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Meta-Analysis
. 2016 Nov 18;11(11):CD002779.
doi: 10.1002/14651858.CD002779.pub3.

Interventions for treating burning mouth syndrome

Roddy McMillan  1 , Heli Forssell, John Ag Buchanan, Anne-Marie Glenny, Jo C Weldon, Joanna M Zakrzewska
Affiliations
Meta-Analysis

Interventions for treating burning mouth syndrome

Roddy McMillan et al. Cochrane Database Syst Rev. .

Abstract

Background: Burning mouth syndrome (BMS) is a term used for oral mucosal pain (burning pain or discomfort in the tongue, lips or entire oral cavity) without identifiable cause. General population prevalence varies from 0.1% to 3.9%. Many BMS patients indicate anxiety, depression, personality disorders and impaired quality of life (QoL). This review updates the previous versions published in 2000 and 2005.

Objectives: To determine the effectiveness and safety of any intervention versus placebo for symptom relief and changes in QoL, taste, and feeling of dryness in people with BMS.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11) in the Cochrane Library (searched 31 December 2015), MEDLINE Ovid (1946 to 31 December 2015), and Embase Ovid (1980 to 31 December 2015). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any treatment against placebo in people with BMS. The primary outcomes were symptom relief (pain/burning) and change in QoL. Secondary outcomes included change in taste, feeling of dryness, and adverse effects.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. Outcome data were analysed as short-term (up to three months) or long-term (three to six months).

Main results: We included 23 RCTs (1121 analysed participants; 83% female). Interventions were categorised as: antidepressants and antipsychotics, anticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies, and topical treatments.Only one RCT was assessed at low risk of bias overall, four RCTs' risk of bias was unclear, and 18 studies were at high risk of bias. Overall quality of the evidence for effectiveness was very low for all interventions and all outcomes.Twenty-one RCTs assessed short-term symptom relief. There is very low-quality evidence of benefit from electromagnetic radiation (one RCT, 58 participants), topical benzodiazepines (two RCTs, 111 participants), physical barriers (one RCT, 50 participants), and anticonvulsants (one RCT, 100 participants). We found insufficient/contradictory evidence regarding the effectiveness of antidepressants, cholinergics, systemic benzodiazepines, dietary supplements or topical treatments. No RCT assessing psychological therapies evaluated short-term symptom relief.Four studies assessed long-term symptom relief. There is very low-quality evidence of a benefit from psychological therapies (one RCT, 30 participants), capsaicin oral rinse (topical treatment) (one RCT, 18 participants), and topical benzodiazepines (one RCT, 66 participants). We found no evidence of a difference for dietary supplements or lactoperoxidase oral rinse. No studies assessing antidepressants, anticonvulsants, cholinergics, electromagnetic radiation or physical barriers evaluated long-term symptom relief.Short-term change in QoL was assessed by seven studies (none long-term).The quality of evidence was very low. A benefit was found for electromagnetic radiation (one RCT, 58 participants), however findings were inconclusive for antidepressants, benzodiazepines, dietary supplements and physical barriers.Secondary outcomes (change in taste and feeling of dryness) were only assessed short-term, and the findings for both were also inconclusive.With regard to adverse effects, there is very low-quality evidence that antidepressants increase dizziness and drowsiness (one RCT, 37 participants), and that alpha lipoic acid increased headache (two RCTs, 118 participants) and gastrointestinal complaints (3 RCTs, 138 participants). We found insufficient/contradictory evidence regarding adverse events for anticonvulsants or benzodiazepines. Adverse events were poorly reported or unreported for cholinergics, electromagnetic radiation, and psychological therapies. No adverse events occurred from physical barriers or topical therapy use.

Authors' conclusions: Given BMS' potentially disabling nature, the need to identify effective modes of treatment for sufferers is vital. Due to the limited number of clinical trials at low risk of bias, there is insufficient evidence to support or refute the use of any interventions in managing BMS. Further clinical trials, with improved methodology and standardised outcome sets are required in order to establish which treatments are effective. Future studies are encouraged to assess the role of treatments used in other neuropathic pain conditions and psychological therapies in the treatment of BMS.

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Conflict of interest statement

Roddy McMillan: none known. Heli Forssell: none known. John AG Buchanan: John Buchanan has previously co‐authored an evidence‐based review for BMJ publications Clinical Evidence on burning mouth syndrome with Joanna M Zakrzewska. Anne‐Marie Glenny: none known. Anne‐Marie Glenny is an editor with Cochrane Oral Health. Joanna M Zakrzewska: Joanna M Zakrzewska has previously co‐authored an evidence‐based review for BMJ publications Clinical Evidence on burning mouth syndrome with John Buchanan. Jo C Weldon: none known. Jo Weldon is a salaried member of staff of Cochrane Oral Health.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Antidepressants/antipsychotics versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
2.1
2.1. Analysis
Comparison 2 Anticonvulsants versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
3.1
3.1. Analysis
Comparison 3 Benzodiazepines versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
3.2
3.2. Analysis
Comparison 3 Benzodiazepines versus placebo, Outcome 2 Symptom relief ‐ long‐term (>3 to ≤6 months).
3.3
3.3. Analysis
Comparison 3 Benzodiazepines versus placebo, Outcome 3 Change in QoL ‐ Depression ‐ short‐term (≤3 months).
3.4
3.4. Analysis
Comparison 3 Benzodiazepines versus placebo, Outcome 4 Change in taste ‐ short‐term (≤3 months).
4.1
4.1. Analysis
Comparison 4 Cholinergics versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
5.1
5.1. Analysis
Comparison 5 Dietary supplements versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
5.2
5.2. Analysis
Comparison 5 Dietary supplements versus placebo, Outcome 2 Symptom relief ‐ short term (≤3 months).
5.3
5.3. Analysis
Comparison 5 Dietary supplements versus placebo, Outcome 3 Symptom relief ‐ short‐term (≤3 months).
5.4
5.4. Analysis
Comparison 5 Dietary supplements versus placebo, Outcome 4 Symptom relief ‐ long‐term (>3 to ≤6 months).
5.5
5.5. Analysis
Comparison 5 Dietary supplements versus placebo, Outcome 5 Change in QoL ‐ short‐term (≤3 months).
6.1
6.1. Analysis
Comparison 6 Electromagnetic radiation versus placebo, Outcome 1 Symptom relief ‐ VAS ‐ short‐term (≤3 months).
6.2
6.2. Analysis
Comparison 6 Electromagnetic radiation versus placebo, Outcome 2 Change in QoL ‐ short‐term (≤3 months).
7.1
7.1. Analysis
Comparison 7 Physical barriers versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
7.2
7.2. Analysis
Comparison 7 Physical barriers versus placebo, Outcome 2 Change in QoL ‐ short‐term (≤3 months).
8.1
8.1. Analysis
Comparison 8 Psychological therapies versus placebo, Outcome 1 Symptom relief ‐ long‐term (>3 to ≤6 months).
9.1
9.1. Analysis
Comparison 9 Topical treatments versus placebo, Outcome 1 Symptom relief ‐ short‐term (≤3 months).
9.2
9.2. Analysis
Comparison 9 Topical treatments versus placebo, Outcome 2 Symptom relief ‐ short‐term (≤3 months).
9.3
9.3. Analysis
Comparison 9 Topical treatments versus placebo, Outcome 3 Symptom relief ‐ long‐term (>3 to ≤6 months).
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References

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References to studies awaiting assessment

NCT02580734 {published data only (unpublished sought but not used)}
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