Association of anxiety, depression, and stress with burning mouth syndrome: a case-control study

Burning mouth syndrome (BMS) is a painful disorder characterized by severe burning in the oral cavity in the absence of clinical signs. In this case-control study, 60 patients were allocated to 3 groups: patients with BMS, patients with benign changes in the oral cavity (anxiety [positive] control group), or healthy patients (negative control group). A visual analog scale (VAS), Beck Anxiety and Depression inventories, Lipp Stress Symptoms Inventory, Xerostomia Inventory-Dutch Version, and a BMS questionnaire were used. Statistical analyses (P < 0.05) were performed using the Kruskal-Wallis with Dunn post hoc, Pearson chi-square, Fisher exact, and multinomial logistic regression tests. Most of the patients were female. The BMS group had more patients who were older than 60 years (P = 0.008), more patients with high VAS scores (P < 0.001), and more patients with moderate or severe anxiety (P < 0.001) and depression (P < 0.001) than the 2 control groups. Patients in the BMS group also had higher rates of stress during the alarm (P = 0.003), resistance (P < 0.001), and exhaustion phases (P < 0.001). All patients with BMS reported burning and xerostomia, 90% reported a feeling of dry mouth, and 80% reported a change in taste; these values were significantly higher than those in the control groups (P < 0.001). Anxiety was independently associated with a 123.80 times greater risk of having BMS (P = 0.004). Psychological factors are directly associated with BMS, and anxiety is the most important of these factor.