Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting muco-sal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.

Mandibular function improved in all SLLLT patients proving the effectiveness in the treatment of pain, as demonstrated by a significant improvement in clinical signs and symptoms of temporomandibular joint disc displacement without reduction and osteoarthritis at the end of treatment and stability over a period of 1 month.

The aim of this study was to evaluate the efficacy of diode superpulsed low-level laser therapy (SLLLT) in reducing experimentally induced orthodontic pain. Overall, 120 subjects (23.01 ± 1.39 years) were enrolled for a clinical trial. Subjects were randomly assigned to upper (U, N = 60) or lower (L, N = 60) jaw groups. All subjects received 4 elastomeric separators mesial and distal to the upper (U group) or lower (L group) right first molar and bicuspids. Each subject of the U and L groups was randomly assigned to laser (Ul, N = 20 and Ll, N = 20), placebo (Up, N = 20 and Lp, N = 20) or control (Uc, N = 20 and Lc, N = 20) sub-groups. Subjects in laser groups received a single GaAs diode SLLLT application (910 nm, 160 mW, beam diameter of 8 mm, applied for 340 s) immediately after placing orthodontic separators. Placebo groups received a simulated SLLLT and controls did not receive any therapy. All participants compiled a survey on pain duration and a 100-mm visual analogue scale immediately after the separators placement and after 12, 24, 36, 48, 72, and 96 h. Pain intensity of laser groups was significantly lower compared to placebo and control groups (p = 0.0001). In the laser group, 70% of subjects felt pain, while in the placebo and control groups all subjects felt pain (p = 0.0001). The end of pain occurred earlier in laser compared to placebo and control groups (p = 0.021). A single-diode SLLLT application appeared to be effective in reducing the intensity and duration of experimentally induced orthodontic pain and could be used in daily orthodontic practice.

Objective: To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances. Materials and Methods: One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E 1 (n 5 15) and E 2 (n 5 15) received a powered rotating-oscillating toothbrush, and groups M 1 (n 5 15) and M 2 (n 5 15) received a manual toothbrush. Groups E 1 and M 1 received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E 2 and M 2 received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI. Results: In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E 1 were lower than those of group E 2 , and at T12, T16, and T20, PI scores of groups M 1 and E 1 were lower compared to those of groups M 2 and E 2 . A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush. Conclusions:The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used. (Angle Orthod. 2014;84:896-901.)

Ninety-five persons receiving treatment for chronic pain were surveyed using the Spirituality and Chronic Pain Survey (SCPS). The survey included a pain assessment, a spiritual/religious practices assessment, and questions related to spiritual/religious beliefs and attitudes. Most participants reported experiencing constant, higher-level pain. The most frequent responses to pain were taking medication (89%) and praying (61%). Results indicated the majority of respondents perceived God or a Spiritual Power as helping them cope with pain and as a source of happiness, connection, and meaning in life. A factor analysis on attitude items of the SCPS identified 4 factors that accounted for 60% of the variance: (a) Spiritual Connection and Meaning, (b) Spiritual Increase and Hopefulness, (c) Spiritual Decrease and Punishment, and (d) Spiritual Power. Results suggest the relevance and utility of spirituality assessment for persons who live with chronic pain. Implications for practice, education, and future research are discussed.

The aim of this study was to assess, by a digital photogrammetric technique, the relative dimensional changes before and after rapid maxillary expansion (RME). The transverse diameters and volumetric variations of the palate were measured by photogrammetry on study casts taken at three different phases of therapy: at the beginning of treatment (T1), on removal of the rapid expander, after expansion and retention for three months (T2), and six months after appliance removal (T3). The sample consisted of 30 children, (age range 7-8 years), all with a crossbite; 15 were angle Class I, six Class II and nine Class III. They were treated with an acrylic splint expander with two turns per day until the maxillary molar palatal cusps were in contact with the mandibular molar buccal cusps. The RME device was used as a passive retainer for three months, after which it was removed. During the following six months, no retention was used and no orthodontic treatment was undertaken. The findings demonstrated a significant relapse (P < 0.001) in the dental transverse diameter in all patients six months after appliance removal, although the palatal volume remained stable.

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Oral prophylaxis with sucralfate prevented oral blisters and oral discomfort. The procedure proved to be cost effective and easy to administer. It did not show significant side effects and may be used routinely in patients with EB.