Burning Mouth Syndrome

A Therapeutic Approach Involving Mechanical Salivary Stimulation

Fabrício T. A. de Souza, DDS; Tânia M. P. Amaral, PhD; Tálita P. M. dos Santos, DDS; Evandro N. Abdo, PhD; Maria C. F. Aguiar, PhD; Antônio L. Teixeira, PhD; Arthur M. Kummer, PhD; Mauro H. N. G. Abreu, PhD; Tarcília A. Silva, PhD

Disclosures

Headache. 2012;52(6):1026-1034. 

In This Article

Abstract and Introduction

Abstract

Objective.— The study aimed to evaluate the effects of salivary stimulation therapy on the salivary flow, quality of saliva, and symptoms in patients with burning mouth syndrome (BMS).
Background.— BMS is a chronic disorder characterized by a burning sensation. Some reports have proposed a role for saliva in the pathogenesis of BMS.
Methods.— Twenty-six BMS patients underwent treatment with salivary mechanical stimulation. Resting and stimulated saliva were collected before and after therapy. Salivary levels of total protein, brain-derived neurotrophic factor, interleukin-10, tumor necrosis factor-α, interleukin-6, and nerve growth factor were assessed before and 90 days after therapy by enzyme-linked immunosorbent assay.
Results.— A significant reduction in the burning sensation and number of burning sites as well as an improvement of taste disturbances and xerostomia were observed after therapy. The salivary flow was not significantly modified. However, the therapy resulted in a significant decrease in salivary levels of total protein and an increase of tumor necrosis factor-α.
Conclusion.— Salivary mechanical stimulation therapy is effective in reducing clinical symptoms of BMS.

Introduction

Burning mouth syndrome (BMS) is a chronic disorder characterized by a burning sensation or other dysesthesias and the clinical appearance of the oral mucosa is within normal limits.[1,2] BMS most commonly affects middle-aged women after menopause; there is an estimated prevalence in this population ranging from 0.7 to 15.0%. The wide variation in prevalence is probably the result of different diagnostic criteria.[1,3] Multiple sites in the oral cavity may be affected, but the tongue is the most common. Symptoms of pain are usually described as burning, scalding, tingling, or a numb feeling that persists for most of the day. Subjective complaints, such as dysgeusia and xerostomia with or without the presence of salivary hypofunction, are also observed.[1,3–6]

The pathogenesis of BMS is unknown. Multiple factors have been associated with BMS and have stirred controversy in the literature. Psychological factors frequently occur in BMS patients.[3,7,8] The role of the central nervous system, including overactivity of the precuneus, underactivity of the thalamus, and dysfunction in the dopaminergic nigrostriatal pathway, has also been reported.[9] Some studies have associated BMS with the use of some medications as topiramate,[10] peripheral sensory disorders with degeneration of trigeminal sensory fibers,[11] or dysfunction of the chorda tympani nerve.[12] The following changes in saliva have also been described in patients with BMS: a decrease in the levels of Mg[13] and chondroitin sulfate; and an increase in glandular kallikrein,[14] K, Cl, Ca, total protein, albumin, immunoglobulin G (IgG), IgM, secretory IgA, lysozyme, Na, and amylase.[15,16] Changes in the levels of salivary cytokines have also been associated with BMS. While increased levels of interleukin-12 (IL-2) and IL-6 have been observed in patients with BMS,[17] other studies found no significant differences in the salivary levels of IL-1β, IL-8, IL-6, and tumor necrosis factor-α (TNF-α) in these patients when compared with those in the controls.[18,19]

Previous studies suggest that a small number of BMS patients who underwent treatment will have a complete remission of symptoms over a period of 5 years.[3,20] Due to the controversy regarding etiology, several therapies have been proposed, including topical medications, clonazepam, benzydamine, capsaicin and lactoperoxidase,[21] lubricants and corticosteroids.[22] Systemic therapies, such as alpha lipoic acid, amisulpride, selective serotonin reuptake inhibitors, and the antidepressants paroxetine and sertraline, have also been proposed with controversial results.[8,21] Cognitive behavioral therapy has also been cited by some authors.[8,21] Patients with BMS and reduced salivary flow have shown an improvement in symptoms with the use of salivary substitutes.[6] Moreover, the use of mechanical salivary stimulation therapy has been shown to reduce BMS symptoms.[23]

This study aims to assess the effects of salivary stimulation therapy using a mechanical sialogogue on salivary flow, quality of saliva, and symptoms of BMS. The salivary levels of total protein, brain-derived neurotrophic factor, IL-10, TNF-α, IL-6, and nerve growth factor were assessed before and after therapy.

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