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Primary burning mouth syndrome in oral submucous fibrosis patients
Oral Oncology 47 (2011) 683
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the Editor Primary burning mouth syndrome in oral submucous fibrosis patients
Burning mouth syndrome (BMS) is characterized by burning sensation in the tongue or oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paresthesia and altered taste for which no medical or dental cause can be found. Criteria for establishing a diagnosis of ‘‘true’’ BMS is presence of burning sensation on clinically healthy oral mucosa in the absence of all known local and systemic etiological factors. The diagnosis of BMS is made by excluding candidal infection, xerostomia, oral galvanism, parafunctional habits such as tongue thrusting, psychological and neurological disturbances, diabetes mellitus, menopause, side effects of drug therapy, vitamin B12 deficiency, and paraneoplastic syndromes, all of which are known to cause oral burning.1 The situation can get worse for clinicians when BMS is present in a setting of known conditions having burning sensation. Such BMS is called ‘‘complicated BMS’’.1 In Indian scenario, patients of OSMF are routinely seen in day to day practice and often clinicians get carried away with the clinical findings and do not take a detailed history of burning sensation which could lead to under diagnosis of the conditions. In our tertiary dental health care academic center, we have seen 300 OSMF patients. Three (1%) patients were diagnosed with concomitant primary BMS. The patients were having habit of chewing Ghutka. Intra-oral examination revealed blanching of oral mucosa and palpable fibrous bands in buccal mucosa. Uvula was shrunken. Mouth openings were slightly restricted. There was no evidence of ulceration, erosion, mucositis, or any pathology on oral mucosa. The first patient of OSMF was diagnosed with BMS at second visit as we have failed to ask in detail about the burning sensation at first visit. In second visit the patient revealed continuous burning sensation of the oral cavity throughout the day. The burning sensation used to develop in the late morning, gradually increase in severity during the day and reach peak intensity by evening. But in patients with OSMF alone, burning sensation occurs only after eating something and is not continuous in nature.2 All the three patients gave history of altered taste sensation which is again one of the characteristic features of BMS. Subjective dryness of the mouth is a feature of BMS but not all the BMS patients give history of dry mouth. Thus these findings are not very helpful in diagnosing BMS on OSMF. Hence in such cases, only reliable factor is taking detailed case history. Although careful history taking will help in suspecting BMS in OSMF, but it can become difficult when BMS is mild and intermittent in nature as type 3 of Lamb et al. classification.3 With this experience in mind, the other two cases were diagnosed at the first visit. Later, in all the three cases nutritional deficiency, diabetes mellitus, menopausal disorders, gastritis, stress, and anxiety were ruled out through hematological assessment of nutritional status, blood glucose, estrogen/proges-
terone concentrations, and detailed history, respectively. These factors rule out secondary BMS. The final diagnosis of OSMF with true/primary/idiopathic BMS type 2 (Lamb et al. classification)3 was made. According to our observation, OSMF patients rarely disclose the history of psychological stress as a reason for starting ghutka chewing habit. Since one of the major etiological factors for BMS is psychological stress, the existence of these two lesions together is justified. However all three patients did not reveal history of any psychological stress. Thus we recommend that further studies in this direction are needed in future to validate this finding. The ‘complicated BMS’ are reported in association with conditions like candidal infection, xerostomia, oral galvanism, parafunctional habits such as tongue thrusting, psychological, and neurological disturbances, diabetic neuropathy, menopause, side effects of drug therapy, vitamin B12 deficiency and anemia. But the association of BMS in OSMF patients has not been reported till date, probably could be because of mingling of the two burning issues. Burning sensation is a major psychological trauma to the patient and should be dealt with care. To conclude we recommend that a proper detailed history taking in OSMF patients is mandatory to avoid under diagnosis of such condition. Conflict of interest statement None declared. References 1. Balasubramaniam R, Klasser GD, Delcanho R. Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma. Aust Dent J 2009;54:293–9. 2. Ranganathan K, Uma Devi M, Joshua E, Kirankumar K, Saraswathi TR. Oral submucous fibrosis: a case control study in Chennai South India. J Oral Pathol Med 2004;33:274–7. 3. Lamey PJ, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J 1988;296:1243–6.
Sachin C. Sarode Gargi S. Sarode 1 Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Maheshnagar, Pimpri, Pune – 18, Maharashtra, India Tel.: +91 9922491465. E-mail addresses: [email protected] (S.C. Sarode), [email protected] (G.S. Sarode)
1
1368-8375/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.oraloncology.2011.05.007
Tel.: +91 9823871462.
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the Editor Primary burning mouth syndrome in oral submucous fibrosis patients
Burning mouth syndrome (BMS) is characterized by burning sensation in the tongue or oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paresthesia and altered taste for which no medical or dental cause can be found. Criteria for establishing a diagnosis of ‘‘true’’ BMS is presence of burning sensation on clinically healthy oral mucosa in the absence of all known local and systemic etiological factors. The diagnosis of BMS is made by excluding candidal infection, xerostomia, oral galvanism, parafunctional habits such as tongue thrusting, psychological and neurological disturbances, diabetes mellitus, menopause, side effects of drug therapy, vitamin B12 deficiency, and paraneoplastic syndromes, all of which are known to cause oral burning.1 The situation can get worse for clinicians when BMS is present in a setting of known conditions having burning sensation. Such BMS is called ‘‘complicated BMS’’.1 In Indian scenario, patients of OSMF are routinely seen in day to day practice and often clinicians get carried away with the clinical findings and do not take a detailed history of burning sensation which could lead to under diagnosis of the conditions. In our tertiary dental health care academic center, we have seen 300 OSMF patients. Three (1%) patients were diagnosed with concomitant primary BMS. The patients were having habit of chewing Ghutka. Intra-oral examination revealed blanching of oral mucosa and palpable fibrous bands in buccal mucosa. Uvula was shrunken. Mouth openings were slightly restricted. There was no evidence of ulceration, erosion, mucositis, or any pathology on oral mucosa. The first patient of OSMF was diagnosed with BMS at second visit as we have failed to ask in detail about the burning sensation at first visit. In second visit the patient revealed continuous burning sensation of the oral cavity throughout the day. The burning sensation used to develop in the late morning, gradually increase in severity during the day and reach peak intensity by evening. But in patients with OSMF alone, burning sensation occurs only after eating something and is not continuous in nature.2 All the three patients gave history of altered taste sensation which is again one of the characteristic features of BMS. Subjective dryness of the mouth is a feature of BMS but not all the BMS patients give history of dry mouth. Thus these findings are not very helpful in diagnosing BMS on OSMF. Hence in such cases, only reliable factor is taking detailed case history. Although careful history taking will help in suspecting BMS in OSMF, but it can become difficult when BMS is mild and intermittent in nature as type 3 of Lamb et al. classification.3 With this experience in mind, the other two cases were diagnosed at the first visit. Later, in all the three cases nutritional deficiency, diabetes mellitus, menopausal disorders, gastritis, stress, and anxiety were ruled out through hematological assessment of nutritional status, blood glucose, estrogen/proges-
terone concentrations, and detailed history, respectively. These factors rule out secondary BMS. The final diagnosis of OSMF with true/primary/idiopathic BMS type 2 (Lamb et al. classification)3 was made. According to our observation, OSMF patients rarely disclose the history of psychological stress as a reason for starting ghutka chewing habit. Since one of the major etiological factors for BMS is psychological stress, the existence of these two lesions together is justified. However all three patients did not reveal history of any psychological stress. Thus we recommend that further studies in this direction are needed in future to validate this finding. The ‘complicated BMS’ are reported in association with conditions like candidal infection, xerostomia, oral galvanism, parafunctional habits such as tongue thrusting, psychological, and neurological disturbances, diabetic neuropathy, menopause, side effects of drug therapy, vitamin B12 deficiency and anemia. But the association of BMS in OSMF patients has not been reported till date, probably could be because of mingling of the two burning issues. Burning sensation is a major psychological trauma to the patient and should be dealt with care. To conclude we recommend that a proper detailed history taking in OSMF patients is mandatory to avoid under diagnosis of such condition. Conflict of interest statement None declared. References 1. Balasubramaniam R, Klasser GD, Delcanho R. Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma. Aust Dent J 2009;54:293–9. 2. Ranganathan K, Uma Devi M, Joshua E, Kirankumar K, Saraswathi TR. Oral submucous fibrosis: a case control study in Chennai South India. J Oral Pathol Med 2004;33:274–7. 3. Lamey PJ, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J 1988;296:1243–6.
Sachin C. Sarode Gargi S. Sarode 1 Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Maheshnagar, Pimpri, Pune – 18, Maharashtra, India Tel.: +91 9922491465. E-mail addresses: [email protected] (S.C. Sarode), [email protected] (G.S. Sarode)
1
1368-8375/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.oraloncology.2011.05.007
Tel.: +91 9823871462.