Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico

• Autor(a) principal: Castro, Luciano Alberto de
• Data de Publicação: 2013
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/3542
• topic: Síndrome da ardência bucal; Glossodínia; Candidose; Burning mouth syndrome; Glossodynia; Candidosis; CIENCIAS DA SAUDE

Burning Mouth Syndrome (BMS) is a chronic painful condition which affects various sites in the oral cavity and is particularly common in the tongue. A process of exclusion must be used if a diagnosis of BMS is to be reached. Studies have suggested that a burning tongue in BMS patients may be caused by a candidal infection even when the tongue appears clinically normal. Aims: To make a precise diagnosis of BMS by means of anamnesis, physical examination, laboratory exams and therapeutic test and to know the clinical profile of these patients. To identify the occurrence and prevalence of Subclinical Atrophic Candidosis (SAC) in the tongue dorsum of BMS patients and to assess the effect of antifungal treatment on the burning tongue. Finally, this study aimed to evaluate the effect of clonazepam mouthwash on burning sensation of patients with final diagnosis of primary BMS. Materials and methods: All patients complaining of a burning mouth sensation were systematically evaluated over a during two-year period. Those BMS patients presenting burning in the tongue were submitted to sialometry and mycological tests. Those diagnosed with SAC received antifungal therapy based on susceptibility testing. The effects of antifungal treatment on the unstimulated salivary flow rate (SFR), colony counting and visual analogue scale (VAS) were assessed. Eighteen patients with final diagnosis of primary BMS were treated with clonazepam mouthwash. Results: Out of 54 patients, 42 (77.8%) were initially diagnosed with primary BMS and 12 (22.2%) were excluded because of local and general causative factors. The patients diagnosed with primary BMS were mainly women, with a mean age of 60.7 years, who presented tongue burning as an isolated symptom or accompanied by xerostomia, tingling or dysgeusia. Hyposalivation was detected in 30.5% of the BMS patients. Twenty-six patients (61.9%) diagnosed with BMS, and presenting burning in the tongue, were submitted to mycological tests. Culture tests indicated that 57.7% of the patients (15/26) exhibited a colony count equal to or more than 5 Candida colonies per agar plate, and were diagnosed with SAC. After a two-week antifungal regimen, there was no significant difference between pre-treatment (0.14 ml/min) and after treatment (0.13 ml/min) SFRs (P=0.706). The antifungal regimen proved effective in treating SAC, as only 3 patients showed more than 5 colonies per agar plate after treatment (P<0.001). There was a significant decrease in the mean VAS after treatment when compared with the pre-treatment rate although none of the patients showed complete remission of the burning sensation. As a general result, clonazepam mouthwash resulted in significant improvement in BMS symptomatology, since the mean VAS went from 5.56 ± 2.77 before treatment to 3.50 ±3.19 afterwards (P = 0.002, Wilcoxon Test). However, one-third of the patients did not respond to treatment. Conclusions: A systematic evaluation, which includes anamnesis and physical examination, of patients complaining of burning mouth sensation is imperative for the diagnosis of primary BMS. However, there are no international guidelines to establish which complementary tests should be used for its final diagnosis. Subclinical atrophic candidosis can often be identified in BMS patients as they may present predisposing factors for oral candidosis, such as low SFR, hyposalivation and the use of removable prostheses. Antifungal treatment improved the symptoms, but was incapable of completely eliminating the burning sensation. Topical treatment with clonazepam mouthwash resulted in significant improvement in BMS symptomatology, but not in all studied patients.