Characterization of Burning Mouth Syndrome in Patients with Parkinson’s Disease

Aims: To determine the prevalence and characteristics of burning mouth syndrome (BMS) in a Parkinson’s disease (PD) population through a self-administered, custom-made survey. Methods: A total of 218 surveys were collected during regular outpatient visits at two Movement Disorders Clinics in Montreal (Canada) and Toulouse (France) to gather information about pain experience, PD-related symptoms, and oral and general health. A neurologist confirmed the diagnosis of PD, drug treatment, Hoehn-Yahr stage, and Schwab & England Activity of Daily Living score. Data between groups were compared using the independent samples Mann-Whitney U test and two-sided exact Fisher test. Results: Data from 203 surveys were analyzed. BMS was reported by eight subjects (seven females and one male), resulting in a prevalence of 4.0% (95% confidence interval [CI] = 2.1–7.8). Five participants with chronic nonburning oral pain were excluded. PD severity and levodopa equivalent daily dose did not differ between non-BMS and BMS participants. Mean poor oral health index was higher in BMS compared to non-BMS subjects (49.0 vs 32.2 points, P < .05). BMS manifested after PD onset in seven patients, did not occur on a daily basis in four, and always coexisted with restless legs syndrome. Conclusion: This survey yielded a low prevalence of BMS in PD patients, indicating no strong link between the two conditions. An augmenting effect such as that resulting from drug treatment in restless legs syndrome or sensory neuropathy cannot be excluded.

burning mouth syndrome; oral pain; Parkinson's disease

1. Lee MA, Walker RW, Hildreth TJ, Prentice WM. A survey of pain in idiopathic Parkinson’s disease. J Pain Symptom Manage 2006;32:462–469.

2. Defazio G, Berardelli A, Fabbrini G, et al. Pain as a nonmotor symptom of Parkinson disease: Evidence from a case-control study. Arch Neurol 2008;65:1191–1194.

3. Wasner G, Deuschl G. Pains in Parkinson disease--many syndromes under one umbrella. Nat Rev Neurol 2012;8:284–294.

4. Gerdelat-Mas A, Simonetta-Moreau M, Thalamas C, et al. Levodopa raises objective pain threshold in Parkinson’s disease: A RIII reflex study. J Neurol Neurosurg Psychiatry 2007; 78:1140–1142.

5. Brefel-Courbon C, Payoux P, Thalamas C, et al. Effect of levodopa on pain threshold in Parkinson’s disease: A clinical and positronemission tomography study. Mov Disord 2005;20: 1557–1563.

6. Scala A, Checchi L, Montevecchi M, Marini I, Giamberardino MA. Update on burning mouth syndrome: Overview and patient management. Crit Rev Oral Biol Med 2003;14:275–291.

7. Kohorst JJ, Bruce AJ, Torgerson RR, Schenck LA, Davis MD. The prevalence of burning mouth syndrome: A population-based study. Br J Dermatol 2015;172:1654–1666.

8. Clifford TJ, Warsi MJ, Burnett CA, Lamey PJ. Burning mouth in Parkinson’s disease sufferers. Gerodontology 1998;15:73–78.

9. Coon EA, Laughlin RS. Burning mouth syndrome in Parkinson’s disease: Dopamine as cure or cause? J Headache Pain 2012;13: 255–257.

10. Stuginski-Barbosa J, Rodrigues GG, Bigal ME, Speciali JG. Burning mouth syndrome responsive to pramipexol. J Headache Pain 2008;9:43–45.

11. Jääskeläinen SK, Rinne JO, Forssell H, et al. Role of the dopaminergic system in chronic pain – a fluorodopa-PET study. Pain 2001;90:257–260.

12. Hagelberg N, Forssell H, Rinne JO, et al. Striatal dopamine D1 and D2 receptors in burning mouth syndrome. Pain 2003;101:149–154.

13. Koszewicz M, Mendak M, Konopka T, Koziorowska-Gawron E, Budrewicz S. The characteristics of autonomic nervous system disorders in burning mouth syndrome and Parkinson disease. J Orofac Pain 2012;26:315–320.

14. Heo JY, Ok SM, Ahn YW, Ko MY, Jeong SH. The application of neuropathic pain questionnaires in burning mouth syndrome patients. J Oral Facial Pain Headache 2015;29:177–182.

15. Zlotnik Y, Balash Y, Korczyn AD, Giladi N, Gurevich T. Disorders of the oral cavity in Parkinson’s disease and parkinsonian syndromes. Parkinsons Dis 2015;2015:379482.

16. Evans AH, Katzenschlager R, Paviour D, et al. Punding in Parkinson’s disease: Its relation to the dopamine dysregulation syndrome. Mov Disord 2004;19:397–405.

17. Ceravolo R, Cossu G, Bandettini di Poggio M, et al. Neuropathy and levodopa in Parkinson’s disease: Evidence from a multicenter study. Mov Disord 2013;28:1391–1397.

18. Paterson AJ, Lamb AB, Clifford TJ, Lamey PJ. Burning mouth syndrome: The relationship between the HAD scale and parafunctional habits. J Oral Pathol Med 1995;24:289–292.

19. Lauria G, Majorana A, Borgna M, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain 2005; 115:332–337.

20. Nagel MA, Choe A, Traktinskiy I, Gilden D. Burning mouth syndrome due to herpes simplex virus type 1. BMJ Case Rep 2015;2015. pii: bcr2015209488.

21. Levenson JL. Burning mouth syndrome as a side effect of SSRIs [letter to the editor]. J Clin Psychiatry 2003;64:336–337; author reply 337–338.