Acupuncture as an Alternative Therapy in the Management of Burning Mouth Syndrome(BMS)

In the routine of dental care,complaints of burning sensation,burning tongue and dry mouth are frequent.Due to the complexity of etiology and diagnosis,treating patients with these sensations is a challenge for clinicians.This study aimed to assess acupuncture as an alternative therapy for patients with burning mouth syndrome(BMS).Clinical data were collected from visits of patients to the School of Dentistry of Piracicaba,State University of Campinas,with the application of a protocol of acupuncture points:LI-4(Hegu),HT-7(Shenmen),SP-6(Sanyinjiao),ST-36(Zusanli),REN-23(Lianquan),REN-6(Qihai),LI-11(Quchi),ExHn3(Yintang),LV-3(Taichong),ExHn12(Jinjin),and ExHn13(Yuye)to treat the symptoms of BMS,from August 2017 to March 2020.The sample consisted of 6 volunteers–5 female and 1 male patients–aged 40 to 79 years.The intensity of BMS was assessed before and after each session with self-reported verbal numerical rating scale(VNRS)during the treatment.On average,each patient had 8.16 sessions using 9.92 acupuncture points per session.Variation of VNRS during the treatment showed a decline in burning mouth in most patients,and 83.34%of the sample showed partial or total improvement of symptoms.This study showed that acupuncture was effective in relieving burning mouth,reducing it by 43%,representing an alternative therapy in the management of symptoms of burning mouth syndrome.

Burning Mouth Syndrome

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.

Dopamine agonist responsive burning mouth syndrome:Report of eight cases

BACKGROUND Burning mouth syndrome(BMS)is characterized by burning sensation of the oral mucosa.There is a lack of effective treatment.In recent years,a special subtype of BMS has been reported,in which oral burning sensation is alleviated after chewing,speaking,or dopaminergic drug delivery.Currently,there are few reports about the subtype of BMS in China.This study was a retrospective analysis of the clinical data of BMS patients sensitive to dopamine agonist at our hospital,aiming to improve the recognition on this disease.CASE SUMMARY Eight patients diagnosed with dopamine agonist responsive BMS at the Liaocheng People's Hospital from January 1,2017 to June 30,2020 were recruited.The clinical manifestations,treatment,and prognosis were retrospectively analyzed.There were three male and five females in the eight patients.The median age was 56 years(range,46-65 years).All the eight patients showed burning pain in the mouth.The symptoms were mild in the morning and severe in the evening,and alleviated after chewing,talking,and other oral activities.Four patients were accompanied by restless legs syndrome(RLS).Family history of RLS was positive in two patients.All patients were treated with pramipexol,and symptoms were basically relieved after 2-8 wk.CONCLUSION Dopamine agonist responsive BMS is a special subtype of BMS,which is alleviated after oral activities.Dopamine receptor agonist is an effective treatment.

Quantified Magnetic Resonance Spectroscopy in the Diagnosis of Burning Mouth Syndrome

Purpose: To investigate potential pathological differences in major brain metabolites in burning mouth syndrome (BMS). Materials and Methods: We prospectively evaluated eight patients and six healthy controls with single voxel magnetic resonance (MR) spectroscopy throughout 2017 using 3-Tesla MR unit. Metabolite levels measured from the left posterior paracingulate white matter. Raw images were processed with Tarquin version 4.3.10 and area under curve values were automatically calculated for GABA (γ-Aminobutyric acid), Ins (myo-inositole), tNAA (N-Acetylaspartate), tCho (total choline), tCr (total creatine) and GLx (glutamine + Glutamat). Major metabolite levels and all metabolites ratio to tCr calculated and compared between two groups using Mann-Whitney U test. Results: GABA/tCR value of the patients (0.589 ± 0.194, median = 0.515) was significantly higher than control group (0.230 ± 0.067, median = 0.220) (P = 0.002). tNAA/tCR value of the patients (1.106 ± 0.218, median: 1.205), was significantly lower than the control group (1.538 ± 0.401, median: 1.705) (P = 0.028). No significant difference was observed between two groups in terms of all other metabolites (P > 0.05). Conclusion: We demonstrated increased GABA and decreased NAA in the left posterior paracingulate region in BMS patients. We suggest that these metabolite alterations in central nervous system might play a key role in the etiology of the disease by inhibiting the suppression of burning sensation.

The Clinical Analysis of 47 Patients with Burning Mouth Syndrome

目的 :研究灼口综合征的临床特征及精神因素分析。方法 :对 4 7例灼口综合征患者的临床资料进行分析并用HAD记分方法对其精神因素进行评估。结果 :BMS患者中女性患病率高 ,男女比率 1:6.5 ,舌部发病最为多见 ,平均发病年龄为 5 3岁 。

Analysis of the Effect of Mindfulness Meditation on Patients with Burning Mouth Syndrome

Objective:To explore the effect of mindfulness meditation on patients with burning mouth syndrome.Methods:60 patients with burning mouth syndrome in our hospital who were treated from January 2021 to December 2022 were selected for this study.The patients were divided into two groups of thirty cases each using the randomized numerical table method.The observation underwent psychological intervention and mindfulness meditation training,while the control group only received symptomatic care.The condition of the patients of both groups was observed and compared.Results:Upon receiving treatment,the patients in the observation group had lower Hamilton Anxiety(HAM-A)scores,and Hamilton Depression(HAMD)scores compared to the control group(P<0.05).The visual analog scale(VAS)scores of the observation group were also lower than those of the control group(P<0.05).Moreover,the efficacy of the nursing intervention in the observation group was higher than that of the control group(P<0.05).Conclusion:Psychological intervention and mindfulness meditation training can effectively improve the clinical symptoms of patients with burning mouth syndrome.Therefore,this treatment method should be popularized.

Burning mouth syndrome

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans.Its common features include a burning painful sensation in the mouth,often associated with dysgeusia and xerostomia,despite normal salivation.Classically, symptoms are better in the morning,worsen during the day and typically subside at night.Its etiology is largely multifactorial,and associated medical conditions may include gastrointestinal,urogenital,psychiatric,neurologic and metabolic disorders,as well as drug reactions.BMS has clear predisposition to peri-/post menopausal females.Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways.Clinical diagnosis relies on careful history taking,physical examination and laboratory analysis.Treatment is often tedious and is aimed at correction of underlying medical conditions,supportive therapy,and behavioral feedback.Drug therapy with alpha lipoic acid,clonazepam,capsaicin,and antidepressants may provide symptom relief.Psychotherapy may be helpful.Short term follow up data is promising,however,long term prognosis with treatment is lacking.BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Salivary levels of cortisol and chromogranin A in patients with burning mouth syndrome: A case-control study

Burning mouth syndrome (BMS) is a poorly understood oral pain disorder characterized by a painful burning sensation in the oral cavity without any mucosal abnormalities. In this study, we evaluated the salivary cortisol and chromogranin A (CgA) levels of patients with BMS in comparison with age-matched controls. Subjects (n = 114) included 81 BMS patients and 33 controls. Patients with BMS were further classified into a subgroup of subjects who occasionally feel a burning sensation (BMS 1), and a subgroup of subjects who always feel a burning sensation (BMS 2). Salivary cortisol and CgA levels were measured using ELISA kits. All individuals with BMS had significantly higher cortisol and CgA levels than the controls did. Furthermore, when comparing the controls with each BMS subgroup, salivary levels of cortisol were significantly higher in both subgroups than controls. In contrast, the level of CgA was significantly higher in the BMS 2 subgroup only. Multiple regression analysis revealed a significant independent association between salivary levels of cortisol and BMS even after adjustment for gender, antidepressant or antianxiety drug use and hypertension (drug-treated). The study revealed that a significant association was observed between salivary cortisol levels and BMS.

Burning Mouth Syndrome: Patient Profiles, Clinical Symptoms, Affecting Associated Factors, and Treatment Responses

Background: The clinical characteristics of burning mouth syndrome (BMS) are not fully understood. We investigated the profiles of BMS patients, characteristics associated with BMS, and the available treatment methods and their effects. Methods: Seventy-four BMS patients without oral mucosal lesions were enrolled. Their medical history, medications taken, and symptom scores were investigated via questionnaires. Laboratory investigations of parameters potentially associated with BMS were performed. Regarding treatment, 0.01% dexamethasone gargle, amitriptyline, and clonazepam were administered individually or in combination, depending on the degree of symptom improvement. Symptoms were scored from 0 - 10 points;these scores were used to evaluate treatment efficacy and patient satisfaction. Results: Mean age of the patients was 63.6 ± 14.2 years;mean symptom prevalence period was 15.5 ± 24.7 months. BMS was not significantly associated with a history of hypertension, diabetes, or any specific medications. Treatment reduced the symptoms of 85.1% subjects (63/74). Conclusions: Contrary to that in previous studies, we observed significant improvements in BMS patients following combination treatment with dexamethasone gargle, amitriptyline, and clonazepam.

BMS患者抑郁、焦虑状况及其与疼痛感受的相关性分析

目的：调查灼口综合征（BMS）患者的心理抑郁及焦虑状况,分析心理状况与疼痛感受的相关性.方法：收集2012年1月～2014年1月期间因灼口综合征就诊患者135例及100名健康志愿者.采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对两组对象进行问卷测试.对BMS患者的主观疼痛程度进行分级.采用SPSS11.0统计分析软件分析BMS患者抑郁、焦虑状况及其与疼痛感受的相关性.结果：BMS患者SAS值及SDS值均高于对照组,差异具有统计学意义（P＜0.01）,SAS值及SDS值在不同疼痛程度的患者中有显著差异（P＜0.01）.结论：BMS患者具有明显的抑郁及焦虑心理,其心理抑郁及焦虑的严重程度与患者临床疼痛的主观感受有关.

刘永年运用清热疏郁法治疗灼口综合征经验

刘永年教授认为灼口综合征的病位在舌与口,和心、脾、肝、肾有关;病因与饮食不节、情志失调、肝肾亏虚等有关,主要病机特点为“热”和“郁”。热邪久蕴,郁而化火,火热循经上扰口舌,则口舌灼痛。本病实证多由湿郁化火、气郁化火导致,虚证多由阴虚热郁导致,故清热疏郁为本病的治疗大法,清热包括清心火、清湿热、清虚热、清瘀热,疏郁即疏肝解郁、透达热邪。

王行宽基于“阴伤内燥”理论辨治围绝经期女性灼口综合征经验

本文介绍王行宽教授基于“阴伤内燥”理论辨治围绝经期女性灼口综合征学术思想和临床经验。王老主张“治病求本,多脏调燮”,从围绝经期女性独特生理特性出发,认为该病当责之肾、肝、心、小肠,发病根本是肾精不足、肝血渐衰,发病关键是肾、肝、心、小肠燥。治疗上总以“阴伤内燥”为纲,从肝肾立论,以滋补肝肾为主、清热润燥为辅,采用二冬汤合百合地黄汤为基本方治疗,临床疗效显著。

因虚致郁论治灼口综合征

灼口综合征的病位在口窍,通过经脉与脾胃紧密关联;且其常与情绪障碍相互为病,“七情内伤,脾胃先病”,脾胃亦有调节转化情志之功。笔者认为“因虚致郁”是灼口综合征发病、病程进展以及预后的重要病机。脾胃虚损则诸窍不利,继而内生痰浊、气滞等多种病邪,形成郁滞之象,导致疾病进展,迁延难愈,故在灼口综合征的防治中应重视顾护脾胃。提出治疗灼口综合征应重以补益脾胃,令中焦不虚,气血通调,同时兼施化痰清火以安疾病之变,调肝脾畅气机以防疾病迁延。临证当从病机入手,共施“补、疏、通”之法,遣方用药则根据病机演变和偏盛程度灵活配伍加减,晓治病之则,扶正祛邪,攻补兼施,提高临床思辨能力,为中医防治灼口综合征提供临床新思路。

老年灼口综合征患者口腔健康相关生活质量影响因素的多元线性回归分析

目的探讨老年灼口综合征(burning mouth syndrome,BMS)患者口腔健康相关生活质量的影响因素。方法选取2022年12月至2023年11月期间于桂林医学院附属口腔医院和上海交通大学医学院附属新华医院就诊的85例老年BMS患者做横断面研究,采用口腔健康影响程度量表(oral health impact profile-14,OHIP-14)评价患者口腔健康相关生活质量,采用病例记录表收集患者的一般人口学信息,并分析疼痛、焦虑、抑郁、睡眠障碍与口腔健康相关生活质量的相关性,经多元线性回归分析筛选影响患者口腔健康相关生活质量的危险因素。结果85例BMS患者的OHIP-14评分为10.36±6.58分。有全身伴随症状患者的OHIP-14评分高于无伴随症状者,差异具有统计学意义(P<0.05)。Pearson相关分析显示,口腔健康相关生活质量与疼痛、焦虑、抑郁、睡眠障碍呈正相关(P<0.05)。多元线性回归分析显示,疼痛(B,0.975;95%CI,0.380-1.570)、焦虑(B,0.314;95%CI,0.072-0.557)、睡眠障碍(B,0.359;95%CI,0.075-0.643)为BMS患者口腔健康相关生活质量的影响因素(P<0.05),R^(2)=0.664表明共解释口腔健康相关生活质量66.4%的变异,调整后R^(2)=0.643表明调整后共解释疾病相关知识水平64.3%的变异。结论疼痛、焦虑和睡眠障碍可能是老年BMS患者口腔健康相关生活质量的危险因素。需明确BMS患者的疼痛、心理和睡眠障碍的类型与程度,据此制定多学科综合治疗方案改善患者的口腔健康相关生活质量。

接纳承诺疗法结合灵性关怀在灼口综合征病人中的应用

目的:探讨接纳承诺疗法(ACT)结合灵性关怀在灼口综合征(BMS)病人中的应用效果。方法:选取2021年11月—2022年6月在医院口腔科确诊的86例BMS病人作为研究对象,采用随机数字表法分为对照组、观察组。对照组实施常规护理,观察组在此基础上实施ACT结合灵性关怀,分别于干预前(T0)、干预结束后(T1)与干预结束后3个月(T2)比较两组病人疼痛[疼痛视觉模拟评分(VAS)评分]、负性情绪[医院焦虑抑郁量表(HADS)评分]、生活质量[世界卫生组织生存质量调查表(WHOQOL-BREF)评分]及睡眠情况。结果:两组病人疼痛评分及焦虑抑郁各项评分均呈时间依赖性下降(P<0.01),且观察组病人在T1和T2时低于对照组(P<0.05);两组病人睡眠时长呈时间依赖性上升(P<0.01),且观察组在T1和T2时长于对照组(P<0.01);两组病人生活质量各项评分均呈时间依赖性上升(P<0.01),且观察组在T1和T2时高于对照组(P<0.05)。结论:ACT结合灵性关怀有助于减轻BMS病人的疼痛、负性情绪,改善其睡眠状况,提高其生活质量。

赵瑞成教授针药结合治疗灼口综合征

赵瑞成教授认为火、湿、瘀毒三者停聚舌体,合而为毒,舌毒内蕴,煎灼舌体,故致灼口综合征,其治疗以滋阴降火、芳香化湿、活血止痛为法,针药结合,疗效确切。介绍赵瑞成教授治疗灼口综合征经验,并附验案一则,以资佐证。

P2X_3受体在灼口综合征患者舌组织神经纤维中的表达

采用免疫组织化学技术结合图像分析系统检测P2X_3受体在12例灼口综合征(BMS)患者和9例正常对照组的舌组织神经纤维中的表达水平,平均吸光度值分别为0.56±0.29和0.15±0.06(P<0.001);P2X_3受体表达水平与疼痛VAS评分无相关性(R2=0.012)。P2X_3受体参与了BMS患者的慢性疼痛,但与疼痛程度无相关性。

灼口综合征患者静态唾液流速和口干症状的相关研究

目的 :探讨不同亚型灼口综合征 (BMS)患者静态唾液流速有无差异以及静态唾液流速与BMS患者口干症状之间有无相关性。方法 :采用舌下置纱团浸唾称重法测定 5 2例BMS患者和 37例正常对照组的静态唾液流速。结果 :BMS组的平均静态唾液流速较对照组低 ,但统计学上无显著差异。BMS的 3个亚型间平均静态唾液流速无统计学上显著差异。具口干症状的BMS患者静态唾液流速与不具口干症状者差异亦不显著。结论

灼口综合征患者定量温度觉阈值分析

目的:分析灼口综合征(BMS)患者定量温度觉阈值(QTTs)。方法:对55名BMS患者与26名健康志愿者进行下唇、舌尖的冷感觉阈值(CDT)、热感觉阈值(WDT)、冷疼痛阈值(CPT)、热疼痛阈值(HPT)测试及焦虑、抑郁状态评估。1月后,对20名治疗后症状好转者复测QTTs。结果:与正常人相比,BMS患者下唇CPT、舌尖CDT、CPT显著降低(迟钝),舌尖HPT显著升高(迟钝);治疗后下唇CPT显著升高,舌尖HPT显著降低(P <0. 05)。舌尖CDT与抑郁有显著相关性(P <0. 05)。结论:定量温度觉检测(QTT)在BMS小纤维神经病变的诊断、评估方面具有一定应用价值,但应排除精神因素的干扰。

从肝肾论治灼口综合征经验分析

目的:总结以肝肾论治灼口综合征(BMS)经验。方法:运用肝肾论对867例BMS患者进行中医辩证施治。其中肝郁脾虚479例,肝肾阴虚火旺388例。以疏肝解郁、滋阴清热,养血安神为治则,以逍遥散为基本方,根据患者不同症状随证加减。以患者疼痛程度(VAS)和中医症侯评价治疗有效率。结果:肝郁脾虚证病人治疗总有效率为85.18%;肝肾阴虚火旺证病人治疗总有效率为82.47%。结论:以肝肾论治疗BMS能有效减轻患者的症状、提高生活质量。