# Photobiomodulation as a Therapeutic Strategy in Burning Mouth Syndrome: A Scoping Review
## 4 Discussion  
The response to treatment in patients with primary BMS is influenced by various pathological factors, including neuropathic components, central vulnerability, and psychiatric comorbidity. These problems are often intricate and interconnected, and addressing them requires a comprehensive approach rather than relying on a single therapy [50]. Like other neuropathic pain conditions, BMS poses challenges in treatment. On average, only 40% of patients experience benefits from their current neuropathic pain medications [51]. Another issue related to BMS treatment is the lack of consistent and continuous medication usage. While psychotropic medications show effectiveness in BMS treatment, approximately 15% of patients discontinue their medication. Implementing motivational interviewing can enhance appropriate adherence to medication [52; 53]. Often, a combination of medications is recommended, along with treatments utilized for other neuropathic pain conditions [52; 53]. Tricyclic antidepressants such as amitriptyline and clomipramine have been tried for BMS, with only 19% of patients reporting very poor outcomes and side effects such as dry mouth [54; 55]. Antidepressants belonging to the group of selective serotonin reuptake inhibitors (SSRIs) such as chlordiazepoxide, diazepam, amisulfide, paroxetine, or serntraline hydrochloride have also been recommended with good results, but with the most side effects such as dizziness, insomnia, nausea, and somnolence [54; 55]. Trazodone was not effective in improving BMS symptoms [56]. Anticonvulsants such as gabapentin and pregabalin are routinely recommended in the pharmacotherapy of BMS,  
Figure 1: Flow chart of the review process. but therapeutic success has not been achieved [55; 56]. Systemic and local treatment with clonazepam should be considered in the treatment of BMS. Clonazepam is a benzodiazeppine and a \(\gamma\)-aminobutyric acid (GABA) receptor agonist. This receptor is widely present in the central nervous system and peripheral tissues, and this drug acting on this receptor may have positive results in the treatment of this syndrome [55; 56; 57; 58]. Pure small-fiber peripheral neuropathy may be better controlled with local clonazepam and central mechanisms may benefit more from systemic clonazepam [55; 56; 57; 58]. Clonazepam, like other benzodiazepines, can cause side effects, mainly drowsiness, impairment of memory and cognitive functions, and dependence on long-term use. Although systemic absorption is low, no side effects have been reported with topical application [55; 56; 57; 58]. \(\alpha\)-lipoic acid (ALA) has been used to treat diabetic neuropathy because it is thought to act as a com- and coenzyme, produce energy (ATP), improve glucose metabolism and stimulate nerve growth factor (NGF) production. In addition, ALA stimulates the elevation of cellular glutathione levels and may prevent peripheral neuropathy [59; 60; 61; 62; 63]. There have been indications for the use of capsaicin in the pharmacological management of burning pain. Capsaicin induces desensitization and depletion of substance P leading to analgesia. A double-blind cross-over study revealed that a 0.025% capsaicin mouth rinse significantly reduced pain with no side effects [64; 65; 63; 66]. Additionally, various topical treatments, such as saliva substitutes, may be helpful when a peripheral mechanism is suspected [66]. To talk about photobiomodulation, it is necessary to start from the assumption that light is a type of electromagnetic radiation and is considered an indispensable source of energy. A photochemical reaction is normally induced by the interaction of light, particularly ultraviolet, visible, and near-infrared light, with external matter. There are numerous examples of interactions between light and biological systems: photosynthesis; the reactions of the photoreceptors of the retina; the synthesis of vitamin D [67].