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• W107942751 abstract "IntroductionBurning mouth syndrome is characterised by a spontaneous burning pain in the oral mucosa without known cause or standardised treatment. The aims of this study are to evaluate and compare the efficacy of clonazepam and diazepam in relieving the symptoms associated with burning mouth syndrome and discuss the physiological reasons for patient response variation. The study also evaluates which patients this treatment might be effective for by correlating treatment efficacy with underlying psychological status.MethodsThe medical records of burning mouth syndrome patients attending an Oral Medicine Private Practice (1999-2004) were reviewed. The patients treated with either diazepam and/or clonazepam were then contacted by post and asked to complete a short questionnaire regarding their response to diazepam/clonazepam drug therapies, their current symptoms and if appropriate the most significant factors in relieving/aggravating their symptoms. Medical research ethics committee clearance was obtained prior to commencement.The patients still receiving treatment for burning mouth syndrome, as well as newly presenting patients diagnosed with burning mouth syndrome, were asked to fill out a hospital, anxiety and depression assessment form. This was used to correlate treatment success with underlying psychological status.Aseparate study examined the differences between patients with Burning mouth syndrome and individuals who experienced other types of mouth pain in terms of their cognitions, coping strategies, affect, and pain experiences. Thirty-three patients were compared to 30 healthy dental patients who experienced other types of mouth pain. Both groups of participants received a hospital, anxiety and depression questionnaire, as well as other questionnaires pertaining to intrusive thoughts, cognitions, sensory and affective mouth pain, and coping strategies.ResultsTwo hundred and twenty-two patients suffering from burning mouth syndrome were identified, 194 patients were treated with benzodiazepines, diazepam and/or clonazepam.Atotal of 92 patients responded to the questionnaire, of which 80 were female and 12 were male. 21 patients were treated with clonazepam for burning mouth syndrome and the remainder with diazepam. 71.4% of patients treated with clonazepam had partial or complete resolution of their oral symptoms, while 55.1% of patients treated with diazepam had partial or complete resolution of their oral symptoms. The duration of therapy with diazepam was more closely correlated with success of the treatment.Thirty patients completed the hospital anxiety and depression scale, of these 20 received diazepam and 10 patients received clonazepam as part of their therapeutic management for burning mouth syndrome. There was no correlation between the success of the medication treatment and underlying anxiety or depression. Anxiety levels, however, were correlated to levels of depression in burning mouth syndrome patients.Individuals who had been diagnosed with burning mouth syndrome experienced significantly different cognitions, affective disorders, used different coping strategies, had increased psychopathology and had dissimilar types of pain experiences in comparison to the control group of dental pain patients.DiscussionA greater percentage of patients taking clonazepam reported either partial or complete relief of symptoms compared to those using diazepam alone. However, the differences were not statistically significant. There was acorrelation between the duration of the drug therapy and relief of symptoms with respect to diazepam but not clonazepam.The literature, and this retrospective investigation, supports treatment of burning mouth syndrome with low dose and topical clonazepam, however treatment is not effective in all patients and the reason for success and failure of treatment is not known. This study attempted to identify a correlation between underlying psychological factors and treatment success with clonazepam and/or diazepam in order to streamline and improve outcomes for burning mouth syndrome patients. There was no correlation found between underlying psychopathology and treatment success with clonazepam/diazepam. Benzodiazepines act both locally and systemically to reduce the symptoms associated with burning mouth syndrome, but clonazepam seems to have greater efficacy than diazepam. Although it may be argued that the drugs are exerting their effect by acting as anxiolytic agents and effecting psychogenic changes in this manner, it appears unlikely. Medications appear to be most effective at either low doses or topically, and not related to individual psychopathology which is suggestive of an alternative mechanism to that when utilized in higher doses as hypnotics/sedatives and perhaps indicative of sensory dysfunction.This second component of this research project supported previous studies that have found that patients with burning mouth syndrome have higher levels of psychopathology than those that experience defined organic types of mouth pain. Significant differences for psychological factors were found to exist between the two mouth pain groups. Burning mouth syndrome sufferers experienced different types of cognitions, coping strategies, pain, and affect in comparison to those who experienced mouth pain caused by an identifiable source. These patients were significantly more likely to experience more emotional pain, have a higher level of current pain, and a worse overall pain experience. These factors are important to consider when treating patients with burning mouth syndrome, as they are more likely to confuse sensory and affective pain when recording pain intensity scores. Consequently, given the multi-dimensional pain experience of burning mouth syndrome patients, a pain intensity scale should be used in combination with an assessment of emotional and psychological aspects of pain. This will enable the clinician to assess treatment efficacy as well as obtain a greater picture of the overall needs of the patient." @default.
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• W107942751 date "2007-01-01" @default.
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• W107942751 title "Investigation into the therapeutic effectiveness of benzondiazapines in the management of burning mouth syndrome." @default.
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