Burning mouth (BM) is a chronic condition that can interfere with quality of life, seen commonly in otherwise health patients but also in patients with systemic conditions that causes dry mouth such as in Sjögren’s syndrome (SS) patients. The aetiology of BM is unknown and there is no available effective treatment at present.
In a recent study by Gupta et al (2016), over half of SS patients who presented with neuropathic symptoms, had small fibre neuropathy (SFN) or ganglionopathy (1). SFN is seen in 5-20% of SS patients presenting with severe neuropathic pain and lancinating or burning pain on the torso, extremities and face (2). However, it is not known whether the burning sensation in the mouth in this group of patients is also due to SFN.
In a study by Lauria et al (2005), showed that a superficial biopsy of the tongue can be helpful in assessing whether damage to the peripheral nerve fibres underlies the pathogenesis BM. Their findings demonstrated that the burning sensation is caused by a small-fibre sensory neuropathy (3). However, they made no attempt to relate it to other manifestations of SFN.
The results of the above two studies were utilized to design the proposed study on the premise that the symptom of BM is due to SFN and would be seen in patients with systemic condition causing neurological impairment.
1. To investigate neuropathological and neurosensory differences between SS patients experiencing BM sensation compared with SS patients without BM
2. To investigate whether small fiber neuropathy (SFN) is present in SS patients with BM
3. To establish the clinical characteristics and case definition of BM
This is a novel prospective study to be conducted at the multidisciplinary SS clinic at Barts and The London School of Medicine and Dentistry, QMUL. The study will be conducted in compliance with the Declaration of Helsinki, ICH-GCP and all of the applicable regulatory requirements.
1- Fifty patients with a confirmed diagnosis of SS in accordance to the American-European Consensus Group Criteria (AECC), and who report constant burning sensation of the dorsum of the tongue for at least one month.
2- Fifty patients with a confirmed diagnosis of SS in accordance to the AECC, and who do not have a BM.
3- Fifty participants who do not have SS or BM
1- Neurological function/neurological impairment of the tongue will be tested by electrical taste threshold using a Rion TR-06 electrogustometer.
2- The density of intraepithelial nerve fibers will be compared in the three groups by tissue examination obtained from a tongue biopsy assessed by an experienced neuropathologist.
This is a novel research project, the results of which will help improve our understanding of the aetiology of BM and may provide information to help in treating this condition.
How to apply:
For more information regarding the project, please contact Dr Anwar Tappuni ([email protected]
Applications should be submitted through the Queen Mary application system. Please indicate the project title and supervisor in the ‘Research Degree Programmes - Additional Questions’ section of the application.
Alongside the application form, please send the following supporting documents:
• Curriculum Vitae (CV)
• Copies of your degree certificates with transcripts
• Proof of English language ability for overseas applicants from non-English speaking countries
• A one-side A4 statement of purpose. This should set out your previous academic or other experience relevant to the proposed research; why you wish to undertake this research at QMUL; your previous research or professional training and what further training you think you will need to complete a PhD; and what ethical issues you will need to consider in undertaking this research.
• Two references. At least one reference must be from an academic referee who is in a position to comment on the standard of your academic work and suitability for postgraduate level study. Where appropriate, a second referee can provide comment on your professional experience.
Please contact Charlotte Royle ([email protected]
) with any queries about the application process.
1. Gupta V, Peters J, Bombardieri M, Radunovic A, Sutcliffe N. Small fiber neuropathy and ganglionopathy in primary Sjögren’s syndrome. EULAR. 2016 - (Personal Communication).
2. Birnbaum J. Peripheral nervous system manifestations of Sjögren’s syndrome: clinical patterns, diagnostic paradigms, etiopathogenesis, and therapeutic strategies. Neurologist. 2010; 16(5):287-97.
3. Lauria G, Majorana A, Borgna M, Lombardi R, Penza P, Padovani A, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain. 2005; 115 (3):332-7.