Antidiuretic Hormone Levels in Men with Burning Mouth Syndrome: A Pilot Study

  • Lee, Yeon-Hee (Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital) ;
  • Hwang, Mi-Jin (Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital) ;
  • Chon, Suk (Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Auh, Q-Schick (Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital)
  • Received : 2017.10.14
  • Accepted : 2017.11.17
  • Published : 2017.12.30


Purpose: Burning mouth syndrome (BMS) is a disabling pain that mostly occurs in elderly women, but rarely in men. It is characterized by an unremitting oral burning sensation and pain without detectable oral mucosal changes. We investigated the clinical and hematologic features of middle-aged men with BMS, and compared the results to those of men with oral mucositis. Methods: Five men with BMS ($48.60{\pm}6.19years$) and five age-matched controls with oral mucositis ($49.80{\pm}15.26years$) underwent clinical and psychological evaluations and blood tests. Psychological status was evaluated using the Symptom Checklist-90-Revised. Cortisol, estradiol, progesterone, testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), and antidiuretic hormone (ADH) levels and erythrocyte sedimentation rate (ESR) were determined from the blood samples. Results: ADH level was significantly lower in men with BMS than in the controls. ADH levels correlated with testosterone (p<0.01), and ACTH levels strongly correlated with ESR (p<0.05). Progesterone level positively correlated with FSH and LH levels. Pain intensity on a visual analogue scale correlated with estradiol level only in men with BMS. Among psychological factors, the obsessive-compulsive disorder, interpersonal-sensitivity, and anxiety scores were higher in men with BMS than in the controls (p<0.05). However, no correlations were observed between the psychological and hematologic factors in both groups. The BMS symptoms presented only on the tongue, with the lateral border being the most prevalent area. Conclusions: Men with BMS may experience dysregulated endocrinologic or psychoneuroendocrinologic interactions, which might affect oral BMS symptoms, aggravating the severity of the burning sensation.



  1. Klasser GD, Fischer DJ, Epstein JB. Burning mouth syndrome: recognition, understanding, and management. Oral Maxillofac Surg Clin North Am 2008;20:255-271, vii.
  2. Grinspan D, Fernandez Blanco G, Allevato MA, Stengel FM. Burning mouth syndrome. Int J Dermatol 1995;34:483-487.
  3. van der Ploeg HM, van der Wal N, Eijkman MA, van der Waal I. Psychological aspects of patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:664-668.
  4. Bergdahl M, Bergdahl J. Burning mouth syndrome: prevalence and associated factors. J Oral Pathol Med 1999;28:350-354.
  5. Schiavone V, Adamo D, Ventrella G, et al. Anxiety, depression, and pain in burning mouth syndrome: first chicken or egg? Headache 2012;52:1019-1025.
  6. Netto FO, Diniz IM, Grossmann SM, de Abreu MH, do Carmo MA, Aguiar MC. Risk factors in burning mouth syndrome: a case-control study based on patient records. Clin Oral Investig 2011;15:571-575.
  7. Wardrop RW, Hailes J, Burger H, Reade PC. Oral discomfort at menopause. Oral Surg Oral Med Oral Pathol 1989;67:535-540.
  8. Cairns BE. The influence of gender and sex steroids on craniofacial nociception. Headache 2007;47:319-324.
  9. Gao J, Chen L, Zhou J, Peng J. A case-control study on etiological factors involved in patients with burning mouth syndrome. J Oral Pathol Med 2009;38:24-28.
  10. Burger HG. The endocrinology of the menopause. Maturitas 1996;23:129-136.
  11. Martinez Jabaloyas JM, Queipo Zaragoza A, Ferrandis Cortes C, Queipo Zaragoza JA, Gil Salom M, Chuan Nuez P. Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors. Actas Urol Esp 2008;32:603-610.
  12. Kim HI, Kim YY, Chang JY, Ko JY, Kho HS. Salivary cortisol, $17{\beta}$-estradiol, progesterone, dehydroepiandrosterone, and ${\alpha}$-amylase in patients with burning mouth syndrome. Oral Dis 2012;18:613-620.
  13. Dias Fernandes CS, Salum FG, Bandeira D, Pawlowski J, Luz C, Cherubini K. Salivary dehydroepiandrosterone (DHEA) levels in patients with the complaint of burning mouth: a casecontrol study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:537-543.
  14. Suri V, Suri V. Menopause and oral health. J Midlife Health 2014;5:115-120.
  15. Kenchadze R, Iverieli M, Okribelashvili N, Geladze N, Khachapuridze N. The psychological aspects of burning mouth syndrome. Georgian Med News 2011;(194):24-28.
  16. Adamo D, Schiavone V, Aria M, et al. Sleep disturbance in patients with burning mouth syndrome: a case-control study. J Orofac Pain 2013;27:304-313.
  17. Trudel E, Bourque CW. Central clock excites vasopressin neurons by waking osmosensory afferents during late sleep. Nat Neurosci 2010;13:467-474.
  18. Spanemberg JC, Rodriguez de Rivera Campillo E, Salas EJ, Lopez Lopez J. Burning Mouth Syndrome: update. Oral Health Dent Manag 2014;13:418-424.
  19. Derogatis LR, Cleary PA. Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychol 1977;16:347-356.
  20. Rosen S, Ham B, Mogil JS. Sex differences in neuroimmunity and pain. J Neurosci Res 2017;95:500-508.
  21. Fischer L, Clemente JT, Tambeli CH. The protective role of testosterone in the development of temporomandibular joint pain. J Pain 2007;8:437-442.
  22. Olsson K, Rundgren M. Inefficiency of isoprenaline to induce drinking in the goat. Acta Physiol Scand 1975;93:553-559.
  23. Robinson D. Nocturia in women. Int J Clin Pract Suppl 2007;(155):23-31.
  24. Vaughan CP, Fung CH, Huang AJ, Johnson TM Nd, Markland AD. Differences in the association of nocturia and functional outcomes of sleep by age and gender: a cross-sectional, populationbased study. Clin Ther 2016;38:2386-2393.e1.
  25. Shaver JL, Lentz M, Landis CA, Heitkemper MM, Buchwald DS, Woods NF. Sleep, psychological distress, and stress arousal in women with fibromyalgia. Res Nurs Health 1997;20:247-257.<247::AID-NUR7>3.0.CO;2-I
  26. Nisenblat V, Engel-Yeger B, Ohel G, Aronson D, Granot M. The association between supra-physiological levels of estradiol and response patterns to experimental pain. Eur J Pain 2010;14:840-846.
  27. Gordon FT, Soliman MR. The effects of estradiol and progesterone on pain sensitivity and brain opioid receptors in ovariectomized rats. Horm Behav 1996;30:244-250.
  28. Stening KD, Berg G, Hammar M, et al. Influence of estrogen levels on thermal perception, pain thresholds, and pain tolerance: studies on women undergoing in vitro fertilization. J Pain 2012;13:459-466.
  29. Vincent K, Tracey I. Hormones and their Interaction with the Pain Experience. Rev Pain 2008;2:20-24.
  30. Woda A, Dao T, Gremeau-Richard C. Steroid dysregulation and stomatodynia (burning mouth syndrome). J Orofac Pain 2009;23:202-210.
  31. Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med 2009;10:289-299.
  32. Browning S, Hislop S, Scully C, Shirlaw P. The association between burning mouth syndrome and psychosocial disorders. Oral Surg Oral Med Oral Pathol 1987;64:171-174.
  33. Bergdahl J, Anneroth G, Perris H. Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: a controlled study. J Oral Pathol Med 1995;24:213-215.
  34. de Souza FT, Teixeira AL, Amaral TM, et al. Psychiatric disorders in burning mouth syndrome. J Psychosom Res 2012;72:142-146.
  35. Scala A, Checchi L, Montevecchi M, Marini I, Giamberardino MA. Update on burning mouth syndrome: overview and patient management. Crit Rev Oral Biol Med 2003;14:275-291.
  36. Grushka M. Clinical features of burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:30-36.
  37. Cerchiari DP, de Moricz RD, Sanjar FA, Rapoport PB, Moretti G, Guerra MM. Burning mouth syndrome: etiology. Braz J Otorhinolaryngol 2006;72:419-423.
  38. Danhauer SC, Miller CS, Rhodus NL, Carlson CR. Impact of criteria-based diagnosis of burning mouth syndrome on treatment outcome. J Orofac Pain 2002;16:305-311.