Femiano Felice, Lanza Alessandro, Buonaiuto Curzio, Gombos Fernando, Nunziata Monica, Cuccurullo Luisa, Cirillo Nicola
Stomatology Department, University of Medicine and Surgery, Naples, Italy.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jan;105(1):e22-7. doi: 10.1016/j.tripleo.2007.07.030.
Burning mouth syndrome (BMS) is a common disorder frequently affecting women past the 5th decade of age. It is characterized by oral burning, mainly involving the tongue, lip, and anterior palate, but without oral lesions or alteration showing in blood tests and/or instrumental findings.
We proposed to exclude alterations due to thyroid function and echographic abnormality in formulating BMS diagnosis. The aim of this study was to propose a blood and instrumental protocol including thyroid function and echography to obtain a correct BMS diagnosis. In the absence of such an assessment, a number of patients with oral burning and hypothyroidism may erroneously be considered BMS patients.
For this study, a group of 123 patients initially diagnosed with BMS was selected, following use of the current preliminary diagnostic protocol for BMS (study group). A further 123 patients with dental problems and without oral burning were selected as a control group. All patients were submitted to further protocol based on a study of their thyroid function and echography.
Thirteen control patients showed some thyroid alteration compared with 85 patients of the study group. In relation to these further examinations, a therapeutic protocol based on use of thyroxine, lipoic acid, or clonazepam was applied for patients belonging to the study group. Fifty-eight patients (47%) showed hypothyroidism and were treated with thyroxine, and 37 (64%) of these showed a positive response (VAS 1 and 0). Twenty-seven patients (22%) evinced euthyroidism with an inhomogeneous parenchyma thyroid echographic pattern. These were treated with lipoic acid, and 23 (85%) of them responded positively (VAS 1 and 0). Thirty-eight patients (31%) showed euthyroidism and no echographic alteration. Only these were considered to be true BMS patients and were treated with lipoic acid. Only 10 (26%) of these patients responded positively (VAS 1 and 0).
This study reveals that subjects with thyroid alterations are often considered to be BMS patients and that hypothyroidism could be responsible for oral burning and/or dysgeusia in some supertaster subjects. For these reasons, we propose that the study of thyroid function be inserted in the diagnostic process for BMS patients.
灼口综合征（BMS）是一种常见疾病，常影响50岁以上的女性。其特征为口腔灼痛，主要累及舌头、嘴唇和硬腭前部，但血液检查和/或仪器检查未显示口腔病变或异常。
我们建议在制定BMS诊断时排除甲状腺功能和超声异常引起的改变。本研究的目的是提出一项包括甲状腺功能和超声检查的血液及仪器检查方案，以获得正确的BMS诊断。在缺乏此类评估的情况下，许多有口腔灼痛和甲状腺功能减退的患者可能会被错误地视为BMS患者。
在本研究中，根据当前BMS初步诊断方案，选择了一组最初被诊断为BMS的123例患者（研究组）。另外选择了123例有牙齿问题且无口腔灼痛的患者作为对照组。所有患者均根据其甲状腺功能和超声检查接受进一步检查方案。
与研究组的85例患者相比，13例对照患者出现了一些甲状腺改变。针对这些进一步的检查结果，为研究组患者应用了基于甲状腺素、硫辛酸或氯硝西泮的治疗方案。58例患者（47%）表现为甲状腺功能减退，接受了甲状腺素治疗，其中37例（64%）有阳性反应（视觉模拟评分1和0）。27例患者（22%）甲状腺功能正常，但甲状腺实质超声图像不均匀。这些患者接受了硫辛酸治疗，其中23例（85%）有阳性反应（视觉模拟评分1和0）。38例患者（31%）甲状腺功能正常且无超声改变。只有这些患者被认为是真正的BMS患者，并接受了硫辛酸治疗。这些患者中只有10例（26%）有阳性反应（视觉模拟评分1和0）。
本研究表明，甲状腺改变的患者常被视为BMS患者，甲状腺功能减退可能是一些味觉过敏受试者口腔灼痛和/或味觉障碍的原因。基于这些原因，我们建议在BMS患者的诊断过程中加入甲状腺功能检查。
