Uncovering Frailty in Burning Mouth Syndrome: Insights From a SUNFRAIL+ Based Multidimensional Assessment

Background: Frailty reflects an age-associated progressive decline in physiological reserve, increasing vulnerability to adverse outcomes. Burning Mouth Syndrome (BMS) is a chronic idiopathic orofacial pain disorder commonly seen in older individuals, yet its relationship with frailty remains uninvestigated. Objectives: This study aims to assess frailty in BMS patients using the SUNFRAIL+ multidimensional screening tool, which facilitates early detection of bio-psycho-social risk factors for frailty in community-dwelling older adults. Methods: This multi-centre case-control study included 104 adults aged ≥ 65 years (52 with BMS and 52 age and sex matched controls). The SUNFRAIL+ tool was used to identify risks and trigger further single-domain evaluation with the Tool for Adherence to Therapies (TAS), Mini-Nutritional Assessment (MNA), Mediterranean Diet Adherence Screener (PREDIMED), Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Quick Mild Cognitive Impairment (Qmci) screen, General Practitioner Assessment of Cognition (GPCOG), Geriatric Depression Scale (GDS), Social Provisions Scale (SPS), socio-economic conditions self-assessment questionnaire (MUSE) and 12-item Short Form Health Survey (SF-12). Results: Patients with BMS showed significantly higher levels of frailty, characterized by higher rates of polypharmacy (76.9% vs. 30.8%), reduced mobility (61.5% vs. 42.3%; p > 0.05), greater cognitive impairment (Qmci 56.8 vs. 75.5), more self-reported depressive symptoms (GDS: 7.5 vs. 4), less social support (SPS: 30 vs. 36), and lower quality of life (SF-12; p < 0.05). Conclusions: Older adults with BMS have a greater proportion of clinical markers of frailty. The SUNFRAIL+ model is effective in revealing hidden vulnerabilities, supporting early, multidisciplinary intervention in this cohort.