Oral Dysaesthesia Flashcards
What is oral dysaesthesia?
Intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day, over more than 3 months, without clinically evident causative lesions
What are the diagnostic criteria for oral dysaesthesia according to ICDH?
Recurring daily for > 2 hours for > 3 months
Pain has burning quality and felt superficially in oral mucosa
Oral mucosa has normal appearance and clinical examination including sensory testing is normal
Not better accounted for by other ICHD3 diagnosis
What are the diagnostic criteria according to the Internation Association for the Study of Pain?
Distinctive entity including all forms of burning sensation in the mouth, including complaints described as:
Stinging sensation or pain
Involving mainly the tongue and lips, hard palate, alveolar ridge, buccal mucosa
In association with an oral mucosa that appears clinically normal
Not attributable to any known organic pathology
What are the features of Lamey and Lewis classification for oral dysaesthesia?
Type 1: Progressive pain throughout the day
Type 2: Constant throughout the day
Type 3: Intermittent symptoms and some symptom free days
What is the problem with the Lamey and Lewis classification?
in daily clinical practice, such classification, based on the course of symptoms, appears useless, as general practitioners (dentist, oral medicine specialist, ENT, gastroenterologist, dermatologist) do not need to make any difference in terms of diagnostic and therapeutic approach. All the treatments currently described in the literature are identical for all three types of BMS, as well as the diagnostic protocol.
By definition oral dysaesthesia is idiopathic
What is the most recent name being used to redefine oral dysaesthesia?
Complex oral sensitivity disorder:
Complex = oral discomfort with single or multiple site involvement, symptoms can be heterogenous, vary in intensity during the day, transform into different type of symptom over time Oral = can present with additional unexplained extra-oral symptoms Sensitivity = may present with all types of sensory symptoms (tactile, nociceptive, thermal, gustatory, proprioceptive) Disorder = condition manifesting symptoms of other diseases
What are the diagnostic criteria used to define complex oral sensitivity disorder?
Any type of oral and oropharyngeal symptom that can be persistent or intermittent with possible phases of remission/exacerbation during the day
Absence of any clinically and instrumentally detectable oral and oropharyngeal lesion
Absence of any type of local and/or systemic factors
When in life and in who is burning mouth syndrome most common?
0.7 - 4.6% of general adult population
5th - 7th decade of life
More common in females than males - post menopause
What causes oral dysaesthesia?
Multifactorial
Damage or dysfunction to peripheral and/or central nervous system: Taste, Small fiber neuropathy, Immune system, Hormones, psychosocial factors
Why is damage or hypofunction of the chorda tympani associated with oral dysaesthesia?
The chorda tympani is thought to have inhibitory signalling for pain that is conducted via the trigeminal nerve.
What can cause small fiber neuropathy?
Damage to peripheral small nerve fibers caused by:
Metabolic disorders
Endocrine disorders
VitB12 deficiency
Viral infections
Autoimmune disorders (Increased IL-6, IL-9 in areas of small fiber neuropathy)
What hormones are associated with oral dysaesthesia?
Dysfunction of hypothalamus-pituitary-gonadal (HPG) axis
Oral mucosa and salivary glands contain oestrogen receptors
Low levels of salivary dehydroepiandosterone (DHEA) and low serum estradiol found in OD patients
Menopause
Increased emotional liability and depressed mood
What psychological factors could explain oral dysaesthesia?
Manifestation of somatization?
Higher prevalence of psychiatric symptoms and/or disorders in OD (85%)
Anxiety, depression, somatization, hypochondria, cancer phobia, insomnia most common
51% of OD patients have a diagnosis of another psychiatric illness
Many OD patients report one or more adverse life events – social history
