Cross-Cultural Differences and Clinical Presentations in Burning Mouth Syndrome: A Cross-Sectional Comparative Study of Italian and Romanian Outpatient Settings

<b>Background/Objectives</b>: Burning Mouth Syndrome (BMS) is a chronic orofacial pain disorder characterized by persistent intraoral burning sensations without visible mucosal lesions. Although its biopsychosocial complexity is increasingly recognized, cross-cultural comparison data remain limited. <b>Methods</b>: This cross-sectional study assessed 60 patients with BMS (30 Italian, 30 Romanian) who underwent standardized clinical, psychological, and sleep evaluations. Data collected included sociodemographics, clinical characteristics, diagnostic history, comorbidities, and symptomatology. The assessment tools used included the Numeric Rating Scale (NRS), Short Form of the McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Statistical comparisons were conducted using Mann-Whitney U and Fisher's exact tests with Bonferroni correction. <b>Results</b>: No significant differences were observed in age, sex, or body mass index. Italian patients had fewer years of education (<i>p</i> = 0.001), higher pain intensity (NRS, <i>p</i> < 0.001), poorer sleep quality (PSQI, ESS, <i>p</i> = 0.001), and more frequent pre-existing sleep disorders (<i>p</i> < 0.001). Romanian patients showed higher levels of anxiety (HAM-A, <i>p</i> < 0.001), longer diagnostic delays (<i>p</i> = 0.002), and more dysesthetic or perceptual symptoms, including tingling and oral dysmorphism (<i>p</i> < 0.05). Stressful events before onset were more common among Romanians (<i>p</i> < 0.001), while Italians more often received a correct diagnosis at first consultation (<i>p</i> = 0.005). <b>Conclusions</b>: This first cross-national comparison of BMS in Western and Eastern Europe shows that cultural, healthcare, and clinician education differences can shape symptom profiles, comorbidities, and diagnostic delays, underscoring the need for personalized, country-specific management strategies.