Burning Mouth Disorder (BMD) - A Neuropathic Pain Disorder

Burning Mouth Disorder (BMD) - a Neuropathic Pain Disorder? An Investigation Using Qualitative and Quantitative Sensory Testing (QST)

Oral burning can have a multitude of reasons. Recent neurophysiologic study results suggest that a primary burning mouth disorder (BMD) may be a peripheral and/or a central neuropathic disorder. The aim of this study is to first identify patients with a primary burning mouth disorder by excluding other possible causes for oral burning. By means of qualitative and quantitative sensory testing and a gustatory examination in the individual patient the investigators want to find out whether neurosensory differences exist between patients with a primary BMD and controls and whether gustatory and neurosensory deficits always coexist in BMD-patients.

Study Overview

• Status: Unknown
• Conditions: Orofacial Pain; Burning Mouth Syndrome; Taste Disorder

Detailed Description

Oral burning can have many different etiologies. Secondary burning mouth disorders (BMD) due to systemic (i.e. diabetes, nutritional deficiencies, allergies), local (i.e. Candidiasis, Lichen planus) or functional factors (i.e. tongue parafunctional activities, mouth breathing) are usually fairly easy to identify and are treated by eliminating the respective cause. A primary BMD as a specific disease is a challenging disorder with regard to assessment and treatment for both, the patient and the dentist. The prevailing hypothesis of a predominantly psychological cause is questioned by recent research results. The typical burning sensation, the partly efficacy of medication that is usually used in chronic, neuropathic pains and recent neurophysiologic studies and finally the finding of a degeneration of epithelial nerve fibers in BMD patients give reason to assume a peripheral and/or central neuropathic etiology. That is, the transduction of nociceptive stimuli in the orofacial region and the transmission and modulation of the nociceptive input might be altered. The hypothesis of a disorder of the gustatory system assumes that gustatory input has an inhibitory influence on the trigeminal nociceptive system. A hypogeusia or ageusia, maybe caused by peripheral nerve degeneration that has been found in BMD patients would therefore lead to a decreased gustatory input which in turn gives way to a central disinhibition of trigeminal nociception, leading to a more painful perception in the oral region. The aim of this study is to first identify patients with a primary burning mouth disorder by excluding other possible causes for oral burning. By means of qualitative and thermal quantitative sensory testing and a gustatory examination in the individual patient we want to find out whether neurosensory differences exist between patients with a primary BMD and controls and whether gustatory and neurosensory deficits always coexist in BMD-patients.

• Study Type: Observational
• Enrollment (Anticipated): 12

Contacts and Locations

• Study Contact: Name: Markus R Fussnegger, Dr.; Phone Number: +49 30 450 562713; Email: markus.fussnegger@charite.de

Study Locations

• Germany
  • Berlin, Germany, D-14197
    • Recruiting
    • Charité - Universitätsmedizin Berlin, Center for dental and craniofacial sciences, Department of restorative dentistry
    • Principal Investigator: Markus R Fussnegger, Dr.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Tertiary care clinic

Description

Inclusion Criteria:

• Primary burning sensation of the tongue, lip or other oral structure
• Average pain intensity between 3 and 9 (VAS-Scale 0-10)
• Written, informed consent
• patient speaks German
• Age > 18 years old

Exclusion Criteria:

• Tumor
• HIV/AIDS
• Diabetes mellitus
• untreated hypothyroidism
• gastroesophageal reflux disease
• Sjögren's disease
• Salivary gland disease
• Vitamin B-, folic acid- and iron deficiency
• Medications causing hyposalivation
• Inflammatory, viral, bacterial, fungal, autoimmune and other diseases of the oral mucosa
• Insufficient prosthodontics
• Allergy against acrylic resin of prosthesis
• Allergy against Chinin-hydrochloride
• Xerostomia
• Pregnancy
• Psychiatric disorder

Study Plan

How is the study designed?

Design Details

• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
A: Patients; Patients with a primary burning mouth disorder Pain (VAS 0-10): 3<x<9 Patient understands and speaks german Age: >18 years
B: Controls; Age and sex matched persons/patients who do not have any history of an oral burning sensation or a burning mouth disorder.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description
Neurosensory differences between Burning Mouth Disorder patients and controls.	The aim of the present study is to identify patients with idiopathic BMD. By way of qualitative and quantitative sensory testing (QST) and gustatory tests we want to find out whether neurosensory differences exist between patients with BMD and controls without any oral burning sensation.

Collaborators and Investigators

• Sponsor: Markus R. Fussnegger
• Collaborators: Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde e.V.
• Investigators: Study Chair: Ingrid Peroz, PD Dr., Charité - Universitätsmedizin Berlin, Center for dental and craniofacial sciences, Department of restorative dentistry, Assmannshauser Str. 4-6, D-14197 Berlin; Study Director: Markus R Fussnegger, Dr., Charité - Universitätsmedizin Berlin, Center for dental and craniofacial sciences, Department of restorative dentistry, Assmannshauser Str. 4-6, D-14197 Berlin

Publications and helpful links

General Publications

• Scala A, Checchi L, Montevecchi M, Marini I, Giamberardino MA. Update on burning mouth syndrome: overview and patient management. Crit Rev Oral Biol Med. 2003;14(4):275-91. doi: 10.1177/154411130301400405.
• Forssell H, Jaaskelainen S, Tenovuo O, Hinkka S. Sensory dysfunction in burning mouth syndrome. Pain. 2002 Sep;99(1-2):41-7. doi: 10.1016/s0304-3959(02)00052-0.
• Lauria G, Majorana A, Borgna M, Lombardi R, Penza P, Padovani A, Sapelli P. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain. 2005 Jun;115(3):332-337. doi: 10.1016/j.pain.2005.03.028.
• Grushka M, Epstein JB, Gorsky M. Burning mouth syndrome and other oral sensory disorders: a unifying hypothesis. Pain Res Manag. 2003 Fall;8(3):133-5. doi: 10.1155/2003/654735.
• Formaker BK, Frank ME. Taste function in patients with oral burning. Chem Senses. 2000 Oct;25(5):575-81. doi: 10.1093/chemse/25.5.575.
• Bartoshuk LM, Snyder DJ, Grushka M, Berger AM, Duffy VB, Kveton JF. Taste damage: previously unsuspected consequences. Chem Senses. 2005 Jan;30 Suppl 1:i218-9. doi: 10.1093/chemse/bjh192. No abstract available.

Study record dates

Study Major Dates

• Study Start: April 1, 2007
• Primary Completion (Anticipated): December 1, 2013
• Study Completion (Anticipated): December 1, 2013

Study Registration Dates

• First Submitted: July 19, 2007
• First Submitted That Met QC Criteria: July 19, 2007
• First Posted (Estimate): July 20, 2007

Study Record Updates

• Last Update Posted (Estimate): December 21, 2012
• Last Update Submitted That Met QC Criteria: December 20, 2012
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: Quantitative sensory testing; Burning mouth disorder; Taste disorder; Gustatory testing; Neuropathic orofacial pain; Oral burning
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Nervous System Diseases; Pain; Neurologic Manifestations; Wounds and Injuries; Neuromuscular Diseases; Stomatognathic Diseases; Peripheral Nervous System Diseases; Sensation Disorders; Burns; Disease; Neuralgia; Somatoform Disorders; Mouth Diseases; Facial Pain; Taste Disorders; Burning Mouth Syndrome
• Other Study ID Numbers: EA4/036/06