Suarez Piedad, Clark Glenn T
Orofacial Pain and Oral Medicine Center, University of Southern California School of Dentistry, Los Angeles 90089, USA.
J Calif Dent Assoc. 2006 Aug;34(8):611-22.
Burning mouth syndrome is characterized by both positive (burning pain, dysgeusia and dysesthesia) and negative (loss of taste and paraesthesia) sensory symptoms involving the lips and tongue, mainly the tip and anterior two-thirds. BMS patients report a persistently altered (metallic) taste or diminished taste sensations. Acidic foods such as tomatoes and orange juice cause considerable distress. Most of the common laboratory tests suggested for BMS patients will be negative as well. BMS is best subcategorized as primary BMS, no other evident disease, and secondary BMS, which is defined as oral burning from other clinical abnormalities. The presence of BMS is very uncommon before the age of 30; 40 years for men. The onset in women usually occurs within three to 12 years after menopause, and is higher in women who have more systemic disease. Quantitative assessment of the sensory and chemosensory functions in BMS patients reveals that the sensory thresholds (significantly higher) are different than in controls. Tongue biopsies have shown that there is a significantly lower density of epithelial nerve fibers for BMS patients than controls. The above data generally support the idea that BMS is a disorder of altered sensory processing which occur following the small fiber neuropathic changes in the tongue. BMS patients frequently have depression, anxiety, sometimes diabetes, and even nutritional/mineral deficiencies, but overall these co-morbid diseases do not fully explain BMS. The management of BMS is still not satisfactory, but because BMS is now largely considered to be neuropathic in origin, treatment is primarily via medications that may suppress neurologic transduction, transmission, and even pain signal facilitation more centrally. Finally, spontaneous remission of pain in BMS subjects has not been definitely demonstrated. The current treatments are palliative only, and while they may not be much better than a credible placebo treatment, few studies report relief without intervention.
灼口综合征的特征是存在涉及嘴唇和舌头（主要是舌尖和前三分之二部分）的阳性（灼痛、味觉障碍和感觉异常）和阴性（味觉丧失和感觉异常）感觉症状。灼口综合征患者报告味觉持续改变（金属味）或味觉减退。西红柿和橙汁等酸性食物会引起极大不适。针对灼口综合征患者建议的大多数常规实验室检查结果也将为阴性。灼口综合征最好分为原发性灼口综合征（无其他明显疾病）和继发性灼口综合征（定义为由其他临床异常引起的口腔灼痛）。30岁之前很少出现灼口综合征；男性在40岁之前也较少见。女性发病通常发生在绝经后三到十二年，且患有更多全身性疾病的女性发病率更高。对灼口综合征患者的感觉和化学感觉功能进行定量评估发现，其感觉阈值（明显更高）与对照组不同。舌活检显示，灼口综合征患者的上皮神经纤维密度明显低于对照组。上述数据总体上支持这样一种观点，即灼口综合征是一种感觉处理改变的疾病，它发生在舌部小纤维神经病变之后。灼口综合征患者经常伴有抑郁、焦虑，有时还伴有糖尿病，甚至存在营养/矿物质缺乏，但总体而言，这些共病并不能完全解释灼口综合征。灼口综合征的治疗仍不尽人意，但由于目前大多认为灼口综合征起源于神经病变，治疗主要通过使用可能抑制神经传导、传递甚至更中枢性疼痛信号促进作用的药物。最后，尚未明确证实灼口综合征患者的疼痛会自发缓解。目前的治疗仅为姑息性治疗，虽然可能并不比可靠的安慰剂治疗好多少，但很少有研究报告未经干预就能缓解症状。
