Psychological stress, cortisol, ACTH, and cortisol/ACTH ratio associated with burning mouth syndrome

Abstract Objective Clinical characteristics of patients with burning mouth syndrome (BMS) were compared in the presence or absence of psychological stress to investigate the clinical, psychological, and haematological indicators. Methods Among 141 BMS patients (117 females, 82.98%; 56.4 ± 12.89 years), inter- and intra-group statistical analyses were conducted according to the presence or absence of psychological stress; BMS patients were divided into psychological-stress (n = 68; 55 females, 56.39 ± 12.89 years) and non-psychological stress group (n = 73; 62 females, 56.03 ± 14.90 years). Results Prevalence of xerostomia was higher in the psychological-stress group than in the non-psychological-stress group (67.6% vs. 34.2%, p < 0.001), and the unstimulated salivary flow rate was respectively lower (1.97 ± 1.79 vs. 2.74 ± 1.59 mL/min, p < 0.01). The SCL-90R subscale values, including somatization, hostility, anxiety, and depression, were higher in the psychological- than in the non-psychological-stress group (all p < 0.05); the cortisol level, adrenocorticotropic hormone (ACTH) level, cortisol/ACTH ratio, and antidiuretic hormone (ADH) level were respectively higher (all p < 0.05). Above-mean values of cortisol (AUC = 0.980, 95%CI: 0.959–1.000) and cortisol/DHEA ratio (AUC = 0.779, 95%CI: 0.701–0.856) were excellent predictors of psychological stress. The strongest correlation was obtained for cortisol (r = 0.831, p < 0.01), while cortisol/DHEA ratio (r = 0.482, p < 0.01) showed substantial correlation. Conclusion In BMS patients, xerostomia, decreased salivary flow rate, and increased cortisol and cortisol/DHEA ratios were associated with psychological stress, highlighting psycho-neuro-endocrinological features.