Abstract Primary burning mouth syndrome (BMS) is defined as an “intraoral burning for which no medical or dental cause was found.” Lifetime prevalence ranges from 3.7% to 18% – 40% in the elderly. There is no consensus among experts on the diagnostic criteria of BMS, the etiology is poorly understood, and there are no existing clinical guidelines. Therefore, BMS is often underdiagnosed and its management complex. For patients with BMS, this lack of clinical expertise may result in decreased quality of life and increased psychological distress.

We conducted a systematic review to identify clinical features, pathophysiology, and therapeutic strategies for BMS. We discuss the multifactorial origin, involving peripheral nerve dysfunction and hormonal dysfunction, as well as psychological traits. We also describe the results of randomized clinical trials for each treatment through a pathophysiologic approach. This review should help clinicians recognize BMS, understand its pathophysiology, and gain an enhanced scientific understanding of therapeutic alternatives.