Sir, we wish to comment on the recent article on oral dysaesthesia (OD).1 The review sheds light on OD particularly focusing on burning mouth syndrome (BMS), offering valuable insights into diagnostic strategies and management approaches. However, several points warrant further discussion and consideration.

Firstly, we deeply agree with the authors' conclusion that BMS is just one manifestation of OD, noting sensory disturbances beyond pain, such as numbness and tingling. Reframing the symptoms of BMS as dysaesthesia rather than solely pain may lead to a more nuanced understanding of this condition. In this regard, the implementation of the Oral Dysaesthesia Rating Scale (oral DRS)2 could prove beneficial in assessing the breadth of sensory disturbances experienced by patients with BMS and OD, thereby guiding treatment decisions and facilitating outcome assessments in clinical practice and research.

Second, diagnostic accuracy is crucial, as evidenced by cases initially diagnosed as BMS that were later found to be oral cancer. However, the diagnosis of typical BMS itself is not so difficult if the characteristic complaints such as pain, or dysaesthesia that is disguised during meals and worsens at night compared to the morning, are noted as they are highly specific in BMS. Although OD should be considered as a diagnosis of exclusion, it is crucial to listen carefully to the patient's complaints and be proactive in diagnosing BMS or OD.

Additionally, we would like to emphasise the entity of ‘oral cenesthopathy' within the spectrum of OD, characterised by unusual oral sensations like excessive mucus or foreign body feelings. Some case reports described the overlap of BMS and oral cenesthopathy,3 which can be difficult to differentiate. We have also reported BMS as comorbid in 26% of patients with oral cenesthopathy. Responsiveness to antidepressants may help determine whether the condition is typical BMS or not. In other words, antidepressants-resistant BMS may share similarities with oral cenesthopathy in their common pathophysiology. Recognising these similarities can inform treatment approaches and improve outcomes for patients with refractory BMS.

In conclusion, further research is necessary to refine diagnostic criteria and improve treatment efficacy. Interdisciplinary collaboration is paramount for advancing patient care and achieving better outcomes in OD. Continued efforts in these areas will enhance our understanding and management of this complex condition.