Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects 
middle-aged/old women with hormonal changes or psychological disorders. This 
condition is probably of multifactorial origin, often idiopathic, and its 
etiopathogenesis remains largely enigmatic. The present paper discusses several 
aspects of BMS, updates current knowledge, and provides guidelines for patient 
management. There is no consensus on the diagnosis and classification of BMS. 
The etiopathogenesis seems to be complex and in a large number of patients 
probably involves interactions among local, systemic, and/or psychogenic 
factors. In the remaining cases, new interesting associations have recently 
emerged between BMS and either peripheral nerve damage or dopaminergic system 
disorders, emphasizing the neuropathic background in BMS. Based on these recent 
data, we have introduced the concepts of "primary" (idiopathic) and "secondary" 
(resulting from identified precipitating factors) BMS, since this allows for a 
more systematic approach to patient management. The latter starts with a 
differential diagnosis based on the exclusion of both other orofacial chronic 
pain conditions and painful oral diseases exhibiting muco-sal lesions. However, 
the occurrence of overlapping/overwhelming oral mucosal pathologies, such as 
infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS 
treatment is still unsatisfactory, and there is no definitive cure. As a result, 
a multidisciplinary approach is required to bring the condition under better 
control. Importantly, BMS patients should be offered regular follow-up during 
the symptomatic periods and psychological support for alleviating the 
psychogenic component of the pain. More research is necessary to confirm the 
association between BMS and systemic disorders, as well as to investigate 
possible pathogenic mechanisms involving potential nerve damage. If this goal is 
to be achieved, a uniform definition of BMS and strict criteria for its 
classification are mandatory.