A Puhakka1, H Forssell2, S Soinila3,4,5, A Virtanen6, M Röyttä7, M Laine2, O Tenovuo4,8, T Teerijoki-Oksa9, S K Jääskeläinen1,10. 1. Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland. 2. Institute of Dentistry, University of Turku, Turku, Finland. 3. Division of Clinical Neurosciences/General Department of Neurology, Turku University Hospital, Turku, Finland. 4. Department of Neurology, University of Turku, Turku, Finland. 5. Institute of Biomedicine, Department of Anatomy, University of Helsinki, Helsinki, Finland. 6. Department of Biostatistics, University of Turku, Turku, Finland. 7. Department of Pathology, Turku University Hospital, Turku, Finland. 8. Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland. 9. Department of Oral Diseases and Pain Clinic, Turku University Hospital, Turku, Finland. 10. Department of Clinical Neurophysiology, University of Turku, Turku, Finland.
Abstract
OBJECTIVE: The pathophysiology of primary burning mouth syndrome (BMS) has remained enigmatic, but recent studies suggest pathology within the nervous system at multiple levels. This study aimed to investigate in detail the contribution of either focal or generalized alterations within the peripheral nervous system (PNS) in the etiopathogenesis of BMS. SUBJECTS AND METHODS: Intraepithelial nerve fiber density (IENFD) of tongue mucosa was assessed in 10 carefully characterized BMS, and the results were compared to 19 age- and gender-matched cadaver controls, 6 with lifetime diabetes. Extensive neurophysiologic and psychophysical examinations of the trigeminal system and distal extremities were performed to profile PNS function in BMS. RESULTS: Patients with BMS had significantly fewer intraepithelial nerve fibers (0,27, s.e. 0,18 mm(-1); P = 0.0253) than non-diabetic controls (0,92, s.e. 0,15 mm(-1)). In the subepithelial space, the amount of nerve fibers did not differ between the groups. The majority (9/10) of patients with BMS showed neurophysiologic or psychophysical signs of a more generalized PNS dysfunction. CONCLUSIONS: Our results in neurophysiologically optimally characterized BMS patients confirm that pure focal small fiber neuropathy of the oral mucosa has a role in the pathophysiology of primary BMS. Furthermore, BMS may be related to a more generalized, yet subclinical peripheral neuropathy.
OBJECTIVE: The pathophysiology of primary burning mouth syndrome (BMS) has remained enigmatic, but recent studies suggest pathology within the nervous system at multiple levels. This study aimed to investigate in detail the contribution of either focal or generalized alterations within the peripheral nervous system (PNS) in the etiopathogenesis of BMS. SUBJECTS AND METHODS: Intraepithelial nerve fiber density (IENFD) of tongue mucosa was assessed in 10 carefully characterized BMS, and the results were compared to 19 age- and gender-matched cadaver controls, 6 with lifetime diabetes. Extensive neurophysiologic and psychophysical examinations of the trigeminal system and distal extremities were performed to profile PNS function in BMS. RESULTS:Patients with BMS had significantly fewer intraepithelial nerve fibers (0,27, s.e. 0,18 mm(-1); P = 0.0253) than non-diabetic controls (0,92, s.e. 0,15 mm(-1)). In the subepithelial space, the amount of nerve fibers did not differ between the groups. The majority (9/10) of patients with BMS showed neurophysiologic or psychophysical signs of a more generalized PNS dysfunction. CONCLUSIONS: Our results in neurophysiologically optimally characterized BMS patients confirm that pure focal small fiber neuropathy of the oral mucosa has a role in the pathophysiology of primary BMS. Furthermore, BMS may be related to a more generalized, yet subclinical peripheral neuropathy.
Authors: Roddy McMillan; Heli Forssell; John Ag Buchanan; Anne-Marie Glenny; Jo C Weldon; Joanna M Zakrzewska Journal: Cochrane Database Syst Rev Date: 2016-11-18
Authors: Brenda de Souza Moura; Natália Dos Reis Ferreira; Marcos F DosSantos; Maria Elisa Rangel Janini Journal: PLoS One Date: 2018-05-21 Impact factor: 3.240