title: Peripheral nervous system involvement in primary burning mouth syndrome--results of a pilot study.
abstract: OBJECTIVE
  The pathophysiology of primary burning mouth syndrome (BMS) has remained enigmatic, but recent studies suggest pathology within the nervous system at multiple levels. This study aimed to investigate in detail the contribution of either focal or generalized alterations within the peripheral nervous system (PNS) in the etiopathogenesis of BMS.
  
  
  METHODS
  Intraepithelial nerve fiber density (IENFD) of tongue mucosa was assessed in 10 carefully characterized BMS, and the results were compared to 19 age- and gender-matched cadaver controls, 6 with lifetime diabetes. Extensive neurophysiologic and psychophysical examinations of the trigeminal system and distal extremities were performed to profile PNS function in BMS.
  
  
  RESULTS
  Patients with BMS had significantly fewer intraepithelial nerve fibers (0,27, s.e. 0,18 mm(-1); P = 0.0253) than non-diabetic controls (0,92, s.e. 0,15 mm(-1)). In the subepithelial space, the amount of nerve fibers did not differ between the groups. The majority (9/10) of patients with BMS showed neurophysiologic or psychophysical signs of a more generalized PNS dysfunction.
  
  
  CONCLUSIONS
  Our results in neurophysiologically optimally characterized BMS patients confirm that pure focal small fiber neuropathy of the oral mucosa has a role in the pathophysiology of primary BMS. Furthermore, BMS may be related to a more generalized, yet subclinical peripheral neuropathy.
authors: Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.
authors: A
authors: A
authors: Puhakka
authors: Institute of Dentistry, University of Turku, Turku, Finland.
authors: H
authors: H
authors: Forssell
authors: Division of Clinical Neurosciences/General Department of Neurology, Turku University Hospital, Turku, Finland.|Department of Neurology, University of Turku, Turku, Finland.|Institute of Biomedicine, Department of Anatomy, University of Helsinki, Helsinki, Finland.
authors: S
authors: S
authors: Soinila
authors: Department of Biostatistics, University of Turku, Turku, Finland.
authors: A
authors: A
authors: Virtanen
authors: Department of Pathology, Turku University Hospital, Turku, Finland.
authors: M
authors: M
authors: Röyttä
authors: Institute of Dentistry, University of Turku, Turku, Finland.
authors: M
authors: M
authors: Laine
authors: Department of Neurology, University of Turku, Turku, Finland.|Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland.
authors: O
authors: O
authors: Tenovuo
authors: Department of Oral Diseases and Pain Clinic, Turku University Hospital, Turku, Finland.
authors: T
authors: T
authors: Teerijoki-Oksa
authors: Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.|Department of Clinical Neurophysiology, University of Turku, Turku, Finland.
authors: S K
authors: SK
authors: Jääskeläinen
mesh_terms: D000368:Aged; D002054:Burning Mouth Syndrome / Q000209:etiology*; D002102:Cadaver; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000473:pathology; D004848:Epithelium / Q000294:innervation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009061:Mouth Mucosa / Q000294:innervation*; D017933:Peripheral Nervous System / Q000473:pathology* / Q000503:physiopathology*; D010865:Pilot Projects; D011603:Psychophysiology; D014059:Tongue / Q000294:innervation*; D014276:Trigeminal Nerve / Q000473:pathology / Q000503:physiopathology
keywords: burning mouth syndrome; intraepithelial nerve fiber density; peripheral neuropathy; small fiber neuropathy