title: Steroid dysregulation and stomatodynia (burning mouth syndrome).
abstract: Stomatodynia ( burning mouth syndrome) is characterized by a spontaneous, continuous burning pain felt in the oral mucosa typically of anxiodepressive menopausal women. Because there is no obvious organic cause, it is considered a nonspecific pain. This Focus Article proposes a hypothesis based on the following pathophysiological cascade: chronic anxiety or post traumatic stress leads to a dysregulation of the adrenal production of steroids. One consequence is a decreased or modified production of some major precursors for the neuroactive steroid synthesis occurring in the skin, mucosa, and nervous system. At menopause, the drastic fall of the other main precursor supply , the gonadal steroids, leads to a brisk alteration of the production of neuroactive steroids. This results in neurodegenerative alterations of small nerves fibers of the oral mucosa and /or some brain areas involved in oral somatic sensations. These neuropathic changes become irreversible and precipitate the burning pain, dysgeusia, and xerostomia associated with stomatodynia, which all involve thin nerve fibers.
authors.affiliation: Department of Endodontic and Restorative Dentistry, Universite d'Auvergne, Clermont-Ferrand, France. alain.woda@u-clermont1.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Woda
authors.forename: Thuan
authors.initials: T
authors.lastname: Dao
authors.forename: Christelle
authors.initials: C
authors.lastname: Gremeau-Richard
mesh_terms: D000305:Adrenal Cortex Hormones / Q000172:deficiency; D002054:Burning Mouth Syndrome / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000172:deficiency; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008875:Middle Aged; D009061:Mouth Mucosa / Q000294:innervation; D009410:Nerve Degeneration; D009412:Nerve Fibers / Q000473:pathology; D009420:Nervous System / Q000503:physiopathology; D018377:Neurotransmitter Agents / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D017698:Postmenopause / Q000502:physiology; D013256:Steroids / Q000502:physiology*; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D012739:Gonadal Steroid Hormones; D018377:Neurotransmitter Agents; D013256:Steroids