Burning Mouth Syndrome: An Evaluation of In Vivo Microcirculation Giuseppe Alessandro Scardina, Teresa Pisano, Francesco Carini, Vincenzo Valenza
and Pietro Messina J Am Dent Assoc 2008;139;940-946 The following resources related to this article are available online at jada.ada.org ( this information is current as of October 9, 2011):
Updated information and services including high-resolution figures, can be found in the online version of this article at:
Downloaded from jada.ada.org on October 9, 2011
This article cites 38 articles, 3 of which can be accessed free: http://jada.ada.org/content/139/7/940/#BIBL Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at:
Copyright © 2011 American Dental Association. All rights reserved. Reproduction or republication strictly prohibited without prior written permission of the American Dental Association.
DDS. Dr. MD.unipa. of whom 14 (10 women and four men) had BMS and 14 (nine women and five men) were healthy control subjects. Italy. Italy.ada. Key Words. the clinical interpretation and treatment of BMS remain problematic.139(7):940-946.5 percent)— particularly after they experience menopause—than in men (1. e-mail “scardina@odonto. which allowed them to examine the morphological characteristics within the capillaroscopic area accurately. Teresa Pisano. Italy. Messina. University of Palermo.1 The prevalence of BMS in the world is about 8 percent. The syndrome affects 3. Italy. 2011
urning mouth syndrome (BMS) is a painful syndrome of which the frequency in the Italian population is significant. Department of Experimental Medicine. The authors examined 28 subjects. Department of Oral Sciences “G. The capillaroscopic examination provided important diagnostic results regarding alterations of the local microcirculation in subjects with BMS when compared with healthy subjects.it”. Department of Oral Sciences. Department of Oral Sciences.05). University of Palermo.
. University of Palermo. Dr. Carini is a researcher.org on October 9. Department of Experimental Medicine. All rights reserved. The results also showed a statistically significant increase in the diameter of the capillary ansae. Vincenzo Valenza.2 BMS often has an unknown etiopathogenesis and is associated with substantial clinical.
Dr. mouth diseases. Methods. Burning mouth syndrome. Dr. 129-90127 Palermo. Results. Scardina is a researcher. 139
http://jada.ada. and is more common in women (5. MD. Burning mouth syndrome (BMS) is an atypical orofacial algesic syndrome. Italy.” Via Del Vespro. Scardina.8 A burning sensation is the
Background.5 It is a clinical entity comprising various burning and dysesthetic conditions of the oral cavity that are not associated with visible alterations of the mucosa. JADA 2008. University of Palermo. diagnostic and therapeutic problems. Dr.7 percent of the Italian population. PhD. Pietro Messina. Conclusion and Clinical Implications. This information could improve the understanding of etiopathogenetic factors and aid in the development of therapeutic strategies for treating this disorder. University of Palermo.org
Copyright © 2008 American Dental Association. DDS. Address reprint requests to Dr.6 Grushka and Sessle7 defined this condition as a burning sensation of the tongue and of other oral mucosa. Vol. They performed videocapillaroscopic examination with a capillaroscope with a fiber-optic probe at a magnification of ×200.R
Burning mouth syndrome
An evaluation of in vivo microcirculation
Giuseppe Alessandro Scardina. Pisano is an internal dentist. afferent ansae and efferent ansae in subjects with BMS compared with subjects in the control group (P = . Francesco Carini. MD
Downloaded from jada. Valenza is a professor. The aim of the authors’ research was to investigate the morphological characteristics of peripheral blood circulation in patients with BMS in comparison with those of the peripheral blood circulation in healthy people.6 percent).3 It can be considered an atypical orofacial algesic syndrome owing to its clinical presentation. Messina is a professor. Because of the absence of a clear clinical objective assessment for this disorder and the lack of a definite understanding of its etiopathogenesis. The results revealed a vascular involvement in BMS.4.
71 ± 12. All rights reserved. to which an optical probe with a video-optical terminal is connected. Thus. Neither the subjects with BMS nor the control subjects had any parafunctional habits that could alter microcirculation or produce inflammation in the oral mucosa. A local microcirculatory disturbance in the areas affected by BMS could contribute to the burning sensations described by patients. epicutaneous patch tests for both dental material and food allergens (such as nuts) are
particularly indicated for patients whose medical history reveals evidence of hypersensitivity. leading to the diagnosis of BMS. we carried out the following assessments in our laboratory: microbiological culture assay (to rule out fungal infections).71 years ± 12. The probe has a video-optical terminal containing a high-definition video sensor on which the user can apply different variable magnification optics from ×10 to ×1.21
* BMS: Burning mouth syndrome. Patients with BMS also may have allergies with or without oral manifestations (erythema). the clinician initially must exclude other pathologies that have similar symptoms. oral hypoglycemic or antiinflammatory agents). Vol. DS Medigroup.11 The aim of our research was to study the morphology of the microcirculation in the affected areas in patients with BMS and compare it with that in equivalent areas in healthy people. We did not test for autoimmune conditions and thyroid dysfunction because they can influence microcirculation. The subjects with BMS were not under treatment for the condition.000.25 Control 5/9 60. The pain is spontaneous and occurs without a triggering factor.
CHARACTERISTIC SUBJECT GROUP With BMS* Sex (Male/Female) Age (Years) (Mean ± Standard Deviation) Age Range (Years) 4/10 60.9 Among the possible risk factors for BMS are numerous physiopathological situations in which the microcirculatory mechanisms are involved in pain generation. 2011
Copyright © 2008 American Dental Association. in our laboratory at the University of Palermo. Some authors found that patients with BMS had parafunctional habits such as tooth grinding and clenching (bruxism) or tongue thrusting that could lead to changes in the intraoral blood flow.R E S E A R C H
pathognomonic symptom of BMS. complete blood cell count.ada. MATERIALS AND METHODS
Demographic characteristics of the recruited subjects.22 The subjects with BMS had healthy oral mucosa. it usually remains moderate but persists for long periods and therefore is difficult to tolerate. 14 with BMS (10 women and four men. The main unit consists of a 100watt cold halogen light source with an incorporated electronic light intensity control and a processing unit for the high-definition video signal (420.16-20 In our study. even if the painful areas of the oral mucosa have a normal appearance.25) and 14 healthy people (nine women and five men. particularly on the anterior one-third of the tongue. vitamin B12 tests.12 When diagnosing possible BMS. we recommend that the clinician use oral swabs to obtain a fungal/bacterial microbiological culture.21.org on October 9. aged 60. We examined the subjects by using computerized videomicroscopic techniques and related software (Videocap 200.
We examined 28 subjects. seric ferritin tests. and a highresolution color monitor to permit viewing of the examined area. with patients reporting symptoms that range from mild to unbearable. The optical probe videomicroscope is composed of a main unit.13-15 Therefore. Italy). cutaneous allergy patch tests (to rule out food allergies). Image digitization allows the user to analyze the fundamental parameters of the patient’s microcirculation (caliber and vessel length) and to calculate the number of capillaries per square milABBREVIATION KEY.
IL: Interleukin.42 ± 14. Subjects included in this study had a symptom typical of BMS: an extensive burning sensation in the oral cavity.
JADA. One of the useful characteristics of the video-optical terminal is its ability to focus directly from the handpiece. We excluded from the study smokers and subjects undergoing treatment with drugs that could alter microcirculation (such as antihypertensive. glucose tests and salivary flow tests. Milan. All patients signed a consent form as required by the Italian Ethical Committee.42 years ± 14. with all tests yielding negative results.org July 2008 941
Downloaded from jada. BMS: Burning mouth syndrome.
.21 [mean ± SD]).
SUBJECTS.1 The intensity of the pain varies among people.10.000 pixels) with an incorporated color calibration device. Italy (Table 1). 139 http://jada. aged [mean ± standard deviation] 60.ada.
All rights reserved. 2011
Copyright © 2008 American Dental Association. in the areas we some portions of the mouth (the palate. it was similar to 30 seconds to two minutes from the beginning of Curri classification type III (“upturned U” or
TABLE 2 942 JADA.) performed videocapildata gathered from the two groups (subjects with laroscopy on all subjects. 1 = one crossing. the mucosa of the tongue. † The authors gave each ansa a score from 0 to 3 on the basis of the number of crossings We examined and measured present: 0 = no crossings.012 1 1 lowing factors: 0. for observed.031 0. last updated in April 2008.244 0. ANSA MEASUREMENT d4 = focusing impossible. Consecutively.009 2 Mean dmorphology of the ansae.D.013 0.010 2 5 dcapillary density (the number of ansae per mm2). seconds from the beginning of the examination). 2 = two or more istics within the capillaroscopic area (a greater crossings. which is the general spatial distribuassociated software to focus on the capillaries. cedure twice in each investigated area (according We used a software called PAST (Version 1.ada.025 0. Hammer. PAST is a freeware For each subject in both the BMS group and developed by Ø.R E S E A R C H
the examination). the archicomply with the examination. where the vascular bed is easily visible owing to the considerable thinness RESULTS of the mucosal lining. example). making it difficult for the patient to with BMS as well as in control subjects. this lens allowed us to explore 3 on the basis of the number of crossings present: accurately all of the morphostructural character0 = no crossings. Harper and P. magnification to identify the microangiotectonic We gave each ansa a tortuosity score from 0 to type and group. We used a lens with ×200 instrument could focus best (Table 2). 0.007 2 3 ddiameter of the capillary ansae.170 0.012 0. d3 = focusing difficult (occurring Evaluation of tortuosity and capillary after more than two minutes from ansae measurements in the lower lip.A. In some cases.T.27 We evaluated tecture of the microcirculation was compatible this parameter according to the following criteria: with Curri28 classification type I. we performed a Length Diameter Efferent Afferent Tortuosity (mm*) (mm) Diameter Diameter (Score)† morphofunctional evaluation of the (mm) (mm) microcirculation involving the fol0.ada. * mm: Millimeter. to perform the data analysis. having 95 percent accuracy even when used of day (morning).26. 2 = two or more crossings. in subjects much time. 3 = distorted. 3 = distorted. shape meters was the visibility of the ansae.81) to a method used in other studies23-26). group B (capild1 = focusing easy (occurring within less than 30 laries located parallel to the mucosal surface. the operator performed the proto analyze numerically irrelevant samples. three capillary ansae per image. focusing on the vessels requires too In the mucosal lining of the lip.008 3 4 dafferent and efferent diameter. the gingiva (sextant II). In patients with We focused our investigation on the mucosa of the BMS.100 0. D.024 0. who were in a seated BMS and control subjects) to highlight any potenposition.182 0. lower lip (frenulum).228 0. magnification does not allow proper focus on the Statistical analysis. This is constant room temperature (23˚C) at the same time sidered to be one of the most efficient statistical tests. by using the same light source at a contially significant statistical differences. 0. the beginning of the examination).011 0. In tion of the microcirculation. We used the Manncapillary ansae). which indiand diameter.009 2 2 dlength of the capillary ansae.
.048 0. The capillaroscopy docOne of the most important morphological paraumented diversities in capillary location. the masticatory mucosa (gingivae) and the condition.A.201 0.org July 2008
Downloaded from jada. Whitney test for nonparametric data to analyze the One operator (G. 0. and the ventral surface of the tongue.013 0. the control group.012 0.185 0. 0. as well as in the microangioteccates the time taken by the instrument and its tonic type.030 0. Vol.org on October 9. all of the observed areas were affected by lower lip. with long capillary loops of even caliber and d2 = focusing relatively easy (occurring within hairpin shape). choosing the ansae on which the limeter of the mucosa. 1 = one crossing.028 0. 139 http://jada. we observed the mucosa of the Ryan in 1995.S.
tion to the surface. Vol.154 × 10-6 microcirculation of the . regarding the ular to the surface.0003 S¶ Total Diameter architecture of the S Afferent Diameter 0.88 18. 2. Owing to the dimensions P CHARACTERISTIC SUBJECT GROUP SIGNIFICANCE of the probe. ‡ BMS: Burning mouth syndrome. 139 http://jada. 2011
Copyright © 2008 American Dental Association. which is one of the most impor* Only the apexes of the capillaries were visible.00490 . in this area we could observe only the density masticatory mucosa alone.25 ± 6. line result characterized by a slight alteration in DISCUSSION the architecture of the microcirculation. on the VALUE (IN MILLIMETERS) (MEAN ± SD‡) other hand.42 ± 6.00240 9. afferent nation with the capillaroscope suggest a borderand efferent ansae diameters are significant. tical analysis. group A: the 0.044 .org on October 9.96 19. All rights reserved. ations occured in both the lips and the tongue.05 was considered to be significant.
. the differences tional alterations observed during the examibetween the two groups in terms of total.R E S E A R C H
hairpin-shaped capillary TABLE 3 ansae that form the Differences between parameters in the labial mucosa of classic “capillary comb”).194 ± 0.186 ± 0. tant morphological parameters in † SD: Standard deviation. had the typWith BMS Control ical characteristics of 28 0.ada. § NS: Not significant.054 0. These alterfrom that of ansae in healthy people. capillary loops in relaP = . In particular. hairpin or comma shape. the ansae were of a § S: Significant (P < . we observed an tant because it is characteristic of the disorder. As Table 3 and Figures 1. With BMS ‡ Control We examined the morphology of the 27.* of the ansae. and only the density could be studied.05).02448 ± 0. the capillary density in subjects with BMS.ada. 4 and 5 show the results of the statisdilatations in the apical portion of the ansae. but we also observed some that were particularly curved and branched.00600 0.003 S§ Density ansae. subjects with BMS* and control subjects.68 . Typically.66 .44 ± 5. however.01677 ± 0.04 ± 14. This parameter is imporof the symptoms. Results of the statistical analysis performed resulting from a loop course perpendicwith the Mann-Whitney test. In evaluation of this parameter could lead to a prethe gingival mucosa.00163 0.00444 0. the apexes of the capil¶ S: Significant. as well as a dilatation of the afferent and the morphology of ansae in patients with BMS efferent ansae in patients with BMS. laries were visible. We also As far as we are aware. we did not examine the VALUE (MEAN ± SD†) palate. The applipatients with BMS depending on the area under cation of capillaroscopy led to important diaginvestigation but not depending on the intensity
JADA. laroscopy in the morphofunctional evaluation of Some of the observed parameters varied in microcirculation in subjects with BMS. only ‡ SD: Standard deviation. this is the first scientific observed a significant difference between the two study that has involved the use of videocapilgroups in the diameter of the capillary ansae.03558 ± 0.† The capillary ansae of P PARAMETER SUBJECT GROUP SIGNIFICANCE the gingivae.) In addition. (Such a diagnosis. Therefore.00170 marginal gingiva did not 19.00688 ± 0. always should be confirmed by further investigawhereas we did not find this parameter’s result tions. † The authors evaluated the differences by means of the Mann-Whitney test for nonparametric data. 3 The gravity and frequency of the morphofunc(page 945) and 4 (page 945) show.01088 ± 0. BMS. and the ansae had the aspect TABLE 4 of evenly distributed dots or commas. therefore. It increase in the total diameter of the capillary is easy for an experienced observer to distinguish ansae. we observed an increase in liminary diagnosis.00833 ± 0.0004 S Efferent Diameter 0. BMS an altered capillary profile resulting from Tables 3.4434 NS§ Length Curri classification type II.4772 NS Density show a constantly parallel orientation of the * BMS: Burning mouth syndrome. we detected in subjects with altered in the other two areas we examined.org July 2008 943
Downloaded from jada.
Therefore. ‡ SD: Standard deviation.† subjects with BMS when P PARAMETER SUBJECT GROUP (MEAN ± SD‡) SIGNIFICANCE compared with that in VALUE healthy subjects. we can exclude these parameters as causes of the altered blood flow. Vol.0005 S Efferent Diameter 0. A † The difference was evaluated with the Mann-Whitney test for nonparametric data.00160 0. Labial microvascular characteristics in a healthy control subject (magnification ×200). these changes seem to be linked to the symptoms of BMS and imply a disturbed vasoreactivity in patients with this disorder. The stimulation with dry ice significantly altered the heart rate in both groups.00180 which the circulatory 20.03844 ± 0.198 ± 0.4432 NS Density mechanisms are involved * BMS: Burning mouth syndrome. 2011
Copyright © 2008 American Dental Association.4566 NS Length risk factors for BMS are 0. They found no significant differences in the other areas they examined (the vestibule and the tongue). Heckmann and colleagues10 investigated the mucosal blood flow in areas typically affected in patients with BMS. bance of the areas § NS: Not significant.13 Other authors described a lower tongue temperature in patients with BMS.02311 ± 0. in pain generation. 139 http://jada.05 was local circulatory disturconsidered significant. both of which could lead to changes in the intraoral blood flow. In
TABLE 5 944 JADA. P = . groups. such as teeth grinding (bruxism) or habitual pressing of the tongue against the teeth. plays a part in the symptoms of BMS. Labial microvascular characteristics in a subject with burning mouth syndrome (magnification ×200).32-34 Our results point out that a disturbed regulation of the mucosal blood circulation Figure 2.662 . affected by BMS could ¶ S: Significant. With BMS Control Among the possible § 0.org July 2008
Downloaded from jada. which also could indicate alterations of the autonomic functions.01537 ± 0.0004 S¶ Total Diameter numerous physiopathoS Afferent Diameter 0.031 .16 ± 13.032 0.R E S E A R C H
nostic results regarding the alterations of the The differences between parameters in the tongues local microcirculation in of subjects with BMS* and control subjects.ada.00210 0.97 20. All rights reserved.32 Still other researchers found parafunctional habits in patients with BMS.ada.00664 ± 0.00423 0.01022 ± 0.222 ± 0.29-31 in .00330 .00835 ± 0.24 ± 5.324 × 10-6 logic situations11.
. Their most interesting observations included a relative increase in vasoreactivity after application of dry ice in patients with BMS compared with that in healthy subjects and notably stronger reactions on the hard palate in patients with BMS than in subjects in the control group. contribute to the burning sensations patients describe. consequently.org on October 9.00230 9. and partial pressure of carbon dioxide did not differ between the two Figure 1.
the presence of these cytokines could symptoms of calor and rubor. or affects. it seems that BMS results from. During the inflammatory
JADA. Pain is the principal increase in the size of the circulatory bed. flow. we found capillary density and diameters of the afferent and efferent ansae to be increased significantly. we observed oral microcirculatory alterFigure 3. Vol.org on October 9. or exchange that leads to the formation of exudate. which which is caused by an increase in the blood flow was correlated with the severity of their sympin the capillaries and is evident in the typical toms. such as an the etiopathogenesis of BMS.ada. Lingual microvascular characteristics in a healthy control subject (magnifiin the vascular diameter and hematic cation ×200). ations in patients with oral lichen planus or rheumatoid arthritis. the neurovascular microcirculatory unit (that is.
.R E S E A R C H
other words.35. In fact. These results point toward the presence of a disturbance in the mucosal circulation.37 toward the interstitial space.05). and IL-2 in the saliva of subjects with BMS. an symptom of the inflammation caused by local bioincrease in blood viscosity levels (caused mainly chemical alterations.35.36 In oral lichen planus. The capillaroscopic examination allowed us to detect a difference between subjects with BMS and healthy people in the diameters of the capillary.36 In patients who had rheumatoid arthritis.36 This process can be described as a sequence of the following events: dvascular modifications of the microcirculation.35. A study by Simci´ and colleagues38 showed an c These vascular modifications during vascular increase in the concentration of interleukin (IL)-6 inflammation determine an active hyperemia. dalterations of the blood-interstitial fluid by aggregation of the red blood cells) or both.ada. 139 http://jada. microcirculatory control of the sensory and autonomic innervation). afferent and efferent ansae. the diameter of the ansae in subjects with BMS showed a statistically significant increase when compared with the diameter of the ansae in healthy mucosa (P = . we observed a reduced caliber of the capillaries. All rights reserved. in particular variations Figure 4. as well as larger. 2011
Copyright © 2008 American Dental Association. the margination of the leukocytes that adhere to dmigration of leukocytes from the blood vessels the endothelial wall. Lingual microvascular characteristics in a subject with burning mouth syndrome (magnification ×200).36 The vascular inflammation develops mainly in correspondence with the microcirculation in the periphery of the blood circulation. probably due to local inflammation.org July 2008 945
Downloaded from jada. elongated capillaries. Our research team has used capillaroscopy to investigate oral microcirculation in oral and systemic diseases. Active hyperemia explain the role of the inflammatory response in can be brought on by different factors.
9:95-106. 11. Messina P. Am Fam Physician 2002. Shepherd MG. Pawlowski J.10(5):388-393. 4. Eur J Oral Sci 2003. Bonanini M. 38. Lukinac LJ.90(3):281-286.65(4):615-620. Curri SB. Heckmann JG. Pain 2001. c c c Muhvi´ -Urek M. Costigan M. 22. Garofano G. 28. J Eur Acad Dermatol Venereol 2004. Med Oral 2002. 13. Grzi´ R. 17. The burning mouth syndrome. Minerva Stomatol 1994. Messina P.37(3):229-235. Messina P. 30. Scardina GA. 39. Chimenos-Kustner E. Bergdahl J. Mediators Inflamm 2006. Rodriguez S. Pain 1995. Detection of salivary interleukin 2 and interleukin 6 c in patients with burning mouth syndrome. 20. Ital J Anat Embryol 2004. Pisano T. Contact allergy in oral disease.97(3): 339-344. 19. Microvascular characteristics of the human filiform papillae: a videocapillaroscopic study. Yonehara N.92(1-2):259-265. Burning mouth syndrome [in Italian]. Majorana A. Crit Rev Oral
Biol Med 2003. Proc Natl Acad Sci U S A 1999. Microvascular periodontal alterations: a possible relationship between periodontitis and rheumatoid arthritis.99(1):48-54. Oral manifestations and dental treatment in menopause [in English. Huang W. 21. Hilz MJ. Miralles-Jorda L.26 ■
Disclosure. Yoshimura M. Glenny AM. Scardina GA. Cekic-Arambasin A. Pain 2001. Ferguson MM.105(4):460-465. et al. Cacioppo A. Interventions for the treatment of burning mouth syndrome. 15.39
Although future research is necessary to enhance the findings of this study. Whitley BD. Simci´ D. Oral Surg Oral Med Oral Pathol 1991. Eddie S.org on October 9. Vol. Peanut sensitivity as a cause of burning mouth. Study of the microcirculation of oral mucosa in healthy subjects. 9. Mechanisms of inflammatory pain. Campisi G. Di Liberto C. Forssell H. Scala A. Scardina GA.115(3):332-337. Fazzi M. J Am Acad Dermatol 2007.98(2):120-128. 6. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008. 29. Messina P.35(1):171-184. 33. Inflammatory pain manifests as spontaneous pain and pain hypersensitivity. Update on burning mouth syndrome: overview and patient management. they have a short turnover. Hallberg LR.62(3):253-257. Urban LA. Carini F. J Oral Pathol Med 1999. Lamey PJ. The burning mouth syndrome remains an enigma.52(11-12):507-521. Palacios-Sánchez MF. Holmes AR.49(4):169-177. Amenábar JM.18(6):676-678. Burning mouth syndrome. García-Sívoli CE. Phlebologie 1990. None of the authors reported any disclosures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004. Scardina GA. Grushka M.87(1):3-11.R E S E A R C H
process.109(2):95-103. Picone V.ada. Dent Clin North Am 1991. 35. Woolf C. Scardina GA. Zangari F.188(2):183-186. Study of microcirculation in oral lichen planus by video-capillaroscopy. Al Quran FA.43(3):407-430.ada. 3. Lamb AB. Pankhurst C.72(6):671-674. Heckmann SM. Zakrzewska JM. Brumini G. Messina P. Sessle B. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007. Frutos R. Spanish]. Type 3 burning mouth syndrome: psychological and allergic aspects. Minerva Stomatol 2003. Hakeberg M. Lamey P.
. 18. The spontaneous pain reflects the direct actions of specific receptors on free terminals of the nociceptors through inflammatory mediators. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Psychological profile in burning mouth syndrome. Minerva Stomatol 2000. 23.23(5):216-219.(1):CD002779. Rothe MJ. Vucicevic-Boras V. Vulnerability and presenting symptoms in burning mouth syndrome. 32. J Oral Pathol Med 1994. Oral Oncol 2003. Vescovi P. Horvat J. 31. Minerva Stomatol 2003. Burning mouth syndrome: clinical experience with 75 patients [in Italian]. Machuca G. J Am Acad Dermatol 1996. 25. modulating or regulating effect. 27. Ann Allergy Asthma Immunol 1996. 8.57(2): 315-321. 37. Calura G. Marques-Soares MS. Messina P. Jordana-Comín X. The mediators can act on one or many cellular types and have different effects depending on the type of tissue or cell. Oral mucosal blood in patients with burning mouth syndrome.57(4):295-304. Med Oral Patol Oral Cir Bucal 2005.org
Copyright © 2008 American Dental Association. Grant-Kels JM. et al. Grushka M. Montevecchi M. Recenti Prog Med 2007.52(7-8):351-363. Spanish]. Borgna M. Br J Anaesth 2001. Manfredi M. et al. these have specific receptors. Marini I. Checchi L. Oral capillaroscopy: a new diagnostic method [in Italian]. 5. Smoking habit and labial microcirculation. Milligan KA. Burning mouth syndrome: prevalence and associated factors. Zakrzewska JM. Burning mouth syndrome. Lauria G. Burning mouth syndrome [in Italian]. 1. Burning mouth syndrome: experiences from the perspective of female patients. Scully C. Pain 2005. Furthermore. Messina P. Microvascular anatomy of the skin and its appendages [in French]. Femiano F. Rogers RS 3rd. Pezelj-Ribari´ S. 10. Torgerson RR. Evaluation of tumour markers in patients with burning mouth syndrome. 14. The burning mouth syndrome: a clinical study [in Italian].28(8):350-354. Scardina GA.7(4):244-253. Gombos F.39(7):742-744. Kidd BL. Hilgert JB. Burning mouth syndrome: a retrospective study of 140 cases in a sample of Catalan population [in English. 2. Med Oral 2002. Trombelli L.111(4):305-311. Negro C. 7. Clin Hemorheol Microcirc 2007. Food allergy in oral medicine: a review of the literature [in Italian]. the question remains whether the alterations we observed are a mere consequence of the symptoms of BMS or reflect a possible cause of the disorder. Anxiety and salivary cortisol levels in patients with burning mouth syndrome: casecontrol study.76(1):37-40. Bergdahl M. Transcriptional and posttranslational plasticity and the generation of inflammatory pain. 2011
JADA. All rights reserved. Bruce AJ. Esame videocapillaroscopio della mucosa orale: evoluzione delle tecniche.7(1):26-30.
Downloaded from jada.2006(1):54632. Ann Anat 2006. important chemical mediators of plasmatic and cellular origin are produced. 31-35. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005. the presence of these alterations could be useful in establishing novel approaches to investigate therapeutic effects of drugs to combat this condition. Ital J Anat Embryol 2003. Savi A. Oral allergy syndrome induced by chestnut (Castanea sativa). 12. Dental Cadmos 2002. Cochrane Database Syst Rev 2005. 16. Burning mouth and saliva. Farmer SA. Berggren U. 36. Davis MD.108(1):39-48. Forabosco A. Antico A. Rees T. Hughes A. 34. 26.96(14):7723-7730.34(1):91-98. when they are produced or released. 24. Influence of painful chronic neuropathy on neurogenic inflammation. Freeman R. Scardina GA.14(4):275-291. Messina P. Reumatismo 2005. and a mediator can stimulate the release of other mediators by target cells with an amplifying. Forsyth A.43(1-2):49-55. Scardina GA.103(4):e30-e34. Burning mouth syndrome: the efficacy of lipoic acid on subgroups. 139