# Support Group as a Management Modality for Burning Mouth Syndrome: A Randomized Prospective Study
## 1 Introduction  
Burning mouth syndrome (BMS) is an idiopathic intraoral chronic pain condition without abnormal clinical or laboratory findings. The symptoms described in the scientific literature are nonspecific and include, in addition to burning pain, dysgeusia, dysesthesia, loss of taste, and paraesthesia [1, 2]. The disorder has no specific histological features, so biopsy does not contribute to diagnosis.  
There is no scientific agreement regarding the classification of BMS. [PERSON] et al. have suggested two main clinical entities: \"primary (true) BMS\" and \"secondary BMS\". The former refers to idiopathic BMS for which oral or systemic causes cannot be identified, and the latter to a variant that results from pathological conditions [3, 4]. \"Secondary BMS\" may potentially arise from systemic abnormalities such as diabetes, nutritional deficiencies, intake of certain drugs, hormonal alterations, and various infections. Moreover, oral burning may accompany local oral abnormalities such as candidiasis, hyposulication, allergic reactions, mechanical and chemical irritations, and oral parafunctions [3].  
BMS has an estimated prevalence of 0.7-7% in the general population. It usually presents in the fifth to seventh decades of life [1, 2, 5, 6] and is seven times more common in females than males [7]. The tongue is the most common site involved, although various oral sites may be affected [8, 9, 10].  
The pathogenesis of BMS is unclear, and it is assumed to be associated with local, neural, inflammatory, and psychological processes. Some studies have specifically implicated hypersensitivity to dental components [11], central mechanisms involving dopamine receptors [12], primary neuropathic dysfunction [7; 13], inflammatory cytokine production [14; 15; 16], and psychosocial influences, somatization, and psychiatric morbidity [17; 18; 19; 10]. Despite the absence of causative organic factors, the precise causative role, if any, of psychological factors has not been elucidated [8; 17; 18; 19; 20; 21; 22; 23; 24; 25].  
Various modalities are used in the management of BMS including pharmacological interventions, behavioral therapy, and psychotherapy. However, there is still no definitive effective gold standard [24]. A previous Cochrane review of therapeutic interventions for BMS found that the existing evidence is of insufficient quality to support or refute the benefit of psychological therapies. The authors emphasized that given the potentially disabling nature of BMS, the need to identify effective modes of treatment was vital [26].  
To the best of our knowledge, only two studies have focused on the effect of group support on pain and anxiety in patients with BMS [20; 25]. Their results suggested that the intervention led to a reduction in pain intensity and anxiety.  
The aim of the present study was to further investigate the effectiveness of a support group in the management of BMS. The evaluation tool was a self-report life-quality questionnaire based on a validated questionnaire by [PERSON] et al. [27]. Modifications were made to suit the purpose of the study (see Appendix A).