Síndrome da Boca Ardente
ICD-10 K14.6 · ICD-11 DA0F

Quando a Síndrome da Boca Ardente Persiste Após o Ácido Alfa-Lipóico ou a Terapia Anticonvulsivante

A síndrome da boca ardente causa dor bucal persistente que pode ser refratária ao tratamento inicial. Quando um esquema de primeira linha centrado no ácido alfa-lipóico ou em agentes anticonvulsivantes não proporciona alívio adequado da dor, um conjunto distinto de intervenções alternativas passa a ser relevante.

Tratamento Anterior — Resposta Inadequada

A terapia de primeira linha com ácido alfa-lipóico ou opções anticonvulsivantes (incluindo gabapentina e pregabalina) não atingiu os objetivos do tratamento: uma redução significativa da dor bucal ardente na escala VAS, ou um benefício sustentado na avaliação a longo prazo além de três meses.

Abordagem de Segunda Linha (Visão Parcial)

A etapa subsequente baseia-se em alternativas com evidências limitadas, mas relatadas, abrangendo preparações herbais e de origem vegetal, medicamentos de diferentes classes farmacológicas e opções de intervenção não farmacológicas — o protocolo estruturado completo especifica quais considerar e em que condições.

Objetivo Clínico

Redução da dor bucal ardente, avaliada por escalas de dor validadas (escore VAS/VNS).

Acesso Imediato a Esquemas Terapêuticos Baseados em Evidências

References

DOI: 10.1177/03331024211036152

Catuama shows promising VNS (0–10) score reduction results compared to placebo with a minimal adverse effect of sleep alteration observed in the study (SMD 0.68, 95% CI 1.21 to 0.16).

At the end of 12 weeks of therapy, there was a reduction in the number of oral mucosa burning sites and improved ability to cope with the burning pain, there was no statistically significant difference with the placebo group (SMD 0.23, 95% CI 0.87 to 0.41).

Ottaviani et al. revealed a short-term (60 days) benefit with 1200 mg/day umPEA in BMS patients (SMD 0.70, 95% CI 1.39 to 0.01) but declining pain relief at 4 months (SMD 0.26, 95% CI 0.94 to 0.41) compared to placebo group.

Administration of 100 mg trazodone daily for the first 4 days followed by 200 mg for 8 weeks significantly decreased patients' VNS pain intensity against baseline (MD 13.9, p < 0.01), but there was no significant difference with the placebo group (SMD 0.06, 95% CI 0.72 to 0.59; RR 0.95, 95% CI 0.61–1.49).

The use of citalopram 10 mg daily followed by an increment to 20 mg after 1 week showed an improvement of VAS score of 87.45% (MD: 7.8, p < 0.001).

Crocin showed a significant reduction in VAS score (MD 7.8, p < 0.001) and has a similar improvement 87.5% of burning mouth score as citalopram.

A cross-over clinical trial involving intervention with a high melatonin dosage (12 mg/day) did not provide pain relief (SMD 0.24, 95% CI 0.39 to 0.87; RR 1.18, 95% CI 0.31–4.43) and sleep score improvement compared to placebo.

A combination of topical spray and swallowing of 900 ppm LVO daily for 12 weeks led to a significant reduction in the median pain score (MD 3.0, p < 0.001) and burning (MD 1.0, p = 0.003) compared to baseline, but there was no significant difference (p = 0.99) when compared with the placebo group.

Ten days of 30,000 pulses of rTMS therapy over the left GDLPFC significantly reduced VAS score (MD: 3.1, p = 0.002) with 75% of patients reporting a decrease in pain intensity of more than 50% compared to baseline.

The hypothesis of wearing the tongue protector to prevent continuous irritation of tongue on teeth or denture has a statistically significant difference in improvement in VAS score between wearer (MD 3.6) and non-wearer with habitual avoidance reminder (MD 1.4, p < 0.001; SMD 1.15, 95% CI 1.76 to 0.54).

View source ↗