The “memory theory of oral psychosomatic disorder （PSD）”^{2, 3）} proposed by the author in 2016 conjectures that the subjective symptom of oral PSD is the retrieved memory of the original dental disease experienced in the past. This article reconsiders the theory through abduction, one of the inferences. Based on this theory, the following suppositions are made: 1） The memory of the subjective symptom of the original dental disease is stored as an engram in the cerebral cortex and retrieved upon activation of the engram. 2） The symptom is reinforced and conditioned with aversion experiences （such as trouble with family, work-related problems, complaints about dental treatment, and so on）. 3） The chronicity of the symptom is explained as long-term memory. 4） The effects of psychological and antidepressant therapy are based on overwriting of the aversion memory with new information and reinforcement thereof. 5） Oral PSD is a single disease and its type is only a label without entity.

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Oral cenesthopathy is characterized by various symptoms from sticky and slimy sensations to bizarre complaints such as coils, wires, or screws without corresponding organic abnormalities, and sometimes involves pain sensations. It is typically difficult to treat since many factors including psychosocial problems interact in a complicated manner. Herein, we present a rare case whose oral cenesthopathy comorbid pain sensations showed much improvement with low-dose amitriptyline monotherapy, considering the psychosocial background.
A 66-year-old female complained of foreign objects with various shapes coming from inside of the left side of her neck and moving into her oral cavity accompanied by stinging and stubbing strong pain. She remained objective and showed understanding of her sensations and psychopharmacotherapy. In addition, her husband had been very understanding and supportive. There was no sign of depression, catastrophizing or intolerability of uncertainty and no abnormal finding in her cognitive function or in brain magnetic resonance images. Hyperfusion in the frontal to temporal regions, which are reported to have a specific pattern in patients with oral cenesthopathy, were observed by single photon emission computed tomography （SPECT）.
She was diagnosed as having oral cenesthopathy. Since these symptoms are generally refractory, the first aim was to relieve the pain, even if only a little. For this aim, amitriptyline was prescribed with the initial dose of 10mg. On day 21, the pain sensations were improving. Her husband had been supportive and always offered thoughtful words to help her accept her feelings. Amitriptyline was increased up to 30mg and almost removed the pain sensations by day 70; however, amitriptyline was decreased to 25mg since dementia-like symptoms were suspected. On day 98, the sensation of movement of foreign objects also improved gradually, and no dementia-like symptoms were found. On day 133, foreign body sensations greatly improved and stabilized with 25mg of amitriptyline by day 217. The asymmetric patterns in SPECT tended to be reduced.
In the present case, not only the pain sensations but also the foreign body sensations were substantially improved with low-dose amitriptyline. Besides the pharmacological effects of amitriptyline, no psychological problems, good understanding of the disease, sharing of the aim of treatment, and the family’s understanding and support had synergistic effects.

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The treatment of chronic pain in an inpatient setting is characterized by intensive, multi-disciplinary treatment. Inpatient treatment may be the better choice in some cases. We report the case of an elderly patient with burning mouth syndrome who successfully recovered with short-term inpatient treatment. A 73-year-old female presented with burning tongue sensation, bitter taste, and dry mouth sensation for 6 months before her first visit. Insomnia, fatigue and body weight loss were evident, and so treatment in a hospital setting was started. Amitriptyline was administered and gradually titrated with the addition of diazepam. With careful monitoring and supportive therapy, the oral symptoms gradually improved. After 15 days of treatment, the pain almost remitted. In this case, we chose treatment in the hospital setting because the symptom of burning mouth syndrome hindered her daily life and her family support was not enough. We took advantage of rapid titration and enough psycho-education. Inpatient treatment may be a good choice depending on the symptoms of burning mouth syndrome and the patient’s social background.

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Radiation therapy is offered as a treatment option for head and neck cancer, but often results in dry mouth.
Pilocarpine has been used for treating dry mouth caused by radiation therapy.
We report a case of dry mouth relieved by ethyl loflazepate and Rebamipide after　chemoradiation therapy, for which Pilocarpine did not work.

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Generally, dental treatment should be discontinued for atypical odontalgia. However, the best timing for restarting dental treatment has not been sufficiently investigated. Here, we report a case of comorbidity of atypical odontalgia and odontogenic pain treated in collaboration with family dentists.
A 47-year-old female office worker complained of persistent dull and contact pain after root canal treatment in the upper right molar. Eight months ago, despite root canal retreatment of the upper right second molar and pulpectomy of the upper right first molar, the tooth pain persisted for several months. The pain continued to worsen with each dental procedure, so she was referred to our department.
Both of the teeth had spontaneous pain, and she felt pain when the teeth were only touched. Intraoral radiography and cone beam computed tomography did not reveal root fracture or perforation of either of the teeth.
She was diagnosed with comorbidity of atypical odontalgia and odontogenic pain. The symptom of atypical odontalgia was greater than that of odontogenic pain at the first visit, therefore she was prescribed amitriptyline 10mg/day, increasing to 30mg/day every week. Moreover, root canal treatment was stopped until the atypical odontalgia alleviated.
Spontaneous pain disappeared by 4 weeks, and occlusal pain was alleviated by 10 weeks. She was able to eat without pain at 18 weeks, and dental treatment was resumed at 24 weeks after the first visit.
Temporary exacerbation of odontogenic pain due to flare-up was observed when root canal treatment was restarted, but extraction of the upper right second molar and root canal treatment and prosthetic treatment of the upper right first molar were completed without exacerbation of atypical odontalgia. At 64 weeks, occlusal pain had completely disappeared, and finally at 73 weeks, medication was stopped after gradually decreasing the dose.
Atypical odontalgia and odontogenic pain often coexist. It is necessary to carefully determine whether atypical odontalgia or odontogenic pain is greater and to consider the priority of treatment. Accordingly, dental education is essential for this treatment. Research with a large number of cases on the timing of restarting dental treatment for comorbid atypical odontalgia and odontogenic pain is needed.

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