Burning mouth syndrome (BMS) is characterised by chronic daily intraoral burning or dysaesthetic sensations, often combined with taste alterations and dry mouth, which cannot be explained by any clinically evident oral or systemic pathology. Around 1%–3.7% of the population suffer from the condition, with highest prevalence figures in menopausal and post-menopausal women up to 12%–18%, and BMS can have a significant impact on quality of life. BMS still seems to be poorly understood in terms of aetiology, although there is growing evidence from multiple lines of research that neuropathic changes at different levels of the neuraxis are critically involved in its pathogenesis. With accurate neurophysiological, psychophysical, neuropathological and neuroimaging methods, clinically homogenous BMS can be subdivided into three major types of neuropathic pain, that may coexist. According to some preliminary evidence, efficacy of different treatments may depend on the neurophysiological subtype of BMS. However, as these subtypes cannot be distinguished with standard clinical examination and detailed diagnostic methods are not routinely applied in the clinic nor in the treatment trials, management of BMS remains challenging, with little high quality evidence available. This review aims to address the current evidence and understanding in relation to aetiology, diagnosis and management of BMS.