Burning mouth syndrome in menopausal women

Many women in menopause experience discomfort in the oral cavity — burning, dysesthesia, xerostomia, taste changes, which lead to a reduction in the quality of life.

Aim: to identify clinical and psychological factors associated with the development of burning mouth syndrome in menopausal women.

Material and methods. Were examined 67 women aged 45–67 years. Assessment of oral pain performed using the Visual analog scale (VAS). Assessment of dry mouth symptoms severity performed using the Challacombe Scale of Clinical Oral Dryness (CSCOD). Psychometric tests was carried out with Spielberger’s Anxiety Test, Montgomery–Asberg Depression Rating Scale (MADRS), Hospital Anxiety and Depression Scale (HADS), Mini-Mental State Examination (MMSE). The Psychological stress measure-25 scale was also used to assess the impact of stress on somatic, behavioral, and emotional indicators of life. The quality of life was measured using the Oral Health Impact Profile-14 (OHIP-14).

Results. Clinically, burning mouth syndrome in menopausal women manifested with various oral symptoms include paresthesias and pain in the tongue, oral cavity, as well as xerostomia and taste disorders. Painful sensations in the tongue developed 1–3 years after the menopause onset and was preceded by stressful life events. The pain scores on the VAS was 63.1 ± 11.8 mm. Depressive disorders were characterized by an average level of personal and situational anxiety, instability to stressful influences. The quality of life assessment in menopausal women using the OHIP-14 scale, the total score was 17.1 ± 5.21 points and corresponded to the sufficient quality of oral health.

Conclusion. Burning mouth syndrome and neuropsychiatric disorders (anxiety, asthenia, depression, phobia, sleep disorders) in menopausal women are pathophysiologically related conditions.

1. Headache Classification Committee of the International Headache Society (HIS). The international classifi cation of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629– 808. https://doi.org/10.1177/0333102413485658

2. Kohorst J.J., Bruce A.J., Torgerson R.R., Schenck L.A., Davis M.D. A population-based study of the incidence of burning mouth syndrome. Mayo Clin. Proc. 2014;89(11):1545–52. https://doi.org/10.1016/j.mayocp.2014.05.018

3. Gao J., Chen L., Zhou J., Peng J. A case-control study on etiological factors involved in patients with burning mouth syndrome. J. Oral. Pathol. Med. 2009;38(1):24–8. https://doi.org/10.1111/j.1600-0714.2008.00708.x

4. Savage N.W., Boras V.V., Barker K. Burning mouth syndrome: clinical presentation, diagnosis and treatment. Australas J. Dermatol. 2006;47(2):77–81; quiz 82–3. https://doi.org/10.1111/j.1440-0960.2006.00236.x

5. Grushka M., Epstein J.B., Gorsky M. Burning mouth syndrome. Am. Fam. Physician. 2002;65(4):615–20. PMID: 11871678

6. Sun A., Wu K.M., Wang Y.P., Lin H.P., Chen H.M., Chiang C.P. Burning mouth syndrome: a review and update. J. Oral. Pathol. Med. 2013;42(9):649–55. https://doi.org/10.1111/jop.12101

7. Maksimova M.Yu., Sineva N.A., Vodop’ianov N.P., Suanova E.T. Burning mouth syndrome (glossalgia). Therapeutic archive. 2014;86(1):107– 110. (in Russian). https://ter-arkhiv.ru/0040-3660/article/view/31464

8. Lamey P.J., Lamb A.B. Prospective study of aetiological factors in burning mouth syndrome. Br. Med. J. (Clin. Res. Ed.). 1988;296(6631):1243–6. https://doi.org/10.1136/bmj.296.6631.1243

9. López-Jornet P., Camacho-Alonso F., Andujar-Mateos P., Sánchez-Siles M., Gómez-Garcia F. Burning mouth syndrome: an update. Med. Oral. Patol. Oral Cir. Bucal. 2010;15(4):e562–8. https://doi.org/10.4317/medoral.15.e562

10. Schiavone V., Adamo D., Ventrella G., Morlino M., De Notaris E.B., Ravel M.G. et al. Anxiety, depression, and pain in burning mouth syndrome: fi rst chicken or egg? Headache. 2012;52(6):1019–1025. https://doi.org/10.1111/j.1526-4610.2012.02171.x

11. Zender R., Olshansky E. Women’s mental health: depression and anxiety. Nurs. Clin. North Am. 2009;44(3):355–64. https://doi.org/10.1016/j.cnur.2009.06.002

12. Sunderland M., Newby J.M., Andrews G. Health anxiety in Australia: prevalence, comorbidity, disability and service use. Br. J. Psychiatry. 2013;202(1):56–61. https://doi.org/10.1192/bjp.bp.111.103960

13. Aggarwal A., Panat S.R. Burning mouth syndrome: A diagnostic and therapeutic dilemma. J. Clin. Exp. Dent. 2012;4(3):e180–5. https://doi.org/10.4317/jced.50764

14. Ni Riordain R., O’Dwyer S., McCreary C. Burning mouth syndrome-a diagnostic dilemma. Ir. J. Med. Sci. 2019;188(3):731– 734. https://doi.org/10.1007/s11845-018-01960-y

15. Jääskeläinen S.K. Pathophysiology of primary burning mouth syndrome. Clin. Neurophysiol. 2012;123(1):71–7. https://doi.org/10.1016/j.clinph.2011.07.054

16. Jääskeläinen S.K. Is burning mouth syndrome a neuropathic pain condition? Pain. 2018;159(3):610–613. https://doi.org/10.1097/j.pain.0000000000001090

17. Imamura Y., Shinozaki T., Okada-Ogawa A., Noma N., Shinoda M., Iwata K. et al. An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives. J. Oral Rehabil. 2019;46(6):574–587. https://doi.org/10.1111/joor.12795

18. Moisset X., Calbacho V., Torres P., Gremeau-Richard C., Dallel R. Co-occurrence of Pain Symptoms and Somatosensory Sensitivity in Burning Mouth Syndrome: A Systematic Review. PLoS One. 2016;11(9):e0163449. https://doi.org/10.1371/journal.pone.0163449

19. Leimola-Virtanen R., Salo T., Toikkanen S., Pulkkinen J., Syrjänen S. Expression of estrogen receptor (ER) in oral mucosa and salivary glands. Maturitas. 2000;36(2):131–7. https://doi.org/10.1016/s0378-5122(00)00138-9

20. Thompson I.O., van der Bijl P., van Wyk C.W., van Eyk A.D. A comparative light-microscopic, electron-microscopic and chemical study of human vaginal and buccal epithelium. Arch. Oral Biol. 2001;46:1091–8. https://doi.org/10.1016/s0003-9969(01)00082-6

21. Välimaa H., Savolainen S., Soukka T., Silvoniemi P., Mäkelä S., Kujari H. et al. Estrogen receptor-beta is the predominant estrogen receptor subtype in human oral epithelium and salivary glands. J. Endocrinol. 2004;180(1):55–62. https://doi.org/10.1677/joe.0.1800055

22. Cao M., Shu L., Li J., Su J., Zhang W., Wang Q. et al. The expression of estrogen receptors and the effects of estrogen on human periodontal ligament cells. Methods Find. Exp. Clin. Pharmacol. 2007;29(5):329–35. https://doi.org/10.1358/mf.2007.29.5.1117560

23. Buencamino M.C., Palomo L., Thacker H.L. How menopause affects oral health, and what we can do about it. Cleve Clin. J. Med. 2009;76(8):467–75. https://doi.org/10.3949/ccjm.76a.08095

24. Grover C.M., More V.P., Singh N., Grover S. Crosstalk between hormones and oral health in the mid-life of women: A comprehensive review. J. Int. Soc. Prev. Community Dent. 2014;4(Suppl.1):S5–S10. https://doi.org/10.4103/2231-0762.144559

25. Gao J., Chen L., Zhou J., Peng J. A case-control study on etiological factors involved in patients with burning mouth syndrome. J. Oral Pathol. Med. 2009;38(1):24–8. https://doi.org/10.1111/j.1600-0714.2008.00708.x

26. Wardrop R.W., Hailes J., Burger H., Reade P.C. Oral discomfort at menopause. Oral Surg. Oral Med. Oral Pathol. 1989;67(5):535– 40. https://doi.org/10.1016/0030-4220(89)90269-7

27. Forabosco A., Criscuolo M., Coukos G., Uccelli E., Weinstein R., Spinato S. et al. Efficacy of hormone replacement therapy in postmenopausal women with oral discomfort. Oral Surg. Oral Med. Oral Pathol. 1992;73(5):570–4. https://doi.org/10.1016/0030-4220(92)90100-5

28. Suri V., Suri V. Menopause and oral health. J. Midlife Health. 2014;5(3):115–20. https://doi.org/10.4103/0976-7800.141187

29. Minicucci E.M., Pires R.B., Vieira R.A., Miot H.A., Sposto M.R. Assessing the impact of menopause on salivary flow and xerostomia. Aust. Dent. J. 2013;58(2):230–4. https://doi.org/10.1111/adj.12057

30. Poon R., Su N., Ching V., Darling M., Grushka M. Reduction in unstimulated salivary flow rate in burning mouth syndrome. Br. Dent. J. 2014;217(7):E14. https://doi.org/10.1038/sj.bdj.2014.884

31. Yalcin F., Gurgan S., Gul G. Oral health in postmenopausal Turkish women. Oral Health Prev. Dent. 2006;4(4):227–33. PMID: 17153644

32. Slade G.D., Spencer A.J. Development and evaluation of the Oral Health Impact Profile. Community Dent. Health. 1994;11(1):3– 11. Community Dent Health. 1994. PMID: 8193981.

33. das Neves de Araújo Lima E., Barbosa N.G., Dos Santos A.C., Araújo Moura Lemos T.M., de Souza C.M., Trevilatto P.C. et al. Comparative Analysis of Psychological, Hormonal, and Genetic Factors Between Burning Mouth Syndrome and Secondary Oral Burning. Pain Med. 2016;17(9):1602–11. https://doi.org/10.1093/pm/pnv087

34. Pezelj-Ribarić S., Kqiku L., Brumini G., Urek M.M., Antonić R., Kuiš D. et al. Proinflammatory cytokine levels in saliva in patients with burning mouth syndrome before and after treatment with low-level laser therapy. Lasers Med. Sci. 2013;28(1):297– 301. https://doi.org/10.1007/s10103-012-1149-5

35. Piradov M.A., Maksimova M.Yu., Sineva N.A., Vodopyanov N.P. Trigeminal neuropathy: Textbook. Moscow: Medical informational Agency, 2019:96 p. (In Russian). https://doi.org/10.30629/978-5-907098-23-7-2019-4-100

36. Jensen M.P., Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk D.C., Melzack R., editors. Handbook of Pain Assessment. New York: Guilford Press; 2011:19–44.

37. The Challacombe Scale of Clinical Oral Dryness. Available at: https://www.dentalhealth.org Accessed December12, 2017.

38. Spielberger C.D., Gorsuch R.L., Lushene R.E. Test manual for the State Trait Anxiety Inventory. Palo Alto, California: Consulting Psychologists Press, 1970.

39. Montgomery S.A., Asberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry. 1979;134:382–9. https://doi.org/10.1192/bjp.134.4.382

40. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr. Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

41. Pangman V.C., Sloan J., Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl. Nurs Res. 2000;13(4):209–13. https://doi.org/10.1053/apnr.2000.9231

42. Reeves T., Stace J.M. Improving patient access and choice: Assisted Bibliotherapy for mild to moderate stress/anxiety in primary care. J. Psychiatr. Ment. Health Nurs. 2005;12(3):341–6. https://doi.org/10.1111/j.1365-2850.2005.00845.x

43. Slade G.D., Spencer A.J. Development and evaluation of the Oral Health Impact Profile. Community Dent. Health. 1994;11(1):3–11. Community Dent Health. 1994. PMID: 819398