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versión impresa ISSN 1698-4447
Med. oral patol. oral cir. bucal (Ed.impr.) vol.10 no.5 nov./dic. 2005
Burning mouth syndrome: A retrospective study of 140 cases in a
sample of catalan population
Síndrome de boca ardiente: Estudio retrospectivo de 140 casos en una muestra de la población catalana
Maria F. Palacios Sánchez (1), Xavier Jordana Comín (2), Carlos E. García Sívoli (3)
(1) Odontóloga, Diploma en Medicina Bucal. Unidad de
Medicina Bucal. Prof. Dr. José Mª Conde Vidal.
Facultat de Odontología, Universitat de Barcelona. España
(2) Profesor Asociado, Unitat dAntropologia (BABVE), Universitat Autònoma de Barcelona, España
(3) Profesor Asociado de Anatomía Dentaria, Facultad de Odontología, Universidad de Los Andes, Mérida, Venezuela
Unidad de Medicina Bucal. Facultad de Odontología.
Universitat de Barcelona. C/ Feixa Llarga, s/n
08907 L´Hospitalet de Llobregat , España.
Received: 28-11-2004 Accepted: 13-05-2005
Palacios-Sánchez MF, Jordana-Comín X,
García-Sívoli CE. Burning mouth syndrome: A
retrospective study of 140 cases in a sample of catalan population.
Med Oral Patol Oral Cir Bucal 2005;10:388-93.
The results of analyzing etiologic and clinical factors, and their connection with the burning mouth syndrome (BMS) in a sample of Catalan (Barcelona, Spain) population are presented in this work. The purpose of this study is to establish connections between BMS and the following variables: age, sex, overt depression, masked depression, cancerophobia, dry mouth, foreign body sensation in the mouth, and burning. 140 clinical cases of patients diagnosed with the disease and 140 cases of control patients are studied here. The data were statistically analyzed to study connections as well as the disease and variables frequency. The obtained results will help understanding possible connections of the studied etiologic and clinical factors with the disease, as well as the course of BMS, and its consequences in the Catalan population.
Key words: Burning mouth syndrome, symptomatic factors, etiologic factors, descriptive study, retrospective study, catalan population.
En este trabajo se presentan los resultados del análisis de factores etiológicos y clínicos y su relación con el síndrome de la boca ardiente (SBA) en una muestra de la población catalana (Barcelona, España). El objetivo del presente estudio es establecer las relaciones entre el síndrome de boca ardiente (SBA) y las siguientes variables: edad, sexo, depresión, depresión enmascarada, cancerofobia, sensación de boca seca, sensación de cuerpo extraño y quemazón, contribuyendo, así, al estudio epidemiológico de esta enfermedad en Cataluña. Se estudian 140 historias clínicas de pacientes diagnosticados con la enfermedad y 140 historias clínicas de pacientes control. Los datos fueron analizados estadísticamente para examinar las relaciones y frecuencias de las variables y la enfermedad. Los resultados obtenidos servirán para entender mejor las posibles relaciones de los factores etiológicos y clínicos estudiados con la enfermedad, así como el desarrollo del SBA y sus implicaciones en la población catalana.
Palabras clave: Síndrome de boca ardiente, factores sintomáticos, factores etiológicos, estudio descriptivo, estudio retrospectivo, población catalana.
The burning mouth syndrome (BMS) is a clinical entity characterized by the presence of chronic burning symptoms, heat or pain in the oral mucosa with no apparent signs, and obvious structural changes; or by the absence of local lesions (1). According to recent studies, the burning mouth syndrome affects 3.7% of the population (1, 2). The prevalence of this syndrome has been published in epidemiologic studies, in different countries and cultures (3). In the United States, 0.7% of the population is estimated to suffer this illness. Its prevalence is even higher in Europe, reaching 7% of the population (3). Around 1-3% of the adult population in developed countries is affected (4). Womens is the most affected group (5.5%), while mens rate is significantly lower (1.6%) (1, 2) BMS is more frequent during womens climatery. 1% of cases occur in the fourth and fifth decade of life (5,6).
The etiology of BMS is unknown, yet some risk factors have been suggested and grouped in three main types: local, systemic, and psychological (7). It is often stated that these factors interaction is complex, and it is not possible differentiating whether they give origin to symptoms or whether symptoms determine the profile of patients suffering this illness (8). Among the local causes of the syndrome, it is possible to mention: mandible dysfunction; oral candidiasis; parafunctional habits; subjective xerostomia; allergic reactions; salivary glands dysfunction; wrongly adapted or designed prosthesis, or dysfunctions due to parafunctional movements of stomatognathic system (chronic involuntary movements of the tongue and mucosa nibbling) causing prosthesis removal. In literature, a connection between problems related to oral prosthesis (adjustment, design) and oral burning feeling is likely to be found, since both can cause central or peripheral changes in the sensorial nerve function, giving place to non-typical oral pains (9-11).
A number of systemic etiologic factors and causes can be related to the burning mouth syndrome. All nutritional anomalies can be counted among the etiologic factors: pernicious anemia, iron deficiency, Vitamin B deficiency, folates deficiency, and Vitamin C deficiency. Regarding systemic diseases, it is worthy to mention: mellitus diabetes, hormonal disorders, general chronic diseases and psychological disorders (12,13). Non controlled mellitus diabetes and some systemic conditions such as gastrointestinal reflux disease are also connected to BMS, more specifically the symptomatology referred to oropharyngeal areas and the base of the tongue (14). In a comparative study of patients with BMS and a control group, Hugoson y Thorstensson (1991) stated that 87.5% of BMS patients were regularly under systemic medication. Psychotropic drugs represented 44%, drugs for digestive disorders represented 25%, drugs for respiratory disorders represented 25%, and 6.2% of them were vitamins (15). Animal studies have been carried out to analyze the connection between dopaminics D1 and D2, and BMS. The results report that dopaminic receptors play a main role diminishing dopamine levels in patients with BMS (16). Depression, masked depression (state in which psychic symptoms are masked), and anxiety are counted among the psychological factors related to BMS. Some psychiatric studies connect anxiety and depression to the symptomatology of patients with BMS (17-20). A high incidence of cancerophobia (20%) can also be seen in these patients. There is an obvious connection between the patients emotional life and BMS; events such as losing a loving one, financial crisis, job or work stability loss, long stressful periods, and long term diseases are connected to BMS (21-23). Likewise, a connection between emotional disorders and the classification of BMS has been found. According to that, moderate anxiety disorders are related to BMS type 1, and severe psychiatric disorders are more related to BMS type 2 (24, 25). In short, psychiatric emotional and conduct disorders are related to over 50% of BMS cases (26).
Despite BMS has been widely studied, its etiology is still uncertain (27). Several reasons could explain that: Absence of appropriate diagnosis criteria standardization and absence of heterogeneous related studies; all of this makes difficult to understand the exact causes of the disease (20). The purpose of this study was to determine the probable connections between BMS and the following variables in a sample of Catalan population: age, sex, depression, masked depression, foreign body sensation in the mouth, and burning.
MATERIAL AND METHOD
A retrospective study of 140 clinical cases of patients diagnosed with BMS was carried out. The cases were obtained from a private consulting stomatologist physician specialized in oral medicine, in Barcelona (Catalonia); those cases took place between 1978 and 2000. The following criteria were used to select the clinical stories of patients diagnosed with BMS: a. patients diagnosed with SBA of any type; b. presence of all or any of the studied variables; c. constant follow up over 6 months. The following variables were analyzed: age, sex, depression, masked depression, cancerophobia, burning, foreign body sensation in the mouth, and dry mouth. To carry out the study, patients were divided in five age groups. An equal number of patients (140 cases) were used as a control group. The middle value ages of patients in BMS group and in control group were 71.2 and 71.1 respectively (Table 1).
A descriptive and retrospective study of the clinical cases was carried out. The study consisted in observing clinical cases of patients diagnosed with BMS, as well as their behavior regarding the variables under study. The data were statistically analyzed with Pearsons chi-square test (χ2), to observe if any difference was detected among the affectation frequencies of the studied variables in both groups. Likewise, a descriptive and multivariable analysis (multiple correspondence analysis) was carried out in order to observe the variables correlation with both groups. All data were analyzed with SPSS (Statistical Package for the Social Sciences), version 12.5 for Windows.
Regarding the distribution of BMS cases with respect to the age groups (Table 1), most cases (46.3 %) were located in the group aged 65-74 years. The group aged 75-84 years represented 31.4 %, while the group aged 55-64 years represented 14.2 %. Most of the studied cases (92,2%) are concentrated in these groups. Likewise, groups aged 45-54 years, and over 85 years represented the lowest rate of cases (7.8%).
The distribution of groups according to sex reported that most patients were female (96.4 %). Male patients were represented by two age groups: from 65 to 74, and from 75 to 84; 2.1% and 1.4% respectively (Table 1).
The analysis of variables reports a higher affectation rate in BMS group rather than in control group, showing important statistical differences except for the masked depression ( p<0.05) (Table 2).
The multiple correspondence analysis (Graph 1) reports the presence of dry mouth, burning feeling, foreign body sensation in the mouth, and cancerophobia to be closely related to BMS group, while their absence is related to control group; this can be seen in dimension 1. On the other hand, depression and masked depression are more related to the patients age rather than to BMS; this can be seen in dimension 2. In spite of that, a small connection between BMS and depression can be observed.
In this study, the middle value of patients age in BMS group is 71.2. When contrasting that value (71.2) with the results obtained in other studies (13, 17, 20, and 26), the middle value in this work appears to be 14.4 years higher than the middle value in compared works. It is important to highlight this result since, up-to-date, it has not been possible to find any other data with a middle value so high.
Most of cases are female (96.4%). This value is consistent with the results obtained in other studies, confirming the information found in specialized literature: female are more affected (1-3). The affectation rate considerably diminishes in men (3.5 %).
Regarding the studied variables, BMS is more related to the burning feeling (38.9 %) and with dry mouth (29.6%). Foreign body sensation and cancerophobia show slightly lower percentages. These results are similar to the ones obtained in other studies (2, 28-31), which places these features among the most frequent in BMS.
Depression and masked depression present a higher rate in BMS group (16.1% and 6.1% respectively). The opposite can be seen in control group: those variables present the lowest rates (9.3% and 4.6%). Despite so important differences, these results confirm that emotional states can be reflected through the mouth in BMS (32).
When comparing the results obtained in this study with the ones obtained in other studies (13, 28, 33), cancerophobia appears the most prevalent state consistent with BMS (28.2 %). However, the affectation rates obtained for depression and masked depression (22.2%) could not be related with the results obtained in other studies (5, 13, 17, 25, and 33).
The continuity of this kind of study is of high importance to understand more accurately the etiologic and symptomatologic profile of this disease, which, in many cases, is able to incapacitate the patient. It is important to study the possible connection with other symptomatic and etiologic variables; it will allow clearing up the epidemiologic behavior of this pathology, especially in Catalonia, where the epidemiologic data were obtained.
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