What's Hot, What's Not: Review of Pharmacological Options for Managing Burning Mouth Syndrome

Summarize the pharmacological options available for managing burning mouth syndrome (BMS).

A PubMed literature search was conducted for articles published between January 2000 and September 2025, which contained the following terms in their title: (1) burning mouth syndrome or (2) stomatodynia.

Review articles, meta-analysis, commentaries, studies not related to the management of BMS, studies not including pharmacological interventions, animal studies, and non-English texts were excluded. The electronic search identified 797 articles. Following the initial screening, 529 articles were excluded and 16 were added after bibliography review. Of the 284 articles assessed for eligibility, 209 were excluded. A total of 75 articles were included.

Clonazepam, alpha lipoic acid, capsaicin, and amitriptyline were the most evaluated interventions. Clonazepam was effective, but its use is limited to the acute management of BMS. Alpha lipoic acid was well tolerated, but ineffective when given as monotherapy. Capsaicin was effective, but associated with patient discomfort. Amitriptyline was effective, but its use is limited by its adverse effect profile. Cannabis sativa, ultramicronized palmitoylethanolamide, pramipexole, and naltrexone were effective, but only evaluated in few studies. Most patients reported symptom recurrence upon therapy discontinuation, suggesting patients with BMS require lifelong management. Combining interventions often resulted in increased effectiveness, but with an increased risk for adverse effects.

BMS is a challenging condition to manage because there are no established treatment guidelines. Consequently, providers may be uncertain how to manage their patients. This review summarizes the available pharmacological options for managing BMS and serves as a resource to guide clinical decisions.

Multiple agents with different mechanisms of action may be beneficial in the management of BMS. In the absence of treatment guidelines, providers may refer to this review when managing their patients.