Phytotherapy efficacy in alleviating burning mouth syndrome symptoms: A systematic literature review

Abstract

Objectives: To evaluate the efficacy and safety of phytotherapeutics medicines interventions for burning mouth syndrome (BMS) in randomised controlled trials. Methods: This systematic review, registered in PROSPERO (CRD42023475271), was conducted in accordance with PRISMA guidelines. Search of PubMed, Scopus, Web of Science, Cochrane CENTRAL, BVS/IBECS, BDTD, SciELO, ScienceDirect, and grey literature (final search April 2025). RCTs in adults with BMS testing phytotherapeutics versus placebo/active control were included. Two reviewers extracted data and assessed risk of bias (RoB 2) and certainty of evidence (GRADE). When appropriate, effects were synthesized as between-group differences, otherwise, narrative synthesis was used. Results: 10 RCTs (n = 653) met inclusion criteria. Women are 75.2 % of participants, treatment durations ranged 1–12 weeks. Capsaicin (rinse/gel/capsule), Catuama, and Kampo (Saiboku-to) showed greater pain reduction than control in individual trials. In contrast, chamomile gel, lycopene-enriched olive oil, Aloe vera, and Hypericum did not show superiority to placebo. Adverse events were generally mild. Conclusions: Evidence for capsaicin (topical/oral) and Catuama is promising but low to moderate certainty due to small samples, heterogeneous formulations, and risk of bias concerns. Controlled studies involving a larger number of patients and longer follow-up are recommended. Clinical relevance: Selected phytotherapeutics may reduce BMS pain with mostly mild adverse effects, but routine use is premature pending higher quality evidence.