Burning Mouth Syndrome 2026: From “Diagnosis of Exclusion” to a Structured Diagnostic Algorithm (Narrative Review)
10.14476/jomp.2026.51.1.20
- Author:
Chang-Kyu OH
1
;
Hye-Min JU
;
Sung-Hee JEONG
;
Yong-Woo AHN
;
Hye-Mi JEON
;
Soo-Min OK
Author Information
1. Department of Biochemistry, School of Medicine, Pusan National University, Yangsan, Korea
- Publication Type:Review Article
- From:
Journal of Oral Medicine and Pain
2026;51(1):20-28
- CountryRepublic of Korea
- Language:English
-
Abstract:
Burning mouth syndrome remains a frequent source of diagnostic delay, repeated consultations, and fragmented care because it has long been treated as a “diagnosis of exclusion.” Recent updates in orofacial pain classification and research diagnostic frameworks support a practical shift: from an exclusionary label toward a structured diagnostic algorithm and staged, phenotype-guided management. This narrative, algorithm-focused clinical review aims to summarize clinically actionable evidence and to propose a “minimum sufficient workup” that prioritizes safety, efficiency, and patient-centered communication.We first outline pragmatic diagnostic criteria and key symptom patterns, then integrate current concepts of mixed mechanisms—peripheral neuropathic features, centralociplastic amplification, and psychosocial modulators—that account for symptom fluctuation and discordance between symptom severity and objective findings. The core of this review is a one-page stepwise algorithm: (1) confirm chronicity and absence of visible mucosal disease, (2) screen for red flags requiring urgent evaluation, (3) address common local contributors (e.g., candidiasis, irritants, contact allergy, xerostomia), (4) perform a targeted systemic/medication/deficiency panel, and (5) phenotype patients to guide staged treatment choices and follow-up. Finally, we provide a practical management framework emphasizing education, trigger control, and individualized combinations of topical, systemic, and behavioral interventions with predefined reassessment intervals. Future priorities include phenotype-stratified randomized trials and implementation outcomes that quantify reductions in diagnostic delay, misdiagnosis, and unnecessary testing.
