Managing Burning Mouth Syndrome: Current and Future Directions

Burning mouth syndrome (BMS) is a chronic pain condition characterized by a persistent burning sensation in the oral mucosa in the absence of visible clinical signs. Its management remains a significant clinical challenge due to the unclear and multifactorial nature of its etiopathogenesis. Differentiating between primary (idiopathic) and secondary (associated with identifiable underlying conditions) BMS is critical for guiding treatment. Current management strategies range from addressing underlying systemic or local factors to utilizing established systemic or topical pharmacologic options (such as benzodiazepines, capsaicin, anticonvulsants, antidepressants), new off-label treatments (including low-dose naltrexone), supplements (such as alpha lipoic acid and phytotherapeutics), alongside non-pharmacological approaches aimed at addressing pain symptoms and enhancing pain-coping skills (such as nerve blocks, cognitive behavioral therapy, and transcranial magnetic stimulation). This review synthesizes the current evidence supporting both established and newly investigated therapies and discusses future research directions to improve outcomes for individuals affected by this chronic pain condition. Ultimately, the best management approach should be based on the most robust evidence-based findings, tailored to the underlying etiopathogenetic mechanisms, and individualized to address patient contributing factors.