Takayuki Suga, Takeshi Watanabe, Yuma Aota, Takahiko Nagamine, Akira Toyofuku
Burning mouth syndrome: The challenge of an aging population.
Geriatr Gerontol Int. 2018 Dec;18(12):1649-1650. doi: 10.1111/ggi.13548.
Abstract/Text
Takayuki Suga, Miho Takenoshita, Akira Toyofuku
Medical comorbidities of patients with burning mouth syndrome.
Oral Dis. 2020 Jan;26(1):238-239. doi: 10.1111/odi.13186. Epub 2019 Oct 10.
Abstract/Text
A Sardella, G Lodi, F Demarosi, C Bez, S Cassano, A Carrassi
Burning mouth syndrome: a retrospective study investigating spontaneous remission and response to treatments.
Oral Dis. 2006 Mar;12(2):152-5. doi: 10.1111/j.1601-0825.2005.01174.x.
Abstract/Text
OBJECTIVE: The aim of this investigation was to evaluate the spontaneous remission rate of burning mouth syndrome (BMS) in a group of subjects suffering from this syndrome.
SUBJECTS AND METHODS: The medical records of BMS patients attending the Unit of Oral Medicine (1995-2002) were reviewed. The patients with a follow-up period of at least 18 months were then contacted over phone and interviewed using a structured ad hoc questionnaire to record their current symptoms and data about their treatment responses to the therapies.
RESULTS: Forty-eight women and five men with a mean age of 67.7 years (range 33-82 years) were included in the study (mean duration of BMS 5.5 years, s.d. +/-1.9 years, mean follow-up period of 56 months). As a consequence of different treatments, 26 patients (49.0%) reported no change in oral symptoms, 15 (28.3%) moderate improvement and 10 (18.9%) a worsening of oral complaints. Only two patients (3.7%) reported a complete spontaneous remission of oral symptoms without any treatment.
CONCLUSIONS: In this study, a complete spontaneous remission was observed in 3% of the patients within 5 years after the onset of BMS. A moderate improvement was obtained in <30% of the subjects.
Takayuki Suga, Trang Thi Huyen Tu, Miho Takenoshita, Lou Mikuzuki, Yojiro Umezaki, Hiroaki Shimamoto, Yasuyuki Michi, Chaoli Hong, Yoshihiro Abiko, Tohru Ikeda, Narikazu Uzawa, Hiroyuki Harada, Akira Toyofuku
Case Report: Hidden Oral Squamous Cell Carcinoma in Oral Somatic Symptom Disorder.
Front Psychiatry. 2021;12:651871. doi: 10.3389/fpsyt.2021.651871. Epub 2021 Apr 1.
Abstract/Text
Background: Burning mouth syndrome (BMS) is a common condition of predominant oral pain without evident cause, that maxillofacial surgeons and otolaryngologists often refer to psychiatrists as somatic symptom disorder. In very rare cases, its typical burning symptom mimics those of other diseases in which serious fatal comorbidities may be missed. We encountered three rare cases of oral squamous cell carcinoma (OSCC) with the first symptom of burning tongue. Case Presentation: Case 1: A 68-year-old woman had burning pain on the left lingual margin for 8 years. Antidepressant treatment was not efficacious. Cytology and biopsy revealed OSCC. Case 2: A 70-year-old man had burning sensation and paralysis of the tongue for 6 months. Magnetic resonance imaging (MRI) revealed a 37 × 23-mm mass under the floor of the mouth and enlargement of lymph nodes on both sides. Case 3: A 90-year-old man had burning sensation of the tongue for 1 year. MRI revealed a 12 × 12-mm mass on the mandible with bone absorption. Conclusion: This case series suggests that psychiatrists must always be careful in regarding BMS as somatic symptom disorder and be cautious of the possibility of OSCC, especially in elderly patients.
Copyright © 2021 Suga, Tu, Takenoshita, Mikuzuki, Umezaki, Shimamoto, Michi, Hong, Abiko, Ikeda, Uzawa, Harada and Toyofuku.
Trang T H Tu, Miho Takenoshita, Hirofumi Matsuoka, Takeshi Watanabe, Takayuki Suga, Yuma Aota, Yoshihiro Abiko, Akira Toyofuku
Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review.
Biopsychosoc Med. 2019;13:1. doi: 10.1186/s13030-019-0142-7. Epub 2019 Jan 31.
Abstract/Text
Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients' quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.
Takayuki Suga, Trang T H Tu, Takahiko Nagamine, Akira Toyofuku
Careful use of clonazepam and alpha lipoid acid in burning mouth syndrome treatment.
Oral Dis. 2022 Apr;28(3):846-847. doi: 10.1111/odi.13776. Epub 2021 Jan 26.
Abstract/Text
Takayuki Suga, Miho Takenoshita, Takeshi Watanabe, Trang Th Tu, Lou Mikuzuki, Chaoli Hong, Kazuhito Miura, Tatsuya Yoshikawa, Takahiko Nagamine, Akira Toyofuku
Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome.
Neuropsychiatr Dis Treat. 2019;15:3599-3607. doi: 10.2147/NDT.S235669. Epub 2019 Dec 30.
Abstract/Text
OBJECTIVE: To assess the therapeutic dose and safety of amitriptyline and the outcome following treatment with amitriptyline among older patients with burning mouth syndrome (BMS).
METHODS: 187 consecutive patients were prescribed amitriptyline as a first-line medication from April 2016 to September 2018 and followed-up for >1 month. Patients were divided into 3 groups: group 1, 113 patients aged <65 years; group 2, 52 patients aged between 65 and 74 years; and group 3, 22 patients aged 75 years or older. The visual analog scale (VAS), Pain Catastrophizing Scale (PCS), Somatic Symptom Scale-8 (SSS-8), Patient Global Impression of Change (PGIC), and Short-form McGill Pain Questionnaire (SF-MPQ) were used for analysis.
RESULTS: Thirty-two patients (17 in group 1, 10 in group 2, and 5 in group 3) stopped taking amitriptyline due to side effects. There were no differences among the groups with respect to sex; scores of VAS, PCS, and SSS-8; and drop-out ratio. There were no significant differences in the VAS, PCS, and PGIC scores among the groups after 1 month. The mean daily dose after 1 month was 20.4 ± 8.6 mg in group 1, 17.3 ± 8.7 mg in group 2, and 13.2 ± 5.8 mg in group 3; this difference was significant (p value = 0.003). About 76% of patients showed improvements in their symptoms (PGIC ≥ 3). About 90% of patients reported side effects. No serious side effects occurred.
CONCLUSION: The therapeutic dose of amitriptyline may be lower for older BMS patients than for younger patients.
© 2019 Suga et al.
Motoko Watanabe, Miho Takenoshita, Trang T H Tu, Akira Toyofuku
Real-world Discontinuation of Antidepressant Treatment in Patients with Burning Mouth Syndrome: A Chart Review.
Pain Med. 2020 Sep 1;21(9):2009-2010. doi: 10.1093/pm/pnz324.
Abstract/Text
Motoko Watanabe, Chihiro Takao, Zhenyan Liu, Gayatri Nayanar, Takayuki Suga, Chaoli Hong, Trang Thi Huyen Tu, Tatsuya Yoshikawa, Miho Takenoshita, Haruhiko Motomura, Takahiko Nagamine, Akira Toyofuku
The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS.
Front Pain Res (Lausanne). 2022;3:809207. doi: 10.3389/fpain.2022.809207. Epub 2022 Mar 4.
Abstract/Text
Burning mouth syndrome (BMS) is defined by chronic oral burning sensations without any corresponding abnormalities. Besides amitriptyline, aripiprazole has been reported as a possible medication to manage BMS. However, especially for elderly patients, the adverse events of these medications would be a problem. The aim of the present study was to investigate the differences in the effectiveness and adverse events of amitriptyline and aripiprazole in very elderly patients with BMS. This is a retrospective comparative study of 80 years old and older patients with BMS who were initially treated with amitriptyline or aripiprazole and who were new outpatients of our department from April 2017 to March 2020. All clinical data, including sex, age, comorbid physical diseases, comorbid psychiatric disorders, the prescribed doses (initial, maximum, and effective dose), prognosis, and adverse events, were collected from their medical charts. Each medication was selected considering their medical history. Amitriptyline was prescribed in 13 patients (11 women, 82.3 ± 2.1 years old) and aripiprazole was prescribed in 27 patients (26 women, 84.2 ± 3.8 years old). There were no significant between-group differences in sex, age, duration of illness, pain intensity, salivation, and psychiatric comorbidity at the first examination. Amitriptyline clinically improved more patients (7 patients, 53.8%) with the effective dose of 10 (7.5, 15.0) mg than aripiprazole (11 patients, 40.7%) of which the effective dose was 1.0 (0.5, 1.5) mg, although there were no significant between-group differences. The adverse events of amitriptyline were found in 9 patients (69.2%) and most patients had constipation (46.2%). For aripiprazole, 7 patients (25.9%) showed adverse events, most of them reported sleep disorder (11.1%). Amitriptyline had significantly longer duration taking medication (p = 0.021) and lower discontinuation (p = 0.043) despite of higher occurrence rate of adverse events (p = 0.015) compared to aripiprazole. These results suggest that both psychopharmacotherapies with a low dose of amitriptyline and aripiprazole are effective for the very elderly patients with BMS. Furthermore, aripiprazole may have some advantages in the adverse events compared to amitriptyline; however, the low dose amitriptyline monotherapy may have more benefit in the effectiveness and tolerability over prudent collaboration with primary physicians.
Copyright © 2022 Watanabe, Takao, Liu, Nayanar, Suga, Hong, Tu, Yoshikawa, Takenoshita, Motomura, Nagamine and Toyofuku.
Durga Paudel, Masafumi Utsunomiya, Koki Yoshida, Sarita Giri, Osamu Uehara, Hirofumi Matsuoka, Itsuo Chiba, Akira Toyofuku, Yoshihiro Abiko
Pharmacotherapy in relieving the symptoms of burning mouth syndrome: A 1-year follow-up study.
Oral Dis. 2020 Jan;26(1):193-199. doi: 10.1111/odi.13226. Epub 2019 Nov 26.
Abstract/Text
OBJECTIVE: Burning mouth syndrome (BMS) is a chronic intraoral burning sensation with no identifiable causes. In this study, we aim to demonstrate the effectiveness of treatment strategy using ethyl loflazepate monotherapy or in combination with milnacipran or amitriptyline.
METHOD: A hospital-based, retrospective study was conducted in 86 patients. The patients were divided into remission group and non-remission group. The remission group comprised patients who were satisfied with their pain relief within a year of treatment initiation and did not require any follow-up treatment. The treatment was considered effective if the patient got remission within 1 year or was able to reduce the visual analogue scale (VAS) score to <20, in the absence of remission.
RESULTS: The treatment strategy was effective in 76.7% of the patients. Significant reductions (p < .05) in VAS scores from 73.5 ± 14.2 at first visit to 14.7 ± 8.7 at last visit in the remission group, and from 79.7 ± 14.3 at first visit to 33.4 ± 23.7 after 1 year of treatment in the non-remission group were noted.
CONCLUSION: The treatment strategy using ethyl loflazepate monotherapy or in combination with milnacipran or amitriptyline can be very effective in reducing pain in BMS patients.
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.
Miho Takenoshita, Haruhiko Motomura, Akira Toyofuku
Low-Dose Aripiprazole Augmentation in Amitriptyline-Resistant Burning Mouth Syndrome: Results from Two Cases.
Pain Med. 2017 Apr 1;18(4):814-815. doi: 10.1093/pm/pnw200.
Abstract/Text
Takayuki Suga, Miho Takenoshita, Trang T H Tu, Takashi Sugawara, Susumu Kirimura, Akira Toyofuku
A case of vestibular schwannoma mimicking burning mouth syndrome.
Biopsychosoc Med. 2021 Mar 21;15(1):7. doi: 10.1186/s13030-021-00209-y. Epub 2021 Mar 21.
Abstract/Text
BACKGROUND: An oral burning sensation with unidentified cause in patients with preexisting psychosocial conditions is usually diagnosed as burning mouth syndrome. However, unexpected organic lesions may be detected in rare cases.
CASE PRESENTATION: A 35-year-old woman had chief complaints of a burning sensation and numbness of the right side of the lip and tongue, as well as a dry sensation of the mouth with a taste disturbance of the right side of the tongue. The symptoms were continuous and did not show any daily fluctuations. The symptoms started without any recognizable triggering factor six months before her first visit to our clinic,. No abnormality was detected in her mouth. MRI images revealed an approximately 30 × 30 mm well-defined mass localized in the right cerebropontine angle compressing the trigeminal nerve, which was diagnosed as schwannoma of the right auditory nerve.
CONCLUSIONS: It is important for clinicians to consider the possibility of brain tumors in their differential diagnosis of BMS. Although it is not always easy to eliminate all diseases that may cause an oral burning sensation in patients with BMS-like symptoms, more attention and careful examination based on the patient's psychosomatic background features and other possible causes are needed to rule out organic diseases.
Takayuki Suga, Trang T H Tu, Junichiro Sakamoto, Akira Toyofuku
A case of vestibular schwannoma with oral burning sensation: surgical complication or burning mouth syndrome?
Biopsychosoc Med. 2021 Aug 23;15(1):13. doi: 10.1186/s13030-021-00215-0. Epub 2021 Aug 23.
Abstract/Text
BACKGROUND: Despite improvements in surgical techniques, the removal of vestibular schwannoma is related to some complications. Recovery from surgical complications of vestibular schwannoma is often difficult and complications sometimes lead to permanent deficits. However, treatable trigeminal symptoms may be missed in atypical cases.
CASE PRESENTATION: A 46-year-old woman complained about burning sensation on her tongue and maxilla for four years before her first visit to our clinic. She visited the neurosurgery department in a university hospital because her facial pain and burning sensation of her tongue were suddenly aggravated. She was diagnosed with vestibular schwannoma and tumour resection was performed. However, her oral pain persisted after surgery. Two months before the initial visit to our clinic, the oral pain became more severe than ever before. When the patient visited a psychiatrist due to a panic attack, the psychiatrist diagnosed her as having somatic symptom disorder and depression and referred her to our clinic. Based on the characteristics of the pain, she was diagnosed as burning mouth syndrome and treated for the same. Within 1.5 months, the pain and burning sensation of the tongue and maxilla almost completely remitted with low dose amitriptyline.
CONCLUSIONS: Our case suggests that there are exceptional cases in which burning mouth syndrome and vestibular schwannoma occur simultaneously. Burning pain after vestibular schwannoma surgery cannot always be considered a complication of surgery.
© 2021. The Author(s).
