As Covid-19 sweeps across the globe, social unrest caused by this unknown virus has spread and the living environment has dramatically changed. Many people are suffering from the stress of changes in their living environment, which is giving rise to various mental problems. In dentistry, such problems affect both dental professionals and patients. Dental professionals should have the latest and correct knowledge about Covid-19, and provide psychological care for patients and dental professionals themselves.

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Counseling is consultation assistance that is provided by using specialized knowledge and skills for the problems and worries of clients.
Counseling in dental care is the provision of assistance by professionals for the effective treatment and health effects for patients.
Thus, counseling education for dental hygiene students is thought to be effective. “Oral health counseling training” as counseling education is carried out for dental hygiene students in our university. In this study, we investigated whether this training affects their self-esteem and attitude toward self-actualization, using a self-esteem questionnaire. The subjects were 148 third-year dental hygiene students who received the training from 2012 to 2018, and an analysis showed that the training was effective in 99.3％. The average scores for “self-acceptance,” “self-actualization attitude” and “fullness” in the self-realm area and “self-expression/personal positiveness” in the other-person area before the training, significantly increased compared to those after the training. Therefore, counseling education for dental hygiene students effectively improves self-esteem and interpersonal relationships, and teaches the importance of an attitude of empathy. On the other hand, the average score for “evaluated consciousness/interpersonal tension” in the other-person area did not change through the training, suggesting that the training contents such as interpersonal relationship ability need to be improved.

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The importance of patients’ biopsychosocial evaluation has been advocated since the Japanese Society of Psychosomatic Dentistry was established. Several studies have showed the possibility of treating oral psychosomatic disorders （OPD）, which seemed to be intractable for a long time. However, in the clinical setting of community-based dental health care, many dentists still regard patients with OPD as troublesome. Even when patients are referred to psychiatrists, some of them tend to refuse, and instead continue seeking an organic cause, resulting in so-called “doctor shopping.” Amid this situation, core hospitals for OPD are needed. In this study, we retrospectively reviewed the patients with oral psychosomatic disorder in our clinic.
A total of 153 patients （34 males, 119 females） who came to our clinic from April 2017 to March 2018 （2 years） were included in this study. We collected their demographic data, medical history, psychological background, detailed diagnosis for OPD and treatment outcome. Additionally, we identified the factors for good clinical outcomes using logistic regression analysis.
The mean age was 64 years old and duration of illness was 24 months. The total number of patients with OPD in 2018 was 99, which was as almost twice that in 2017. Burning mouth syndrome, oral cenesthopathy, atypical odontalgia and phantom bite syndrome were seen in 112 （66％）, 29 （17％）, 20 （12％） and 5 （3％） cases, respectively. Seventy of the cases were referred from dental hospitals and clinics. As to medical history, cardiovascular disorder, digestive disorder, and nervous system disorder were seen in 68 （44％）, 64 （42％）, and 57 （37％） cases, respectively. Depression was seen in 28 cases （18％）, and schizophrenia in one case. An examination of biopsychosocial background revealed insomnia in 135 cases （88％）. Suicidal ideation was seen in 45 cases, but they were not severe except for one case who was undergoing treatment for severe depression in a psychiatric hospital. Logistic regression analysis revealed that the duration of illness was a significant predictor for good outcome. Early detection and treatment may lead to a better prognosis of OPD.
This study showed the potential large demand for OPD in community-based dental health care. It is necessary to provide a medical system for OPD patients and to better educate dentists about OPD.

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Recently, reports of Kampo treatment for oral psychosomatic disorder have been increasing. The basics of Kampo medicine are to identify the patient’s pattern from the patient’s constitution, strength, resistance, and manifestation of symptoms, and to administer the appropriate medicine. In the consultation to determine the patient’s pattern, a Kampo medicine-specific palpation （pulse examination, abdominal examination） is performed, but these operations are unfamiliar and difficult for ordinary dentists. Therefore, we considered the Cornell Medical Index Health Questionnaire （CMI） as an alternative to patient’s pattern, which can be understood by ordinary dentists.
In this study, we investigated the relationship between the therapeutic effect of hangekobokuto administered to female patients with oral psychosomatic disorder and various items of CMI. The results did not correspond to the abnormal sensation in the throat, which is the target of conventional use, but instead to stomach upset. It is suggested that hangekobokuto may be effective for oral psychosomatic disorder with stomach upset.

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Though amitriptyline is recognized as a primary treatment option for burning mouth syndrome, rumination about pain sometimes persists even after reduction of pain. A 58-year-old female with complaints of burning sensations of the tongue and mouth, and dry mouth sensation was referred to our clinic. With amitriptyline, the tongue pain was almost completely eliminated. However, two months later, symptoms recurred; she obsessively checked her tongue. Upon adding aripiprazole to amitriptyline, this obsessive symptom was quickly improved. Almost one year since the first visit, the oral symptoms have almost been relieved, without major side effects. This case suggests augmentation therapy of aripiprazole and amitriptyline may be effective for BMS patients with refractory rumination.

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Dental phobia typically emerges during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life.
This report describes a case study of a 13-year-old girl who presented with dental phobia. The referral came from a private dental clinic doctor who had been unable to carry out even the simplest dental treatment on her. The patient required prevention, conservation, and root canal treatment, but had refused any treatment and would not open her mouth. In order to provide dental treatment, general anesthesia was administered to the patient due to her severe dental phobia. After dental treatment with general anesthesia, her response did not change. However, she requested treatment upon awakening. We created an anxiety hierarchy for dental treatment and provided exposure to a standard dental procedure. As a result, she was able to undergo dental treatment in the awake condition.
We learned from this case that dental treatment under general anesthesia was not enough to treat the patient with severe dental phobia and that the use of anxiety hierarchy should be considered as an option.

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舌痛症の治療としては抗うつ薬の有効性が古くから知られているが，十分に服用できず，治療に難渋することがしばしばある．その他の治療法として，抗てんかん薬等の神経障害性疼痛治療薬の有効性が示唆されている．今回，抗うつ薬抵抗性の本症にバルプロ酸ナトリウムが奏功した1例を経験したので報告する．患者は61歳の会社員，男性．主訴は舌背中央部と両側舌縁の灼熱感と味覚障害であった．不眠症のためトリアゾラムを服用していた．前医にてアミトリプチリンを処方されたが部分寛解にとどまり中断していた．当科にてアリピプラゾールとミルタザピンを処方したが，中途覚醒等の副作用で継続服用できなかった．10代の頃から続く頭痛の既往があり，舌痛症と潜在的な頭痛の要素の関連を疑い，バルプロ酸ナトリウム100mg/day，クロナゼパム0.6mg/dayに処方変更した．特に副作用もなく，灼熱感と味覚障害は波状ながら1年程かけて徐々に消失していった．本症例では舌痛は潜在する頭痛の要因に関連していたのではないかと考えられた．頭痛の既往があり，抗うつ薬抵抗性の舌痛症にバルプロ酸ナトリウムとクロナゼパムの併用療法が1つの選択肢となる可能性が示唆された．

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