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.

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.

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.

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.

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 。

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。

中国人灼口综合征患者的社会心理卫生背景调查

目的：了解中国人灼口综合征患者的精神因素背景，及其在疾病发生发展中的作用。方法：采用ＥＰＱ、ＳＣＬ－９０、ＬＥＳ量表，分别从个性特征、心理卫生状况及生活事件应激背景３个方面对３０例灼口综合征（ＢＭＳ）患者组和３０例正常对照组进行调查。结果：ＢＭＳ组中内向不稳定型多，显著高于正常组；多项情绪因子得分也显著高于正常组，同时ＢＭＳ组具有明显偏高的生活事件应激背景。结论：灼口综合征很可能是因一些应激性社会生活事件作用于一些具有特殊个性特征的敏感个体后引发的一系列情绪障碍及躯体不适感。

灼口综合征患者临床资料的分析

目的 探讨与灼口综合征患者疼痛程度相关的因素。方法 对 78例灼口综合征患者进行详细的临床调查 ,并对与疼痛有关的 7个因素进行多因素逐步回归分析。结果 精神障碍、植物神经功能异常、口干及瘀血程度等 4个因素与灼口综合征患者的疼痛程度成正相关。结论 心理治疗。

灼口综合征与焦虑抑郁症状的病例对照研究

目的：分析灼口综合征（BMS）患者的焦虑及抑郁症状，探讨 BMS 的危险因素。方法：以口腔医院黏膜科诊断为 BMS 的147名患者作为病例组；以性别及年龄匹配的正常人群140人作为对照组，进行病例对照研究。采用自制的 BMS 危险因素问卷收集病例组和对照组的全身情况和药物史；采用焦虑自评量表和抑郁自评量表评价试验组和对照组的焦虑抑郁症状。统计方法包括 t 检验，χ2检验和 logistic 回归分析。结果：病例组焦虑症状评分高于对照组[（44.4±9.9）vs.（35.7±6.2）]，病例组抑郁症状评分高于对照组[（48.1±11.6）vs.（37.5±8.9）]，差异有统计学意义（P ＜0.001）。BMS 的危险因素为受教育程度低（OR ＝1.91，95％CI：1.04～3.49）、缺血性脑卒中史（OR ＝4.46，95％CI：1.87～10.95）、焦虑症状（OR ＝8.12，95％CI：2.60～25.37）及抑郁症状（OR ＝2.5795％CI：1.26～5.27）。结论：BMS是多因素导致的疾病，其中较低的受教育水平、缺血性脑卒中史、焦虑及抑郁症状是 BMS 的主要危险因素，对 BMS 的治疗应联合精神科，加强心理治疗手段。

灼口综合征患者心理学相关因素的临床分析

的 对 98例灼口综合征 (BMS)患者进行心理学相关因素研究 ,以了解BMS与心理障碍关系 ,为进一步心理行为治疗提供理论依据。方法 对 98例非病理性BMS患者进行心理学病因、心因性躯体症状观察 ,并对BMS患者组和相配对的正常组进行SAS、SDS和SCL90量表的分析。结果 98例BMS患者中 ,有 95 %有各种心理学病因 ,所有患者存在各种心因性躯体症状 ,最常见的为睡眠障碍 ( 90 .8% ) ;有 96 %患者存在中重度的抑郁 ,75 %患者存在中重度的焦虑 ;SCL90量表主要以躯体化、强迫症状、抑郁、焦虑、精神病性为主。结论 BMS是一类以抑郁为主的心理障碍症状群 ;心理学病史、心因性躯体症状具有临床诊断的参考价值 ,心理量表分析则可进一步明确心理障碍的类型和程度 ,心理行为治疗可能是治疗精神性BMS的有效方法。

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。