Page 11 - GP Fall 2019

and objective diagnosis. Saliva, a biofluid, combined with a diminished cleansing ac- pain. As part of potential postmenopausal
is produced by multiple major and minor tion reflects a compromised host defense conditions, BMS has an onset of 3 years
salivary glands. The submandibular glands function that renders the dentition of meno- prior, to 12 years after, menopause and
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produce two-thirds of the volume of un- pausal women highly susceptible to infec- patients suffering from it often report an al-
stimulated whole saliva, while the parotid tion, erosion and caries. 21 teration in taste and a feeling of dryness in
glands produce 50% of the volume of stim- the mouth even when salivary flow testing
ulated whole saliva. Although saliva’s It is important to note that xerostomia can demonstrates a normal flow rate. 27
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primary component is water, it contains be induced by external causes, namely
proteins that create viscoelasticity, a key drugs (such as anticoagulants, antidepres- In the past, burning mouth syndrome was
to enabling the adherence of saliva to oral sants, antihypertensives, antiretrovirals, identified as a condition of primarily psy-
surfaces. These salivary films contribute hypoglycemics, levothyroxine, multivi- chogenic origin. This continues to interfere
to oral microbiome regulation. In recent tamins and supplements, non-steroidal with the dedication and attention clinicians
years, saliva has also been recognized as a anti-inflammatory drugs, and steroid in- may give patients with these symptoms.
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body fluid rich in disease biomarkers. 16 halers). The increase in polypharmacy as The misperception is fueled by the 5:1 fe-
menopausal women age has the potential male to male ratio of the condition and the
Amylase and mucin are the two textural to exacerbate the harmful effects of the presence of stress as a factor. BMS does
salivary components. The glucose-cleaving diminished endogenous salivary function affect both sexes and its incidence in the
enzyme amylase, primarily secreted by the typical of menopause. 22 general population increases with age. In
parotid gland, functions to initiate diges- any case, complaints of BMS should be
tion by hydrolyzing starch into sugars. Clinical management of xerostomia is followed up. It is vital to understand that
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Mucin, 70% of which is produced by minor aimed at reducing the risk for oral disease there are conditions where an identifiable
salivary glands, is essential for the hydra- (candidiasis, caries, periodontitis) and im- pathophysiology for burning mouth exists
tion and lubrication of oral tissues, which proving comfort. The clinician should offer and these should be ruled out before di-
facilitate speech. Mucin provides a protec- products and strategies that increase the agnosing BMS. These conditions include
tive layer within the oral cavity by altering oral pH, stimulate the flow of remaining lichen planus, geographic tongue, candida
the localization and retention of salivary functioning tissue, provide lubrication, and infections and drug-therapy side effects.
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proteins and, through interaction, reduc- mimic the liquid cleansing quality of stim- Today, hormonal change is considered a
es the pathogenicity of oral microbes and ulated saliva. Patients should be advised to: risk factor in the development of BMS in
facilitates their removal. In addition to women because of the overwhelming num
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preventing demineralization of hard tissues • Avoid drying foods such as dry crackers ber of postmenopausal women affected.
through its pH buffering, saliva promotes • Reduce intake of acidic products
mucosal repair and electrolyte balance. 19 • Increase water intake Current considerations of the pathophysi-
• Avoid sugary food and drinks ology of BMS include disinhibition of the
In the absence of illness or pathology, hu- • Perform oral hygiene as instructed trigeminal nerve due to degeneration of the
man salivary secretion averages 1.5–2.0 • Use sugar-free salivary stimulants chorda tympani branch of the facial nerve
mL/min (1 to 1.5L per day). Stimulated (xylitol products, ginger, aloe vera) and altered production of neuroactive ste-
saliva accounts for up to 90% of daily sal- • Avoid dehydrating liquids (caffeinat- roids in the nervous system mucosa due
ivary output. Unstimulated salivary flow ed coffee/tea, alcohol) to dysregulation and reduction of adrenal
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is 0.3–0.4 mL/min over a 10-minute period • Use oral lubricants and salivary steroids. 26
whereas stimulated salivary flow can in- substitutes
crease to 4.0 mL/min for the same time pe- pH neutralizers (arginine bicarbonate and Treatment goals for burning mouth syndrome
riod. The decrease in female reproductive calcium carbonate) may be useful and sys- include reduction or alleviation of pain sen-
hormones during menopause causes a re- temic sialagogues (parasympathetic drugs) sation, restoration of taste perception, and
duction in salivary output to an extent that may be prescribed. 23,24 support for emotional impact of chronic pain,
leaves many women in a hypofunctional utilizing the following methods:
state. Hyposalivation is determined when Burning mouth syndrome (BMS)
the stimulated salivary rate is ≤0.5–0.7 mL/ Stomatodynia, or burning mouth syndrome, • Reassurance that the condition is not
min and the unstimulated rate is ≤0.1 mL/ has a strong correlation with menopause. life-threatening
min (this unstimulated rate is only consid- It is a chronic disorder characterized by a • Medications that reduce the activity
ered normal during sleep). Both of these burning, tender, tingling, hot, scalding, and of nerve fibers. Drug therapy with al-
are measured over a 10-minute period. 20 numb sensation in the oral mucosa and is pha lipoic acid, clonazepam, and an-
experienced in the absence of any visible tidepressants may provide symptom
Reduced lubrication, the major oral change alteration in the oral mucosa. Once be- relief.
with hyposalivation, affects taste, swallow- lieved to affect only the tongue, BMS is • Stress management
ing, and speech and manifests clinically now known to affect other oropharangeal • Yoga
in tongue fissuring, increased plaque ac- areas as well, with the anterior two thirds • Exercise
cumulation, and mucosal atrophy. Micro- of the tongue the most common site. It is • Topical capsaicin
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scopically, decreased pH buffering allows considered an idiopathic condition as there • Sipping a cold beverage, sucking on
increased growth of damaging acidophilic is no confirmed etiology and no confirma- ice chips or chewing sugarless gum
bacteria. The reduction in the available tory diagnostic test. Reported symptoms help to ease pain 26
protective cellular components of saliva range from mild discomfort to intense
www.nysagd.org l Fall 2019 l GP 11