Oral fire, mental storm: the profound interplay between trigeminal neuralgia, burning mouth syndrome and mental health disorders

Abstract

Chronic orofacial pain conditions such as trigeminal neuralgia (TN) and burning mouth syndrome (BMS) extend well beyond physical discomfort and are increasingly recognized as disorders that affect psychological and emotional well-being. Both are frequently overlooked in dental and general medical practice, yet both produce functional limitation, social withdrawal and measurable psychiatric morbidity. This narrative review examines the links between chronic orofacial pain and mental health, with emphasis on the neurobiological and psychosocial mechanisms that connect them. It also considers the role of modifiable behavioral risk factors, particularly tobacco and nicotine exposure, which sensitize transient receptor potential channels on trigeminal and oral mucosal afferents and may aggravate oral burning and neuropathic facial pain. Peripheral sensitization drives central sensitization within trigeminal pathways and alters affective-motivational circuits, contributing to the depression, anxiety, sleep disruption and cognitive impairment reported in these patients, and creating a self-sustaining pain-distress loop. The review argues for interdisciplinary management that combines pharmacological neuromodulation, adapted dental care, psychological therapy, tobacco cessation support, nutritional correction and patient education, delivered within a preventive public health framework. Dental practitioners are well placed to detect these conditions early, to screen for tobacco use and emotional distress, and to coordinate referral. Treating the mouth and the mind together, rather than sequentially, offers the best prospect of restoring function and quality of life.