Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Efficacy of alpha-lipoic acid in patients with burning mouth syndrome compared to that of placebo or other interventions: a systematic review with meta-analyses

  • Christy, Jessica (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Noorani, Salman (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Sy, Frank (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Al-Eryani, Kamal (Clinical Dentistry, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Enciso, Reyes (Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry of University of Southern California)
  • Received : 2022.07.06
  • Accepted : 2022.08.31
  • Published : 2022.10.01
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Abstract

Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène®, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0-10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

Keywords

Acknowledgement

The protocol of this systematic review was registered in PROSPERO CRD42021290489. Drs. Christy, Noorani, Sy, Al-Eryani, and Enciso contributed to the conceptualization, methodology, investigation, and validation. Drs. Christy, Noorani, and Sy conducted the data extraction with Dr. Enciso helping in the validation. Dr. Enciso conducted the electronic search and formal analysis. Drs. Christy, Noorani, Sy, Al-Eryani, and Enciso wrote the original draft and participated in the review and editing of the final manuscript.

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