Anxiety and salivary cortisol levels in patients with burning mouth syndrome: case-control study

Anxiety and salivary cortisol levels in patients with burning mouth syndrome: case-control study

Amenabar JM, Pawlowski J, Hilgert JB, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(4):460–465.[Medline]

The authors conducted this case-control study to assess the anxiety and salivary cortisol levels in patients with burning mouth syndrome (BMS). They studied 30 patients who had experienced oral burning, pain or both for at least six months, had no mucosal lesions or other clinical signs of disease and whose results from a battery of laboratory tests were within the range of normal values. The patients (case subjects) included 24 women and six men with a mean age of 61.6 years. Thirty control subjects without oral complaints were matched to the case subjects by sex, race, marital status, income and educational level. The authors measured anxiety levels by using the Beck Anxiety Inventory, which is used to evaluate symptoms of anxiety perceived by the subject during the week preceding the assessment. The investigators assessed stimulated and unstimulated flow rates of whole saliva and had all subjects collect stimulated saliva for measurement of cortisol levels at three points during a single day.

The patients with BMS reported experiencing pain for periods that ranged from six to 96 months, with an average of 32.8 months. The respective stimulated and unstimulated salivary flow rates in the case and control groups were not statistically significantly different from each other, although the patients with BMS reported subjective xerostomia significantly more frequently than did the control subjects (60.0 percent versus 26.7 percent). The authors found that members of the BMS group had higher anxiety levels than did members of the control group; 13 percent of patients with BMS and none of the control subjects had severe anxiety. In addition, the subjects with BMS had significantly higher salivary cortisol levels at each of the three sampling times than did the control subjects.

The results of this study confirmed that patients with BMS have significantly higher levels of anxiety than do people without this syndrome and showed an association between high anxiety levels and salivary cortisol levels, a physiological indicator of stress. Moreover, they showed that the subjective reports of xerostomia by patients with BMS generally are not related to an actual reduction in salivary flow.

Significance. The absence of clinical signs associated with BMS provides a challenge to understanding the etiology and pathogenesis of this disorder. This study provides additional support for an association between anxiety and BMS on the basis of both a psychological assessment and a physiological marker.
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