We have been using Cliniclown (CC) once a month in pediatric dentistry since May, 2006. This had to be done on the basis of a clear understanding of the special nature of the dental treatment environment, according to various rules and with full consent. We also gave questionnaires to the 84 patients who cooperated in order to know their impressions of the trial. It was found that many patients: 1) Appreciated the presence of the CC in the dental clinic 2) Were able to relax during treatment 3) Enjoyed their time with CC and wanted to do it again. Problem areas included the sudden popping of the balloon, the difficulty of how to deal with all patients equally, and puzzlement at how to interact with the unfamiliar CC. Wewill continue to use this method in the desire to help children enjoy their visit to the dental clinic and receive treatment with courage and in comfort.
This study explored the relationship between stress response, severity of pain, oral-related health, and the subjective symptom of dry mouth in glossodynia patients. Thirty-seven glossodynia patients completed a questionnaire that included the pain severity sub-scale of the Brief Pain Inventory, an Oral Health Impact Profile, and Stress Response Scale-18. Spearman's rank-correlation coefficient was applied. The Stress Response Scale scores were correlated with those for the severity of pain (rs=0.36-0.69) and the Oral Health Impact Profile (rs=0.34-0.62). The results also revealed that patients with severe dry mouth symptoms exhibited serious psychological stress responses.
We have applied PMR (Progressive Muscle Relaxation) to muscles in and around the oral cavity to develop an oral relaxation method. In this study, we assessed the effects of oral relaxation treatment for adults, including elderly persons, on the secretion rates of saliva and secretary immunoglobulin A (sIgA). The subjects were divided into three groups by age, (20-39, 40-59 and 60- 90 years old), in order to compare the effects of oral relaxation in different age groups. We also compared the secretion rates for saliva and sIgA for subjects with and without medication to grasp the medicinal effects on salivary secretion. The salivary secretion rate rose significantly with tongue relaxation in the 20-39 age group and in subjects without medication, but not with either tongue or mouth relaxation in subjects on medication. The secretion of sIgA in saliva increased significantly with mouth relaxation in the 40-59 age group, with both tongue and mouth relaxation in 60-90 age group, and with both tongue and mouth relaxation in groups both with and without medication compared with the control group. The results of this study suggest that the oral relaxation is useful for promoting the secretion of both saliva and sIgA.
Objective: To present clinical experience with the anti-anxiety drug, Solanax®, in the treatment of 17 glossodynia patients. Study design: The patients consisted of 1 male and 16 females, 17 in total, with amean age of 67.9 ± 2.4 years, and CMI testing was performed. Solanax®; was administered orally to each of the 17 patients for 12 weeks. The clinical examination evaluated oral stimulatory, neuropsychological and somatic symptoms. Results: In the CMI test, 19%(3/16) of patients were diagnosed as either provisionally neurotic or neurotic. Tongue pain recovery rates were high after 12 weeks of Solanax ® administration and 2 and 4 weeks after its completion, with a reduction of symptoms in more than 60% of the patients. The recovery rates for other oral stimulatory symptoms besides tongue pain were also high after 12 weeks of administration and 2 and 4 weeks after its completion, with improvement observed in more than 55% of cases. There were, however, as side effects, reports of drowsiness (12%: 2/17), unsteadiness on the feet (6%: 1/17) and dry mouth (6%: 1/17). Conclusion: The results suggest that Solanax® may be clinically useful and safe for the long-term treatment of glossodynia patients.
Glossodynia is one of the most common dental psychosomatic disorders. We have beenstudying possible catalysts for the disease in 56 cases, consisting of 49 female and 7 male patients. Whereas the majority consisted of women in their 40's in a report of 20 years ago, most of the patients this time were females in their 50's and 60's. Dental treatment was the catalyst for Glossodynia in 29 of the female and 6 of the male cases, including 22 cases of prosthesis, half of which involved the setting of dentures. No correlation with dental treatment was found in 21 cases, and no specific catalyst was found in the majority of these, namely, in 14 cases. Regarding duration of the symptoms, 12 of the cases related to dental treatment were treated for less than a year. This applied to only 3 of the cases with no correlation to dental treatment. The psychological tests, Zung's SDS, the MD inquiry sheet and CMI revealed no remarkable differences between the group of cases caused by dental treatment and the group of those uncorrelated to dental treatment. The MAS tangible anxiety test showed high anxiety levels among patients with no correlation to dental treatment. In view of the above, we propose that consideration to the risk of Glossodynia should be given when providing dental treatment, especially in the case of prosthetics for females in their 50's and 60's with elevated anxiety levels.
Various difficulties were encountered when a patient suffering from mild but aggressive schizophrenia complained to a newspaper about a tooth extraction appointment. The patient was a 23- year-old female receiving outpatient psychiatric treatment for schizophrenia. She also complained several times to our hospital by telephone. Her psychiatrist later became aware of the situation and was able to resolve the issue. The fact that we were unaware that she was being treated for schizophreniawhen she visited our department raises various points requiring serious reflection, including with regard to the method of making appointments. This experience highlighted the difficulty of handling a schizophrenic patient who visits without referral from a psychiatrist, and the importance of establishing reliable routine procedures.
A longitudinal study on the problems encountered with a young female schizophrenia patient during eight years of dental treatment is reported. She first visited our surgery complaining of pain on a left upper molar. She had lost only one tooth at this time. Thirteen teeth were intact, seven were decayed, and eleven had been restored. She continued to demand treatment for pain in various teeth, one after another, but often cancelled her appointments because she felt that her teeth were not being treated properly. Her oral hygiene was very poor. Many teeth had dental caries and eighteen had to be extracted because of advanced decay within three years of her first visit. She gradually stabilized mentally four years after her first visit and came to want denture treatment. Two sets of dentures were constructed during a half-year period. She rejected the first quickly in a delusional condition. She accepted the second but her attitude towards them fluctuated under the influence of delusion. Today, she accepts them well. Dental treatment was provided 177 times in 8 years. Twenty-two teeth were extracted and only seven remain. Throughout, the course of treatment has been influenced by her schizophrenic mental disorder and this situation is expected to continue. Dentists do have to pay very close attention to the mental condition of the patient when providing treatment.
Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause and hypersensitivity to stimuli in radiographically normal teeth. Patients complain of continuous pain even after extended endodontic treatment. This report presents two cases of AO in patients who visited our clinic in 2007 from the psychosomatic perspective. We examined their medical histories, treatment procedures and prescriptions as described in their medical records. (Case 1)Female, 39 years old. Chief complaint: Pain on the right maxillary second premolar. The patient felt pain on the right maxillary first molar and the crown of the tooth was removed. She subsequently changed clinics and the tooth was extracted. Laser therapy and a pulpectomy were provided on account of the pain but she again changed clinics because of the constant toothache. She visited our clinic while receiving treatment at a pain clinic. SAIDs and milnacipran were ineffective. The pain was alleviated by amitriptyline. (Case 2)Female, 38 years old. Chief complaint: Post extraction pain on the right maxillary molar and right orbital pain. The right maxillary molar was extracted after repeated root canal treatment (RCT) but the pain remained following tooth extraction and she next visited oral surgery. She was diagnosed as normal by the oral surgeon, and then visited our clinic. She refused to take antidepressants at first in spite of repeated counseling to do so, but did agree to take the medicines after three months. The pain was relieved by amitriptyline. It is very difficult to diagnose AO due to the very nature of dental treatment. Despite the reports that some antidepressants are effective against AO, dentists often have difficulty in treating AO patients due to individual variations in the response to medicines. Further, as the patients themselves believe that their pain is caused by dental problems, they sometimes refuse antidepressants. Patients are inclined to become angry or distrustful because of their prolonged pain and repeated dental treatment, so it is important both to prescribe appropriate medications and to be receptive and listen attentively to what they say.