This study examined somatosensory amplification using the Japanese version of the somatosensory amplification scale (SSAS) (Nakao, M., et al.: 2001) in patients with vague oral complaints.
The subjects consisted of 57 patients (15 males aged 66.8±10.8 years, 42 females aged 63.9±9.7 years) attending our clinic, of whom 24 had glossodynias, 20 oral paresthesias, 15 taste abnormalities, 14 saliva abnormalities and 7 indefinite oral pain (overlapping in some patients).
The SSAS scores in these patients were compared with those in 57 control individuals (15 males aged 67.3±12.0 years, 42 females aged 63.8±10.2 years) who visited our clinic for general dental treatment.
The results were as follows:(1) The SSAS scores in general were significantly higher in these patients with vague complaints than in the controls (p<0.001).(2) The SSAS scores were higher in these patients than in the male controls (p<0.01), female controls (p<0.001), controls less than 65 (p<0.01), and controls over 66 (p<0.001).(3) The SSAS scores for males were not significantly different from those for females, and there was no significant difference between those aged less and more than 66.(4) The SSAS scores of patients with multiple complaints were not significantly different from those of patients with a single complaint.(5) The SSAS scores were higher in patients with glossodynia (especially as a single complaint) than without glossodynia, though not significantly.
Our findings suggested that SSAS may be a clinically useful tool for dealing with patients with vague oral complaints.

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We administered milnacipran hydrochloride, one of the 4th-generation antidepressants, to patients with oral diseases in which the intervention of psychosocial factors was strongly suspected. The eight subjects consisted of five cases of glossalgia, one of dysgeusia, and two of oral discomfort. The dose levels were 15mg in six and 30mg in two cases. Five patients olso received other medicaments jointly due to the insufficient efficacy of previous chemotherapy. The jointly used agents included anxiolytics, autonomic regulators, cevimeline. hydrochloride, and Hangekobokuto. The remaining three were given milnacipran hydrochloride alone.
The effects were evaluated by means of SRS after four weeks. The symptoms were alleviated in six cases but unchanged in two. Of the subjects taking milnacipran hydrochloride alone, two improved but one did not.
>From the foregoing, we concluded that the administration of milnacipran.hydrochloride.is effective for use with such oral diseases as glossalgia.

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The reactions of a schizophrenic patient group (average 44.7 years old) toward damage to maxillary anterior teeth were compared with those of three other groups: the healthy (57.4 years old), patients with physical complaints (59.4 years old) and those with other mental disorders (44.7 years old). The purpose was to investigate the views of schizophrenic patients on what constitutes healthy teeth.
For all subjects, the chief complaints related to damage to maxillary anterior teeth concerned esthetic or masticatory disturbance. Significant differences were observed concerning the details of the chief complaint among the four groups. The most notable difference was observed between the healthy (64 %) and schizophrenic (only 15 %) groups with respect to the number reporting esthetic disturbance of the total 129 subjects, 81 % desired dental treatment for maxillary anterior teeth. Significant differences were noted between the four groups concerning their attitude toward treatment, especially between the schizophrenic (62 %) and healthy (100 %) groups. Ninety-two patients underwent treatment. Except for only, two cases in the other mental disorder group, nearly all (ninety patients, 98 %) reported improvement after treatment. The majority referred to esthetic and masticatory improvement. The largest difference was found in the numbers of those referring to esthetic improvement in the schizophrenic (only 19 %) and healthy (84 %) groups. The rates of those reporting improved masticatory function ware 52 % in the schizophrenic and 8 % in the healthy groups.
The results of this study suggest that many patients in the schizophrenic group had less interest in their own teeth and damage to them, and also in the esthetic aspects of maxillary anterior teeth, than members of the healthy group. They appear to have a different mental image of what constitutes health in anterior teeth. It was also found that 68 % of the schizophrenic group did undergo dental treatment of the anterior teeth and all showed a positive reaction to the results. The author considers that such dental treatment for schizophrenic patient is worth while and meaningful.

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Glossodynia is one of the most common psychosomatic disorders seen in dental practice.
In this paper we report a case of glossodynia that was treated effectively by a psychosomatic approach.
The patient was 65-year-old female who had several biopsychosocial aspects to her profile.
These included such psychosocial factors as cancer phobia, perfectionism, object loss (retirement) and living alone, together with some biological factors as well.
We obtained immediate and excellent therapeutic effect in this case through the use of both physical and psychological treatments.

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“Adolescent paranoia” includes phobias of emitting foul odor from one's own body, fear of eye-to-eye confrontation and dysmorphophobia.
A 21-year old man visited the department of dentistry of our hospital complaining of foul breath, whose concern about his odor was delusional. He also exhibited “egorrhea” symptoms, such as fear of eye-to-eye confrontation and monologue, and was diagnosed as having adolescent paranoia by a psychiatrist. The patient had started avoiding people, shut himself away in his room and talked to himself from the age of 15 or 16, after initially becoming concerned about his pimples. He also became concerned about foul breath and having suspicious eyes from the age of 17, felt that others were avoiding him, and became self-recriminatory. He later presumed that his thoughts were being expressed by his mouth contrary to his will.
The self-rating questionnaire for assessing the severity of phobia of emitting foul breath received a high score of 36 out of 40. The questionnaire indicated the delusion of having halitosis, delusion of reference and poor social adaptability. He was, accordingly, diagnosed as suffering from Group III (severe) type of phobia of emitting foul breath. On the day of his first visit, he was also examined by a psychiatrist, and diagnosed as having adolescent paranoia and administered 1 mg of risperidone.
This patient's symptoms suggested the possibility of schizophrenia. Thus it was preferable to pay attention to other symptoms of schizophrenia and the patient was therefore observed carefully.
Dentists are likely to receive outpatients of this type who require immediate referral to psychiatrists. The case of this patient demonstrates the importance of an accurate differential diagnosis regarding complaints of emitting foul breath.

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The condition of a 47 year old female temporo-mandibular disorder patient with slight mental retardation was hard to diagnose in detail and some analgesics induced adverse effects, making it difficult to reduce her pain. She was admitted to Kyushu Dental College hospital to undergo stellate ganglion block (SGB) at her own wish. Cognitive behavioral therapy was used to help her understand her own condition, and arthrocentesis was performed for diagnosis under intravenous sedation. There were no abnormal findings beside click. After this treatment, her complications reduced without analgesics, suggesting that they included psychological factors. It was necessary not only to perform detailed examinations but also to help the patient understand her own condition in this case.

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We report the case of a patient who could not wear a denture due to a severe vomiting reaction. The condition was diagnosed as denture phobia or maladaptation to the denture. We considered as one possible reason for this condition the bullying she received from her step-mother in childhood.
In this case, nearly sixty years had passed since the bullying occurred, but she remembered it clearly. She had long since become a mother herself and learned to see her step-mother in a more positive light.
PTSD could not be diagnosed, so we explained the relationship in terms of the mental trauma in her childhood and treated her with supportive mental therapy. In medical therapy, we administered an antiaxiety drug because we suspected that her chief complaint was the fear of the vomiting reaction experienced when wearing the denture. We also used the exposure method of behavioral therapy to reduce the denture phobia.

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外科的顎矯正治療後に, 咬合の異常感の他, 姿勢のねじれ, 全身倦怠など多彩な全身的不定愁訴を呈していた39歳, 女性の顎関節症患者に, SNRIであるmilnacipranによる治療を行った. SNRIを6ヶ月かけて30mg/dayから120mg/dayまで増量したところ, 咬合の異常感, 広範囲の疼痛や随伴症状の睡眠障害, 慢性疲労, 全身のこわばり, 痺れ感, 抑うつ気分などが, 経時的および用量依存的に改善していった. 本症例は線維筋痛症の診断基準も満たしており, 両者の随伴症状の重複や抗うつ薬への反応の共通性から, このタイプの顎関節症の背景には線維筋痛症と類似した中枢性の病態生理学的機序が存在するのではないかと考えられた.

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