Salivary Levels of Cortisol, 17β-Estradiol, Progesterone, Dehydroepiandrosterone and α-Amylase in Patients with Burning Mouth Syndrome

Abstract

Burning mouth syndrome (BMS) is characterized by a painful burning sensation or other dysesthesias of the oral mucosa, with no visible mucosal abnormalities upon clinical examination, so that seriously exacerbates quality of life. The anatomical proximity between saliva and the area of BMS symptoms and the importance of steroid hormones in the pathophysiology of BMS have resulted in the investigation of possible salivary biomarkers. The aim of this study was to investigate salivary cortisol, 17β-estradiol, progesterone, dehydroepiandrosterone (DHEA) and α-amylase levels in patients with BMS compared with controls and to investigate whether these levels could be predictors for treatment outcome in patients with BMS. Thirty female patients with BMS and twenty female control subjects were included. Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) samples were collected, and their flow rates were determined. Salivary levels of cortisol, 17β-estradiol, progesterone and DHEA were analyzed using enzyme immunoassay kits. The enzymatic activity of α-amylase was determined using maltotriose as a substrate. Salivary transferrin level was measured to determine the level of blood contamination in saliva samples. Symptom checklist-90-revision (SCL-90-R) was used for psychological characteristics of patients with BMS. Treatment protocols of patients with BMS included control of parafunctional habits, use of artificial saliva, and clonazepam medication.

The obtained results were as follows:

1. The patient group showed significantly higher levels of cortisol in UWS (P < 0.05) and of 17β-estradiol in SWS (P < 0.05).

2. When the patients were divided into older (≥60 years) and younger (<60 years) groups, the older group showed a significantly lower level of progesterone in UWS (P < 0.05).

3. There was no significant correlation between all scales of SCL-90-R and the levels of salivary analytes.

4. There was no significant correlation between the treatment efficacy and the levels of salivary analytes.

In conclusion, patients with BMS had significantly higher levels of cortisol in UWS and of 17β-estradiol in SWS. These indicate that dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis and gonadal steroids are involved in the pathogenesis of BMS.