• 제목/요약/키워드: Burning mouth syndrome

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Clinical Guidelines to Diagnose and Manage Dental Patients with Hyposalivation and Xerostomia

  • Jeong-Kui Ku;Pil-Young Yun;Sungil Jang;Won Jung;Kyung-Gyun Hwang
    • Journal of Korean Dental Science
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    • 제16권1호
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    • pp.9-22
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    • 2023
  • Xerostomia is defined as the subjective complaint of dry mouth with or without hyposalivation, which is insufficient salivary secretion from salivary gland. Xerostomia can lead to multiple oral symptoms such as dental caries, halitosis, burning mouth syndrome, and oral candidiasis, which can significantly impact the well-being of patients, especially in geriatric patients who may already have compromised health. Clinical findings of xerostomia include decreased salivary flow and alterations in salivary composition. These changes can lead to various oral health problems such as dental caries, periodontitis, swallowing and speaking difficulties, taste disturbances, halitosis, mucosal diseases, and burning mouth syndrome. Recognizing these clinical manifestations is essential for early diagnosis and appropriate management. Although several reasons and risk factors have been suggested for xerostomia such as aging, chemo-radiation therapy, systemic disease, and Sjögren's syndrome, the polypharmacy is recently highlighted especially in elderly patients. Understanding the etiology and risk factors associated with xerostomia is crucial for effective management. To manage xerostomia patients, a multidisciplinary guideline should be established beyond dental care. Through this literature review, we summarized consideration for diagnostic, therapeutic, nursing essentials for the clinical guideline. By addressing the underlying causes and implementing appropriate treatment strategies, healthcare professionals can improve the quality of life for individuals suffering from xerostomia.

Treatment Protocol for Secondary Burning Mouth Syndrome in Candida albicans- or Non-albicans-Positive Patients

  • Ju, Hye-Min;Jeong, Sung-Hee;Ahn, Yong-Woo;Jeon, Hye-Mi;Ok, Soo-Min
    • Journal of Oral Medicine and Pain
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    • 제47권3호
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    • pp.126-134
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    • 2022
  • Purpose: This study aimed to propose an efficient treatment approach for infection with different candida species. Methods: Fifty-three patients who presented with a chief complaint of oral mucosal pain and exhibited positive candida culture findings were divided into two groups (Candida albicans and non-albicans). Pain, mucosal manifestations, salivary flow rates, durations of disease and treatment, and responses to treatment (nystatin and clonazepam) were investigated in both groups. Results: Patients in the C. albicans group exhibited more prominent clinical characteristics (erythematous lesions, tongue coatings, and hyperalgesia) than those in the non-albicans group. In total, 70% of patients in the non-albicans group showed no abnormalities in the oral mucosa. Patients in the C. albicans group showed increased resistance to nystatin treatment compared to those in the non-albicans group, especially with longer disease durations. The patients resistant to nystatin treatment showed positive responses to clonazepam. Conclusions: Patients with oral mucosal pain should be tested for the presence of Candida, even in the absence of mucosal abnormalities, especially those infected with non-albicans species. If no response to antifungal therapy is observed, treatment with clonazepam should be initiated, especially in patients infected with C. albicans.

구강 작엽감 증후군 (BMS)의 임상적 특징 및 치료에 관한 연구 (A Study on The Clinical Characteristics and Treatment in Burning Mouth Syndrome)

  • Mi-Jung Yeom;Chong-Youl Kim
    • Journal of Oral Medicine and Pain
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    • 제20권1호
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    • pp.39-52
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    • 1995
  • Burning mouth syndrome is characterized by a burning sensation in oral cavity without clinical signs. There has b een no established theories about the diagnosis and treatment. The purpose of this article is to examine the clinical feature of BMS patients of Korean and to present a treatment protocol that can be helpful in clinical applications. The subjects chosen for the study were 52 patients who had visited Department of Oral Diagnosis at Yonsei University Dental Hospital and were diagnosed as BMS. We did questionnaires and precise oral exam, laboratory exam, grouping of our patients, individual treatment for the groups and classification of responses to the treatment. The following results were obtained: 1. Chief complaints were throbbing (71.2%), pricking, stinging, tingling (30.8%), burning(25a%). The tongue is the most frequently affected site (82.7%), followed by full mouth, gingiva, palate, buccal mucosa, lips, throat, labial mucosa and floor of mouth. 2. The average age of onset was 48.1 year and the male to female ratio was 1 to 3. The average duration of symptom was 11.69 months for male and 23.07 months for female. 3. 32.7% of patients had appealed continuous pain, which was the most cases. Aggravating factors were peppery food, salty food, hot food, fatigue, tension conversation, sour food, cold food and toothpaste. Reducing factors were cold food, diet, going to sleep and smoking. 4. Associated symptoms were dry mouth, other life problem, altered taste perception, bad taste, throat pain, tingle and difficulty in swallowing. 5. Most of patients had appealed that there was not associated event on onset of symptom, and the order of prevalence is as fallow; dental treatment, stress, denture wearing, an attack of a systemic disease. 92.3% of patient appealed that there was no psychological withering and 7.7% of patients appealed positively. 6. There were eight males and four females that had jobs. 7. There was no family history in 100% of patients in questions about presence of family history. 8. 96.2% of patients appealed that there was no oral habits. 13.5% of patients had dryness of oral mucosa in oral exam. A significant relation to dental prosthesis was not observable, but incidence of diseases due to stress appeared high in BMS which had the clinical characteristics as above. A group having low serum iron was 63.5% and in this group period of potential iron deficiency appeared high in incidence just before move to anemia. A group represented positive response was 38.5% in fungus study for Candida albicans. Since we can expect high treatment response by prescription of iron-contained drug and antifungal drug in these patients, diagnosing patients' condition of BMS can be achieved in more various aspects through study for serum iron and Candida albicans. Furthermore, it is expected that treatment protocol can be made.

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수면장애가 구강작열감 증후군에 미치는 영향에 대한 고찰 (Review about effects of sleep disturbances on Burning mouth syndrome)

  • 임현대;이유미
    • Journal of Oral Medicine and Pain
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    • 제38권4호
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    • pp.313-318
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    • 2013
  • 수면은 외부의 자극에 대해 반응하지 않는 상태로 만성통증을 지닌 환자는 수면 장애를 겪고 있으며 수면장애는 통각과 민한 상태를 유발하고 통증인지에 영향을 미친다. 구강작열감 증후군은 구강점막에 화끈거리는 감각을 포함하는 만성 안면통증으로 감각과 통증 역치가 변성되고 신경병증 징후를 보인다. 구강작열감 증후군은 첫 번째로 국소적, 전신적 요인 즉, 흡연, 투약 등 작열감 증상의 원인으로 가능한 요인을 제거하고, 두 번째로는 환자를 안심시키는데 있다. 수면박탈 내인성, 외인성 아편유사제의 진통효과는 수면 계속성 즉, 선택적인 렘수면 박탈은 아편유사제 진통효과를 방해 하고 opioid protein synthesis 억제를 야기하고 ${\mu}$${\delta}$ opioid 수용체 친화력을 감소시킨다. enkephalinase-inhibitor와 MAO-B inhibitor 적용으로 나타나는 아편유사제의 진통상승효과는 렘수면 박탈시에 무효화 된다. 렘수면 박탈후에는 5-HT 와 5-hydroxy indole acetic acid 레벨이 유의하게 감소되고, 아편유사체에 활성에 의해 유발되는 통증억제를 지지하는 세로토닌 체계를 가능하지 않게 한다. 구강작열감 증후군은 설말단 신경섬유에서 추삭변성 변화가 있고 특히, 열자극, 냉자극 및 미각 유해수용성 자극의 인지를 포함한 감각변화가 폐경기후 생식스테로이드의 급격한 감소가 신경활성 스테로이드 생성에 변성을 일으켜며, 이것은 말초성 변성와 중추성 변성이 존재함을 제시한다. 구강작열감 증후군은 기본적으로 가능한 요인을 제거하는 것이 중요하므로 구강작열감의 진행을 방지하고, 만정적인 작열감의 경감을 위하여 증상 경과에 영향을 미칠 수 있는 수면에 대하여 고찰하고자 한다.

구강 작열감 증후군에서 클로나제팜의 국소적 적용 (Topical Application of Clonazepam to Burning Mouth Syndrome)

  • 심영주;최종훈;안형준;권정승
    • Journal of Oral Medicine and Pain
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    • 제34권4호
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    • pp.429-433
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    • 2009
  • 구강 작열감 증후군은 혀나 구강점막에 객관적인 이상징후(abnormal sign)를 보이지 않으면서 혀 및 구강점막의 지속적인 통증을 보이는 만성 질환이다. 연관된 것으로 추정되는 요인이 다양하고 환자마다 통증 양상이 다소 다르게 나타날 수 있어 적절한 진단 및 효과적인 치료를 제공하기 어려운 경우가 많다. 혀나 구강점막의 작열감은 알러지, 캔디다감염, 부기능습관, 타액선 기능저하 등과 같은 국소요인과 당뇨병, 갑상선기능저하증, 영양결핍 등과 같은 전신적 요인, 그리고 우울증, 걱정, 암공포증 등과 같은 심인성 요인과 연관되어 발생할 수 있다. 그러므로, 임상가들은 작열감을 유발할 수 있는 원인들에 대하여 숙지하고 있어야 하며, 혈액검사 등의 관련 검사를 통한 적절한 평가를 정확하고 세심하게 시행하여 효과적인 치료를 제공할 수 있어야 한다. 이러한 구강 작열감 증후군의 치료에는 약물요법, 인지행동요법, 심리치료 등 다양한 치료들이 시도되어지고 있다. 현재 구강작열감 증후군의 치료에 이용되고 있는 약물에는 클로나제팜(clonazepam), 가바펜틴(gabapentin), 삼환성항우울제(amitriptyline), 알파리포산(alpha-lipoic acid), 캡사이신(capsaicin) 등이 보고되고 있으며, 이 중 클로나제팜을 국소적으로 적용하는 것이 전신 투여하는 다른 약물에 비해 부작용이 적으면서 효과도 상당히 좋은 것으로 보고되고 있다. 이에 구강 작열감 증후군 환자에게 클로나제팜을 국소적으로 적용한 증례를 통해 그 효과를 확인하고자 하였다.

구강작열감증후군 환자에서 기울과 전중($CV_{17}$)압통의 상관성 - Algometer를 이용한 전중압통의 정량화 측면에서 - (Correlation between Qi-Stagnation and Pressure Pain Threshold on $CV_{17}$ (Danzhong : 膻中) in Burning Mouth Syndrome Patients - In the Perspective of Quantification of Pressure Pain Threshold on $CV_{17}$ by using Algometer -)

  • 강경;김진성;선종기;손지희;김주연;장승원;손지영;이현주;류봉하
    • 대한한방내과학회지
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    • 제33권4호
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    • pp.498-510
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    • 2012
  • Objectives : This study was designed to find out whether there is a correlation between qi-stagnation score and pressure pain threshold (PPT) on acupuncture point $CV_{17}$ in burning mouth syndrome (BMS) patients. Methods : Thirty BMS patients who newly visited Oral Disease Clinic at the Kyung Hee University Korean Medicine Hospital were surveyed. The subjects were evaluated on age, illness duration, sex, self-assessed severity of BMS, qi-stagnation score, and PPT on 3 acupuncture points ($CV_{17}$, Rt. $SP_9$, Lt. $SP_9$). Results : There was significant correlation between age and PPT on $CV_{17}$ (p=0.005). Therefore, partial correlation analysis with age as control variable was done, and the result showed significant correlation between qi-stagnation score and PPT on $CV_{17}$ (p=0.001). Qi-stagnation diagnostic point by PPT on $CV_{17}$ was suggested as 3.8056 $kg/cm^2$ based on the fact that diagnostic score is 28.50 in the qi-stagnation questionnaire. Furthermore, considering that PPT is effected by age, we could attain qi-stagnation diagnostic equation of PPT on $CV_{17}$, that is suggested as $0.047{\times}(age)+0.848kg/cm^2$. PPT of 3 acupuncture points ($CV_{17}$, Rt. $SP_9$, Lt. $SP_9$) was compared, and the result showed that PPT was significantly lower on $CV_{17}$ (w/Rt $SP_9$: p=0.022, w/Lt. $SP_9$: p=0.012). Also, significance and correlation coefficient with qi-stagnation were higher on $CV_{17}$ (p<0.001, r=-0.620) than Rt. $SP_9$ (p=0.023, r=-0.413) or Lt. $SP_9$ (p=0.014, r=-0.444). Conclusions : The result of this study suggested that PPT on $CV_{17}$, measured quantitatively by algometer, had a strong correlation with qi-stagnation score in BMS patients. Therefore, the study showed that $CV_{17}$ can be a useful acupuncture point in diagnosing qi-stagnation by measuring PPT in BMS patients.

타액분비저하에 따른 구강작열감증후군 환자의 임상적 특징 비교 (Comparison of the Clinical Characteristics of Patients with Burning Mouth Syndrome due to Hyposalivation)

  • 이하늘;김동윤;백소영;정해인;이현진;조윤재;하나연;김진성
    • 대한한방내과학회지
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    • 제41권5호
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    • pp.838-847
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    • 2020
  • Objectives: The aim of this study was to investigate the clinical characteristics of patients with Burning Mouth Syndrome (BMS) due to hyposalivation (HS). Methods: We reviewed the clinical records of 39 BMS patients who visited the Department of Digestive Diseases of Kyunghee Korean Medicine Hospital from March 1st, 2020 to July 31st, 2020. The subjects were classified according to the presence or absence of hyposalivation and both groups were compared for the proportion of coated tongue, heart rate variability (HRV), Ryodoraku, and the numeral rating scale (NRS) score of tongue pain results. Results: The BMS with Hyposalivation (HS group) and the BMS without Hyposalivation (Non-HS group) showed a significant difference in the proportion of coated tongue and the NRS score for tongue pain. The NRS score was significantly higher in the Non-HS group and the proportion of coated tongue was lower. However, no significant differences were noted in several HRV parameters between the two groups. The most frequent accompanying symptoms were xerostomia and dyspepsia. Conclusions: The results of this study suggest that hyposalivation might be one of the main causes of tongue pain, the key complaint in BMS patients. Sympathetic/parasympathetic imbalance might not be a main contribution of hyposalivation in BMS. Instead, factors such as the number of medications taken seem to correlate with hyposalivation in BMS. This results could be useful in the management of BMS patients with hyposalivation in clinical practice.

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;Noorani, Salman;Sy, Frank;Al-Eryani, Kamal;Enciso, Reyes
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제22권5호
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    • pp.323-338
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    • 2022
  • 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.

Stevens-Johnson syndrome and abuse of anabolic steroids

  • Cocca, Serena;Viviano, Massimo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제43권1호
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    • pp.57-60
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    • 2017
  • Stevens-Johnson syndrome (SJS) is characterized by mucocutaneous tenderness and typical hemorrhagic erosions, erythema and epidermal detachment presenting as blisters and areas of denuded skin. SJS is often observed after drug use as well as after bacterial or viral infections. Several drugs are at high risk of inducing SJS, but there are no cases in the English literature regarding anabolic steroid use triggering SJS. In our paper, we describe a case in which use of anabolic androgenic steroids (AAS) was associated with SJS. The patient participated in competitive body-building and regularly took variable doses of AAS. Initial symptoms (headache, weakness, pharyngodynia, and fever) were ignored. After a week he presented to the Emergency Department with a burning sensation on the mouth, lips, and eyes. Painful, erythematous, maculopapular, and vesicular lesions appeared all over the body, including on the genitals. During hospitalization, he also developed a cardiac complication. The patient had not taken any drugs except AAS.

Effect of Botulinum Toxin Injection and Physical Therapy to Reduce Tongue Pain and Discomfort: Case Reports

  • Kwon, Dae-Kyung;Park, Hee-Kyung
    • Journal of Oral Medicine and Pain
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    • 제45권4호
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    • pp.120-123
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    • 2020
  • The causes of tongue pain and discomfort include systemic disease, malnutrition, mental illness, fungal infection, and neuropathy. Three postmenopausal women reported burning sensations and stiffness of the tongue for various periods, from one month to four years. There were no objective etiological factors to cause the tongue pain and discomfort. Muscular tenderness upon palpation of masticatory muscles, sternocleidomastoid, trapezius, and tongue were observed. Physical therapy approaches such as moist hot pack, ultrasound, and myomonitor were performed on three patients with tongue pain, just as for temporomandibular joint disease. Additional botulinum toxin injection therapy was applied to one patient who displayed a clenching habit. All three patients showed a marked improvement in their tongue symptoms after the muscle relaxation and botulinum toxin injection therapy.