灼口综合征危险因素的多因素分析
【摘要】 目的 探讨灼口综合征的危险因素。方法 应用成组病例对照研究方法，对87例灼口综合征患者及82例对照的危险因素进行了调查，并用Logistic回归分析方法进行综合探讨。结果 Logistic回归分析建立了一个包括6个自变量的回归方程，伸舌自检、咬唇、牙周炎、吸烟、不良的近期医疗结局、抑郁情绪为灼口综合征发病的主要危险因素，其中影响权重最大的因素为伸舌自检。结论 戒除口腔不良卫生习惯、去除局部刺激因素、戒烟以及保持良好的情绪状态等可预防灼口综合征的发生。
关键词 灼口综合征 危险因素 病例对照研究 Logistic回归分析
【文献标识码】 A 【文章编号】 1609-6614(2003)14-1257-04
A multiple variable analysis on the risk factors of burning mouth syndrome
, 百拇医药
Chen Lizhang，Gao Jianming，Peng Jieying，et al.
School of Public Health，Central South University，Changshai410078.
【Abstract】 Objective To evaluate and analyze the risk factors of burning mouth syndrome(BMS).Methods Eighty-seven consecutive patients with BMS and a randomly selected control group(n=82)were comprehensively investigated with the method of case-control study，and of logistic regression analysis.Results A regression equation which included6variables had been established by logistic regression analysis，indicating that the habit of tongue thrusting，biting lip，periodontitis，smoking，outcome of recent malmedication，depression were the principal risk facˉtors，among which the weight of tongue thrusting was the most common one.Conclusion These data suggested the measures such as refraining from oral bad habits，removing local irritating factors，stopping smoke，good mental health status could help the prevention of BMS.
, 百拇医药
Key words burning mouth syndrome risk factors case-control study Logistic regression analysis
Burning mouth syndrome(BMS)is defined as burnˉing and painful sensations in the mouth when the oral mucosa is clinically normal [1，2].Multiple sites in the oral cavity may be affected，the most common one being the tongue.BMS patients have dry mouth，thirst，dysgeusia and other accompanied symptoms.“Glossodynia”，“Glosˉsopyrosis”and“oral dysesthesia”are different synonyms for the term“burning mouth syndrome” [3，4] .In recent years，the prevalence of BMS increased and it has beˉcome a common chronic oralfacial pain disorder [5] .The causes of BMS remains open to controversy.Treatment based on some possible etiologic factors is frequently inˉeffective，and no therapy for BMS has proven generally effective.The purpose of this studywas to investigate and determine the risk factors of BMS with the method of case-control study，and of logistic regression analysis.
, 百拇医药
1 Material and methods
Eighty-seven consecutive patients attending the Oral Medicine Clinic，Xiang ya hospital or second hospiˉtal，Central South University during the period March， 2002，to November，2002，who had a diagnosis of BMS but no clinical evidence of oral pathosis comprised the study group.Adiagnosis of BMS was based on estabˉlished criteria.The absence of visible oral lesions was verified in each case.The control group consisted of82persons，matched for age and sex，who were randomly seˉlected from among those patients att
, 百拇医药
ending the Oral Medicine Clinic for identifiable organic causes such as decayed tooth，dental treatment，and other mucosal disˉeases.
A self-designed questionnaire，self-rating anxiˉety scale(SAS)and self-rating depression scale(SDS)were applied to all the subjects.The contents of our investigation included demographic characteristic，part dentate，denture problems，exodontia，allergies，oral bad habits，gingivitis，periodontitis，systemic diseases，menopause，occupational risk factors，smoking，alcohol abuse，prescribed medication，negative life events in the past two years，depression，anxiety，et al.All the data obˉtained wer
, http://www.100md.com
e transferred to a data bank and analyzed staˉtistically in spss10.0for windows.The chi-square test，t test and logistic regression analysis were used for statistical analysis of the data.A5%significance level was used for all statistical tests and comparisons.
2 Results
Of the total of87cases of BMS identified，66(75.9%)were women，of whom47(54%)were menopausal or postmenopausal.The ratio of women to men was3.14.The mean age of the BMS subjects was52.6，and the range was28to83years.71(81.6%)of the BMS subˉjects were between the age group40to70years.Duration of symptoms varied from more than10days to10years，with a medium of nine months.TableⅠdescribed the characteristics of the BMS and control groups used in this study.There was no statistically significant differˉence with respect to age，gender in the two groups，which suggested the patients with BMS and the control group were successfully sex-and age-matched.
, 百拇医药
TableⅠ characteristics of BMS and control groups 略
The variables for which statistically significant difˉferences(P<0.05)could be shown between BMS and control group by the method of monofactor analysis are displayed in TableⅡ.Thirteen variables，education，tongue thrusting，biting lip，periodontitis，central nervous system(CNS)disturbances，arthritis，menopausal，chronˉic respiratory infection，smoking，the outcome of preˉscribed me dication，self-medication，the scores of anxiˉety，the scores of depression，differed significantly beˉtween the BMS group and the controlgroup.For all the other variables investigated the differences between the patients with BMS and the control patients were small and not statistically significant.
, 百拇医药
Logistic regression analysis with back-ward elimiˉnation was applied to optimize the relationship between the thirteen variables and BMS.The enter probability for stepwise was0.05，and the removed probability for stepˉwise0.10.As a result，a regression equation which inˉcluded6variables had been established by logistic reˉgression analysis，and were shown in TableⅢ.The six variables，tongue thrusting，biting lip，periodontitis，smoking，the outcome of recent medication，depression were principal risk factors related to BMS.Their odds raˉtios were55.9，8.2，9.5，12.6，3.4，12.6respectively.The standard coefficient of regres
, 百拇医药
sion of tongue thrusting was1.082，the largest one.The chi-square test used to test the goodness of the regression equation gave a fairly satisfactory result(X2 =17.316，P=0.027，R 2 =0.769).
TableⅡ monofactor analysis about risk factors of BMS 略
Discussion
The present study has again demonstrated the comˉplexity of the causes of BMS.A total of52variables were considered in our study.As far as could be ascertained，no previously published study on this subject has investiˉgated as many possible variables as in our study.
, http://www.100md.com
The use of logistic regression analysis when studyˉing variables associated with BMS was in our opinion fruitful，which can pick out several predominantly reˉsponsible factors from multiple variables，and showed their odds ratios.The method of monofactor analysis usuˉally leads to unilateral and incomprehensive inference in the determination of a disease’s risk factors.When comˉbined with amultivariate statistical model，the disadvanˉtages disappear.
Uhis study provided support that bad oral habits are causative agents in BMS，such as tongue thrusing，biting lip.A explanation for this association is thatthese oral habits strain the fibers of tongue muscle，increase the consumption of oxygen，help the congregation of the waste of metabolism in the tissue of tong
, http://www.100md.com
ue and result in a pain and burning sensation at last.
The presence of periodontitis was statistically sigˉnificant in BMS and it entered the regression equation in our study.Periodontitis，as a common infection，usually is caused by dental plaque，dental calculi，faulty denture，et al.all of which are local irritating factors in BMS.It unˉderlines the need for the maintenance of optimal oral hyˉgiene by the patients with BMS.One study [6] shows78%of BMS patients had local stimulators.Symptoms could still exist and other normal sites might be complicated even if the local stimulators were removed.
, 百拇医药
A significant relationship between smoking and BMS was found.This is an interesting observation and can probably be ascribed to the effects of some harmful substances in cigarette such as benzo(a)pyrene，polyˉcyclic aromatic hydrocarbons.Many studies [7～10] have verified there was a significant increase of mi
cronucleatˉed(MN)cells in oral mucosa of smokers than in that of nonsmokers.The detection of the number of MN cells is a simple，rapid，and effective method to identify chromoˉsome damage.Tobacco has played an effect on oral muˉcosa damage.In our country only one precedent study [11] had ever reported the relationship between smoking and BMS in the conclusion that smoking ranked the first sysˉtemic etiologic factor in male BMS.
, 百拇医药
77%(67/87)of BMS patients had prescribed medˉ ication in the past six months，but their treatments were ineffective，only3patients cured，26relieved，38with no change at all.Although the precise details of the medicaˉtions were not recorded，antibiotics，antidepressants and proprietary mouth rinses were among th
e drug categories commonly included.It is well known that excessive use of these drugs might lead to resultant mucosal irritation.Because of the bad outcomes of treatments，BMS patients went to see doctor again and again，which aggravated their anxiety about physical health，on the other hand，the duration of BMS assumed a chronic tendency.
, 百拇医药
Many studies [12～14] have shown that BMS patients suffer from various psychological problems which is in accordance with our result.Anxiety，depression，somatiˉzation symptoms seem to be common psychological probˉlems among BMS patients.BMS can be treated both loˉcally and systemically as well as with different psychoˉlogical methods.
In conclusion，BMS is a multifactorial condition and remains poorly understood.Refraining from bad oral habits，removing local irritating factors，stopping smoke，good mental health status may help the prevention of BMS.
, 百拇医药
References
1 Bergdahl J Anneroth G.Burnin mouth syndrome:literature review and model for research and management.J Oral Pathol Med，1993，22:433-438.
2 Zhao M，Chen QM，Lin M，et al.Relationships between the symptom of xerostomia and non-stimulated salivary flowrates in patients with burnˉing mouth syndrome.WCJC，2001，19(3):169-177.
3 Wadrop RW.Hailes J.Burger H.et al.Oral discomfort at menopause Oˉral Surg Oral Med Oral Pathol，1989，67(5):535-540.
, http://www.100md.com
4 Lamey PJ.Lamb AB.Prospective study of aetiological factors in burning mouth syndrome.Br Medical J，1988，296(6631):1243-1246.
5 Meng J.Advance in the research of burning mouthing syndrome.Antholˉgy of Medicine，2001，20(5):721-723.
6 Gao S，Yang SJ，Wang ZK.A multiple variable analysis of burning……(Ⅰ)clinical data analyse.J Modern Stomatol，1995，9(3):143-145.7 Zhou X，Liu HW.Study of micronuclei in exfollative cells of normal muˉcosa.J Modern Stomatol，2001，15(4):251-253.
, http://www.100md.com
8 Ozkul Y.Donmez H.Erenmemisoglu A.et al.Induction of micronuclei by smokeless tobacco buccal mucosa cells of habitual users.Mutageneˉsis，1997，12(4):285-287.
9 Bagwe AN.Bhisey RA.Occupational exposure to tobacco and resultant genotoxicity in bidi industry workers.Mutat Res.1993，299(2):103-109.
10 Kayal JJ，Trivedi AH.Dave BJ，et al.Incidence of micronuclei in oral mucosa of users of tobacco products singly or in various combinations.Mutagenesis，1993，8(1):31-33.
, 百拇医药
11 Li L，Li Y.Glossodynia etiology and clinical analyse.Chinese Journal of Pain Medicine，2000，4(4):194-198.12 Trikkas G，Nikolatou O，Samara C，et al.Glossodynia:personality charˉacteristics and psychopathology.Psychother Psychosom，1996，65(3):163-168.
13 Bogetto F，Maina G，Ferro G，et al.Psychiatric comorbidity in patients with burning mouth syndrome.Psychosom Med，1998，60(3):378-385.
14 Lauritano D，Spadari F，Formaglio F，et al.Etiopathogenic，clinical-diagnostic and therapeutic aspects of the burning mouth syndrome.Reˉsearch and treatment protocols in a ptient group.Minerva Stomatol，1998，47(6):239-251.
作者单位： 1 410078 中南大学公共卫生学院
2 410078 中南大学口腔学院
(审 校 卢信义), 百拇医药(陈立章)
关键词 灼口综合征 危险因素 病例对照研究 Logistic回归分析
【文献标识码】 A 【文章编号】 1609-6614(2003)14-1257-04
A multiple variable analysis on the risk factors of burning mouth syndrome
, 百拇医药
Chen Lizhang，Gao Jianming，Peng Jieying，et al.
School of Public Health，Central South University，Changshai410078.
【Abstract】 Objective To evaluate and analyze the risk factors of burning mouth syndrome(BMS).Methods Eighty-seven consecutive patients with BMS and a randomly selected control group(n=82)were comprehensively investigated with the method of case-control study，and of logistic regression analysis.Results A regression equation which included6variables had been established by logistic regression analysis，indicating that the habit of tongue thrusting，biting lip，periodontitis，smoking，outcome of recent malmedication，depression were the principal risk facˉtors，among which the weight of tongue thrusting was the most common one.Conclusion These data suggested the measures such as refraining from oral bad habits，removing local irritating factors，stopping smoke，good mental health status could help the prevention of BMS.
, 百拇医药
Key words burning mouth syndrome risk factors case-control study Logistic regression analysis
Burning mouth syndrome(BMS)is defined as burnˉing and painful sensations in the mouth when the oral mucosa is clinically normal [1，2].Multiple sites in the oral cavity may be affected，the most common one being the tongue.BMS patients have dry mouth，thirst，dysgeusia and other accompanied symptoms.“Glossodynia”，“Glosˉsopyrosis”and“oral dysesthesia”are different synonyms for the term“burning mouth syndrome” [3，4] .In recent years，the prevalence of BMS increased and it has beˉcome a common chronic oralfacial pain disorder [5] .The causes of BMS remains open to controversy.Treatment based on some possible etiologic factors is frequently inˉeffective，and no therapy for BMS has proven generally effective.The purpose of this studywas to investigate and determine the risk factors of BMS with the method of case-control study，and of logistic regression analysis.
, 百拇医药
1 Material and methods
Eighty-seven consecutive patients attending the Oral Medicine Clinic，Xiang ya hospital or second hospiˉtal，Central South University during the period March， 2002，to November，2002，who had a diagnosis of BMS but no clinical evidence of oral pathosis comprised the study group.Adiagnosis of BMS was based on estabˉlished criteria.The absence of visible oral lesions was verified in each case.The control group consisted of82persons，matched for age and sex，who were randomly seˉlected from among those patients att
, 百拇医药
ending the Oral Medicine Clinic for identifiable organic causes such as decayed tooth，dental treatment，and other mucosal disˉeases.
A self-designed questionnaire，self-rating anxiˉety scale(SAS)and self-rating depression scale(SDS)were applied to all the subjects.The contents of our investigation included demographic characteristic，part dentate，denture problems，exodontia，allergies，oral bad habits，gingivitis，periodontitis，systemic diseases，menopause，occupational risk factors，smoking，alcohol abuse，prescribed medication，negative life events in the past two years，depression，anxiety，et al.All the data obˉtained wer
, http://www.100md.com
e transferred to a data bank and analyzed staˉtistically in spss10.0for windows.The chi-square test，t test and logistic regression analysis were used for statistical analysis of the data.A5%significance level was used for all statistical tests and comparisons.
2 Results
Of the total of87cases of BMS identified，66(75.9%)were women，of whom47(54%)were menopausal or postmenopausal.The ratio of women to men was3.14.The mean age of the BMS subjects was52.6，and the range was28to83years.71(81.6%)of the BMS subˉjects were between the age group40to70years.Duration of symptoms varied from more than10days to10years，with a medium of nine months.TableⅠdescribed the characteristics of the BMS and control groups used in this study.There was no statistically significant differˉence with respect to age，gender in the two groups，which suggested the patients with BMS and the control group were successfully sex-and age-matched.
, 百拇医药
TableⅠ characteristics of BMS and control groups 略
The variables for which statistically significant difˉferences(P<0.05)could be shown between BMS and control group by the method of monofactor analysis are displayed in TableⅡ.Thirteen variables，education，tongue thrusting，biting lip，periodontitis，central nervous system(CNS)disturbances，arthritis，menopausal，chronˉic respiratory infection，smoking，the outcome of preˉscribed me dication，self-medication，the scores of anxiˉety，the scores of depression，differed significantly beˉtween the BMS group and the controlgroup.For all the other variables investigated the differences between the patients with BMS and the control patients were small and not statistically significant.
, 百拇医药
Logistic regression analysis with back-ward elimiˉnation was applied to optimize the relationship between the thirteen variables and BMS.The enter probability for stepwise was0.05，and the removed probability for stepˉwise0.10.As a result，a regression equation which inˉcluded6variables had been established by logistic reˉgression analysis，and were shown in TableⅢ.The six variables，tongue thrusting，biting lip，periodontitis，smoking，the outcome of recent medication，depression were principal risk factors related to BMS.Their odds raˉtios were55.9，8.2，9.5，12.6，3.4，12.6respectively.The standard coefficient of regres
, 百拇医药
sion of tongue thrusting was1.082，the largest one.The chi-square test used to test the goodness of the regression equation gave a fairly satisfactory result(X2 =17.316，P=0.027，R 2 =0.769).
TableⅡ monofactor analysis about risk factors of BMS 略
Discussion
The present study has again demonstrated the comˉplexity of the causes of BMS.A total of52variables were considered in our study.As far as could be ascertained，no previously published study on this subject has investiˉgated as many possible variables as in our study.
, http://www.100md.com
The use of logistic regression analysis when studyˉing variables associated with BMS was in our opinion fruitful，which can pick out several predominantly reˉsponsible factors from multiple variables，and showed their odds ratios.The method of monofactor analysis usuˉally leads to unilateral and incomprehensive inference in the determination of a disease’s risk factors.When comˉbined with amultivariate statistical model，the disadvanˉtages disappear.
Uhis study provided support that bad oral habits are causative agents in BMS，such as tongue thrusing，biting lip.A explanation for this association is thatthese oral habits strain the fibers of tongue muscle，increase the consumption of oxygen，help the congregation of the waste of metabolism in the tissue of tong
, http://www.100md.com
ue and result in a pain and burning sensation at last.
The presence of periodontitis was statistically sigˉnificant in BMS and it entered the regression equation in our study.Periodontitis，as a common infection，usually is caused by dental plaque，dental calculi，faulty denture，et al.all of which are local irritating factors in BMS.It unˉderlines the need for the maintenance of optimal oral hyˉgiene by the patients with BMS.One study [6] shows78%of BMS patients had local stimulators.Symptoms could still exist and other normal sites might be complicated even if the local stimulators were removed.
, 百拇医药
A significant relationship between smoking and BMS was found.This is an interesting observation and can probably be ascribed to the effects of some harmful substances in cigarette such as benzo(a)pyrene，polyˉcyclic aromatic hydrocarbons.Many studies [7～10] have verified there was a significant increase of mi
cronucleatˉed(MN)cells in oral mucosa of smokers than in that of nonsmokers.The detection of the number of MN cells is a simple，rapid，and effective method to identify chromoˉsome damage.Tobacco has played an effect on oral muˉcosa damage.In our country only one precedent study [11] had ever reported the relationship between smoking and BMS in the conclusion that smoking ranked the first sysˉtemic etiologic factor in male BMS.
, 百拇医药
77%(67/87)of BMS patients had prescribed medˉ ication in the past six months，but their treatments were ineffective，only3patients cured，26relieved，38with no change at all.Although the precise details of the medicaˉtions were not recorded，antibiotics，antidepressants and proprietary mouth rinses were among th
e drug categories commonly included.It is well known that excessive use of these drugs might lead to resultant mucosal irritation.Because of the bad outcomes of treatments，BMS patients went to see doctor again and again，which aggravated their anxiety about physical health，on the other hand，the duration of BMS assumed a chronic tendency.
, 百拇医药
Many studies [12～14] have shown that BMS patients suffer from various psychological problems which is in accordance with our result.Anxiety，depression，somatiˉzation symptoms seem to be common psychological probˉlems among BMS patients.BMS can be treated both loˉcally and systemically as well as with different psychoˉlogical methods.
In conclusion，BMS is a multifactorial condition and remains poorly understood.Refraining from bad oral habits，removing local irritating factors，stopping smoke，good mental health status may help the prevention of BMS.
, 百拇医药
References
1 Bergdahl J Anneroth G.Burnin mouth syndrome:literature review and model for research and management.J Oral Pathol Med，1993，22:433-438.
2 Zhao M，Chen QM，Lin M，et al.Relationships between the symptom of xerostomia and non-stimulated salivary flowrates in patients with burnˉing mouth syndrome.WCJC，2001，19(3):169-177.
3 Wadrop RW.Hailes J.Burger H.et al.Oral discomfort at menopause Oˉral Surg Oral Med Oral Pathol，1989，67(5):535-540.
, http://www.100md.com
4 Lamey PJ.Lamb AB.Prospective study of aetiological factors in burning mouth syndrome.Br Medical J，1988，296(6631):1243-1246.
5 Meng J.Advance in the research of burning mouthing syndrome.Antholˉgy of Medicine，2001，20(5):721-723.
6 Gao S，Yang SJ，Wang ZK.A multiple variable analysis of burning……(Ⅰ)clinical data analyse.J Modern Stomatol，1995，9(3):143-145.7 Zhou X，Liu HW.Study of micronuclei in exfollative cells of normal muˉcosa.J Modern Stomatol，2001，15(4):251-253.
, http://www.100md.com
8 Ozkul Y.Donmez H.Erenmemisoglu A.et al.Induction of micronuclei by smokeless tobacco buccal mucosa cells of habitual users.Mutageneˉsis，1997，12(4):285-287.
9 Bagwe AN.Bhisey RA.Occupational exposure to tobacco and resultant genotoxicity in bidi industry workers.Mutat Res.1993，299(2):103-109.
10 Kayal JJ，Trivedi AH.Dave BJ，et al.Incidence of micronuclei in oral mucosa of users of tobacco products singly or in various combinations.Mutagenesis，1993，8(1):31-33.
, 百拇医药
11 Li L，Li Y.Glossodynia etiology and clinical analyse.Chinese Journal of Pain Medicine，2000，4(4):194-198.12 Trikkas G，Nikolatou O，Samara C，et al.Glossodynia:personality charˉacteristics and psychopathology.Psychother Psychosom，1996，65(3):163-168.
13 Bogetto F，Maina G，Ferro G，et al.Psychiatric comorbidity in patients with burning mouth syndrome.Psychosom Med，1998，60(3):378-385.
14 Lauritano D，Spadari F，Formaglio F，et al.Etiopathogenic，clinical-diagnostic and therapeutic aspects of the burning mouth syndrome.Reˉsearch and treatment protocols in a ptient group.Minerva Stomatol，1998，47(6):239-251.
作者单位： 1 410078 中南大学公共卫生学院
2 410078 中南大学口腔学院
(审 校 卢信义), 百拇医药(陈立章)