Case-Control Evaluation of Fungiform Papillae Density in Burning Mouth Syndrome

It has been hypothesized that high fungiform papillae density may be a risk factor for developing burning mouth syndrome (BMS) (Grushka and Bartoshuk, 2000).

Objective: Evaluate whether fungiform papillae density (FPD) differs between burning mouth syndrome (case) and control subjects. 

Methods: FPD was determined separately for the left and right sides of the tongue using digital photographs from 18 cases (ages 33 to 76, 1 male) and 35 pain-free controls (ages 23 to 71, 8 males).   Two calibrated observers independently determined FPD within 6 mm diameter circles that included test sites for lingual pain sensitivity on the left and right side of the tongue. The averages of the two raters’ counts for each site were then used to assess differences in FPD between cases and controls.

Results: Inter-rater reliability following calibration was excellent (r=0.94).  In controls, FPD negatively correlated with age (r = -0.36, p < 0.04).   Cases tended to have greater age- and gender-corrected FPD than did controls (24.7 vs. 21.2 papillae, F(1,48)=2.91, p = 0.09). Papillae counts on the left and right side of the tongue were correlated in the sample as a whole (r=0.32, p < 0.04) and in the controls (r=0.48, p < 0.01).  However, there was no correlation between left and right side papillae counts in cases only.

Conclusions:  Consistent with the hypothesis that high FPD is a risk factor for BMS, cases tended to have a higher FPD than did controls.  FPD generally declined with age.  The lack of correlation between left and right side counts in cases may be an indication of asymmetrical or unilateral nerve damage in these patients.

Supported by National Institute of Dental and Craniofacial Research grants 3R21DE018768-02S1 (PI, Mark Drangsholt) and T32 DE07132 (PI, Timothy DeRouen) and by Grant UL1RR025014 from the NIH National Center for Research Resources.