Burning mouth syndrome is a condition in which the patient perceives a sensation of intraoral burning, typically of the anterior tongue. This article presents a case report of a patient presenting for orofacial pain evaluation in whom ciguatera neurotoxin poisoning is diagnosed. The clinician should be aware of neurotoxin poisoning as a possible cause of symptoms of burning mouth, especially among patients who have recently traveled to a tropical area. Recognition of this condition in this case highlights the need for a detailed and accurate patient history. (Quintessence Int 2005;26:547–550)