- Email: [email protected]
Burning mouth syndrome: mast cell connection
LETTERS TO THE EDITOR
Burning mouth syndrome: mast cell connection To the Editor: We read with interest the article by Lawrence B. Afrin, who proposes a role for mast cells (MCs) in burning mouth syndrome (BMS) pathogenesis.1 This author reported that “BMS has not previously been attributed to mast cell disease (MCD).” We would like to highlight that we were the first to propose a connection between MC activity and BMS.2 In 20 patients with essential BMS, without any other oral or systemic disease, we demonstrated a significantly persistent higher concentration of salivary tryptase, a useful indicator of local MC activity, indicating MC involvement in BMS. We suggested that the activation of MC degranulation could be induced by nerve growth factor, whose role in BMS is well established,3 and that MC could be a further source of this neurotrophin. Finally, tryptase could be involved also in the initiation of neuropathic pain, as previously suggested.4,5 Including mast cell activation syndrome or disorder (MCAD) among the risk factors for BMS is undoubtedly a progress in understanding the pathogenesis of this disease; however, our work showed that MC can play a key role in BMS independently of MCAD. Violetta Borelli, PhD Giuliano Zabucchi, PhD Department of Life Sciences University of Trieste Trieste, Italy REFERENCES 1. Afrin LB. Burning mouth syndrome and mast cell activation disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:465-72. 2. Borelli V, Marchioli A, Di Taranto R, Romano M, Chiandussi S, Di Lenarda R, et al. Neuropeptides in saliva of subjects with burning mouth syndrome: a pilot study. Oral Dis 2010;16:365-74. 3. Yilmaz Z, Renton T, Yiangou Y, Zakrzewska J, Chessell IP, Bountra C, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. J Clin Neurosci 2007;14:864-71. 4. Kawabata A, Kawao N, Kuroda R, Tanaka A, Itoh H, Nishikawa H. Peripheral PAR-2 triggers thermal hyperalgesia and nociceptive responses in rats. Neuroreport 2001;12:715-9. 5. Vergnolle N, Bunnett NW, Sharkey KA, Brussee V, Compton SJ, Grady EF, et al. Proteinase-activated receptor-2 and hyperalgesia: a novel pain pathway. Nat Med 2001;7:821-6. doi:10.1016/j.tripleo.2011.04.016
414
Dental specialists need to lead the way to becoming superordinate oral physicians To the Editor: In response to the need for greater access to oral and primary health care at lower cost, dentists in general and specialists in particular with the most advanced training among dental professionals need to assume a new superordinate designation as oral physicians to oversee all dental care, whether provided by dentists or nondentists. With hundreds of systemic/genetic disorders manifest in the mouth and surrounding craniofacial area supporting the relationship between oral and systemic disease, dental specialists should be the first of the dental professionals to become oral physicians who will provide specialty care, as well as limited preventive primary care. Moreover, as recently pointed out,1,2 it will not be too long before the public will not be capable of or interested in differentiating dentists from nondentists who are providing oral health care. Without additional training, dentists and certainly selected dental specialists are already de facto oral physicians, being at least as qualified as most paramedical professionals who are legally entitled in most states to add the suffix “physician” to their professional designation, i.e., chiropractic, podiatric, and optometric (in 9 states) physicians. Moreover, the designation of oral physician is a more accurate representation of the actual and potential health care services that dentists/specialists can provide, thereby enhancing the public’s perception of the scope of current training for these expanded health care responsibilities. Donald B. Giddon, DMD, PhD Clinical Professor, Harvard School of Dental Medicine Boston, Massachusetts Former Dean, NYU College of Dentistry T. Howard Howell, Jr, DDS Dean for Dental Education A. Lee Loomis Professor of Periodontology Harvard School of Dental Medicine Boston, Massachusetts REFERENCES 1. Palmer C. Alaska dental therapist report issued: ADA welcomes dialogue. ADA News 2010. Available at: http://www.ada.org/ news/4936.aspx. Accessed December 16, 2010.
Burning mouth syndrome: mast cell connection To the Editor: We read with interest the article by Lawrence B. Afrin, who proposes a role for mast cells (MCs) in burning mouth syndrome (BMS) pathogenesis.1 This author reported that “BMS has not previously been attributed to mast cell disease (MCD).” We would like to highlight that we were the first to propose a connection between MC activity and BMS.2 In 20 patients with essential BMS, without any other oral or systemic disease, we demonstrated a significantly persistent higher concentration of salivary tryptase, a useful indicator of local MC activity, indicating MC involvement in BMS. We suggested that the activation of MC degranulation could be induced by nerve growth factor, whose role in BMS is well established,3 and that MC could be a further source of this neurotrophin. Finally, tryptase could be involved also in the initiation of neuropathic pain, as previously suggested.4,5 Including mast cell activation syndrome or disorder (MCAD) among the risk factors for BMS is undoubtedly a progress in understanding the pathogenesis of this disease; however, our work showed that MC can play a key role in BMS independently of MCAD. Violetta Borelli, PhD Giuliano Zabucchi, PhD Department of Life Sciences University of Trieste Trieste, Italy REFERENCES 1. Afrin LB. Burning mouth syndrome and mast cell activation disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:465-72. 2. Borelli V, Marchioli A, Di Taranto R, Romano M, Chiandussi S, Di Lenarda R, et al. Neuropeptides in saliva of subjects with burning mouth syndrome: a pilot study. Oral Dis 2010;16:365-74. 3. Yilmaz Z, Renton T, Yiangou Y, Zakrzewska J, Chessell IP, Bountra C, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. J Clin Neurosci 2007;14:864-71. 4. Kawabata A, Kawao N, Kuroda R, Tanaka A, Itoh H, Nishikawa H. Peripheral PAR-2 triggers thermal hyperalgesia and nociceptive responses in rats. Neuroreport 2001;12:715-9. 5. Vergnolle N, Bunnett NW, Sharkey KA, Brussee V, Compton SJ, Grady EF, et al. Proteinase-activated receptor-2 and hyperalgesia: a novel pain pathway. Nat Med 2001;7:821-6. doi:10.1016/j.tripleo.2011.04.016
414
Dental specialists need to lead the way to becoming superordinate oral physicians To the Editor: In response to the need for greater access to oral and primary health care at lower cost, dentists in general and specialists in particular with the most advanced training among dental professionals need to assume a new superordinate designation as oral physicians to oversee all dental care, whether provided by dentists or nondentists. With hundreds of systemic/genetic disorders manifest in the mouth and surrounding craniofacial area supporting the relationship between oral and systemic disease, dental specialists should be the first of the dental professionals to become oral physicians who will provide specialty care, as well as limited preventive primary care. Moreover, as recently pointed out,1,2 it will not be too long before the public will not be capable of or interested in differentiating dentists from nondentists who are providing oral health care. Without additional training, dentists and certainly selected dental specialists are already de facto oral physicians, being at least as qualified as most paramedical professionals who are legally entitled in most states to add the suffix “physician” to their professional designation, i.e., chiropractic, podiatric, and optometric (in 9 states) physicians. Moreover, the designation of oral physician is a more accurate representation of the actual and potential health care services that dentists/specialists can provide, thereby enhancing the public’s perception of the scope of current training for these expanded health care responsibilities. Donald B. Giddon, DMD, PhD Clinical Professor, Harvard School of Dental Medicine Boston, Massachusetts Former Dean, NYU College of Dentistry T. Howard Howell, Jr, DDS Dean for Dental Education A. Lee Loomis Professor of Periodontology Harvard School of Dental Medicine Boston, Massachusetts REFERENCES 1. Palmer C. Alaska dental therapist report issued: ADA welcomes dialogue. ADA News 2010. Available at: http://www.ada.org/ news/4936.aspx. Accessed December 16, 2010.