Marcadores salivales en síndrome de Boca Ardiente

Abstract

Introduction: Burning Mouth Syndrome is characterized by intraoral burning symptoms without justifying clinical lesions. Its etiology remains unknown, although there are several factors which can act as triggers of the disease: psychological state, different nervous disorders or hormonal factors. Despite the application of different therapies, none has proven to be effective enough in all SBA patients, therefore treatment is still being investigated. Consequently, the need to find biomarkers that help us understand the etiology of this entity and allow the monitoring and follow-up of these patients is evident. Likewise, these biomarkers can be useful to verify the effectiveness of new therapies and to prevent an outbreak in a stressful situation which can trigger or worsen the disease. A recent example of this is the beginning of the Covid-19 pandemic. Objectives: Study of salivary markers related to Burning Mouth Syndrome. Evaluate a Melatonin and Clonazepam treatment versus placebo in BMS. Study the response to stress during Covid-19 pandemic in BMS patients. Material and Method: For the salivary biomarkers settings, 11 markers related to inflammation and immunity against clinical variables were analyzed in unstimulated complete saliva samples using the drainage technique. Two dimensional electrophoresis technique was applied to obtain a saliva proteomic profile of 11 patients with SBA. The treatment response with Melatonin was evaluated in 23 patients against clonazepam group (n=16) and placebo group (n=25). Various clinical variables such as burning degree were evaluated before and after treatment. A total of 40 BMS patients were included to evaluate the impact of the pandemic, clinical variables related to pain and psychological state was evaluated before and after the beginning of Covid-19. Results: Significantly higher levels of: sAA, IgA and MIP-4 and significantly lower levels of uric acid and FRAP were found in saliva of BMS patients compared to control, these markers were positively related to pain, quality of life and anxiety. Different levels of sAA, immunoglobulins, leukocyte elastase inhibitor and coiled-coin domain containing protein 25 were obtained in the proteomic analysis. Melatonin and Clonazepam obtained statistically significant differences with respect to placebo in the reduction of burning symptoms. BMS patients showed a significant worsening of anxiety and burning intensity after the beginning of the pandemic. Conclusions: Saliva could be considered an appropriate biological fluid for the diagnosis, study and control of Burning Mouth Syndrome. Melatonin can be an alternative treatment for SBA, but more studies are needed to clarify its effectiveness compared to placebo. Topical application of Clonazepam continues to be one of the first choices of treatment for this disease. COVID-19 pandemic has acted as a trigger for increased anxiety, sleep quality, and burning intensity in patients with SBA