Exploring the Association of Burning Mouth Syndrome with Depressive and Anxiety Disorders in Middle-Aged and Older Adults: A Systematic Review

Abstract

Background: Burning Mouth Syndrome (BMS) is an idiopathic condition mainly affecting middle-aged and older individuals with hormonal disturbances or psychiatric disorders and is characterized by chronic pain. The etiopathogenesis of this multifactorial syndrome is largely unknown. The objective of the present systematic review was therefore to evaluate the relationship of BMS with depressive and anxiety disorders in middle-aged and older individuals. Methods: We selected studies evaluating BMS and depressive and anxiety disorders assessed with validated tools, published from their inception up to April 2023, using PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar databases and adhering to the PRISMA 2020 guidelines/PRISMA 2020 27-item checklist. This study is registered on PROSPERO (CRD42023409595). The National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies were used to examine the risk of bias. Results: Two independent investigators rated 4322 records against the primary endpoint and found 7 records meeting the eligibility requirements. Anxiety disorders were found to be the most common psychiatric disorders related to BMS (63.7%), followed by depressive disorders (36.3%). We found a moderate association of BMS with anxiety disorders, with multiple studies included (n = 7). Moreover, we found a low association of BMS with depressive disorders (included studies, n = 4). The role of pain appeared to be controversial in explaining these associations. Conclusions: In middle-aged and older subjects, anxiety and depressive disorders may be potentially related to the development of BMS. Furthermore, also in these age groups, females showed higher risk of developing BMS than males, even when taking into account multimorbidity such as sleep disorders, personality traits, and biopsychosocial changes as suggested by study-specific findings.

Oral mucosal diseases and psychosocial factors: progress in related neurobiological mechanisms

“…A systematic review involving middle-aged and elderly subjects revealed a moderate association between BMS and anxiety disorder, but a lower correlation between BMS and depression disorder. 14 Women were shown to be at higher risk of developing BMS than men, and in addition to anxiety and depression, the study showed that personality characteristics, sleep disorders and bio-psychosocial changes worsened in middle-aged and elderly patients with BMS. 14 Because most of the results analysed by the researchers were from cross-sectional studies, the causal relationship between anxiety disorder, depressive disorder and BMS could not be determined.…”

“… 14 Women were shown to be at higher risk of developing BMS than men, and in addition to anxiety and depression, the study showed that personality characteristics, sleep disorders and bio-psychosocial changes worsened in middle-aged and elderly patients with BMS. 14 Because most of the results analysed by the researchers were from cross-sectional studies, the causal relationship between anxiety disorder, depressive disorder and BMS could not be determined. 14 Moreover, BMS is also frequently present in patients with Parkinson’s disease, characterized by dopamine dysregulation (confirmed by positron emission tomography) in the nigrostriatal dopaminergic pathway.…”

“… 14 Because most of the results analysed by the researchers were from cross-sectional studies, the causal relationship between anxiety disorder, depressive disorder and BMS could not be determined. 14 Moreover, BMS is also frequently present in patients with Parkinson’s disease, characterized by dopamine dysregulation (confirmed by positron emission tomography) in the nigrostriatal dopaminergic pathway. 15 As a potential biomarker for diagnosis of Parkinson’s disease, pathological α-synuclein accumulates abnormally in the oral mucosa of patients with Parkinson’s disease.…”