Burning Mouth Syndrome – Glossodynia

Lasers Med Sci. 2016 Feb 12. [Epub ahead of print]

A randomized pilot study to assess the safety and the value of low-level laser therapy versus clonazepam in patients with burning mouth syndrome.

Arduino PG1, Cafaro A2, Garrone M2, Gambino A2, Cabras M2, Romagnoli E3, Broccoletti R2.
Author information
1Department of Surgical Sciences, Oral Medicine Section, University of Turin, Unito Lingotto Dental Institute c/o Lingotto, Via Nizza 230, 10126, Turin, Italy. paologiacomo.arduino@unito.it.
2Department of Surgical Sciences, Oral Medicine Section, University of Turin, Unito Lingotto Dental Institute c/o Lingotto, Via Nizza 230, 10126, Turin, Italy.
3Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy.
Comparison between low-level laser therapy (LLLT) and clonazepam for treating burning mouth syndrome (BMS) patients has never been documented; the aim of this study was to assess the effects of LLLT photobiomodulation versus medical therapy with clonazepam on BMS. Thirty-three patients (25 female, 8 male, mean age=67.12) were randomly allocated to two different groups: the first one (group A, 18 patients) underwent two laser irradiation sessions weekly for 5 weeks, whereas the second one (group B, 15 patients) received topical clonazepam therapy [half a tablet (2 mg) in the mouth without swallowing for 3 min, three times a day for 21 days]. LLLT was delivered with a continuous wave 980-nm aluminum gallium arsenide (AlGaAs) diode laser and the output of 300 mW, delivering a Fluence of 10 J/cm2, using a “spot technique,” with an average power density of about 1 W/cm2. The laser probe was held perpendicularly at a distance of about 2 mm from the mucosa. Visual analogue scale (VAS), McGill Pain Questionnaire, present pain intensity (PPI), and Oral Health Impact Profile (OHIP-49) assessed sensation of pain. Hospital Anxiety and Depression Scale and Geriatric Depression Scale assessed levels of anxiety and depression. Twelve weeks after the end of treatment, patients treated with LLLT experienced a decrease in pain sensation reported for all the parameters analyzed: VAS (P=0.004), McGill Pain Questionnaire (P=0.002), PPI (P=0.002), and OHIP-49 (P=0.010). The group treated with clonazepam had less favorable results for VAS (P=0.33), McGill Pain Questionnaire (P=0.005), PPI (P=0.013), and OHIP-49 (P=0.25). Levels of anxiety and depression did not change statistically in any groups (P>0.05). Comparing the two groups, LLLT appeared to be superior in improving pain perception, but statistically only at 8 weeks after the end of the protocol proposed (P=0.026). Based on this preliminary trial, LLLT is capable of reducing the symptoms of patients with BMS with a constant and long-lasting effect, experienced since the end of the first applications.
J Biomed Opt. 2015 Sep;20(9):098001. doi: 10.1117/1.JBO.20.9.098001.

Efficacy of low-level laser therapy for the treatment of burning mouth syndrome: a randomized, controlled trial.

Spanemberg JC1, López López J2, de Figueiredo MA1, Cherubini K1, Salum FG1.
Author information
1Pontifical Catholic University of Rio Grande do Sul-PUCRS, Oral Medicine Division, Avenida Ipiranga 6690, room 231, CEP 90610-000, Porto Alegre, Brazil.
2University of Barcelona: Bellvitge University Campus, Oral Pathology Division, Departament of Odontoestomatology-School of Dentistry, Pabellón de Gobierno C/FeixaLLarga, s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.
The aim of the present study was to assess the effect of low-level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS). A diode laser was used in 78 BMS patients who were randomly assigned into four groups: IR1W, n = 20 (830 nm, 100 mW, 5 J, 176 J/cm2, 50 s, LLLT weekly sessions, 10 sessions); IR3W, n = 20 (830 nm, 100 mW, 5 J, 176 J/cm2, 50 s, three LLLT weekly sessions, 9 sessions); red laser, n = 19 (685 nm, 35 mW, 2 J, 72 J/cm2, 58 s, three LLLT weekly sessions, 9 sessions); and control-group (CG), n = 19. Symptoms were assessed at the end of the treatment and eight weeks later; quality of life related to oral health was assessed using the Oral Health Impact Profile (OHIP-14). Statistical analysis was carried out using repeated measures analysis of variance followed by the posthoc Tukey test. There was significant reduction of the symptoms in all groups at the end of the treatment, which was maintained in the follow-up. The scores of the IR1W and IR3W laser groups differed significantly from those of the CG. There was also a decrease in the OHIP-14 scores in the four groups. The IR3W laser group scores differed significantly from those of the CG. LLLT reduces the symptoms of BMS and may be an alternative therapeutic strategy for the relief of symptoms in patients with BMS.
Lasers Med Sci.  2012 Jul 8. [Epub ahead of print]

Proinflammatory cytokine levels in saliva in patients with burning mouth syndrome before and after treatment with low-level laser therapy.

Pezelj-Ribari S, Kqiku L, Brumini G, Urek MM, Antoni R, Kuiš D, Glažar I, Städtler P.


Department of Oral Medicine and Periodontology, School of Dentistry, Faculty of Medicine, University of Rijeka, Bra?e Branchetta 20, Rijeka, Croatia, sonja.pezelj-ribaric@medri.hr.


The aim of this study was to determine the levels of proinflammatory tumor necrosis factor-alpha (TNF-?) and interleukin-6 (IL-6) cytokines in whole unstimulated saliva in subjects with burning mouth syndrome (BMS) before and after treatment with low-level laser therapy (LLLT). BMS is characterized by a continuous, painful burning sensation in a clinically normal-appearing oral mucosa. A sample consisting of 40 consecutive subjects was selected on a voluntary basis from the pool of patients who presented for diagnosis and treatment of BMS at the Oral Medicine Unit of the Faculty of Medicine of the University of Rijeka. For determination of salivary levels of TNF-? and IL-6, ELISA (Sigma Immunochemicals, St. Louis, MO, USA) was performed to determine the salivary levels of TNF-? and IL-6. After 4 weeks of LLLT, the salivary levels of TNF-? and IL-6 in the experimental group decreased significantly (p?<?0.001). There was no significant difference in the experimental group regarding visual analogue scale.

Photomed Laser Surg.  2011 Dec;29(12):793-6. doi: 10.1089/pho.2011.3016.

Effect of low-level laser therapy in the treatment of burning mouth syndrome: a case series.

dos Santos Lde F, Carvalho Ade A, Leão JC, Cruz Perez DE, Castro JF.


Department of Clinical and Preventive Dentistry, Oral Medicine Unit, Federal University of Pernambuco, Recife/PE, Brazil.



The aim of this study was evaluate the effect of low-level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS) patients.


BMS is a clinical condition characterized by a burning sensation in a morphologically normal oral mucosa, without association with systemic disorders.


Ten patients with oral burning sensation were included in the study. After careful evaluation of medical history and oral examination, the diagnosis of BMS was established. All patients were submitted to one weekly session of LLLT for 10 weeks. A continuous wavelength of 660?nm, power 40?mW, 20?J/cm(2), 0.8?J/point, with each point irradiated for 10?sec. In all sessions the burning intensity was evaluated with a 10-cm visual analogue scale (VAS), with 0 indicating no symptoms and 10 indicating the worst burning possible. The burning intensity evaluation by VAS was performed immediately before (VAS baseline) and immediately after each LLLT session. The nonparametric Wilcoxon test was used for statistical analysis, considering significance of 5%.


All patients reported improvement in all sessions, with reduction in VAS scores by up to 58% in the tenth session. When only the VAS baseline of the first session was compared with the other sessions, there was a statistically significant reduction in VAS scores in the fourth (p=0.03), fifth (p=0.03), sixth (p=0.009), seventh (p=0.003), eighth, ninth, and tenth (all p=0.002) sessions.


LLLT may be an alternative treatment for the relief of oral burning in patients with BMS.

Photomed Laser Surg. 2010 Dec;28(6):835-9.

Low-level laser therapy in burning mouth syndrome patients: a pilot study.

Kato IT, Pellegrini VD, Prates RA, Ribeiro MS, Wetter NU, Sugaya NN.

1 Centro de Lasers e Aplicações, Instituto de Pesquisas Energéticas e Nucleares – IPEN/CNEN-SP, Cidade Universitária , São Paulo, Brazil .



Abstract Objective: The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on the treatment of burning mouth syndrome (BMS). In addition, the laser effect was compared on the different affected oral sites.

Materials and Methods: Eleven subjects with a total of 25 sites (tongue, lower lip, upper lip, and palate) affected by a burning sensation were selected. The affected areas were irradiated once a week for three consecutive weeks with an infrared laser (??=?790?nm). The probe was kept in contact with the tissue, and the mucosal surface was scanned during the irradiation. The exposure time was calculated based on the fluence of 6?J/cm(2), the output power of 120?mW, and the area to be treated. Burning intensity was recorded through a visual analog scale before and after the treatment and at the 6-week follow-up. The percentage of the improvement in symptoms was also obtained.

Results: Burning intensity at the end of the laser therapy was statistically lower than at the beginning (p?<?0.01). Patients reported an 80.4% reduction in the intensity of symptoms after laser treatment. There was no statistical difference between the end of the treatment and the 6-week follow-up, except for the tongue site.

Conclusion: Under the investigated parameters, infrared LLLT proved to be a valuable alternative for BMS treatment, providing a significant and lasting reduction in symptoms.

Photomed Laser Surg. 2010 Oct 22. [Epub ahead of print]

Treatment of Burning Mouth Syndrome with a Low-Level Energy Diode Laser.

Yang HW, Huang YF.

1 Oral Medicine Center, Chung Shan Medical University Hospital , Taichung City, Taiwan .


Abstract Objective: To test the therapeutic efficacy of low-level energy diode laser on burning mouth syndrome.

Background: Burning mouth syndrome is characterized by burning and painful sensations in the mouth, especially the tongue, in the absence of significant mucosal abnormalities. Although burning mouth syndrome is relatively common, little is known regarding its etiology and pathophysiology. As a result, no treatment is effective in all patients. Low-level energy diode laser therapy has been used in a variety of chronic and acute pain conditions, including neck, back and myofascial pain, degenerative osteoarthritis, and headache.

Methods: A total of 17 patients who had been diagnosed with burning mouth syndrome were treated with an 800-nm wavelength diode laser. A straight handpiece was used with an end of 1-cm diameter with the fiber end standing 4?cm away from the end of handpiece. When the laser was applied, the handpiece directly contacted or was immediately above the symptomatic lingual surface. The output used was 3?W, 50?msec intermittent pulsing, and a frequency of 10?Hz, which was equivalent to an average power of 1.5?W/cm(2) (3?W?×?0.05?msec?×?10?Hz?=?1.5?W/cm(2)). Depending on the involved area, laser was applied to a 1-cm(2) area for 70?sec until all involved area was covered. Overall pain and discomfort were analyzed with a 10-cm visual analogue scale.

Results: All patients received diode laser therapy between one and seven times. The average pain score before the treatment was 6.7 (ranging from 2.9 to 9.8). The results showed an average reduction in pain of 47.6% (ranging from 9.3% to 91.8%). The burning sensation remained unchanged for up to 12 months.

Conclusion: Low-level energy diode laser may be an effective treatment for burning mouth syndrome.

Oral Diseases, Volume 10 Issue 4 Page 217  – July 2004

Experimental Oral Medicine

Effects of near-infrared irradiation to stellate ganglion in glossodynia

M Nakase, K Okumura, T Tamura, T Kamei, K Kada, S Nakamura, M Inui, T Tagawa

Objective: This study was designed to assess the effect of stellate ganglion
near-infrared irradiation (SGR) on glossodynia and the mechanism of action.

Study design: Thirty-seven patients with glossodynia received SGR once
weekly for 4 weeks. The response to treatment was evaluated on the basis of
the change in pain intensity, assessed with a visual analogue scale (VAS)
before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight
healthy subjects were studied.

Results: Tongue pain as assessed by the VAS decreased in 28 of the 37
patients (75.7%). Mean pain intensity decreased significantly from 5.1 ± 2.2
to 1.9 ± 2.1 (P < 0.05). Tongue blood flow at rest in the patients with
glossodynia [7.2 ± 1.6 ml min1 (100 g)1] was significantly lower than that
in the healthy subjects [7.8 ± 0.23 ml min1 (100 g)1]. Five minutes after
SGR, the temperature of the tongue rose 1.5 ± 0.21°C, and blood flow
increased to 8.5 ± 1.2 ml min1 (100 g)1. Tongue blood flow (at rest) after 4
weeks of SGR had increased to 7.7 ± 1.1 ml min1 (100 g)1.

Conclusion: SGR is an effective treatment for glossodynia. The mechanism bywhich SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associatedwith glossodynia. This is followed by normalization of decreased tongueblood flow, thereby alleviating pain