1.Burning Mouth Syndrome 2026: From “Diagnosis of Exclusion” to a Structured Diagnostic Algorithm (Narrative Review)
Chang-Kyu OH ; Hye-Min JU ; Sung-Hee JEONG ; Yong-Woo AHN ; Hye-Mi JEON ; Soo-Min OK
Journal of Oral Medicine and Pain 2026;51(1):20-28
Burning mouth syndrome remains a frequent source of diagnostic delay, repeated consultations, and fragmented care because it has long been treated as a “diagnosis of exclusion.” Recent updates in orofacial pain classification and research diagnostic frameworks support a practical shift: from an exclusionary label toward a structured diagnostic algorithm and staged, phenotype-guided management. This narrative, algorithm-focused clinical review aims to summarize clinically actionable evidence and to propose a “minimum sufficient workup” that prioritizes safety, efficiency, and patient-centered communication.We first outline pragmatic diagnostic criteria and key symptom patterns, then integrate current concepts of mixed mechanisms—peripheral neuropathic features, centralociplastic amplification, and psychosocial modulators—that account for symptom fluctuation and discordance between symptom severity and objective findings. The core of this review is a one-page stepwise algorithm: (1) confirm chronicity and absence of visible mucosal disease, (2) screen for red flags requiring urgent evaluation, (3) address common local contributors (e.g., candidiasis, irritants, contact allergy, xerostomia), (4) perform a targeted systemic/medication/deficiency panel, and (5) phenotype patients to guide staged treatment choices and follow-up. Finally, we provide a practical management framework emphasizing education, trigger control, and individualized combinations of topical, systemic, and behavioral interventions with predefined reassessment intervals. Future priorities include phenotype-stratified randomized trials and implementation outcomes that quantify reductions in diagnostic delay, misdiagnosis, and unnecessary testing.
2.Age Estimation Using Attrition and Pulp Cavity Size of the Mandibular First Molar in Korean Population
Hee-Won KIM ; Hye-Mi JEON ; Kyung-Hee KIM ; Hye-Min JU ; Soo-Min OK ; Sung-Hee JEONG ; Yong-Woo AHN
Korean Journal of Legal Medicine 2025;49(1):1-6
In forensic science, age estimation is essential for identifying both living and deceased individuals. Teeth and jawbones serve as reliable indicators due to their gradual age-related changes and resistance to environmental factors. Among the various methods, attrition and pulp cavity size are commonly used to estimate adult age. This study aimed to enhance the accuracy of age estimation in Korean adults by combining measurements of tooth attrition and pulp cavity size obtained from panoramic radiographs of mandibular first molars. We evaluated 118 patients (62 male, 56 female) who visited Pusan National University Dental Hospital between 2010 and 2024. Radiographs and clinical photographs were analyzed for grade C teeth with exposed dentin using Takei’s method, and the pulp chamber height ratio (PCHR) and width ratio (PCWR) were measured using Jeon’s method. Intraobserver reliability was high (intraclass correlation coefficient>0.6), with no significant sex-based differences in PCHR and PCWR. Both ratios negatively correlated with age, with PCWR showing a stronger correlation, particularly in females (r=–0.606). This study derived an improved age estimation formula with R² values ranging from 0.540 to 0.546 when both PCHR and PCWR were combined. Despite the limitations of this study, such as its small sample size and reliance on panoramic radiographs, the findings suggest that combining tooth wear and pulp cavity size offers a more robust tool for age estimation in clinical and forensic settings.
3.Age Estimation Using Attrition and Pulp Cavity Size of the Mandibular First Molar in Korean Population
Hee-Won KIM ; Hye-Mi JEON ; Kyung-Hee KIM ; Hye-Min JU ; Soo-Min OK ; Sung-Hee JEONG ; Yong-Woo AHN
Korean Journal of Legal Medicine 2025;49(1):1-6
In forensic science, age estimation is essential for identifying both living and deceased individuals. Teeth and jawbones serve as reliable indicators due to their gradual age-related changes and resistance to environmental factors. Among the various methods, attrition and pulp cavity size are commonly used to estimate adult age. This study aimed to enhance the accuracy of age estimation in Korean adults by combining measurements of tooth attrition and pulp cavity size obtained from panoramic radiographs of mandibular first molars. We evaluated 118 patients (62 male, 56 female) who visited Pusan National University Dental Hospital between 2010 and 2024. Radiographs and clinical photographs were analyzed for grade C teeth with exposed dentin using Takei’s method, and the pulp chamber height ratio (PCHR) and width ratio (PCWR) were measured using Jeon’s method. Intraobserver reliability was high (intraclass correlation coefficient>0.6), with no significant sex-based differences in PCHR and PCWR. Both ratios negatively correlated with age, with PCWR showing a stronger correlation, particularly in females (r=–0.606). This study derived an improved age estimation formula with R² values ranging from 0.540 to 0.546 when both PCHR and PCWR were combined. Despite the limitations of this study, such as its small sample size and reliance on panoramic radiographs, the findings suggest that combining tooth wear and pulp cavity size offers a more robust tool for age estimation in clinical and forensic settings.
4.Age Estimation Using Attrition and Pulp Cavity Size of the Mandibular First Molar in Korean Population
Hee-Won KIM ; Hye-Mi JEON ; Kyung-Hee KIM ; Hye-Min JU ; Soo-Min OK ; Sung-Hee JEONG ; Yong-Woo AHN
Korean Journal of Legal Medicine 2025;49(1):1-6
In forensic science, age estimation is essential for identifying both living and deceased individuals. Teeth and jawbones serve as reliable indicators due to their gradual age-related changes and resistance to environmental factors. Among the various methods, attrition and pulp cavity size are commonly used to estimate adult age. This study aimed to enhance the accuracy of age estimation in Korean adults by combining measurements of tooth attrition and pulp cavity size obtained from panoramic radiographs of mandibular first molars. We evaluated 118 patients (62 male, 56 female) who visited Pusan National University Dental Hospital between 2010 and 2024. Radiographs and clinical photographs were analyzed for grade C teeth with exposed dentin using Takei’s method, and the pulp chamber height ratio (PCHR) and width ratio (PCWR) were measured using Jeon’s method. Intraobserver reliability was high (intraclass correlation coefficient>0.6), with no significant sex-based differences in PCHR and PCWR. Both ratios negatively correlated with age, with PCWR showing a stronger correlation, particularly in females (r=–0.606). This study derived an improved age estimation formula with R² values ranging from 0.540 to 0.546 when both PCHR and PCWR were combined. Despite the limitations of this study, such as its small sample size and reliance on panoramic radiographs, the findings suggest that combining tooth wear and pulp cavity size offers a more robust tool for age estimation in clinical and forensic settings.
5.Age Estimation Using Attrition and Pulp Cavity Size of the Mandibular First Molar in Korean Population
Hee-Won KIM ; Hye-Mi JEON ; Kyung-Hee KIM ; Hye-Min JU ; Soo-Min OK ; Sung-Hee JEONG ; Yong-Woo AHN
Korean Journal of Legal Medicine 2025;49(1):1-6
In forensic science, age estimation is essential for identifying both living and deceased individuals. Teeth and jawbones serve as reliable indicators due to their gradual age-related changes and resistance to environmental factors. Among the various methods, attrition and pulp cavity size are commonly used to estimate adult age. This study aimed to enhance the accuracy of age estimation in Korean adults by combining measurements of tooth attrition and pulp cavity size obtained from panoramic radiographs of mandibular first molars. We evaluated 118 patients (62 male, 56 female) who visited Pusan National University Dental Hospital between 2010 and 2024. Radiographs and clinical photographs were analyzed for grade C teeth with exposed dentin using Takei’s method, and the pulp chamber height ratio (PCHR) and width ratio (PCWR) were measured using Jeon’s method. Intraobserver reliability was high (intraclass correlation coefficient>0.6), with no significant sex-based differences in PCHR and PCWR. Both ratios negatively correlated with age, with PCWR showing a stronger correlation, particularly in females (r=–0.606). This study derived an improved age estimation formula with R² values ranging from 0.540 to 0.546 when both PCHR and PCWR were combined. Despite the limitations of this study, such as its small sample size and reliance on panoramic radiographs, the findings suggest that combining tooth wear and pulp cavity size offers a more robust tool for age estimation in clinical and forensic settings.
6.Psychosocial and Clinical Characteristics of Temporomandibular Disorder Patients Attributing Symptoms to Dental Treatment
Hee-Won KIM ; Yong-Woo AHN ; Sung-Hee JEONG ; Hye-Min JU ; Kyung-Hee KIM ; Hye-Mi JEON ; Soo-Min OK
Journal of Oral Medicine and Pain 2025;50(1):16-24
Purpose:
Temporomandibular disorder (TMD) is a multifactorial condition influenced by biological, psychological, and social factors. Some patients perceive dental treatment as the cause of their TMD, which may impact symptom perception and treatment response.This study aims to compare the psychosocial and clinical characteristics of patients who attribute their TMD onset to prior dental treatment (DT group) with those who do not (NT group).
Methods:
A total of 250 patients diagnosed with TMD at Pusan National University Dental Hospital between January and October 2024 were included. Patients were classified into the DT group (n=92) if they attributed their symptoms to previous dental procedures, while the remaining NT group (n=158) consisted of patients with other primary complaints. Patients were additionally categorized into Generation X (1965-1980), Generation Y (1981-1999), and Generation Z (2000-2012). Clinical assessments were conducted following the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and psychosocial factors were evaluated using the Oral Behaviors Checklist (OBC), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-15 (PHQ-15).
Results:
The DT group had a significantly higher mean age (54.16±16.87 years) compared to the NT group (39.71±19.12 years, p<0.001). Psychological distress scores (PHQ-9, GAD-7, and PHQ-15) were significantly higher in the DT group, particularly among Generation X patients (p<0.05). Muscle-related pain was more prevalent in the DT group (75%) than in the NT group. Interestingly, OBC scores were higher in the NT group (p<0.05).
Conclusions
Patients who attributed their TMD onset to dental treatment reported higher psychological distress and a greater prevalence of muscle-related pain, underscoring the need for a biopsychosocial approach to TMD management. Clinicians should consider the impact of patient perception on TMD symptoms and integrate psychological assessment and counseling to enhance treatment efficacy and patient adherence.
7.Evaluation of the Geriatric Oral Health Assessment Index Based on Oral Health-Related Behaviors and Status of Older Adults in Gangneung-si
Jin-Sun CHOI ; Hye-Rim JEON ; Soo-Myoung BAE ; Sun-Jung SHIN ; Bo-Mi SHIN ; Hye-Young YOON ; Hyo-Jin LEE
Journal of Dental Hygiene Science 2025;25(4):360-369
Background:
This study aimed to assess the Geriatric Oral Health Assessment Index (GOHAI) based on oral health-relatedbehaviors and oral health status among older adults in Gangneung-si.
Methods:
A total of 77 adults aged 65 years or older in Gangneung-si who voluntarily participated in an oral health care programwere included. GOHAI was administered as a self-reported questionnaire to evaluate oral health-related quality of life (OHRQoL).GOHAI consists of 12 items rated on a six-point Likert scale, with higher scores indicating better oral health and higher QoL.Assessment items included general characteristics, systemic disease, oral health-related behaviors, and tooth and periodontal status. The Shapiro–Wilk test was used to assess normality prior to comparing GOHAI scores across independent variables.Depending on normality results, differences in mean scores were analyzed using the independent samples t-test, one-way analysis of variance, or the Mann–Whitney U test.
Results:
The highest-scoring item was “Did your teeth or dentures bother you when you wanted to speak?”, whereas the lowest-scoring item was “Were you pleased or happy looking at your teeth, gums, or dentures?” A significant difference was observed according to the number of remaining teeth; participants with 20 or more teeth had higher GOHAI scores (41.86±5.22) than those with 19 or fewer teeth (38.33±3.83; p=0.046).
Conclusion
Significant differences in GOHAI scores were found in relation to systemic disease and the number of remaining teeth.These findings can support the development of strategies and policies to improve OHRQoL in older adults in Gangneung-si.
8.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
9.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
10.Periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to kidney transplant surgery
Youn-Kyung CHOI ; Hye-Mi JEON ; Ji-Young JOO ; Hyun-Joo KIM ; Eun-Young KWON
Journal of Dental Rehabilitation and Applied Science 2024;40(2):46-54
Purpose:
The purpose of this study was to compare the periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to renal transplantation surgery with those having normal kidney function.
Materials and Methods:
Patients who had been undergoing dialysis for end-stage renal disease and been referred to the Dental Clinic Center bythe Department of Nephrology at University Hospital for intraoral evaluation prior to kidney transplantation surgery. For comparisonof periodontal status, subjects without abnormalities in kidney function were matched with the patients by age and gender and selected as healthy controls. The patients’ age, gender, comorbidities, type of dialysis received, and duration of dialysis were investigated by reference to their medical records, and data on their periodontal status were analyzed via the relevant periodontal records.
Results:
A total of 102 patients, including 51 dialyzed patients and 51 healthy control group subjects, participated in this study. In the patients with end-stage renal disease undergoing dialysis with periodontal probing depth of 5 mm or more, percentage of sites with clinical attachment level of 4 mm or more, percentage of teeth with bleeding on probing, number of missing teeth, and ratio of moderate to severe periodontitis were all significantly greater than in the healthy controls.
Conclusion
The periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to kidney transplantation was worse than that of healthy controls.

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