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Woda A, Dao T et al. J Orofac Pain 2009; 23: 219–220

The major criticism of the proposed aetiology (J Orofac Pain 2009; 23: 202–210), is that steroid dysregulation is generalised, although it is purported that stomatodynia occurs only in the oral cavity. In this rebuttal, it is argued that there is 'compelling evidence that neurosteroids can act locally (as in stomatodynia)...to locally influence neuronal activity'. Furthermore, the responding authors state that the reason why systemic steroid therapy does not resolve the condition is that irreversible neuropathic damage has already occurred. In addition, some of these synthetic steroids cannot be metabolised into neurosteroids. Saliva could have a particular role in the aetiology of stomatodynia, as the condition is restricted to those regions, bathed in this fluid. Intriguingly, a higher density of taste buds has been found in those with stomatodynia.