title: "Burning tongue" and "burning tip": the diagnostic challenge of the burning mouth syndrome.
abstract: OBJECTIVE
  To investigate the clinical features of burning mouth syndrome (BMS) in a large cohort of patients and to correlate them with the results of tongue biopsy.
  
  
  METHODS
  We screened 98 patients complaining of oral burning pain for at least 6 months. Forty-two patients were excluded after screening for contact sensitivity to dental materials, food allergies, tongue injuries, malignancies, connective tissue and metabolic disorders, oral infectious diseases, vitamin deficiencies, and other systemic diseases known to cause neuropathy. Fifty-six patients underwent neurologic examination and assessment of pain intensity, depression, anxiety, quality of sleep, and quality of life. Tongue biopsy with the quantification of epithelial nerve fibers (ENF) was performed in 51 patients.
  
  
  RESULTS
  Compared with 9 healthy participants (4.13+/-1.85 SD), epithelial innervation density was significantly reduced in 38 patients (1.35+/-1.46 SD; P<0.0001) and normal in 13 patients (6.1+/-2.19 SD). The clinical features differed in the two groups: patients with reduced ENF density complained of pain in the whole tongue, lips, hard palate, and alveolar ridges, reported dysgeusia and xerostomia in 29% of cases (P<0.001), and 24% of them were depressed. Patients with normal innervation complained of pain on the tip of the tongue, reported dysgeusia and xerostomia in 7.7% of cases, and 54% of them were depressed (P<0.017).
  
  
  CONCLUSIONS
  The diagnostic criteria for BMS are not defined yet and the relationship with depression and anxiety is debated. We proposed a biopsy-supported approach for the diagnosis. Our study shows that BMS can present with two distinct clinical pictures and that tongue biopsy can contribute to the assessment of the diagnosis. Mood disorders occur frequently and should be considered when approaching patients and treatment options. These observations could help physicians in identifying patients with BMS and addressing them with the appropriate diagnostic work-up and treatment.
authors.affiliation: Neuromuscular Diseases Unit, IRCCS Foundation Carlo Besta National Neurological Institute, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Penza
authors.forename: Alessandra
authors.initials: A
authors.lastname: Majorana
authors.forename: Raffaella
authors.initials: R
authors.lastname: Lombardi
authors.forename: Francesca
authors.initials: F
authors.lastname: Camozzi
authors.forename: Sara
authors.initials: S
authors.lastname: Bonadeo
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Sapelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lauria
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D002054:Burning Mouth Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008046:Lip / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D014059:Tongue / Q000473:pathology; D014060:Tongue Diseases / Q000209:etiology*