital of Stomatology, Beijing, China for gain of mechanical somatosensory function with no somatosensory loss. Mild Hongwei Liu, PhD Department of Oral Medicine elevations in anxiety scores were seen in 30% of the BMS patients, and 50% Peking University School and Hospital of and 36.7% had mild and moderate elevations, respectively, in depression scores. Stomatology, Beijing, China No anxiety or depression was detected in the control group. QST results, but not Qiu-Fei Xie, PhD psychologic scores, were significantly correlated with patients’ subjective pain Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and ratings (PHS, Spearman coefficient –0.384, P = .029; CPT, Pearson coefficient Research, Peking University School and –0.370, P = .034; MPT, Pearson coefficient –0.376, P = .032; PPT, Pearson Hospital of Stomatology National Engineering Laboratory for Digital coefficient 0.363, P = .037). Conclusion: The present findings documented and Material Technology of Stomatology distinct differences in somatosensory function in patients with primary BMS Key Laboratory of Digital Stomatology Beijing, China compared to controls, indicating a complex pathophysiology and interaction Peter Svensson, PhD between impairments in nociceptive processing and psychologic functioning. Section of Orofacial Pain and Jaw Function J Oral Facial Pain Headache 2019;33:278–286. doi: 10.11607/ofph.2358 Department of Dentistry Aarhus University, Aarhus, Denmark Department of Dental Medicine Keywords: burning mouth syndrome, psychological changes, quantitative Karolinska Institutet, Huddinge, Sweden; sensory testing, somatosensory profiles Scandinavian Center for Orofacial Neurosciences Correspondence to: Professor Hongwei Liu, Prof Qiu-Fei Xie urning mouth syndrome (BMS) is typically described by pa- Department of Oral Medicine, School and Hospital of Stomatology, Peking University tients as a burning sensation of the oral mucosa in the absence Zhongguancun Nandajie 22 of clinically apparent mucosal alterations. BMS mainly affects 100081 Beijing, China. B 1,2 Email: [email protected]; middle-aged women with psychologic disorders, and the tongue is [email protected] the most often affected site; however, the palate and other oral muco- Fax: +86 10 6217 3402 sal sites can also be involved.3 So far, the pathogenesis is regarded *The authors contributed equally to this work. as largely idiopathic.3,4 In general, most studies concur that the etiol- Submitted October 9, 2018; accepted November 29, 2018. ogy is multifactorial and will include local, systemic, and psychogen- ©2019 by Quintessence Publishing Co Inc. ic factors.3,4 Somatosensory function in BMS has been the focus of 278 Volume 33, Number 3, 2019 © 2019 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Yang et al several investigations5–10; however, so far, few stud- ies have applied a comprehensive and standardized Patients with burning Healthy participants battery of quantitative sensory testing (QST) with a symptoms in oral mucosa from community limited sample.11 assessed for eligibility assessed for eligibility Somatosensory sensitivity can be measured (n = 138) (n = 25) using QST and can be applied to the orofacial re- gion.12–19 There are several studies that have showed Excluded (n = 108) Excluded (n = 7) alterations in thermal sensory thresholds in BMS 5,9,10,20 Not meeting inclusion Not meeting inclusion patients. Most of these studies have revealed criteria (n = 96) criteria (n = 5) negative sensory signs using different test devices Not completing whole Not completing whole and methods. The German Research Network on test (n = 12 ) test (n = 2) Neuropathic Pain (DFNS) has established a stan- dardized QST protocol for examination and data Primary burning mouth Age- and gender- analysis that systematically evaluates thermal and syndrome patients matched healthy mechanical somatosensory functions.13,21 This stan- (n = 30) participants (n = 18) dardized protocol has been applied in the assess- Women (n = 25) Women (n = 15) ment of somatosensory functions in BMS patients Men (n = 5) Men (n = 3) by Hartmann et al with a small sample size (n = 5).11 More systematic evaluations using this standardized Fig 1 Flow diagram of participant enrollment. protocol to explore the somatosensory abnormalities of BMS patients are needed. Due to the multifactorial etiology of BMS, the psy- or vitamin B complex deficiency; and medications chologic conditions of the patients have been widely affecting the nervous system, such as tranquilizers, evaluated, and increased levels of anxiety and de- antihistamines, or pain medication. A total of 138 pa- pression have been reported in previous studies.1,4,22 tients with burning symptoms from the Department of The aims of this study were to evaluate somato- Oral Medicine, School and Hospital of Stomatology, sensory function at the oral mucosa according to a Peking University, participated in the study. Eighteen standardized QST protocol and to assess psycho- age- and gender-matched healthy volunteers from logic characteristics in BMS patients. Finally, asso- the community participated in the study. ciations of somatosensory function and psychologic Finally, 30 BMS patients were diagnosed features with perceived pain intensity in BMS pa- with primary BMS (25 women and 5 men, mean tients were tested using correlation and regression age of 50.9 ± 9.2 years, mean pain history of analyses. It was hypothesized that there would be 16.6 ± 22.2 months, mean pain intensity of 3.2 ± 1.5 distinct somatosensory and psychologic differences on 0- to 10-cm visual analog scale [VAS]), and 108 between BMS patients and controls, as well as a sig- patients were diagnosed with BMS due to second- nificant correlation between these parameters and ary pathology. Eighteen controls (15 women and 3 perceived pain intensity in BMS patients. men, mean age 53.2 ± 7.0 years) completed the QST and psychologic questionnaires (Fig 1). All par- ticipants gave written informed consent. The study Materials and Methods adhered to the Declaration of Helsinki II and was approved by the local ethics committee in China Participants (PKUSSIRB-201412029). From 2014 to 2015, Chinese BMS patients were re- cruited from the Department of Oral Medicine, Peking Quantitative Sensory Testing