title: Unexplained somatic comorbidities in patients with burning mouth syndrome: a controlled clinical study.
abstract: OBJECTIVE
  To evaluate the prevalence of unexplained extraoral symptoms in a group of patients with burning mouth syndrome (BMS) and compare the prevalence with that in patients with oral lichen planus (OLP) and age- and gender-matched controls.
  
  
  METHODS
  The occurrence of extraoral symptoms was analyzed in a group of 124 BMS patients, a group of 112 oral lichen planus (OLP) patients, and a group of 102 healthy patients. Oral symptoms were collected by a specialist in oral medicine and a general dentist, while data concerning unexplained extraoral symptoms were gathered by each specialist ward, ie, ophthalmology, gynecology, otolaryngology, gastroenterology, neurology, cardiology, internal medicine, and dermatology. A Fisher exact test (α = .05) and Kruskal-Wallis test (α = .05) were performed for statistical analysis.
  
  
  RESULTS
  In the BMS group, 98 (96.1%) patients reported unexplained extraoral symptoms, while 4 (3.9%) patients reported only oral symptoms. A painful symptomatology in different bodily regions was reported more frequently by BMS patients (83.3%) than by OLP patients (1.8%) and healthy patients (11.7%) (P < .0001). The differences in the overall unexplained extraoral symptoms between BMS (96.1%) and OLP patients (9.3%) (P < .0001) and between BMS (96.1%) and healthy patients (15.7%) (P < .0001) were statistically significant. The unexplained extraoral symptoms in BMS patients consisted of pain perceived in different bodily areas (odds ratio [OR]: 255; 95% confidence interval [CI]: 58.4-1112), ear-nose-throat symptoms (OR: 399.7; 95%CI: 89.2-1790), neurological symptoms (OR: 393; 95% CI: 23.8-6481), ophthalmological symptoms (OR: 232.3; 95% CI: 14.1-3823), gastrointestinal complaints (OR: 111.2; 95% CI: 42.2-293), skin/gland complaints (OR: 63.5; 95% CI: 3.8-1055), urogenital complaints (OR: 35; 95% CI: 12-101), and cardiopulmonary symptoms (OR: 19; 95% CI: 4.5-82).
  
  
  CONCLUSIONS
  The great majority of BMS patients presented with several additional unexplained extraoral comorbidities, indicating that various medical disciplines should be involved in the BMS diagnostic process. Furthermore, the results suggest that BMS may be classified as a complex somatoform disorder rather than a neuropathic pain entity.
authors.affiliation: Department of Odontostomatological and Maxillofacial Sciences, "Federico II" University of Naples, Italy. mignogna@unina.it
authors.forename: Michele D
authors.initials: MD
authors.lastname: Mignogna
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pollio
authors.forename: Giulio
authors.initials: G
authors.lastname: Fortuna
authors.forename: Stefania
authors.initials: S
authors.lastname: Leuci
authors.forename: Elvira
authors.initials: E
authors.lastname: Ruoppo
authors.forename: Daniela
authors.initials: D
authors.lastname: Adamo
authors.forename: Claudia
authors.initials: C
authors.lastname: Zarrelli
mesh_terms: D002054:Burning Mouth Syndrome / Q000145:classification / Q000453:epidemiology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D017676:Lichen Planus, Oral / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team; D015995:Prevalence; D013001:Somatoform Disorders / Q000175:diagnosis*; D018709:Statistics, Nonparametric; D013577:Syndrome