Burning Mouth Syndrome Underlying Factors: A Roadmap From a Network Perspective

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Abstract
Objective: To investigate the relationship between biological, psychological, and social factors underlying Burning Mouth Syndrome (BMS). Subjects and Methods: A case ( n = 40) and control ( n = 42) study containing 80 variables was examined using two network models based on regularized partial correlations ( n = 82). Results: The structure of the associative pathways with the BMS was revealed. Direct associations involved Gastrointestinal Alterations (0.23), Vitamin D Deficiency (0.29), Musculoskeletal Alterations (0.29), Symptom Severity Score 2 (SSS2) (0.22), Cortisol Variation (0.10), Interpersonal Sensitivity (0.04), Hostility (0.03). Global Severity Index, Symptom Severity Score 1, Psychoticism, Obsession‐Compulsion, Depression, Anxiety, and Somatization were indirectly related. The SSS2 was the most influential on BMS accuracy. Conclusions: Gastrointestinal alterations and vitamin D deficiency show a significant influence on BMS while cortisol mediates in multiple associative pathways between musculoskeletal alterations, gastrointestinal alterations, vitamin D deficiency, non‐restorative sleep, fatigue, and cognitive problems. In addition to anxiety and depression, psychoticism, interpersonal sensitivity, and hostility stand out as psychological factors that seem to be related to a lack of vitamin D. None of the factors studied seem to have a relevant predictive potential for BMS, except for nonspecific symptoms of central sensitization.

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