Research carried out at Universidade Veiga de Almeida – UVA – Rio de Janeiro (RJ), Brazil, and at Universidade do Estado do Rio de Janeiro – UERJ – Rio de Janeiro (RJ), Brazil.
(1) School of Dentistry, Universidade do Estado do Rio de Janeiro – UERJ – Rio de Janeiro (RJ), Brazil; Postgraduate Program (Master of Professional Studies) on Speech Therapy, Universidade Veiga de Almeida – UVA – Rio de Janeiro (RJ), Brazil.
(2) School of Dentistry, Department of Oral Diagnostic and Surgical Sciences, Universidade do Estado do Rio de Janeiro – UERJ – Rio de Janeiro (RJ), Brazil. (3) Postgraduate Program (Master of Professional Studies) on Speech Therapy, Universidade Veiga de Almeida – UVA – Rio de Janeiro (RJ), Brazil.
Conflict of interests: No
Authors’ contribution: SGP leading researcher, research development, preparation of research timetable, survey of literature, data collection and analysis, writing the manuscript, article submission and paperwork procedures; MHC co-advisor, research development, preparation of research timetable, data analysis, manuscript proofreading, approval of manuscript’s final version; EMGB advisor, research development, preparation of research timetable, data analysis, proofreading of manuscript, approval of manuscript’s final version.
Correspondence address: Silvana da Gama Pastana. Faculdade de Odontologia, Universidade do Estado do Rio de Janeiro, Setor de Fonoaudiologia, Edifício Paulo de Carvalho. R. 28 de Setembro, 157, Vila Isabel, Rio de Janeiro (RJ), Brazil, CEP: 20551-030. E-mail: sgpastana@ig.com.br
Received: 1/18/2013; Accepted: 9/4/2013
Complaints to oral functions and verification of the speech of
individuals diagnosed with burning mouth and xerostomia
Queixas fonoaudiológicas e verificação da fala de indivíduos com
diagnóstico de ardência bucal e xerostomia
Silvana da Gama Pastana1, Marília Heffer Cantisano2, Esther Mandelbaum Gonçalves Bianchini3
ABSTRACT
Purpose: To investigate complaints related to oral functions in the presence of burning mouth and dry mouth, and analyze changes in the manner of articulation of speech. Methods: There were 66 participants, age range 30-78 years, arranged in three groups: burning mouth group, xerostomia group, and group of individuals without oral symptoms. In-terviews, as well as a clinical exam of the oral cavity and the recording of the subjects’ speech based on a pre-set list of words, were carried out. Results: Dry mouth was found as a common characteristic for the first two groups. Regarding symptom localization, the xerostomia group described a larger amount of structures affected by the symptom. The complaints that were most frequently reported by this group were tired-ness and struggle to speak, and struggle and choke during deglutition. The struggle complaint was significant in comparison with the burning mouth group, and the symptom was aggravated in presence of speech. Most of the subjects reporting dry mouth either as the main symptom or as an associated symptom gave off clicks during speech. A higher inci-dence of those clicks was found in the xerostomia group. No eviinci-dence of phonetic changes were found in the symptomatic groups. Conclusion: Regarding the complaints involving the oral functions, struggle speaking and swallowing were the most frequently reported by the subjects in the xerostomia group. Clicks were found in the speech of the majority of the subjects with dry mouth. Despite the symptomatology identified and the number of affected oral structures. Despite the symptomatology and the number of affected oral structures, no evidence of phonetic changes in the individuals with oral symptoms.
Keywords: Burning Mouth Syndrome; Xerostomia; Phonetics; Speech; Oral Medicine
RESUMO
Objetivo: Investigar as queixas das funções orais em presença dos sintomas de ardência e secura bucal e analisar as alterações da fala em seu aspecto articulatório. Métodos: Foram avaliados 66 indivíduos com idade entre 30 e 78 anos, divididos em três grupos: grupo ardência bucal, grupo xerostomia e grupo sem sintomas bucais. Foram realizadas entre-vistas, exame clínico da cavidade oral e gravação da fala, com utilização de fichário evocativo. Resultados: A característica comum nos dois primeiros grupos foi a presença do sintoma de secura bucal. Na locali-zação dos sintomas, o grupo xerostomia apresentou maior quantidade de estruturas afetadas pelo sintoma. As queixas mais referidas por esse grupo foram cansaço e força na fala e força e engasgos à deglutição. A queixa de força foi significativa, na comparação com grupo de ardência bucal, com aumento do sintoma provocado pela função de fala. Dos sujeitos que se queixaram de boca seca, como sintoma principal, ou associado, a maioria apresentou ruídos durante a fala. O grupo xerosto-mia apresentou maior ocorrência desse ruído. Não foram evidenciadas alterações fonéticas nos grupos de sintomas bucais. Conclusão: Das queixas envolvendo as funções orais, falar e deglutir com força foram as mais referidas pelos indivíduos do grupo xerostomia. Observou-se a presença de estalidos na fala da maioria dos sujeitos com o sintoma de secura bucal. Apesar das sintomatologias apresentadas e do número de estruturas orais afetadas, não houve evidência de alteração fonética nos indivíduos com sintomas bucais.
INTRODUCTION
Burning Mouth Syndrome (BMS) is a disease characteri-zed by a blazing sensation and/or constant pain in the mouth, without any associations to injuries in the oral cavity. The incidence of BMS is higher in middle-aged women and in elderly individuals(1,5). The intensity of the burning or blazing
sensation is variable, and is intensified in the course of the day(4,6). Frequently, the blazing sensation affects more than
one area(2,4), and the tongue is mentioned as the most affected
structure(2-7); it can also affect other structures of the oral
ca-vity, such as lips, palate, gums and buccal mucosa(3-5), as well
as – though less frequently – the floor of the mouth(3) and the
oropharynx(2). The term “syndrome” in BMS is used because
of the simultaneous association between the burning sensation and other subjective symptoms, such as xerostomia and dys-geusia(2,4,7,8). BMS etiology is described as multifactorial(5) due
to its enigmatic condition.
Complaints about the oral functions are so described: ag-gravation of the symptomatology when speaking and ingesting hot food(9), as well as acid(10) and spicy(7,11) foods; improvement
or suppression of the symptom in liquid and food intake(6,11);
relief of the sympom when ingesting cold foods(10). Subjects
also report that the ingestion of liquid or food at extreme tem-peratures may either aggravate or alleviate the symptoms(2).
Saliva plays a fundamental role in maintaining health, due to its multiple functions, directly related to the flow rate and to its specific components. Any change in its quantity and quality can, to a higher or lower degree, bear several consequences and interfere with the body homeostasis(8). The role of saliva
in the oral cavity ranges from lubrication of the mucosa to the gastrointestinal functions(12). Saliva also plays a defensive role
by means of bacterial clearance and cleaning of food particles, moistening and breaking food, helping to create bolus, facili-tating mastication, swallowing and speech(13).
Changes in saliva may produce symptoms such as xe-rostomia, the most common clinical manifestation of oral complaints, due to its association with several factors(13-15). It
is described as a subjective sensation of dryness in the mouth, which does not necessarily reflect hyposalivation, which is a reduced flow of saliva(16). Among the various causes of
xerosto-mia, Sjögren Syndrome is the systemic disease that most affects the saliva. Its autoimune condition causes chronic inflammation of the salivary glands, with incidence of a disorder in saliva’s chemical components, causing a change in the quantity and quality of the saliva(17,18). Xerostomia is the main manifestation
of this syndrome(19). Dry mouth can affect the oral mucosa as a
whole(20), but subjects also state that structures such as the lips(21)
and the oropharynx(16,22) are also affected. The symptom can
oc-cur continuously(23), with periods of considerable discomfort(20).
Xerostomia is constantly described in association with burning mouth(2,15,23,24) and change in taste(4,8). The presence
of taste disorders can exacerbate oral discomfort and impair
both the appetite and food intake, affecting the individual’s quality of life(24). Subjects also inform the use of strategies
and/or medication in order to try to alleviate oral discomfort, to minimize the symptomatology(19,23). Because xerostomia is
related to multiple factors, and due to its frequent association with other oral symptoms, treatments have palliative effects and aim to reduce oral discomfort, in order to diminish the several complaints of individuals with dry mouth symptom(14,18,19,23).
Many studies refer to the impact of dry mouth on speech, mastication and swallowing(14-19,23-26), as well as on the voice(27).
Complaints referring to xerostomia are usuallly identified by means of questionnaires(15-17,19,23,25). Some studies try to
inves-tigate objectively the impairment of the oral functions related to dry mouth and/or hyposalivation(17,28); however, few studies
have reported the association of this symptom and speech(29,30).
This study aims to describe the characteristics – from the point of view of speech therapy – of individuals diagnosed with burning mouth and xerostomia, and to identify possible interferences in the oral functions and the impact of those symptoms on the manner of speech.
METHODS
This research was approved by the Research Ethics Committee of Hospital Universitário Pedro Ernesto in the Universidade do Estado do Rio de Janeiro (UERJ), under the protocol nº 2856/2011. It was considered presenting no risk, and required the signature of a Free Prior and Informed Consent by all participants. Subjects were outpatients from Policlínica Piquet Carneiro, diagnosed with of burning mouth and xe-rostomia, and referred to speech-language evaluation by the Stomatology Department of UERJ. The dental diagnosis had been previously carried out by an odontologist with expertise in oral pathology. Since it is a symptomatology, the diagnosis was carried out by means of observation of clinical signs, based on clinical history data, clinical evaluation and inspection of the oral cavity. Individuals without burning sensation or dry mouth complaints were also evaluated, as the Control Group.
The sample consisted of 66 subjects, 62 female and four male, age range 30-78 years, thus grouped: G1 = 22 individu-als diagnosed with burning mouth (20 female and two male), age range 44-78 years, age mean 60.4 years; G2 = 22 female subjects diagnosed with xerostomia, age range 34-70 years, age mean 58.7 years; G3 = 22 individuals withouth complaints of burning mouth and/or dry mouth (20 female and two male), age range 30-69 years, age mean age 50.2 years.
The exclusion criteria were: neurological and/or cognitive impairment, congenial, acquired or evolutive neurological diseases; hearing impairment, speech disfluency; dentofacial deformities or temporomandibular joint disorders; any type of injury in the oral cavity; and use of dentalbraces or piercing in the oral structures.
theraphist signing as the leading author of this research. All were seen individually, indoors, at scheduled times. Each individual was submitted to an interview for identification data (name, age, gender) and to a dental diagnosis. The clini-cal history of the symptomatology included: duration of the disease; associated symptoms; affected structures; intensity of the symptom, measured by means of a visual analogue scale (VAS). Based on this scale, each individual was oriented to give scores to the intensity of their symptom. Those scores ranged from 1 to 10, respectively minimum and maximum intensity. Subjects were asked to answer the evaluator’s question: “On a scale from 1 to 10, 1 standing for minimum, and 10 standing for maximum, what grade would you give to the intensity of that symptom?”. Subjects were also asked to provide the fol-lowing information: whether the symptom was continuous; whether there were periods of intensification of the symptom; what strategies they used to alleviate the symptom; types of oral complaints caused by the symptom; whether the symptom exacerbated or reduced in the presence of the oral function; whether the oral function was modified by the symptom.
In sequence, they were submitted to an exam of the oral cavity, in order to inspect the integrity of all the structures in-volved in the manner of speech. The oral inspection protocol consisted of the following structures: dental status, bite pattern, characteristics of the tongue, lips, cheeks and tonsils. After explaining to each subject about the recording of speech, a headsetwith a microphone (Bright® 01409) was placed on the head of the patient, who was in upright position, facing the computer, in order to facilitate the visualization of the pictures. Audio recording (Sony Vaio®, Netbook Windows 7® operating
system) and footage (Sony® DSC-W320 Camera) took place
simultaneously. The recording consisted of the subjects’ utter-ing their name, age, and identifyutter-ing 87 pictures from a pre-set list of words, which contained all the phonemes of Brazilian Portuguese. Speech records were phonetically transcribed and analysed.
In order to facilitate measurement of the intensity of the symptoms, scores ranging from 1 to 10 were marked, based on the VAS. Three groups were then formed: mild (1-3), moderate (4-7) and severe (8-10).
Both the questionnaire and the oral inspection and speech protocols used for the interview and for the evaluation were designed especially for this study by both speech therapists signing this research, in the Postgraduate Program – Master of Professional Studies in Speech Therapy of Veiga de Almeida University (UVA).
Data is presented in tables, expressed by frequency (n) and percentage (%), for nominal and ordinal categorical data, and mean, standard deviation, median, interquartile range (IQR), minimum and maximum, for quantitative data. In order to check the presence of significant differences regarding the tested variables (duration of the disease; number of associ-ated symptoms; number of affected structures; intensity of the
symptoms; periods of intensification of the symptoms; continu-ous symptom; use and number of strategies to minimize the symptoms; types of complaints related to the oral functions; changes noticed; and number of subjects with clicks) between G1 (burning mouth), G2 (xerostomia) and G3 (control), χ2 Test,
or Fisher’s Exact Test, were applied for comparison of categori-cal data; for comparison of numericategori-cal data, one-way ANOVA (age) and Kruskall-Wallis nonparametric ANOVA (number of clicks) were used. Tukey’s and Dunn’s (nonparametric) multiple comparisons tests were used to identify which groups differed significantly, to the 5% level.
Nonparametric method was used because some variables did not show a normal distribution (Gaussian distribution), due to great dispersion and rejection of the hypothesis of normality according to the Kolmogorov-Smirnov test. The criterion for determining significance was the 5% level. Statistical analysis was processed by statistics software SAS® System, version 6.11
(SAS Institute, Inc., Cary, North Carolina).
RESULTS
Duration of the disease ranged from 1 year to over 10 years in G1 and G2. Differences between both groups were found as to the number of associated symptoms. In G1 there was a larger number of subjects with two associated symptoms, whereas in G2, majoritarily, only one associated symptom was found per individual. Regarding the number of affected structures, no difference was found between both groups. As to the intensity of the symptoms,measured by means of a Visual Analogue Scale (VAS), the symptomatic groups showed moderate inten-sity, and there was no difference between both groups. Both groups were similar as to the periods of intensification and to the occurrence of the symptom. Both groups said that the symptoms are continuous and are intensified in certain periods. A high percentage of subjects in both groups reported the use of strategies to minimize the symptoms. As to the number of strategies, most individuals in both groups use at least one type of strategy to alleviate the symptom, with no differences between the groups (Table 1).
Regarding the associated symptoms, burning sensation appeared in 45.5% (n=10) of the subjects in the xerostomia group, and dry mouth in 72.7% (n=16) of the individuals in the burning mouth group. Alterations in smell and taste appeared in the same percentage in both groups – respectively 18.2% (n=4) and 45.5% (n=10). The percentage of pain in the burning mouth group was 22.7% (n=5), and in the xerostomia group was 9.1% (n=2).
in the xerostomia group, in comparison to the burning mouth group. The lips and oropharynx also show high percentage in the xerostomia group (Figure 1).
The strategies used to minimize the oral symptoms that showed differences were food intake in G1 and medication in G2. As to the ingestion of liquids, although there was higher percentage of this strategy in G2, no differences were found in comparison to G1. Other strategies, such as the use of ice, rinsing the mouth, finding distractions, eating sweets and stopping talking were informed; in spite of a greater diversity of strategies in G1, no differences were found in comparison to G2 (Figure 2).
As regards oral functions complaints, the general compari-son between the percentage results showed that the xerostomia group reported a greater number of complaints in comparison to the burning mouth group. Also, it was found that, although the complaints about tiredness during speech presented a higher percentage in the xerostomia group, there was no difference between both groups. Struggle to speak or swallow were found in G2, which differs from G1. Complaints related to choke were more frequently mentioned in the xerostomia group, but no Table 1. Comparative clinical history of both symptomatic groups
Clinical history of symptoms
G1 (n=22)
G2
(n=22) p-value
n % n %
Duration of disease
1-5 years 16 72.7 10 45.5 0.20
5-10 years 4 18.2 9 40.9
> 10 years 2 9.1 3 13.6
Nº of associated symptoms
0 3 13.6 6 27.3 0.039*
1 5 22.7 10 45.5
2 12 54.5 3 13.6
3 or 4 2 9.1 3 13.6
Nº of affected structures
1-2 15 68.2 10 45.5 0.081
3-4 6 27.3 5 22.7
≥ 5 1 4.5 7 31.8
Intensity of the symptoms
mild (1-3) 2 9.1 1 4.5 0.63
moderate (4-7) 14 63.6 12 54.5
severe (8-10) 6 27.3 9 40.9
Occurrence of a period of intensification 17 77.3 17 77.3 1
Occurrence of continuous symptom 14 63.6 14 63.6 1
Use of strategies to minimize the symptoms 18 81.8 16 72.7 0.47
Nº of strategies to minimize the symptoms
none 4 18.2 3 13.6 0.37
1 9 40.9 11 50.0
2 6 27.3 8 36.4
3 3 13.6 0 0
*Significant values (p<0.05) – χ2 Test or Fisher’s exact test
Note: G1 = Burning mouth group; G2 = Xerostomia group
χ2 Test or Fisher’s exact test (p<0.05)
differences were found when compared to the burning mouth group (Table 2).
Regarding the influence of the oral functions on the symp-toms researched, in G2 it was found that speaking aggravates
the dry mouth symptom, which differs from G1. As to the effect of mastication on either symptom, few subjects related aggravation of either symptom after mastication. Both G1 and G2 were similar as to modifications of the oral functions caused by the oral symptoms. Although 27.3% of the subjects with burning mouth reported the modification of speech, only 4.5% said to use the strategy of stopping talking to alleviate the symptom (Figure 2) (Table 3).
As to alterations in speech, there was low incidence of pho-netic change between both groups of oral symptoms. However, the methodology employed in this study allowed for an obser-vation of the articulatory dynamics and the identification of a specific noise, such as a “click” in the speech of many subjects. Such clicks were found either between articulatory sequences or during the speech of those subjects with dry mouth, regardless of the group to which they belonged (Tables 4 and 5).
DISCUSSION
Sample characterization showed that the findings in this study are in agreement with the literature, which points that
Table 2. Distribution and identification of complaints regarding oral functions in the burning mouth and xerostomia groups
Oral functions Complaints
G1 (n=22)
G2 (n=22)
p-value
Frequency Frequency
% n %
Speech Tiredness 6 27.3 12 54.5 0.066
Struggle 0 0 5 22.7 0.024*
Noise 0 0 1 4.5 0.50
Mastication Tiredness 3 13.6 2 9.1 0.50
Struggle 0 0 2 9.1 0.24
Noise 0 0 2 9.1 0.24
Deglutition Struggle 0 0 7 31.8 0.004*
Noise 0 0 0 0 NA
Choke 2 9.1 5 22.7 0.20
* Significant values (p<0.05) – χ2 Test or Fisher’s exact test (p<0.05)
Note: G1 = Burning mouth group; G2 = Xerostomia group
χ2 Test or Fisher’s exact test (p<0.05)
Figure 2. Strategies employed to minimize oral discomfort in both symptomatic groups
Table 3. Changes noticed by the subjects in the burning mouth and xerostomia groups
Changes Noticed
G1 (n=22)
G2 (n=22)
p-value
Frequency Frequency
n % n %
Speaking aggravates the symptom 7 31.8 20 90.9 <0.0001*
Mastication aggravates the symptom 2 9.1 2 9.1 0.70
The symptom affects the speech 6 27.3 3 13.6 0.22
The symptom affects mastication 2 9.1 2 9.1 0.70
The symptom affects deglutition 1 4.5 2 9.1 0.50
* Significant values (p<0.05) – χ2 Test or Fisher’s exact test (p<0.05)
most patients with burning mouth(1-5) and dry mouth(15,19,24,29)
complaints are female. Control Group was paired as to gender, in order to avoid biases regarding this variable. As to age, even though it was not controlled in this study, as it used outpatients in sequence, no differences between the symptomatic groups were found. Only G3 was paired as to this variable. This datum may point that both BMS and dry mouth seem to affect mainly the population aged 50 years or around(1,15,24).
Regarding patients’ clinical history, the symptomatic groups showed similarities in may aspects, which agrees with the reviewed literature(2,4-8,11,16,22,23). Some studies, however,
found variations especially regarding the intensity of the symptom(4,22,24). Because the symptomatology has a subjective
character, variations can be expected as to this aspect. This study confirmed the use of strategies to minimize the symptoms(6,11,19,23), which shows that the subjects seek relief
machanisms as a way to minimizing the symptomatology. This study also confirmed the associated symptoms by both groups, i.e., the main symptom in one group appears as an as-sociated symptom in the other group, and vice-versa(4,7,8,15,23,24).
The diversity of symptoms found and associated to the main symptoms – burning sensation and dry mouth – probably makes it difficult to discover the cause, which, as a conse-quence, results in various treatments(14,18,19,23). Some studies
refer to BMS as a condition associated with chronical pain(5).
However, this symptom was the least reported by individuals in both groups(3,16).
The tongue was reported as the most affected oral stucture by the burning sensation and dry mouth. Such a result is in agreement with the reviewed literature on BMS, and with the involvement of other structures to a lower degree(2-4,6). The
xe-rostomia group mentioned a larger amount of structures affected with dry mouth, including the lips and the oropharynx(16,21,22). It
is important to highlight that the oropharynx was not informed in G1, which means it appeared less frequently in BMS(2,3).
Another important observation is that, according to the table displaying the number of structures affected by dry mouth,
previously shown, the comparison between both groups poin-ted at an expressive tendency towards G2. Such tendency was confirmed in the identification of the oral structures affected.
The literatura states that individuals with burning mouth and/or dry mouth make use of medications(4,6), as well as
substitutos salivares, lip moisturizers, gels, chewing gums, water with drops of lemon juice and salivary stimulants(4,19,23).
In this study, the most significant strategies were food, in G1, and medication, in G2(2,6,10,11,14,23,25). The use of liquids,
espe-cially water, is referred in the literature as a common strategy to both groups(11,14,15,22,29). Frequent utilization of water alone is
mentioned as capable of causing relief in patients with xeros-tomia(23). Other strategies have also been reported, as shown
in the literature(9-11,13,14). It seems important to highlight that in
this analysis, even though various oral structures were said to be affected with burning sensation and dry mouth, only one subject in G1 reported to “stop talking” in order to alleviate the burning sensation; this strategy was not mentioned in G2. This datum may suggest that the burning sensation and/or dry mouth, in spite of subjects’ complaints, do not interfere in their communication(26,30).
Burning sensation and/or dry mouth complaints are referred in the literature(2,10,15,17,19,25,26), with a consequent negative
im-pact in the individuals’ quality of life(16,24), including the social
aspect as well(7,13). In this study, complaints such as tiredness
and struggle were reported in both groups, especially in the xerostomia group. Studies identified difficulties performing those functions in individuals with dry mouth(15,19,29). Struggle
to speak, in turn, can be explained due to the involvement of the articulators in the oral cavity, especially the tongue, whose mo-vements demand greater effort due to its inefficient lubrication. The literature describes that both quantitative and qualitative changes in the saliva may cause impairment of mastication, swallowing and speech(15,21,26), depending on the etiology and
degree of discomfort.
As to swallowing, it can be inferred that dry mouth would demand greater effort, due to the parchedness of the oral Table 4. Phonetic changes and clicks in the studied groups
Speech G1
(n=22)
G2 (n=22)
G3
(n=22) p-value
Phonetic changes (0 – 3) (0 – 1) 0 NA
Clicks 4 ± 10 (0 – 22) 13.5 ± 15.3 (0 – 62) 0 ± 2 (0 – 34) <0.0001*
*The number of clicks was shown by the median ± IQR (minimum–maximum) and compared using Kruskal-Wallis’s ANOVA (p<0.0001)
Note: G1 = Burning mouth group; G2 = Xerostomia group; G3 = Control group; NA = not applicable
Table 5. Number of subjects with clicks during speech in the presence or absence of dry mouth
Function x Symptom
Dry mouth (n=38)
No dry mouth
(n=6) p-value
n % n %
Speech associated to click 31 81.6 1 16.7 0.003*
mucosa, especially the oropharynx region, reported by the group with that symptom. Some studies showed changes, es-pecially in deglutition, in individuals with Sjögren Syndrome, and dysphagia was referred as an important change associated with dry mouth(29). Dry mouth, in its various degrees of
seve-rity, could explain the difficulty in speaking and swallowing in those individuals(15,19).
As to the occurrence of changes in the oral symptoms, cau-sed by the oral functions, G2 showed that speaking aggravates dry mouth. Speech is a dynamic function, which, associated to voice, requires the respiratory mechanism, together with the rhythmical and sequencial movement of the articulators, tongue and lips, which can show signs of dry mouth(21). Thus, it
was indeed expected that individuals with dry mouth reported aggravation of the symptom after speaking(27,29).
This study found low occurrence of subjects reporting aggravation of the symptoms after mastication. Food intake, associated to the masticatory movements, stimulates saliva-tion(12), which probably causes relief in those subjects(10,16).
Besides, many individuals mentioned the ingestion of liquids during meals, which promotes moisturization of the oral mucosa(17,19,21,23,25) in people with dry mouth, and reduction or
suppression of the symptoms with ingestion of food in indivi-duals with burning sensation(6,11).
The symptomatic groups presented similar results as to changes in the oral functions due to the oral symptoms. Studies showed that mastication was affected in presence or dry mouth, and that difficulties in mastication and deglutition are more frequent in an advanced stage of hipofunction of the salivary gland(23,26,28), considering that hyposalivation alone would not
affect the performance of mastication(30). Although 27.3% of
the subjects with burning sensation reported modifications on speech, only 4.5% mentioned to “stop talking” as a strategy to alleviate the symptom. One factor that can be associated with this is the low percentage of pain, which could in fact influen-ce changes in mastication, deglutition and speech. Therefore, despite the complaints reported by the subjects, the burning sensation and dry mouth do not seem to be capable of leading to great changes in the oral functions, when there is absence of pain.
Results referring to alterations in speech, some studies report the presence of “clicks” in subjects with dry mouth symptom, which appear either during their speech or in the pauses of the articulatory sequences(14-16,19,23). Thus, due to the
reduction of the saliva, the tongue sticking to the palate could cause a “click”, which is perceptible in the speech of patients with Sjögren syndrome, mainly in cases of extremely dry mouth(18,29). Such noise observed during the speech does not
seem to be associated with the movement of the jaw(30), but to
the movement of the tongue against the palate(18,29).
Results show complaints reported by the subjects who suffer from chronical oral symptoms, such as burning sensation and dry mouth. Further studies with larger samples may confirm
the oral clinical profile of those individuals. The identification and relevance of complaints for a larger acknowledgement of those clinical characteristics may help to divise treatments that, if not curative, can minimize the reported discomfort regarding the oral functions. More often than not, such complaints can be unnoticed and mask diseases that may negatively influence those individuals’ quality of life in the future. Thus, the role of the speech therapist working on the diagnosis and rehabilita-tion of Orofacial Motricity is to check, by means of thorough evaluation, those complaints that may be associated with and affect speech, mastication and deglutition. The acknowled-gement of various signs and symptoms in the oral cavity will permit appropriate referral, making it possible to have an early interdisciplinary diagnosis.
CONCLUSION
Out of the complaints associated to the oral functions, struggling to speak and swallow were most frequenly reported by the subjects in the xerostomia group, and the symptom is aggravated by speaking. Dry mouth, reflected by the presence of clicks, interferes with speech and was found in the majority of the subjects with this symptom, whether as the main symptom or associated with burning mouth syndrome. No evidence of phonetic change in the individuals with oral symptoms was found. Burning sensation and dry mouth do not seem to impair speech regarding its manner of articulation.
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