Publication: Abordaje multidimensional del síndrome de boca ardiente: una exploración de terapias, biomarcadores salivales y percepción del paciente
Authors
García Martínez, Ana
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Escuelas::Escuela Internacional de Doctorado
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López Jornet, María Pía ; Tvarijonaviciute, Asta
Publisher
Universidad de Murca
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Introducción: El Síndrome de Boca Ardiente (SBA) es un trastorno de dolor crónico oral, de etiología multifactorial, que afecta la calidad de vida del paciente. Pese a la variedad de tratamientos propuestos, los resultados no son concluyentes, lo que resalta la importancia de evaluar la satisfacción del paciente para valorar la percepción terapéutica en individuos con dolor crónico.
Objetivos: Evaluar la eficacia de distintos tratamientos para el SBA, incluyendo Láser de diodo a baja potencia (LLLT) y Clonazepam, mediante el análisis de biomarcadores salivales, el impacto de factores clínicos y psicológicos y la satisfacción del paciente a través del cuestionario SAT-Q.
Material y método: Se llevó a cabo un ensayo clínico aleatorizado simple ciego con un total de 89 pacientes distribuidos en cuatro grupos: Grupo 1 (LLLT + Clonazepam), Grupo 2 (Láser sham placebo), Grupo 3 (LLLT), Grupo 4 (Clonazepam). Se recogieron muestras de saliva antes y después del tratamiento, realizando un seguimiento al inicio, al mes y a los tres meses. Se analizó la saliva para cuantificar biomarcadores salivales. Además, se aplicaron pruebas como la Escala Visual Analógica (EVA) para evaluar la intensidad de los síntomas y su evolución a la vez que diversos cuestionarios validados como la Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Escala de Somnolencia de Epworth (ESS), Xerostomia Inventory, Oral Health Impact Profile-14 (OHIP-14) y Mini-Nutritional Assessment (MNA). También se realizó un estudio observacional, transversal y retrospectivo en 151 pacientes diagnosticados con SBA, recogiendo datos clínicos y de tratamiento mediante una encuesta telefónica. La mejoría del ardor y la eficacia percibida se evaluó mediante EVA y la satisfacción global con el cuestionario SAT-Q. Se compararon cinco tratamientos: melatonina, ácido α-lipoico, clonazepam, láser de baja intensidad (LLLT) y fitoterapia.
Resultados: Se observó la reducción significativa en la intensidad del ardor mediante EVA tras el tratamiento de los grupos Láser + Clonazepam (p = 0,029) y Láser (p = 0,005). A nivel bioquímico, el grupo Láser presentó disminuciones relevantes en varias citoquinas proinflamatorias, incluyendo IL7, IL8, IL12, IL17 y TNFα. El grupo Láser + Clonazepam mostró reducciones en IL21 e IL7, mientras que el grupo Clonazepam solo tuvo cambios en IL13, IL2 e IL4. Psicométricamente, se encontró mejoría significativa en el estrés percibido (p = 0,016) y una relación entre edad, duración del síndrome y la intensidad de los síntomas en diferentes momentos del seguimiento. No se hallaron asociaciones significativas con el número de zonas bucales afectadas.
En cuanto a la percepción del tratamiento, el láser obtuvo mejor puntuación en mejoría del ardor, eficacia percibida y satisfacción global (p < 0,001), mientras que los efectos secundarios se concentraron en el grupo con clonazepam (p < 0,001). Una mejor respuesta clínica, junto con mayor adherencia y percepción de eficacia, se asoció con mayor satisfacción del paciente.
Conclusiones: El tratamiento LLLT se mostró eficaz en la reducción de la sintomatología del SBA y en la disminución de biomarcadores inflamatorios salivales, siendo además el abordaje que reportó mayor nivel de mejoría y satisfacción percibida por los pacientes. La adherencia al tratamiento y la percepción de eficacia estuvieron directamente relacionadas con la satisfacción en el tratamiento, mientras que su disminución se asoció a la recidiva. Variables clínicas como la edad, el tiempo de evolución o el número de zonas afectadas no influyeron en la evolución del cuadro ni del estado psicológico del paciente. Es necesario realizar estudios longitudinales con mayor rigor metodológico, el uso sistemático de herramientas como el SAT-Q para el seguimiento clínico y la estandarización de protocolos terapéuticos de forma multidisciplinar.
Background: Burning Mouth Syndrome (BMS) is a chronic oral pain disorder of multifactorial origin that significantly affects patients’ quality of life. Despite the wide range of therapeutic approaches proposed, results remain inconclusive, emphasizing the importance of assessing patient satisfaction to better understand treatment perception in individuals with chronic pain. Objectives: To evaluate the efficacy of various treatments for BMS—including low-level laser therapy (LLLT) and clonazepam—by analyzing salivary biomarkers, the impact of clinical and psychological factors, and patient satisfaction through the SAT-Q questionnaire. Materials and Method: A single-blind randomized clinical trial was conducted involving 89 patients, distributed into four groups: Group 1 (LLLT + Clonazepam), Group 2 (Sham Laser/Placebo), Group 3 (LLLT), and Group 4 (Clonazepam). Saliva samples were collected before and after treatment, with follow-up assessments conducted at baseline, one month, and three months. Saliva was analyzed for inflammatory biomarkers. In addition, instruments such as the Visual Analogue Scale (VAS) were used to assess symptom intensity, along with validated questionnaires including the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Epworth Sleepiness Scale (ESS), Xerostomia Inventory, Oral Health Impact Profile-14 (OHIP-14), and Mini-Nutritional Assessment (MNA). A complementary cross-sectional, retrospective observational study was also carried out with 151 patients diagnosed with BMS. Clinical and treatment data were collected via structured telephone surveys. Burning sensation relief and perceived efficacy were measured using the VAS, and overall satisfaction was assessed through the SAT-Q. Five treatments were compared: melatonin, α-lipoic acid, clonazepam, LLLT, and phytotherapy. Results: A significant reduction in burning sensation was observed in the Laser + Clonazepam (p = 0.029) and Laser (p = 0.005) groups. Biochemically, the Laser group showed marked decreases in several pro-inflammatory cytokines, including IL7, IL8, IL12, IL17, and TNFα. The Laser + Clonazepam group exhibited reductions in IL21 and IL7, while the Clonazepam group showed changes in IL13, IL2, and IL4. Psychometrically, a significant improvement in perceived stress was noted (p = 0.016), along with correlations between age, symptom duration, and intensity at different follow-up points. No significant associations were found regarding the number of affected oral areas. In terms of treatment perception, LLLT received the highest scores for burning relief, perceived efficacy, and overall satisfaction (p < 0.001), while adverse effects were most commonly reported in the clonazepam group (p < 0.001). Greater clinical response, together with higher adherence and perceived efficacy, were strongly associated with increased patient satisfaction. Conclusions: LLLT was found to be effective in reducing BMS symptomatology and in lowering inflammatory salivary biomarkers. It also yielded the highest levels of patient-reported improvement and satisfaction. Treatment adherence and perceived efficacy were directly associated with satisfaction, whereas reduced adherence was linked to symptom relapse. Clinical variables such as age, duration of the condition, or the number of affected sites did not influence symptom progression or psychological outcomes. Future research should focus on longitudinal studies with greater methodological rigor, systematic use of tools such as the SAT-Q for clinical follow-up, and the development of standardized, multidisciplinary treatment protocols.
Background: Burning Mouth Syndrome (BMS) is a chronic oral pain disorder of multifactorial origin that significantly affects patients’ quality of life. Despite the wide range of therapeutic approaches proposed, results remain inconclusive, emphasizing the importance of assessing patient satisfaction to better understand treatment perception in individuals with chronic pain. Objectives: To evaluate the efficacy of various treatments for BMS—including low-level laser therapy (LLLT) and clonazepam—by analyzing salivary biomarkers, the impact of clinical and psychological factors, and patient satisfaction through the SAT-Q questionnaire. Materials and Method: A single-blind randomized clinical trial was conducted involving 89 patients, distributed into four groups: Group 1 (LLLT + Clonazepam), Group 2 (Sham Laser/Placebo), Group 3 (LLLT), and Group 4 (Clonazepam). Saliva samples were collected before and after treatment, with follow-up assessments conducted at baseline, one month, and three months. Saliva was analyzed for inflammatory biomarkers. In addition, instruments such as the Visual Analogue Scale (VAS) were used to assess symptom intensity, along with validated questionnaires including the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Epworth Sleepiness Scale (ESS), Xerostomia Inventory, Oral Health Impact Profile-14 (OHIP-14), and Mini-Nutritional Assessment (MNA). A complementary cross-sectional, retrospective observational study was also carried out with 151 patients diagnosed with BMS. Clinical and treatment data were collected via structured telephone surveys. Burning sensation relief and perceived efficacy were measured using the VAS, and overall satisfaction was assessed through the SAT-Q. Five treatments were compared: melatonin, α-lipoic acid, clonazepam, LLLT, and phytotherapy. Results: A significant reduction in burning sensation was observed in the Laser + Clonazepam (p = 0.029) and Laser (p = 0.005) groups. Biochemically, the Laser group showed marked decreases in several pro-inflammatory cytokines, including IL7, IL8, IL12, IL17, and TNFα. The Laser + Clonazepam group exhibited reductions in IL21 and IL7, while the Clonazepam group showed changes in IL13, IL2, and IL4. Psychometrically, a significant improvement in perceived stress was noted (p = 0.016), along with correlations between age, symptom duration, and intensity at different follow-up points. No significant associations were found regarding the number of affected oral areas. In terms of treatment perception, LLLT received the highest scores for burning relief, perceived efficacy, and overall satisfaction (p < 0.001), while adverse effects were most commonly reported in the clonazepam group (p < 0.001). Greater clinical response, together with higher adherence and perceived efficacy, were strongly associated with increased patient satisfaction. Conclusions: LLLT was found to be effective in reducing BMS symptomatology and in lowering inflammatory salivary biomarkers. It also yielded the highest levels of patient-reported improvement and satisfaction. Treatment adherence and perceived efficacy were directly associated with satisfaction, whereas reduced adherence was linked to symptom relapse. Clinical variables such as age, duration of the condition, or the number of affected sites did not influence symptom progression or psychological outcomes. Future research should focus on longitudinal studies with greater methodological rigor, systematic use of tools such as the SAT-Q for clinical follow-up, and the development of standardized, multidisciplinary treatment protocols.
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