Phytotherapy efficacy in alleviating burning mouth syndrome symptoms: A systematic literature review

To evaluate the efficacy and safety of phytotherapeutics medicines interventions for burning mouth syndrome (BMS) in randomised controlled trials. This systematic review, registered in PROSPERO (CRD42023475271), was conducted in accordance with PRISMA guidelines. Search of PubMed, Scopus, Web of Science, Cochrane CENTRAL, BVS/IBECS, BDTD, SciELO, ScienceDirect, and grey literature (final search April 2025). RCTs in adults with BMS testing phytotherapeutics versus placebo/active control were included. Two reviewers extracted data and assessed risk of bias (RoB 2) and certainty of evidence (GRADE). When appropriate, effects were synthesized as between-group differences, otherwise, narrative synthesis was used. 10 RCTs (n=653) met inclusion criteria. Women are 75.2% of participants, treatment durations ranged 1-12 weeks. Capsaicin (rinse/gel/capsule), Catuama, and Kampo (Saiboku-to) showed greater pain reduction than control in individual trials. In contrast, chamomile gel, lycopene-enriched olive oil, Aloe vera, and Hypericum did not show superiority to placebo. Adverse events were generally mild. Evidence for capsaicin (topical/oral) and Catuama is promising but low to moderate certainty due to small samples, heterogeneous formulations, and risk of bias concerns. Controlled studies involving a larger number of patients and longer follow-up are recommended. Selected phytotherapeutics may reduce BMS pain with mostly mild adverse effects, but routine use is premature pending higher quality evidence.