Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of candida species

Abstract

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.

Queixas fonoaudiológicas e verificação da fala de indivíduos com diagnóstico de ardência bucal e xerostomia

“…This datum may point that both BMS and dry mouth seem to affect mainly the population aged 50 years or around (1,15,24) . Regarding patients' clinical history, the symptomatic groups showed similarities in may aspects, which agrees with the reviewed literature (2,(4)(5)(6)(7)(8)11,16,22,23) . Some studies, however, found variations especially regarding the intensity of the symptom (4,22,24) .…”

“…This study also confirmed the associated symptoms by both groups, i.e., the main symptom in one group appears as an associated symptom in the other group, and vice-versa (4,7,8,15,23,24) . The diversity of symptoms found and associated to the main symptoms -burning sensation and dry mouth -probably makes it difficult to discover the cause, which, as a consequence, results in various treatments (14,18,19,23) .…”

“…Burning sensation and/or dry mouth complaints are referred in the literature (2,10,15,17,19,25,26) , with a consequent negative impact in the individuals' quality of life (16,24) , including the social aspect as well (7,13) . In this study, complaints such as tiredness and struggle were reported in both groups, especially in the xerostomia group.…”

“…The intensity of the burning or blazing sensation is variable, and is intensified in the course of the day (4,6) . Frequently, the blazing sensation affects more than one area (2,4) , and the tongue is mentioned as the most affected structure (2)(3)(4)(5)(6)(7) ; it can also affect other structures of the oral cavity, such as lips, palate, gums and buccal mucosa (3)(4)(5) , as well as -though less frequently -the floor of the mouth (3) and the oropharynx (2) . The term "syndrome" in BMS is used because of the simultaneous association between the burning sensation and other subjective symptoms, such as xerostomia and dysgeusia (2,4,7,8) .…”

“…Complaints about the oral functions are so described: aggravation of the symptomatology when speaking and ingesting hot food (9) , as well as acid (10) and spicy (7,11) foods; improvement or suppression of the symptom in liquid and food intake (6,11) ; relief of the sympom when ingesting cold foods (10) . Subjects also report that the ingestion of liquid or food at extreme temperatures may either aggravate or alleviate the symptoms (2) .…”