Effect of Medications, Dietary Supplements and Psychosocial Interventions in Burning Mouth Syndrome Patients: A Systematic Review with Meta-analyses

Abstract

The objective of this review is to determine the efficacy of cognitive behavioral therapy, oral and topical medications as well as dietary supplements to reduce pain in burning mouth syndrome patients (BMS). Methods: The Cochrane Library, Medline via PubMed and Web of Science were searched. Eligible studies were limited to randomized placebo-controlled trials on interventions used to treat BMS. Risk of bias was independently assessed in triplicate. Results: Twenty-two studies were included in this review. Fifteen reported baseline and post-treatment pain intensity, however due to the heterogeneity of the interventions subgroup analyses are presented by intervention. Subgroup analyses on the reduction of pain with alpha-lipoic acid (ALA) showed no significant difference with placebo (p=.713). However, a subgroup analysis with four studies showed ALA improved patients' symptoms significantly (RR=2.676; 95% CI 1.933 to 3.705; p<.001). Individual studies showed significant improvement in pain intensity with topical clonazepam (p<.001), capsaicin (p<.001), catuama (p=.009), and CBT (p<.001). No significant differences were found in individual studies reporting pain reduction with benzydamine HCl, chamomile, H. perforatum, lidocaine, lycopene-enriched olive oil and trazodone (p>.05). Pooled results with two studies each showed capsaicin (p<.001) and CBT (p=.031) significantly improved patients' symptoms. Conclusions: Low quality of evidence is available due to heterogeneity of the interventions, unclear or high risk of bias and differences in outcomes reported resulting in small number of studies included in each subgroup analysis. ALA, topical clonazepam, CBT, catuama and capsaicin should be studied further in high quality randomized clinical trials to provide recommendations for BMS patients.

Efficacy of alpha-lipoic acid in patients with burning mouth syndrome compared to that of placebo or other interventions: a systematic review with meta-analyses

“…The pooled results showed that patients receiving ALA were 92% more likely to have an improvement in BMS symptoms (P = 0.031). These results are consistent with reviews by De Souza et al [ 28 ], Liu et al [ 14 ], and Phan et al [ 29 ].…”

“…Liu et al [ 14 ] reported that five of six studies showed an improvement, with no significant differences in pain scores between ALA and placebo. Phan et al [ 29 ] reported that ALA showed no significant difference in pain reduction from placebo (P = 0.713) and that ALA significantly improved patients’ symptoms in four studies (RR = 2.676; P < 0.001).…”