Objectives: The aim of this study was to characterize the diagnostic process that patients with burning mouth syndrome (BMS) undergo and to identify the potential pitfalls encountered in the workup and management of BMS.

Study design: A retrospective chart review of patients with BMS seen at the Oral Medicine clinic at Brigham and Women's Hospital (Boston, MA) was conducted from January 2014 to April 2017. Abstracted data focused on the period from onset of symptoms to referral to the Oral Medicine clinic for definitive diagnosis and included providers consulted, symptom characteristics, diagnostic tests performed, and provisional diagnoses and treatments offered.

Results: One hundred and two patients (86.3% females) were included (median age 60 years). Median time from onset of symptoms to referral to the Oral Medicine clinic was 12 months (range 4-370 months). Patients saw a median of 3 providers (range 1-7); 30.4% had undergone a diagnostic test; 63.7% had been given a provisional diagnosis; and 78.4% had received treatment. Candidiasis was the most common misdiagnosis (25.5%), and antifungal medication was the most frequently prescribed therapy (27.5%).

Conclusions: Patients with BMS experience delay in diagnosis and management despite seeking and receiving professional care. Many undergo unnecessary tests and tend to be misdiagnosed or receive no diagnosis at all. Even those correctly diagnosed with BMS often receive inappropriate or ineffective treatment.