Burning Mouth Syndrome: Clinical Presentation and Management

Lamb, Andrew Bowen (1990) Burning Mouth Syndrome: Clinical Presentation and Management. DDS thesis, University of Glasgow.

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A review of the literature on Burning Mouth Syndrome (BMS) revealed that many aetiological factors for the condition had been proposed. Nevertheless the relative role of individual factors had rarely been assessed and no prospective study previously had been reported. Therefore the aim of the study was to further understand the aetiology of BMS and to devise a treatment protocol. The design of the study specifically avoided the approach of other authors which had focused attention only on their particular specialist areas. As a result treatment was often of a fragmented nature with multiple referrals to practitioners in different specialties. The past literature was further confused by the inclusion of patients with specific conditions in which the patient may report a burning sensation such as erosive lichen planus and geographic tongue. These conditions characterised by possible mucosal changes have their own specific treatment regimes and are distinct from BMS where patients have no visible oral changes. Based on a knowledge of the literature a prospective study of 150 patients with BMS was undertaken. Care was taken to ensure that no patients that had visible oral changes were included. It became clear that patients with BMS gave a varied history and therefore did not constitute a homogenous group. The validity of recognising subtypes of BMS was evaluated as it could have prognostic implications. A classification system was introduced such that patients who said their burning was absent on waking, developed as the day progressed and was maximal in the evening were termed Type I BMS. Others who reported burning which was present on waking and was constant throughout the day were termed Type 2 BMS. In both Type I and Type 2 BMS burning was unremitting being present every day. Less commonly patients reported variable burning which was not necessarily present each day, these patients being classified as Type 3 BMS. Thirty five per cent of patients were classified Type I, 54% Type 2 and 11% Type 3. In order to quantify the severity of symptoms a linear analogue scale was employed. This allowed a baseline assessment of the severity of patients' initial symptoms and allowed progress during treatment to be quantified. Other data collected and analysed included the oral site of burning, duration of symptoms, age, sex, sleep pattern, home and social circumstances and cancerphobia. Haematological investigations included serum ferritin, corrected whole blood folate, serum vitamin B12, blood film and haemoglobin. Biochemical investigations were undertaken to detect undiagnosed diabetes mellitus and for 67 patients assays for Vitamin B1, B2, B6 and Vitamins A, C, D and E were completed. The oral flora was sampled and stimulated parotid salivary flow rates were estimated. Dentures, if worn, were assessed for factors contributing to overloading of the oral tissues in particular tongue restriction and excessive vertical dimension were noted. Parafunctional activity was investigated. Psychological aspects of BMS have tended to dominate the literature. In this study one third of patients were assessed using the Cattell's 16 PF Form C questionnaire. The results from this component of the study indicated that 60% of the sample had psychological abnormalities. A structured treatment protocol was developed so that any detected abnormalities were managed appropriately. Using the linear analogue scale to assess outcome of treatment 60% of patients with BMS were cured and sustained improvement in symptoms was reported by a further 11% with a minimum follow up period of 18 months. Whilst 54% of patients assessed with the Cattell's 16 PF Form C questionnaire as being psychologically disabled were cured compared to 68% of patients who were assessed as psychologically normal, those patients with a Type 2 history of BMS particularly when anxiety was present were significantly less likely to have a successful outcome. This finding supports the opinion that patients with BMS should not be regarded as a homogeneous group. The results of the study have placed in context the relative importance of organic factors including haematological, biochemical, microbiological and prosthodontic elements and non-organic factors such as psychological status. For the first time a prospective analysis of a cohort group has permitted justification for attention to be paid to all potential aetiological factors, since only 4756 of patients cured were cured as a result of treatment of one factor alone. However, replacement dentures, management of parafunctional activity, vitamin B1 and vitamin B6 replacement therapy and the use of the tricyclic anti depressant, Dothiepen (Prothiaden) were shown to be the most useful in treatment. The precise role of all aetiological factors is fully discussed and the importance of taking cognisance of psychological, social and domestic circumstances and cancerphobia is stressed. Finally suggestions for future avenues of research are proposed.

Item Type: Thesis (DDS)
Qualification Level: Doctoral
Keywords: Dentistry
Date of Award: 1990
Depositing User: Enlighten Team
Unique ID: glathesis:1990-78070
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09
URI: https://theses.gla.ac.uk/id/eprint/78070

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