Abstract
A 55-year-old housewife presented with persistent oral complaints—including a sensation of palatal pressure, traction in the mandibular dentition, and burning sensations in the tongue, palate, and mandibular gingiva—that first appeared after prosthodontic treatment of her right maxillary molars. For three years, she had visited a few dentists, otolaryngologist, physician, and gynecologist to discuss her symptoms without achieving relief. At her initial visit to our department, she expressed reluctance to take antidepressants; however, following a careful explanation of side effects and with the support of her family, she consented to treatment with amitriptyline. After titrating the dose up to 40mg/day, her palatal pressure improved substantially within approximately two months, enabling her to resume household activities. However, her uncomfortable sensation remained at about 20% of the level at the initial consultation, and she continued to feel anxious about going out. In the fourth month of treatment, aripiprazole （1mg/day） was added. By the fifth month, she was able to dine out and gradually broaden her activities to include exercise, travel, and golf. Although approximately 20% of the mandibular traction sensation and palatal pressure remained, both she and her husband were satisfied with her recovery, therefore drug therapy was accomplished in 2 years and 6 months after her initial visit.
In cases of complicated oral complaints after dental procedures, and where neither organic abnormalities nor psychiatric disorders can be identified, patients are often shuttled between medical and dental specialties, prolonging their suffering and daily life impairments. While “oral dysesthesia” is admittedly an imprecise term, it may encompass conditions that fall through the gaps of standard diagnostic criteria and provide a gateway for introducing appropriate psychosomatic treatment.
