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INVESTIGATIVE REPORT
Usefulness of Psychiatric Intervention in a Joint Consultation
for the Treatment of Burning Mouth Syndrome: A Monocentric
Retrospective Study
Vinciane LE BRIS 1 , Myriam CHASTAING 1 , Martine SCHOLLHAMMER 1 , Emilie BRENAUT 1,2 and Laurent MISERY 1,2
Department of Dermatology, University Hospital of Brest, and 2 Laboratory of Neurosciences (EA4685), University of Western Brittany,
Brest, France
1
Primary burning mouth syndrome is a term used for
chronic oral mucosal pain with no identifiable organic
cause. The aim of the study was to evaluate the use-
fulness of a psychiatric intervention for treating bur-
ning mouth syndrome based on a joint consultation
with a psychiatrist and a dermatologist. The study was
proposed to all patients who visited this consultation
group between 2001 and 2017 for the treatment of pri-
mary burning mouth syndrome. The patients answe-
red a questionnaire that was administered via mail. Of
the 57 patients diagnosed with primary burning mouth
syndrome, 38 were included. Seven patients (18.4%)
no longer had pain; 8 (21.1%) estimated that the pain
had decreased by greater than 50%; 11 (28.9%) es-
timated the decrease at between 30 and 50%, and 12
(31.6%) estimated a less than 30% decrease. Only
14 patients (36.8%) remained under treatment with
antidepressants, as compared to 63.2% before the
psychiatric intervention. This psychiatric intervention
could be considered a valuable tool in the global bur-
ning mouth syndrome treatment strategy.
Key words: burning mouth syndrome; anxiety; depression;
antidepressant; psychiatric intervention.
Accepted Nov 20, 2018; E-published Nov 21, 2018
Acta Derm Venereol 2019; 99: 813–817.
Corr: Laurent Misery, Department of Dermatology, University Hospital,
FR-29609 Brest, France. E-mail: [email protected]
P
rimary burning mouth syndrome (BMS) is a term
used for a chronic disorder that is defined by the
International Headache Society as an “intraoral burning
or dysaesthetic sensation recurring daily for more than
2 h per day over more than 3 months, without clinically
evident causative lesion” (1). Symptoms include burning
pain or discomfort on the tongue, lips, teeth or in the
entire oral cavity, occasionally associated with dysgeusia
or xerostomia, without any identifiable organic cause. Its
prevalence has been estimated at between 0.1 and 3.9%
of the general population (2, 3). In a recent study, the
incidence of BMS was 11.4 per 100,000 person-years
(4). It is most common in perimenopausal or post-me
nopausal women (4). The pathophysiology is currently
misunderstood. BMS has been shown to be associated
with a neuropathic component, with underlying damage
to the nerves (e.g., small-fiber neuropathies) and/or a
SIGNIFICANCE
Primary burning mouth syndrome is a term used for chronic
oral mucosal pain with no identifiable organic cause. Bur-
ning mouth syndrome are frequently associated with psy-
chiatric disorders. We conducted a monocentric study to
evaluate the usefulness of a psychiatric intervention in a
joint consultation with a psychiatrist and a dermatologist.
Most of our patients demonstrated a significant decrease
in pain and a small percentage of patients were comple-
tely symptom-free after such interventions. The psychiatric
intervention seems to be a good and lasting therapeutic
option, and should be integrated in the global strategy in
burning mouth syndrome treatment.
psychiatric component, with co-morbidities (anxiety,
depression or/and personality disorder) and putative
triggering stressful events in the genesis of this disease
(5–8). Patient quality of life is impaired (9). There are
no treatment guidelines, and multiple pharmacological
agents have been trialed, in particular, antidepressants
(10, 11). Recently, a Cochrane review of studies of in
terventions for treating BMS concluded that there was
insufficient evidence to support or refute the use of any
interventions in managing BMS and encouraged the
assessment of the role of neuropathic pain treatments
and psychiatric therapies in the treatment of BMS (12).
Since 2001, in our department, we have organized a
joint consultation with a psychiatrist (MC) and a derma
tologist (LM then MS) (13). In this consultation, many
outpatients are found to suffer from BMS. We conducted
a self-reported retrospective and uncontrolled study to
evaluate the usefulness of psychiatric intervention in
this consultation.
PATIENTS AND METHODS
The study was proposed to all primary BMS patients who came to
the consultation with the dermatologist and psychiatrist between
2001 and 2017 in the Dermatology Department of the University
Hospital of Brest, France. The inclusion criteria were BMS as
sessed by the presence of symptoms of pain in the oral mucosa,
with or without subjective oral dryness or loss or alteration of taste
sensation, normal oral mucosa and the presence of pain on most
days for more than 4 months. Somatic causes, such as diabetes
mellitus or vitamin or nutritional deficiency, were excluded based
on standard laboratory tests. The following exclusion criteria
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3094
Acta Derm Venereol 2019; 99: 813–817