The Arachidonic Acid (AA)-NMDA Receptor Axis describes a crucial neurochemical pathway where glutamate activation of NMDA receptors releases AA. AA binds directly to NMDA receptor subunits, increasing their open probability and also affecting other receptors and cellular processes, linking neuronal activity to lipid signalling.

Burning mouth syndrome (BMS) is a chronic oral mucosal pain disorder that significantly impacts patients' quality of life. While pharmacologic treatment is primarily used for patients with BMS, outcomes are limited, and nonpharmacologic adjuvant treatments are necessary in refractory patients. This study aimed to assess the feasibility and potential effectiveness of soft intraoral appliances as an adjunctive therapy for patients with refractory BMS. A retrospective chart review of nine female patients diagnosed with primary BMS, all of whom had persistent symptoms despite undergoing conventional pharmacologic treatment, was conducted. Five patients received soft intraoral appliances (appliance group), whereas four declined and continued pharmacologic therapy alone (non-appliance group). The oral symptoms were assessed using a 10-cm visual analog scale. Symptom severity was compared within and between groups over the observation period, and the treatment response was analyzed. The median observation periods were 4 months and 4.5 months in the appliance group and non-appliance group, respectively. Most of the appliance users reported initial discomfort that subsided after adaptation, and no severe adverse events were observed. One patient was able to reduce medication use. Compared with the non-appliance group, the appliance group showed changes in symptom scores, with a tendency toward improvement, particularly in relation to aching, stinging, and the effect of oral complaints on daily life. The response rates for these domains were significantly higher in the appliance group (p < 0.05). Soft intraoral appliances may present a feasible adjunctive therapeutic option for selected patients with refractory BMS, particularly those with a limited response to pharmacologic treatments. However, given the small sample size and exploratory design of this case series, these findings should be interpreted as preliminary observations and require confirmation in larger prospective studies.

Efficacy of acupuncture in burning mouth syndrome: A placebo-controlled trial.

Comment on “Prevalence of Burning Mouth Syndrome in Parkinson's Disease: A Prospective Case–Control Study”

Background/Objectives: Photobiomodulation therapy (PBMT) is a non-invasive therapeutic modality that enhances tissue healing, modulates inflammation, and reduces pain. Despite increasing clinical use, evidence regarding PBMT in geriatric oral conditions has not been comprehensively synthesized. This systematic review aimed to evaluate the clinical efficacy and safety of PBMT in managing orofacial conditions in older adults. Methods: A systematic search of PubMed, Embase, Scopus, and Google Scholar was conducted to identify randomized controlled trials (RCTs) published between January 2000 and March 2025. Eligible studies included patients aged ≥60 years receiving PBMT for orofacial conditions. Study selection followed predefined criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and findings were narratively synthesized. Results: Twenty-three RCTs were included. Evidence for PBMT was most frequently reported in cancer therapy-induced oral mucositis (n = 8), with consistent reductions in lesion severity and pain. Studies on burning mouth syndrome (n = 7) and hyposalivation (n = 2) generally reported improvements in symptoms, although placebo effects were noted. Fewer studies evaluated postoperative pain (n = 2), oral lichen planus (n = 1), peri-implant conditions (n = 1), and implant osseointegration (n = 2). No clinically significant adverse events were reported. However, heterogeneity in PBMT parameters and outcome measures limited comparability. Conclusions: PBMT is a safe and clinically effective adjunctive therapy for managing orofacial conditions in older adults, particularly oral mucositis. These findings support its integration into geriatric oral care. Standardized protocols and well-designed RCTs are needed to determine optimal treatment parameters and long-term effectiveness.

i) To assess the emotional health status and oral manifestations in pre-menopausal and post-menopausal women. ii) To evaluate the correlation between emotional health status and oral manifestations in pre-menopausal and post-menopausal women. iii) To assess the oral symptoms and emotional state of women in relation to the duration after cessation of menstruation. A total of 68 women were included and categorized into pre-menopausal (n = 34) and post-menopausal (n = 34) groups. post-menopausal women were further subdivided into three groups based on the duration of cessation of menstruation. After the women provided written informed consent, a questionnaire with binary (yes/no) response options was used to document their emotional health, followed by a detailed case history and clinical examination to assess oral signs and symptoms. A statistically significant (P < 0.05) correlation was detected between women's menopausal status and emotional health status. Burning mouth syndrome was more prevalent among post-menopausal women, with the highest prevalence in Group 2 (33.30%), whereas Group 3 had the highest mean periodontal index and number of missing teeth. Post-menopausal women frequently experience oral discomfort, including xerostomia, burning mouth, gustatory changes, and hyposalivation, which are associated with changes in emotional health. The early diagnosis of oral alterations is crucial and should be evaluated alongside other systemic changes. This study aimed to enhance interspecialty cooperation and understanding to improve the health of post-menopausal women.

Comments on "Bibliometric Analysis of Research Trends and Collaborations in Burning Mouth Syndrome, Anxiety, and Depression: A Comprehensive Study (2000-2024)" by Lu and Lu.

Frailty reflects an age-associated progressive decline in physiological reserve, increasing vulnerability to adverse outcomes. Burning Mouth Syndrome (BMS) is a chronic idiopathic orofacial pain disorder commonly seen in older individuals, yet its relationship with frailty remains uninvestigated. This study aims to assess frailty in BMS patients using the SUNFRAIL+ multidimensional screening tool, which facilitates early detection of bio-psycho-social risk factors for frailty in community-dwelling older adults. This multi-centre case-control study included 104 adults aged ≥ 65 years (52 with BMS and 52 age and sex matched controls). The SUNFRAIL+ tool was used to identify risks and trigger further single-domain evaluation with the Tool for Adherence to Therapies (TAS), Mini-Nutritional Assessment (MNA), Mediterranean Diet Adherence Screener (PREDIMED), Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Quick Mild Cognitive Impairment (Qmci) screen, General Practitioner Assessment of Cognition (GPCOG), Geriatric Depression Scale (GDS), Social Provisions Scale (SPS), socio-economic conditions self-assessment questionnaire (MUSE) and 12-item Short Form Health Survey (SF-12). Patients with BMS showed significantly higher levels of frailty, characterized by higher rates of polypharmacy (76.9% vs. 30.8%), reduced mobility (61.5% vs. 42.3%; p > 0.05), greater cognitive impairment (Qmci 56.8 vs. 75.5), more self-reported depressive symptoms (GDS: 7.5 vs. 4), less social support (SPS: 30 vs. 36), and lower quality of life (SF-12; p < 0.05). Older adults with BMS have a greater proportion of clinical markers of frailty. The SUNFRAIL+ model is effective in revealing hidden vulnerabilities, supporting early, multidisciplinary intervention in this cohort.

To investigate the clinical, gustatory, salivary, psychological, and laboratory features of patients with taste disturbances, stratified by burning mouth syndrome (BMS) and Candida status, and to determine the contribution of oral Candida status independent of BMS subtype. This retrospective study analyzed 141 patients with taste disturbances, classified into six groups based on burning mouth symptoms and oral Candida culture status: primary BMS, secondary BMS, and non-BMS patients, each subdivided by Candida status. To evaluate the independent role of Candida, positive Candida culture was not considered a local factor in defining secondary BMS. Clinical characteristics, taste test results, whole salivary flow rates, psychological profiles, and blood laboratory parameters were compared across groups, with age-matching applied when groups differed in age. In the primary BMS, Candida-positive patients showed no normogeusia and had significantly lower objective taste scores after age-matching. Stimulated whole salivary flow rates were significantly reduced in Candida-positive patients with primary BMS and in those without burning mouth symptoms. Psychological distress was more pronounced in the Candida-positive subgroups within the primary BMS and in overall BMS groups. A positive oral Candida culture is not universally associated with impaired taste but is associated with gustatory deficits, hyposalivation, and psychological stress in specific subgroups, particularly primary BMS. A positive oral Candida culture may aggravate oral symptoms and psychological distress in patients with BMS, particularly those with primary BMS. Recognizing Candida as an independent variable could improve etiology-based diagnosis and tailored management of taste-related complaints.

Objective: To investigate the clinical effects of multidisciplinary comprehensive treatment on patients with burning mouth syndrome (BMS) in pain, anxiety, depression, and sleep status, providing additional clinical evidence for developing effective BMS diagnosis and treatment regimens. Methods: This prospective self-controlled study enrolled 40 BMS patients from Periodontics and Oral Medicine Department of Hospital of Stomatology, Guangxi Medical University between January and October 2023. Assessments were conducted using the visual analogue scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI). Each patient received multidisciplinary comprehensive treatment, consisting of oryzanol-vitamin B2-vitamin E supplementation combined with psychological counseling and cognitive behavioral therapy, for 1 to 2 months. After a 2-year follow-up, pain, anxiety, depression, and sleep status before and after treatment were recorded and compared. Paired t-tests (for normally distributed data) or Wilcoxon signed-rank tests (for skewed data) were used to compare quantitative measures between pre- and post-treatment groups. Spearman rank correlation analysis was applied to examine correlations among changes in scale scores. Results: Among BMS patients, 92.5% (37/40) were females, with a mean age of (56.10±8.02) years, median education duration of 5.00 (3.00) years, and median disease duration of 12.00 (15.75) months. After 1-2 months of comprehensive treatment, the oral symptom cure rate was 30.0% (12/40), the improvement rate was 45.0% (18/40), and the total effective rate was 75.0% (30/40) in the 2-year follow-up. The VAS, SAS, SDS, and PSQI scores before and after treatment were 5.00 (3.00) vs. 2.00 (3.00), 42.50 (15.63) vs. 35.63 (11.25), 44.66±12.15 vs. 37.50 (11.88), and 8.48±3.86 vs. 7.00 (5.50), respectively. At the 2-year follow-up, pain, anxiety, depression, and sleep scores were all significantly lower than those before treatment (all P<0.05). Conclusions: Multidisciplinary comprehensive treatment for BMS can effectively alleviate its pain symptoms, relieve anxiety, depression and improve sleep conditions.

Multivariate genomic analysis elucidates the genetic architecture of shared components of burning mouth syndrome.

Advanced technologies and complementary or adjunctive interventions are increasingly used for chronic or recurrent orofacial pain (OP), but comparative evidence remains fragmented across diagnoses, modalities, and outcomes. We conducted a systematic evidence map with selective meta-analyses (PROSPERO CRD420251270501) following PRISMA 2020. Six databases were searched from inception to 31 December 2025 for randomized and non-randomized intervention studies in adults with temporomandibular disorders (TMD), burning mouth syndrome (BMS), trigeminal neuralgia (TN), and other chronic or recurrent orofacial pain phenotypes. Two reviewers independently screened records, extracted data, assessed risk of bias using validated tools, and rated certainty with GRADE. Random-effects meta-analyses of randomized comparisons used standardized mean differences within prespecified follow-up windows and reported prediction intervals. Pain intensity was prioritized, and disability, jaw function, quality of life, global improvement, medication outcomes, and adverse events were extracted when available. We included 130 studies (n = 6879 participants). Non-randomized intervention studies were retained to widen the evidence map and to capture feasibility, durability, and safety signals that are often underrepresented in early randomized trials. These studies were synthesized narratively and did not contribute to pooled comparative estimates or to certainty upgrading. Low risk of bias was uncommon, and reporting of function, quality of life, and harms was inconsistent, which limited pooling. Safety outcomes were not reported in 37 of 130 included studies, and denominators were often unclear, which limits risk-benefit interpretation. In BMS, photobiomodulation or low-level laser therapy (PBM/LLLT) versus inactive control reduced short-term pain (k = 6, N = 200, standardized mean difference - 0.81, 95% CI - 1.35 to - 0.27). The 95% prediction interval crossed the null (- 1.80 to 0.17), while certainty was moderate. Most pharmacologic and supplement interventions for BMS showed uncertain or inconsistent effects. For TMD, effects varied by modality and comparator and were generally low or very low certainty. Evidence for TN and digital therapeutics was sparse, and adverse-event reporting was inconsistent. PBM/LLLT shows the clearest short-term analgesic signal for BMS versus inactive control, but transportability remains uncertain given null-crossing prediction intervals and limited long-term data. Future trials should standardize outcomes, extend follow-up, and report harms transparently to support diagnosis-stratified care.

Cutaneous sensory syndromes (CSS) are a heterogeneous group of disorders characterized by itch, burning, pain, or other dysesthesias on normal or minimally altered skin. They share convergent biology that includes aberrant small-fiber input, spinal and supraspinal sensitization, and neuroimmune crosstalk that perpetuates the itch-scratch cycle. This narrative review synthesizes current concepts and practical management across seven types of CSS encountered in adult practice: scalp dysesthesia, vulvodynia, scrotodynia, brachioradial pruritus, notalgia paresthetica, burning mouth syndrome, and psychogenic itch. We first outline a clinically focused pathophysiology from peripheral pruriceptors through dorsal horn circuits to cortical networks and descending control, and we integrate the brain-skin axis and autonomic influences. We then present a pragmatic evaluation framework that emphasizes targeted history, symptom mapping, red flags, a minimal laboratory panel, selective imaging or biopsy, and patch testing when product exposure suggests contact allergy. Management is organized around education and trigger modification, topical neuromodulators for focal disease, class-level systemic neuromodulators when symptoms are frequent or widespread, and psychoderm integration that addresses attention, mood, sleep, and behavioral loops. Disorder specific sections highlight distinctive clinical clues and low risk first steps, with adjuncts for refractory cases. This narrative review provides a concise, mechanism-informed roadmap to improve diagnosis, counseling, and outcomes in CSS.

Background: Burning Mouth Syndrome (BMS) is a chronic condition marked by a persistent burning sensation in the mouth, often without visible lesions or a clear cause. Recent studies have suggested a potential link between iron deficiency and BMS, particularly in populations with low serum iron levels.Objectives: This study aims to investigate the relationship between serum iron levels and the prevalence of BMS in a cohort of 190 patients, with a focus on age and gender as contributing factors.Materials and Methods: A cross-sectional observational study was conducted on 190 patients presenting with oral burning sensations. Serum iron levels were measured using standard laboratory methods, and statistical analyses were performed using SPSS software. The study included stratified analyses by age and gender to identify potential patterns in serum iron deficiency.Results: The analysis revealed that 85.3% of the patients had low serum iron levels, with a significant correlation between low iron levels and the presence of BMS symptoms. Stratified analysis indicated that iron deficiency was particularly prevalent among female patients and those over 60 years of age.Conclusion: The findings of this study suggest that serum iron deficiency is a significant contributor to BMS, particularly in women and older adults. These results underscore the importance of routine serum iron assessments in patients with unexplained oral burning sensations, potentially guiding more targeted treatment strategies.

Background/Objectives: Photobiomodulation (PBM) therapy has shown potential in managing orofacial neuropathic pain (ONP); however, inconsistent PBM dosimetry and methodological variability limit its clinical application. This World Association for Photobiomodulation Therapy (WALT) Position Paper aims to critically appraise current evidence and provide recommendations for Clinical Practice Guidelines (CPG) and Expert Consensus Opinion (ECO) where appropriate. Methods: Evidence evaluation was guided by the HANNA (Holistic Analysis & Novel Normative Actions) Framework, a structured multi-step methodology integrating systematic review, quality appraisal, and expert consensus. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Methodological quality was assessed using validated tools: AMSTAR 2 for systematic reviews, RoB2 for randomized controlled trials (RCTs), and ROBINS-I for non-randomized studies (NRCTs). The AGREE II Reporting Checklist was applied to ensure transparency and rigor in the development of WALT recommendations. The Somerfield Criteria were used to rate the level of evidence (LoE) for each included ONP condition, where deemed appropriate. Results: WALT CPG were established for primary burning mouth syndrome (BMS), supported by robust evidence (LoE I) from 204 patients across six "Low RoB" RCTs and NRCTs, and 557 patients included in a "High-Confidence" systematic review and meta-analysis of "low RoB" RCTs. WALT ECO were developed for idiopathic trigeminal neuralgia (TN) and post-herpetic neuralgia (PHN), both supported by LoE II. Insufficient evidence precluded formal recommendations for post-traumatic trigeminal neuralgia, glossopharyngeal neuralgia, and occipital neuralgia. Conclusions: This Position Paper introduces the HANNA Framework, for the first time, as a robust and transparent methodology for developing WALT recommendations by delivering evidence-based CPG for PBM in the management of neuropathic pain associated with primary BMS, along with ECO for both TN and PHN. These recommendations support PBM as a safe and effective therapeutic approach, and provide a structured roadmap for future research and periodic guidelines updates.

Long-term efficacy of photobiomodulation in burning mouth syndrome: A secondary analysis of a randomized controlled trial.

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

Development, quality and safety assessments of nanoemulsions containing capsaicin for the treatment of burning mouth syndrome

Background/Objectives: Burning Mouth Syndrome (BMS) is a common oral condition in older women and is characterized by a multifactorial etiology. To date, no standardized treatment strategy has been established. The aim of this study was to evaluate the effectiveness of topical application of capsaicin (0.025 mg/cm2) in the form of a mucoadhesive bilayer polymer reducing burning sensations in BMS. The study assessed levels of depression, sleep disturbances, and quality of life. Material and Methods: The proof-of-concept study included 29 patients with symptoms of BMS. The peripheral origin of BMS was confirmed by lingual nerve block. Pain intensity was assessed using the Numeric Rating Scale (NRS-11) and the Short-Form McGill Pain Questionnaire (SF-MPQ). Depression, sleep disturbances, and quality of life were evaluated using the Beck Depression Inventory (BDI), Athens Insomnia Scale (AIS), and WHO Quality of Life Questionnaire (WHOQoL). Results: A reduction in pain was observed in over 86% patients. Decrease in burning at treatment sites was recorded immediately after treatment and also at the 3-month follow-up. Gender, taste disturbances, depression, and age were found to have a significant effect on final NRS-11 scores. Conclusions: Significant reduction in pain intensity was achieved in nearly all treated patients, with adverse effects being rare.

Background: Lidocaine hydrochloride (LDCA) is one of the medications used to treat burning mouth syndrome (BMS). The purpose of this study is to investigate whether benzocaine (BEN) can also be used for the treatment and examination of BMS. This study used quantitative sensory testing to investigate the effects of two surface anesthetics on the sensory function of the tongue tip.Methods: Thirty healthy women participated in this study. All participants completed a single-blind, randomized crossover study. Surface anesthetics- (2%LDCA, 20%BEN) and vaseline (control) were applied to the tongue tip. The experiment was conducted over three days, with each drug applied on a different day in a randomized order. The mechanical detection threshold (MDT), mechanical pain threshold (MPT), and numerical rating scale (NRS) were measured at the following points: before application of the drug (pre), immediately, at 5, 15, 30, and 60 minutes after application of the drug.Results: MDT immediately (P < 0.01), at 5 (P < 0.01) and 15 (2%LDCA: P = 0.0112, 20%BEN: P = 0.0128) minutes after application of the drug were significantly higher than pre-values in both local anesthetic sessions. MPT immediately (P < 0.01), at 5 (P < 0.01), 15 (P < 0.01), and 30 (P = 0.0026) minutes after application of 2%LDCA was significantly higher than pre-values. MPT immediately (P < 0.01), at 5 (P < 0.01) and 15 (P = 0.0057) minutes after application of 20%BEN was significantly higher than pre-values. NRS scores did not differ significantly between measurement periods or between drugs.Conclusions: This study suggested that 2%LDCA and 20%BEN may have comparable anesthetic effects on the sensory function of the healthy tongue tip.