In Japan dentists are widely involved in the research and treatment of various oral psychosomatic disorders （PSD） such as glossodynia, atypical odontalgia, oral dysesthesia, phantom bite, unexplained complaints related to dentures and dental prostheses, and so on, under the system of medico-dental dualism. Dentists refer to such disorders as “shika-shinshinsho” in Japanese. Patients with these disorders are usually treated mainly by dentists with psychotherapy and psycho-pharmacotherapy.
However, those in the psychiatrist community sometimes have differences of opinion and disagreements on the subject of treatment. The reason for this conflict probably derives from a lack of clear definition of PSD under dualism. This article presents the following six necessary factors that would help support the definition of PSD: （1） persistence of dental complaints, （2） absence of an irritant factor, （3） absence of an abnormal dental finding on examination, （4） absence of dental disease and its respective treatment, （5） past negative experiences and/or memories and （6） no trouble concerning cognition, behavior, human relations, and feelings and/or mood.
It is crucial to have a better understanding of these disorders and their treatment requirements to achieve effective management. Therefore, dentists should consider defining PSD more precisely in order to maintain an objective role for therapy under the Japanese system of medico-dental dualism.

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Although the exact etiology of burning mouth syndrome （BMS） is still unknown, there are three leading hypotheses: the first is that BMS is caused by a disorder of the peripheral nervous system as a neuropathic pain; the second is that BMS is caused by a disorder of the central nervous system associated with stress and anxiety; and the third is that both hypotheses are involved in BMS. In this article, we summarize reports that epigenetics such as DNA methylation and histone modifications in the peripheral and central nervous systems may be involved in the pathogenesis of BMS.

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Burning mouth syndrome （BMS） is characterized as a chronic burning sensation in the oral cavity without any organic abnormalities and is often accompanied with complaints about taste alteration. The aim of this study was to investigate gustatory sensation and the interaction between taste stimulation and clinical characteristics including pain sensation in patients with BMS.
This was a retrospective clinical study involving 50 new outpatients with BMS for whom the following data were completely collected: sex, age, duration of illness, pain intensity at first visit （initial visual analogue scale; initial VAS）, stimulated saliva secretion, and the results of taste examinations and psychological examinations.
Among the 50 patients （40 females, 10 males, mean age: 59.5±15.0 years old）, 28 patients （56.0％） complained of taste alteration, 32 patients （64.0％） showed normal gustatory sensation by the paper disc taste examination and 44 patients （88.0％） did so by the whole mouth taste examination. Weak negative interactions were observed as follows: between the taste intensity of sweet, sour, and salty solutions with moderate concentration and duration of illness; between the taste intensity of sweet, sour, and bitter solutions with moderate to high concentration and saliva secretion; between the taste intensity of salty and bitter solutions and the scores of self-rating depression scale; and between the taste intensity of sweet and salty solutions and the scores of the short intolerance of uncertainty scale. There was no significant interaction between taste intensity and complaints of taste alteration, age and initial VAS. Moreover, 23 patients （46.0％） showed pain alteration by taste stimuli with significantly lower detecting thresholds of all four basic tastes in the paper disc taste examination and significantly higher pain intensity with salty, sour and bitter solutions compared to the patients without pain alteration.
In the present study, most patients showed normal gustatory sensation despite their complaints of taste alteration. The taste intensity was affected by the duration of illness, saliva secretion, depression and intolerance of uncertainty; moreover, the pain intensity seemed to be exacerbated by salty, sour and bitter taste stimuli. These results suggest that the gustatory and pain sensations in BMS interact in a complex manner involving physiological, neurological and psychological factors.

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The objective of the present study was to use qualitative research to highlight the needs of oral cancer patients and clarify the impact of their condition on social activities. Semi-structured interviews were held with 22 oral cancer patients and analyzed with reference to the grounded theory approach. The recorded oral data were used to identify oral cancer-related issues and impacts, and the feelings of the subjects; codenames indicating the meanings of the data were attached, and those with similar codes were gathered into categories. Additionally, the categories were linked on the basis of conditions, context, behavioral/mutual behavioral strategy, and outcome. The detailed analysis focused on the oral cancer-specific category ‘reduction in social contact due to changes in dietary habits’ and on ‘impact on work,’ which has important relevance to supporting social activities.
In response to the question as to what had been painful or very difficult, frequent reference was made to the impact on dietary habits. In addition to the reduced pleasure in eating, the change in dietary habits had also resulted in reduced social contact and reduced opportunity for social pleasures. By contrast, those who had been able to accept their disability and alter their values were able to concentrate on the value remaining for them, suggesting that psychosocial support in oral cancer survivors can improve quality of life.
Meanwhile, oral cancer survivors of working age experienced a large impact on their work life. Continuing to work appeared to not only provide economic stability, but also the perception of having a role in society, increasing the likelihood of patients feeling a sense of purpose and a reason to live. Providing support in partnership with a medical social worker from immediately after diagnosis to help the patient continue working not only provides economic support during recovery, but is also important in enabling continued social contact and a sense of purpose in life.

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Abstract: It has been reported that the number of people who feel depressed or stressed is increasing due to the effects of the COVID-19 pandemic. We report a case in which taste disorders began to be felt from the time when the patient’s work was drastically reduced and he had to stay at home.
The patient, a male in his 60s, was a sightseeing bus driver. The chief complaint was abnormal taste. His work was drastically reduced due to the COVID-19 pandemic, and after he had to wait at home all day, tongue pain, discomfort in the mouth, and abnormal taste appeared. At our department, we advised him to have confidence in his oral health because the results of taste function tests tended to improve at each visit. In addition, when ethyl loflazepate was prescribed, it showed a remarkable effect: the tongue pain and discomfort in the mouth disappeared, and after 5 months, he became unaware of the taste abnormality with his usual diet.
This case is considered to be a concrete example of the development of dental psychosomatic disorders such as dysgeusia due to the spread of COVID-19.

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It is difficult to diagnose toothache of unknown cause, especially intractable chronic odontogenic pain or atypical odontalgia. We report a case of atypical odontalgia in the left mandibular second premolar with acute alveolitis. A female in her 70s presented with dull pain in her left mandibular second premolar. Five years prior, she had undergone repeated treatment for pain in the lower first premolar and second premolar, which were abutment teeth for a removable partial denture of the mandible. The symptoms of the former disappeared after frequent root canal treatment, but the latter did not improve. After consulting multiple physicians, psychogenic involvement was suspected and she was referred to our department. Examination revealed no obvious dental or atypical odontalgia findings, but air trap was noted. She was administered herbal medicine Hangekobokuto, which was ineffective, followed by amoxicillin to no effect. A remarkable effect was observed with escitalopram oxalate. However, shortly thereafter, perimandibular inflammation of the lower second premolar suddenly developed. Her symptoms disappeared following tooth extraction after anti-inflammatory therapy. However, five months later, when a new denture was made, oral burning mouth syndrome developed.
Odontogenic and non-odontogenic pain may coexist presenting as toothache, and it is necessary to consider the possibility.

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In the super-aging society in Japan, visiting dental services have been gaining attention. The main targets of visiting dental services are general dental treatment, professional oral care, and swallowing assessment. It is reported that over 6 million people are in need of long-term care in Japan, implying that over 100,000 elderly people who cannot visit dental clinics could be suffering from burning mouth syndrome （BMS） considering its prevalence. Thus, in addition to these visiting dental services, psychosomatic dental treatment might be needed, although there are no reports on visits for such treatment. Herein, we report a case of BMS and oral cenesthopathy under the clinical setting of visiting dental services in which the clinical outcome was favorable.
A 91-year-old woman living in a long-term health care facility complained of a burning sensation in her tongue, spontaneous salty taste, and an uncomfortable sensation of something clinging to her incisor. Her complaints began after receiving a composite resin filling for her incisor by the visiting dental services of Fukuoka Dental College. She was referred to a specialist in psychosomatic dentistry and was diagnosed with BMS and oral cenesthopathy. She had a history of cerebellar infarction, but no cognitive impairment was detected. After informed consent was obtained from the patient and her family, we started psychopharmacological treatment under the clinical setting of visiting dental services. We initiated aripiprazole 0.5mg/day and gradually increased its dose. After a week of the initial prescription, the burning pain was relieved. One month later, the salty taste and uncomfortable sensation were also improved. Symptoms of BMS and oral cenesthopathy are stable and have improved with aripiprazole 1mg/day, without any adverse effects.
As part of a community-based integrated care system, visiting dental services have proved valuable, including in the prevention of aspiration pneumonitis. Furthermore, treatment for psychosomatic dental symptoms is required. Treatment for psychosomatic dentistry at visiting services has some advantages. Patients who cannot come to the clinic because of systemic diseases such as brain infarction can be treated. Furthermore, the patient’s actual living conditions can be checked. Nevertheless, some points need attention. Patients using visiting dental/care services tend to have more systemic diseases and take more drugs than outpatients. Thus, more frequent and careful follow-up is important. Psychosomatic dentistry under visiting dental services may be an effective option for patients who cannot visit dental clinics, as seen in the present case.

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