In this study, among 2,105 patients diagnosed with burning mouth syndrome （BMS） who visited the Department of Oral Medicine, Hokkaido University Hospital during the 14-year period from 2010 to 2023, 42 patients received a monotherapy of duloxetine for ＞2 weeks. We retrospectively investigated the characteristics and therapeutic effects of the drug. Patients received a monotherapy of duloxetine at an initial dose of 20mg/day for BMS, with dose escalation to 40mg/day if no effect was observed, and up to 60mg/day if still no effect was observed. The survey items included each patient’s age, sex, duration of illness, treatment results, and side effects. For cases wherein the patient was judged to have improved based on treatment results, we also examined the period until the onset of therapeutic effects, the dose at which therapeutic effects were achieved, and recurrence. The average age of the patients was 60 （median 62） years, of whom 81％ were women. The average disease duration was 27 months （median 10 months） and displayed a polarized tendency. The overall improvement rate was 36％ （15 cases out of 42）, with 73％ of improved cases （11 cases out of 15） showing efficacy within 1 month, all at 20mg/day. Four of the other improved cases also showed efficacy within 2 months, at a dose of 40mg/day. We observed no statistically significant difference in improvement rates based on sex. Similarly, no statistically significant differences in improvement rates were observed between groups when the study population was bisected by the median values of age and disease duration. Side effects were observed in 71％ of cases （30 cases out of 42）; however, no cardiovascular or severe side effects necessitating oral therapy discontinuation were reported. The recurrence rate among patients who completed duloxetine treatment owing to improvement was 20％ （3 cases out of 15）.

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Burning mouth syndrome （BMS） and oral candidiasis are common conditions among patients reporting tongue pain. While these diseases can occur independently, they sometimes present concomitantly. However, the clinical characteristics of such concomitant cases have not been well documented. In this study, we analyzed 211 patients diagnosed with BMS and treated at our department over the past nine years. The patients were divided into two groups: 71 patients with concomitant oral candidiasis, confirmed by a positive Candida cultivation test at their first visit, and 140 patients with isolated BMS, confirmed by a negative Candida cultivation test.
Comparing background factors, the concomitant group was significantly older and more likely to report pain when ingesting stimulants, subjective dry mouth, and higher visual analog scale score for tongue pain at their first visit compared to the isolated BMS group （p＜0.05）. However, multivariate analysis, using oral candidiasis as the dependent variable and these factors as explanatory variables, identified age as the only significant factor. The concomitant group demonstrated a significantly worse prognosis than the isolated BMS group. However, the prognosis was not influenced by treatment approaches for candidiasis or the presence or absence of Candida eradication. Furthermore, no difference in prognosis was observed between the two groups depending on the BMS treatment. 　These findings indicate that when BMS occurs concomitantly with oral candidiasis, the prog­no­sis is poorer. However, associated factors, such as the nature of tongue pain, tend to be similar to those of BMS. This similarity makes diagnosis challenging based only on medical history or physical examination, emphasizing the importance of Candida cultivation testing.

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Dental treatment is stressful and causes anxiousness, and tooth extraction in particular is a nerve-wracking procedure for patients. It is known that the palms perspire during nervousness, and so continuous measurement of sweating may be used to evaluate the stress response. In this study, we investigated changes in the amount of emotional sweating during tooth extraction using a sensor for sweating.
The study included 26 healthy patients who underwent mandibular wisdom tooth extraction under local anesthesia. Changes in the amount of sweating of the palms were measured.
The results showed that the physical stimulation of anesthesia promoted sweating, but physical stimulation during tooth extraction, which was under pain control, did not affect changes in sweating. Furthermore, sweating was also accelerated after tooth extraction. The results suggest that both physical stimulation and mental tension may influence emotional sweating during tooth extraction.

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Japan’s aged population is rapidly increasing and the country has become a super-aged society. The average age of our department’s first-visit patients is 64.2 years, and the number of patients with oral psychosomatic disorders is also increasing. The number of patients with dementia is increasing along with the aging of the population, and it has been reported that oral dysesthesia and burning mouth syndrome may precede dementia with Lewy bodies. Although it has been pointed out that regular monitoring of cognitive function is important in clinical practice of oral psychosomatic disorders, the treatment of patients with burning mouth syndrome with dementia has not yet been established.
A 70-year-old housewife came to our hospital with a chief complaint of tingling pain at the tip of the tongue. Based on the clinical findings and the characteristics of her complaints, we diagnosed her with burning mouth syndrome, but because we suspected cognitive decline, we decided not to prescribe antidepressants at the initial visit and to monitor her progress with symptomatic treatment. After careful consultation, we referred the patient to a neurologist at the request of the patient and her husband, and she was diagnosed with Alzheimer’s disease. The neurologist prescribed donepezil. We prescribed a small dose of aripiprazole for burning mouth syndrome, with the neurologist’s recommendation. After the prescription, there were no side effects or further deterioration of cognitive function, and the pain gradually improved. After discontinuation of the prescription, there was no recurrence of pain.
Treatment with aripiprazole was successful in this patient with burning mouth syndrome comorbid with Alzheimer’s disease. Appropriate communication with the patient’s family and collaboration with a neurologist are important in the treatment. We believe that it is necessary to continue to accumulate detailed case reports and consider appropriate measures in the future.

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Introduction: Atypical odontalgia is a challenging dental pain condition with no apparent organic causes, often occurring after dental procedures. Here, we report a case of atypical odontalgia following tooth extractions for dental pain, successfully managed with pharmacotherapy.
Case: A 66-year-old woman experienced recurrent pain in the mandibular left molar region despite multiple tooth extractions. Referred to the Oral Medicine Consultation Clinic, Health Sciences University of Hokkaido Hospital, she showed no organic abnormalities but exhibited mild depressive tendencies. Initial treatment with ethyl loflazepate reduced her VAS score from 70 to 20. After a temporary exacerbation, milnacipran hydrochloride was added, resulting in a VAS score improvement to 10. The patient remains stable on both medications.
Discussion: This case highlights that dental interventions may not effectively address psychosomatic disorders like atypical odontalgia. The combination of anxiolytics and SNRIs proved effective, suggesting a promising therapeutic strategy.

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Parkinson’s disease （PD） often presents non-motor symptoms, such as mood disorders and sensory abnormalities, during its prodromal phase. We report a case of a patient diagnosed with PD during treatment for oral dysesthesia.
A 64-year-old male with a history of depression presented with persistent lip discomfort. Despite supportive psychotherapy and medication adjustments, his symptoms progressed over several years, including systemic fatigue, oral dysesthesia, and lip tremors. These led to a diagnosis of PD.
Abnormal oral sensations may be prodromal non-motor symptoms of PD, warranting careful evaluation in similar cases.

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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.

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In this article, I mention that BMS based on the criteria of ICHD-Ⅲ cannot be theoretically physical disease. BMS is subjective symptom itself. BMS related various factors reported in many studies should not be regarded as the factors explaining BMS as physical disease, but as attribute of BMS patient complaining the subjective symptom. Studies of BMS need both approaches on the levels of micro and macro, namely substance and human-being.

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