Women were more likely than men to have the condition as were patients over age 64

A chronic oral pain disorder referred to as “burning mouth syndrome” significantly increased the risk of depression and anxiety in a representative sample of Korean participants compared to matched unaffected controls, a retrospective, population-based cohort study found.

In a sample of 1,758 participants, subjects who had been diagnosed with burning mouth syndrome — a chronic oral pain condition that presents clinically as a burning sensation in the oral cavity without any evidence of abnormal lesions or laboratory findings — had almost at 3-fold risk of developing depression at an adjusted hazard ratio (aHR) of 2.77 (95% CI, 2.22-3.45) compared to those who did not, Jong-Yeup Kim, MD, PhD, Hallym University College of Medicine, Gangwon-do, Republic of Korea, and colleagues reported in JAMA Otolaryngology — Head Neck Surgery.

The risk of developing anxiety was also over two-fold higher in patients with the syndrome at an aHR of 2.42 (95% CI, 2.02-2.90) compared to those without the syndrome, investigators added.

In contrast, there was no excess risk of either dementia or Parkinson’s disease (PD) in burning mouth syndrome patients compared with controls.

“To our knowledge, the present study is the first to analyze the risk of developing psychoneurological conditions, such as depression, anxiety, dementia, and PD, in patients with burning mouth syndrome,” Kim and colleagues observed.

“Clinicians should be aware of the potential comorbidities that may be present in patients with burning mouth syndrome and be prepared to make appropriate referrals to mental health professionals,” they suggested.

The nationwide representative cohort sample from the Korean National Health Insurance Service—National Sample Cohort database was used for the current analysis.

In the total sample, 61.8% were female, 39.9% were under the age of 45 years, and 37.9% were between 45-64 years of age. The remaining 22.2% were over the age of 64.

Some 586 patients had been diagnosed with burning mouth syndrome and the remaining 1,172 participants did not have the syndrome.

“We found that female patients and older patients were associated with a significantly higher likelihood of developing depression and anxiety,” Kim and colleagues noted.

Among females, the aHR for developing depression was over two-fold higher at an aHR of 2.13 (95% CI, 1.62-2.80) for those with the syndrome compared to those without.

In the same subgroup of females, the risk of developing anxiety was about 1.5-times higher at an aHR of 1.47 ((5% CI, 1.19-1.82) for those with the syndrome compared to those without, researchers noted.

For participants over the age of 64, the risk of developing depression was slightly lower than it was for females at an aHR of 1.68 (95% CI, 1.16-2.43).

However, the risk of older adults developing anxiety was again over two-fold greater at an aHR of 2.13 (95% CI, 1.57-2.91) for those with the syndrome compared to those without.

Comorbidities were also significantly associated with the development of both depression and anxiety at an aHR of 2.87 (95% CI, 2.03-4.04) and 2.27 (95% CI, 1.73-2.99), respectively, for those with the syndrome compared to those without.

“In general, psychological disorders may be associated with the modulation of pain perception, increasing nerve transmission by peripheral pain receptors and altering individuals’ perception of pain,” they suggested.

“Given this association,” the authors added, “psychosocial events may often be associated with the onset or exacerbation of symptoms in patients with burning mouth syndrome.”

Limitations of the study included investigators’ inability to adjust for potential confounding factors including undiagnosed mental health problems and other comorbidities associated with psychoneurological conditions.

Commenting on the study, editorialists Federica Galli, PhD, and Gabriella Pravettoni, PhD, both from the European Institute of Oncology in Milan, Italy, pointed out that the increased risk of depression and anxiety observed in patients with burning mouth syndrome is not new but the same finding here further substantiates the role of psychological factors in this particular syndrome.

“[T]he association of anxiety and depression is more the rule than the exception in most patients with chronic pain disorders and diseases,” they observed.

Thus, burning mouth syndrome might be thought of as a model of a psychosomatic disorder where the biological milieu interacts with psychological factors, they suggested.

By this, the editorialists don’t mean that whatever gives rise to the burning mouth syndrome is only psychological in nature but that the role of psychological factors in this syndrome is likely more prominent than it is in most diseases.

The identification of these psychological factors is important, the editorialists suggested, as this could prevent time-consuming and expensive diagnostic examination as well as prescriptions for multiple medications that likely would not benefit these patients.

“The patient with burning mouth syndrome should be made aware that her/his condition is still poorly understood by evidence-based medical research,” Galli and Pravettoni elaborated.

“[And] that this lack of understanding means uncertainty in diagnosis and treatment and that the role of psychological factors is likely to be associated with this disorder,” they added.

The editorialists suggested that patients with these types of conditions may benefit from a psychological support system.

They also noted that a good exchange of information between the health care provider and the patient can be therapeutic as well, as good information helps ease anxiety and depression and allows patients to better cope with the syndrome.

  1. Patients with a chronic oral pain disorder referred to as burning mouth syndrome had almost a 3-fold higher risk of depression and an over 2-fold greater risk of anxiety than matched controls without the syndrome.

  2. Women were more likely than men to be diagnosed with the burning mouth syndrome as were patients over the age of 64 compared with younger patients.

Pam Harrison, Contributing Writer, BreakingMED™

The study was supported by a grant from the Korea Health Technology Research and Development Project.

The authors and editorialists had no conflicts of interest to declare.

Cat ID: 52

Topic ID: 87,52,730,192,52,55