Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico
Autor(a) principal: | |
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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 |
Resumo: | 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. |
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Ribeiro-Rotta, Rejane Fariahttp://lattes.cnpq.br/9466795079344876Ribeiro-Rotta, Rejane FariaSugaya, Norberto NobuoCosta, Claudiney CandidoBatista, Aline CarvalhoSilva, Maria do Rosário Rodrigueshttp://lattes.cnpq.br/1749024668988981Castro, Luciano Alberto de2014-11-06T10:34:42Z2013-04-26CASTRO, Luciano Alberto de. Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico. 2013. 146 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2013.http://repositorio.bc.ufg.br/tede/handle/tede/3542Burning 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.A síndrome da ardência bucal (SAB) é uma condição dolorosa crônica que pode afetar vários sítios da mucosa bucal, sendo especialmente frequente na língua. O diagnóstico da SAB deve ser realizado pelo método de exclusão. Estudos têm sugerido que a ardência lingual nos pacientes portadores de SAB pode ser causada por candidose, mesmo que a língua esteja clinicamente normal. Objetivos: Realizar diagnóstico da SAB utilizando os princípios da anamnese, exame físico, exames complementares e prova terapêutica; conhecer o perfil clínico desses pacientes; identificar a ocorrência e prevalência de Candidose Atrófica Subclínica (CAS) no dorso lingual e avaliar o efeito da terapia tópica com clonazepam nos pacientes com diagnóstico final de SAB primária. Materiais e métodos: Pacientes com queixa de ardência bucal, atendidos no período de 2 anos em um centro de referência em estomatologia na região centro-oeste, foram sistematicamente avaliados. Aqueles pacientes com SAB e apresentando ardência na língua foram submetidos à sialometria e exames micológicos. Os pacientes com diagnóstico de SAB e CAS receberam tratamento antifúngico, de acordo com o resultado dos testes de suscetibilidade. Foram avaliados os efeitos do tratamento antifúngico sobre o fluxo salivar não estimulado, a contagem de colônias de Candida e a sensação de ardência dos pacientes com SAB e CAS. E ainda, o efeito do clonazepam, na forma de colutório, sobre a sensação de ardência em pacientes com diagnóstico final de SAB primária. Resultados: Do total de pacientes avaliados (n=54), 42 (77,8%) tiveram diagnóstico inicial de SAB primária e 12(22,2%) foram excluídos devido a causas locais e gerais. Os pacientes diagnosticados com SAB primária eram formados principalmente por mulheres, com média de idade de 60,7 anos, apresentando queixa de ardência bucal isolada ou acompanhada de boca seca, formigamento e disgeusia. A hipossalivação foi detectada em 30,5% dos pacientes com SAB. Vinte e seis pacientes (61,9%) com diagnóstico de SAB e ardência na língua foram submetidos a exames micológicos. Destes, os testes de cultura indicaram que 57,7% (15/26) exibiram contagem de colônias ≥5 colônias de Candida por placa de ágar, sendo diagnosticados com CAS. Após 2 semanas de tratamento antifúngico, não foi observada diferença significativa nos valores do fluxo salivar não estimulado, antes (0,14 ml/min) e depois (0,13 ml/min) do tratamento (P=0,706). A terapia antifúngica foi eficaz para tratar a CAS, uma vez que apenas 3 pacientes exibiram contagem de colônias ≥ 5 após 2 semanas (P<0,001). Apesar de nenhum dos pacientes ter apresentado remissão total da ardência, houve redução na média da escala visual analógica numérica (EVA) de 6 para 4 (P=0,002, Teste de Wilcoxon). De modo geral, o colutório de clonazepam promoveu melhora significativa na ardência, alterando os valores médios da EVA de 5,56 ±2,77 para 3,50 ± 3.19 (P= 0,002, Teste de Wilcoxon). No entanto, um terço dos pacientes não respondeu a essa forma de terapia. Conclusões: O método sistemático de avaliação dos pacientes com ardência bucal por exclusão é essencial para o diagnóstico da SAB primária, entretanto não há padronização internacional para a escolha dos exames complementares a serem empregados. A CAS pode ser frequentemente identificada em pacientes com SAB já que muitos deles possuem fatores predisponentes para a candidose bucal, como o baixo fluxo salivar e o uso de próteses móveis. O tratamento antifúngico promoveu alívio dos sintomas, mas não foi capaz de eliminar a ardência completamente. O tratamento tópico com clonazepam promoveu melhora da sintomatologia da SAB, mas não em todos os pacientes.Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-11-05T10:30:21Z No. of bitstreams: 2 Tese Luciano Alberto de Castro - 2013.pdf: 1800248 bytes, checksum: 271cbcb47ef9b1579e7794d1dd4e20e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-06T10:34:42Z (GMT) No. of bitstreams: 2 Tese Luciano Alberto de Castro - 2013.pdf: 1800248 bytes, checksum: 271cbcb47ef9b1579e7794d1dd4e20e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)Made available in DSpace on 2014-11-06T10:34:42Z (GMT). No. of bitstreams: 2 Tese Luciano Alberto de Castro - 2013.pdf: 1800248 bytes, checksum: 271cbcb47ef9b1579e7794d1dd4e20e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-04-26application/pdfhttp://repositorio.bc.ufg.br/tede/retrieve/11838/Tese%20Luciano%20Alberto%20de%20Castro%20-%202013.pdf.jpgporUniversidade Federal de GoiásPrograma de Pós-graduação em Ciências da Saúde (FM)UFGBrasilFaculdade de Medicina - FM (RG)http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessSíndrome da ardência bucalGlossodíniaCandidoseBurning mouth syndromeGlossodyniaCandidosisCIENCIAS DA SAUDESíndrome da ardência bucal: um estudo sobre o processo de diagnósticoBurning mouth syndrome: a study on the process of diagnosisinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis-100686431261774531060060060015457724759504863388765449414823306929reponame:Repositório Institucional da UFGinstname:Universidade Federal de Goiás (UFG)instacron:UFGLICENSElicense.txtlicense.txttext/plain; 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dc.title.por.fl_str_mv |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
dc.title.alternative.eng.fl_str_mv |
Burning mouth syndrome: a study on the process of diagnosis |
title |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
spellingShingle |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico Castro, Luciano Alberto de Síndrome da ardência bucal Glossodínia Candidose Burning mouth syndrome Glossodynia Candidosis CIENCIAS DA SAUDE |
title_short |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
title_full |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
title_fullStr |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
title_full_unstemmed |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
title_sort |
Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico |
author |
Castro, Luciano Alberto de |
author_facet |
Castro, Luciano Alberto de |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Ribeiro-Rotta, Rejane Faria |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9466795079344876 |
dc.contributor.referee1.fl_str_mv |
Ribeiro-Rotta, Rejane Faria |
dc.contributor.referee2.fl_str_mv |
Sugaya, Norberto Nobuo |
dc.contributor.referee3.fl_str_mv |
Costa, Claudiney Candido |
dc.contributor.referee4.fl_str_mv |
Batista, Aline Carvalho |
dc.contributor.referee5.fl_str_mv |
Silva, Maria do Rosário Rodrigues |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/1749024668988981 |
dc.contributor.author.fl_str_mv |
Castro, Luciano Alberto de |
contributor_str_mv |
Ribeiro-Rotta, Rejane Faria Ribeiro-Rotta, Rejane Faria Sugaya, Norberto Nobuo Costa, Claudiney Candido Batista, Aline Carvalho Silva, Maria do Rosário Rodrigues |
dc.subject.por.fl_str_mv |
Síndrome da ardência bucal Glossodínia Candidose |
topic |
Síndrome da ardência bucal Glossodínia Candidose Burning mouth syndrome Glossodynia Candidosis CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Burning mouth syndrome Glossodynia Candidosis |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
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. |
publishDate |
2013 |
dc.date.issued.fl_str_mv |
2013-04-26 |
dc.date.accessioned.fl_str_mv |
2014-11-06T10:34:42Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
CASTRO, Luciano Alberto de. Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico. 2013. 146 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2013. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/3542 |
identifier_str_mv |
CASTRO, Luciano Alberto de. Síndrome da ardência bucal: um estudo sobre o processo de diagnóstico. 2013. 146 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2013. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/3542 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-1006864312617745310 |
dc.relation.confidence.fl_str_mv |
600 600 600 |
dc.relation.department.fl_str_mv |
1545772475950486338 |
dc.relation.cnpq.fl_str_mv |
8765449414823306929 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Ciências da Saúde (FM) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Medicina - FM (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFG instname:Universidade Federal de Goiás (UFG) instacron:UFG |
instname_str |
Universidade Federal de Goiás (UFG) |
instacron_str |
UFG |
institution |
UFG |
reponame_str |
Repositório Institucional da UFG |
collection |
Repositório Institucional da UFG |
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tasesdissertacoes.bc@ufg.br |
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