Psychological Subtypes and Intervention Strategies in Burning Mouth Syndrome: A Narrative Review

Burning mouth syndrome (BMS) is a complex chronic orofacial pain condition characterized by a multifactorial etiology and poorly understood pathophysiology. Conventional monotherapies often have limited efficacy, necessitating a transition toward personalized management. Accordingly, we searched PubMed, Web of Science, Embase, and the Cochrane Library for articles published up to January 2026 using keywords related to BMS. Following screening, we synthesized the available evidence to propose a psychological classification framework for BMS, identifying four distinct subtypes: emotion-dominant, stressor-related, cognitive-distortion, and personality-based. These four subtypes were derived from a synthesis of existing literature on BMS comorbidities and clinical heterogeneity, providing potential insights for clinical practice. We delineated the core clinical features and putative neurobiological mechanisms and validated the psychometric assessment tools corresponding to each phenotype. We also evaluated evidence-based interventions tailored to these psychological profiles. Current evidence supports cognitive behavioral therapy (CBT) as a well-supported first-line intervention for emotional- and personality-based dimensions, biofeedback for stressor-related symptoms, and mindfulness-based cognitive therapy (MBCT) for addressing cognitive distortions. We posit that a stratified, integrated therapeutic strategy grounded in rigorous psychological subtyping can address the limitations of traditional "one-size-fits-all" approaches, thereby potentially helping to guide individualized treatment strategies and improve clinical outcomes, pending prospective validation. Future research should prioritize the clinical validation and feasibility of this precision-oriented paradigm to establish a new standard of care for patients with BMS.