Burning mouth syndrome is a persistent, idiopathic pain syndrome that is associated with burning pains in the mouth with no observable clinical abnormalities. Burning mouth syndrome is multifactorial and heterogeneous, mostly affecting middle-aged and elderly women, which makes its diagnostics and treatment particularly difficult. The evidence-based narrative review synthesizes results from randomized controlled trials that were published between 2020 and 2025 from comprehensive searches of PubMed (MEDLINE), Embase, and DOAJ databases. Thirteen randomized controlled trials of pharmacological, non-pharmacological, and integrative therapies were chosen with the help of strict inclusion criteria. Antidepressants, especially vortioxetine, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors, were proven to be very effective, especially on patients who experience psychological co-morbidities. Non-pharmacological treatments, such as low-level laser therapy, photobiomodulation, oral cryotherapy, and low-level laser therapy in combination with the other two intervention types, demonstrated positive effects on pain and oral health-related quality of life. Melatonin and standardized herbal regimens were also other therapeutic options that had safety profiles. According to general trends, most interventions are well accepted, and placebo responses are still prevalent, particularly in device-based studies. Limitations of the studies are small sample sizes, variability of intervention protocols, brief follow-up time, and the inability to generalize the results of single-center studies. These results suggest the use of a personalized, multimodal treatment approach to Burning mouth syndrome and the necessity of conducting larger, multicenter studies with standard outcomes to maximize patient care.