White matter hyperintensities in Burning Mouth Syndrome assessed according to the Age-Related White Matter Changes scale

Abstract

BackgroundWhite matter hyperintensities (WMHs) of the brain are observed in normal aging, in various subtypes of dementia and in chronic pain, playing a crucial role in pain processing. The aim of the study has been to assess the WMHs in Burning Mouth Syndrome (BMS) patients by means of the Age-Related White Matter Changes scale (ARWMCs) and to analyze their predictors.MethodsOne hundred BMS patients were prospectively recruited and underwent magnetic resonance imaging (MRI) of the brain. Their ARWMCs scores were compared with those of an equal number of healthy subjects matched for age and sex. Intensity and quality of pain, psychological profile, and blood biomarkers of BMS patients were further investigated to find potential predictors of WMHs. Specifically, the Numeric Rating Scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hamilton rating scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) were administered.ResultsThe BMS patients presented statistically significant higher scores on the ARWMCs compared to the controls, especially in the right frontal, left frontal, right parietal-occipital, left parietal-occipital, right temporal and left temporal lobes (p-values: <0.001, <0.001, 0.005, 0.002, 0.009, 0.002, and <0.001, respectively). Age, a lower educational level, unemployment, essential hypertension, and hypercholesterolemia were correlated to a higher total score on the ARWMCs (p-values: <0.001, 0.016, 0.014, 0.001, and 0.039, respectively). No correlation was found with the blood biomarkers, NRS, SF-MPQ, HAM-A, HAM-D, PSQI, and ESS.ConclusionPatients with BMS showed a higher frequency of WMHs of the brain as suggested by the higher ARWCs scores compared with the normal aging of the healthy subjects. These findings could have a role in the pathophysiology of the disease and potentially affect and enhance pain perception.

Prevalence of hypertension and correlation with mental health in women with burning mouth syndrome: A case-control study

“…The impact of long-term elevated blood pressure on cerebral health involves structural pathological changes of the brain such as WMH, cortical thinning, enlarged Virchow-Robin spaces, and brain atrophy (67), suggesting that HTN can accelerate brain aging in the same areas involved in chronic pain. However, it is difficult to determine if these brain alterations are a direct consequence of HTN but it could explain the previous study results in which a high prevalence of WMH was found in patients with BMS (68,69).…”

Burning Mouth Syndrome and Hypertension: Prevalence, Gender Differences and Correlation with Pain and Psycho-social Characteristics

“…This sample size was obtained using the effect size value equal to 0.65, measured in a previously published research study regarding the ARWMCs. [25] The calculations were computed using the GPower software (v 3.1.9). Data analyses were performed using the R software (v. 4.2.0 -R Core Team, 2016).…”

“…[44] Moreover, this high prevalence of WMCs in the brain of patients with BMS has been further confirmed in a more extensive study suggesting a potential role of cardiovascular risk factors, especially HTN, in the brain's aging and subsequently in aggravating the disease. [25] Until now, the role of comorbidities in BMS has been poorly studied and understood but in a recent study de Pedro et al have reported that BMS patients suffered from worsened health status, consuming more medications with a worse general quality of life, need an interdisciplinary therapy approach. [8] Therefore, the primary outcome of this study has been to establish if there is any difference in terms of the prevalence of the one of the most common medical comorbidities such as HTN between BMS patients and control subjects in order to confirm these previous studies findings.…”

“…[8] Instead in the case control study of JQ Jin et al on 352 BMS patients and 391 controls, despite significant differences between groups were found in terms of gender, age, BMI, education level, job status, brain imaging abnormalities, total cholesterol, scores of anxiety, and depression no differences were found in the prevalence of HTN between cases and controls [24] Recently, in a sample of 100 BMS patients HTN was found in 58% of the subjects and it was considered the most important predictor of white matter changes (WMCs) of the brain, which in turn may potentially amplify pain perception in patients affected by this disease. [25] Therefore, we wanted to further evaluate the prevalence of HTN in a large sample of BMS patients, compared with a control group of subjects without BMS, in order to compare our results with previous studies and to better elucidate the relationships between HTN and BMS analyzing if this comorbidity may be an aggravating factor which should be investigated for the BMS assessment. To the best of our knowledge, none of these previous studies have been focused specifically on the analysis of prevalence of HTN in a sample of BMS patients.…”

Stomatognathic Diseases: State of the Art and Future Perspectives

“…The aetiopathogenesis of this disease is complex and may be multifactorial, as local, systemic, and psychological factors are considered to be involved in generating symptoms. A recent publication points to the idea that enhanced pain perception in BMS could be linked to a higher frequency of white matter hyperintensities (WMHs) in the brain [ 28 ]. The literature indicates that psychotherapy and behavioral feedback may help to eliminate BMS symptoms [ 29 ].…”