World Journal of Dentistry

Register      Login

VOLUME 12 , ISSUE 6 ( November-December, 2021 ) > List of Articles


Epithelial Thickness and Mouth Opening Negatively Correlates with the Burning Sensation of the Oral Cavity: A Pilot Clinicopathological Study

Yashwant Ingale, Gargi S Sarode, Namrata Sengupta

Keywords : Burning sensation, Epithelial thickness, Fibrosis, Mouth opening, Oral submucous fibrosis

Citation Information : Ingale Y, Sarode GS, Sengupta N. Epithelial Thickness and Mouth Opening Negatively Correlates with the Burning Sensation of the Oral Cavity: A Pilot Clinicopathological Study. World J Dent 2021; 12 (6):458-462.

DOI: 10.5005/jp-journals-10015-1874

License: CC BY-NC 4.0

Published Online: 24-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objectives: The present study aimed to quantify the burning sensation in oral submucous fibrosis (OSMF) patients and correlated then with epithelial atrophy, degree of fibrosis, and mouth opening. Materials and methods: Total 53 OSMF cases without ulcerations and vesicle formation were recruited in the present study. The severity of burning sensation of the oral cavity was determined by a 10-mm visual analog scale (VAS, numeric scale type), in which 0 demonstrates no pain and 10 shows severe intolerable pain. The inter-incisal distance was calculated using Vernier caliper while the epithelial thickness and fibrosis grades were evaluated histopathologically under the light microscope. Results: The mean VAS score in OSMF patients observed was 4.43 ± 1.53. A weak negative correlation was observed between VAS score and epithelial thickness (r = −0.245) as well as VAS score and mouth opening (r = −0.431). The epithelial thickness values were correlated with the mouth opening from OSMF patients. With regard to the grade of fibrosis, the VAS score was maximum in advanced stages (6.81 ± 0.6) and showed decreasing trend in intermediate (4.44 ± 0.5) and early stages (2.66 ± 0.48). There were statistically significant differences in the VAS score in all the grades of fibrosis (p < 0.00001). Conclusion: The burning sensation increases with a decrease in the epithelial thickness, mouth opening, and fibrosis in the connective tissue stroma. Since intra-epithelial nerve endings are the main carriers of burning sensation, maintaining the disturbed homeostasis of oral epithelium with the restoration of epithelial thickness could mitigate the burning sensation in OSMF patients. Clinical significance: The results of the present study showed that the burning sensation in OSMF patients negatively correlates with the epithelial thickness. Moreover, increased fibrosis was associated with increasing the burning sensation. Maintaining epithelial homeostasis with medicinal intervention could probably help in reducing the burning sensation of the oral cavity in OSMF patients.

  1. Sarode SC, Sarode GS, Karmarkar S, et al. A new classification for potentially malignant disorders of the oral cavity. Oral Oncol 2011;47(9):920–921. DOI: 10.1016/j.oraloncology.2011.06.005.
  2. Sarode GS, Sarode SC, Maniyar N, et al. Malignant transformation rate based stratification model for oral potentially malignant disorders: a potential idea. J Oral Biol Craniofac Res 2020;10(4):490–491. DOI: 10.1016/j.jobcr.2020.07.017.
  3. Peng Q, Li H, Chen J, et al. Oral submucous fibrosis in Asian countries. J Oral Pathol Med 2020;49(4):294–304. DOI: 10.1111/jop.12924.
  4. Gondivkar SM, Bhowate RR, Gadbail AR, et al. Quality of life-related “patient-reported outcome measures” in oral submucous fibrosis patients. J Contemp Dent Pract 2018;19(3):331–338. DOI: 10.5005/jp-journals-10024-2262.
  5. Sarode SC, Gondivkar S, Gadbail A, et al. Oral submucous fibrosis and heterogeneity in outcome measures: a critical viewpoint. Future Oncol 2021;17(17):2123–2126. DOI: 10.2217/fon-2021-0287.
  6. Sarode SC, Sarode GS. Burning sensation in oral submucous fibrosis and its possible association with mucin secreted by affected minor salivary glands. Oral Oncol 2013;49(4):e16–e17. DOI: 10.1016/j.oraloncology.2013.01.004.
  7. Sarode GS, Sarode SC, Gadbail A, et al. Localized peripheral autonomous neuropathy and dysfunctional myoepithelial cells: a novel hypothesis for xerostomia in oral submucous fibrosis. Med Hypotheses 2020;144:109998. DOI: 10.1016/j.mehy.2020.109998.
  8. Warnakulasuriya S. Clinical features and presentation of oral potentially malignant disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;125(6):582–590. DOI: 10.1016/j.oooo.2018.03.011.
  9. Kumar LB, Mathew P, Madhavan N, et al. Evaluation of mast cells and burning sensation in various stages of oral submucous fibrosis. J Oral Biol Craniofac Res 2020;10(4):430–434. DOI: 10.1016/j.jobcr.2020.07.005.
  10. Liem RS, van Willigen JD. Ultrastructure of intra-epithelial nerve endings in the hard palate of the rat, Rattus norvegicus. Arch Oral Biol 1985;30(6):461–466. DOI: 10.1016/0003-9969(85)90090-1.
  11. Watanabe IS. Ultrastructures of mechanoreceptors in the oral mucosa. Anat Sci Int 2004;79(2):55–61. DOI: 10.1111/j.1447-073x.2004.00067.x.
  12. Pindborg JJ. Oral submucous fibrosis as a precancerous condition. J Dent Res 1966;45(3):546–553. DOI: 10.1177/00220345660450031701.
  13. Rangnathan K, Mishra G. An overview of classification schemes for oral submucous fibrosis. J Oral Maxillofac Pathol 2006;10:55–58.
  14. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain 2016;13(1):67–75. DOI: 10.1016/j.sjpain.2016.06.012.
  15. Barrêtto Ede P, Ferreira e Ferreira E, Pordeus IA. Evaluation of toothache severity in children using a visual analogue scale of faces. Pediatr Dent 2004;26(6):485–491.
  16. Pedersen A. Psychologic stress and recurrent aphthous ulceration. J Oral Pathol Med 1989;18(2):119–122. DOI: 10.1111/j.1600-0714.1989.tb00747.x.
  17. Mehdipour M, Taghavi Zenouz A, Farnam A, et al. The relationship between anger expression and its indices and oral lichen planus. Chonnam Med J 2016;52(2):112–116. DOI: 10.4068/cmj.2016.52. 2.112.
  18. Tamási B, Brodszky V, Péntek M, et al. Validity of the EQ-5D in patients with pemphigus vulgaris and pemphigus foliaceus. Br J Dermatol 2019;180(4):802–809. DOI: 10.1111/bjd.16883.
  19. Rai A, Kaur M, Gombra V, et al. Comparative evaluation of curcumin and antioxidants in the management of oral submucous fibrosis. J Investig Clin Dent 2019;10(4):e12464. DOI: 10.1111/jicd.12464.
  20. Mahato B, Prodhan C, Mandal S, et al. Evaluation of efficacy of curcumin along with lycopene and piperine in the management of oral submucous fibrosis. Contemp Clin Dent 2019;10(3):531–541. DOI: 10.4103/ccd.ccd_937_18.
  21. Lanjekar AB, Bhowate RR, Bakhle S, et al. Comparison of efficacy of topical curcumin gel with triamcinolone-hyaluronidase gel individually and in combination in the treatment of oral submucous fibrosis. J Contemp Dent Pract 2020;21(1):83–90. DOI: 10.5005/jp-journals-10024-2726.
  22. Cai X, Yao Z, Liu G, et al. Oral submucous fibrosis: a clinicopathological study of 674 cases in China. J Oral Pathol Med 2019;48(4):321–325. DOI: 10.1111/jop.12836.
  23. Arakeri G, Rai KK, Hunasgi S, et al. Oral submucous fibrosis: an update on current theories of pathogenesis. J Oral Pathol Med 2017;46(6):406–412. DOI: 10.1111/jop.12581.
  24. Sarode SC, Chaudhary M, Gadbail A, et al. Dysplastic features relevant to malignant transformation in atrophic epithelium of oral submucous fibrosis: a preliminary study. J Oral Pathol Med 2018;47(4):410–416. DOI: 10.1111/jop.12699.
  25. Teruel A, Patel S. Burning mouth syndrome: a review of etiology, diagnosis, and management. Gen Dent 2019;67(2):24–29.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.