Burning mouth syndrome: updates on pathogenesis and diagnostic algorithms

Burning Mouth Syndrome (BMS) is a complex, chronic neuropathic orofacial pain disorder characterized by a persistent burning or dysesthetic sensation in the oral cavity without an identifiable organic cause. Accurate diagnosis and effective management of BMS pose significant challenges to clinicians, necessitating a comprehensive and multidisciplinary approach. This review delves into BMS's pathogenesis and diagnostic algorithms, highlighting the latest advancements in understanding the underlying mechanisms and diagnostic strategies. Utilizing specific diagnostic algorithms assists clinicians in assessing and selecting appropriate treatment strategies, thereby minimizing diagnostic delays. These algorithms are crucial for excluding other causes of oral burning by focusing on symptomatology, patient history, and clinical examination. They involve ruling out oral infections, nutritional deficiencies, hormonal imbalances, autoimmune disorders, and medication side effects as potential causative factors. Supporting the diagnostic process, additional tests such as blood tests (including a thrombophilic panel and Neuron-Specific Enolase), neurosensory assessments, neuroradiological examinations, and evaluations of psychological profiles and cognitive function may be employed. Neurosensory assessments and neuroradiological examinations can provide insights into possible neuropathic causes, while psychological and cognitive assessments can identify any psychological factors and the extent to which cognitive decline may contribute to the condition. A comprehensive diagnostic approach not only aids in the accurate identification of BMS but also helps differentiate it from other oral conditions with similar presentations. This thorough evaluation is essential for developing a tailored treatment plan that addresses each patient's specific needs, ultimately improving clinical outcomes and enhancing the quality of life for individuals suffering from BMS.