The number of patients with chronic diseases is increasing as the population ages. Many of these are suffering from psychological problems. This article summarizes the mental and psychological backgrounds of patients with chronic diseases including diabetes, cardiovascular diseases, kidney diseases and collagen and collagen-related diseases. The most common psychological problem experienced by patients with chronic diseases is depressive symptoms. Depressive symptoms frequently decrease the ability of self-management, which leads to worsening of dental problems. Dentists should consider mental and psychological problems in patients with chronic diseases.

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The purpose of this retrospective study was to evaluate the exfoliative cytology of oral mucosal lesions. We researched 225 specimens of 211 patients who underwent exfoliative cytology at the Department of Oral Medicine in Kyushu Dental University Hospital from April 2018 to March 2019. Patient age, sex, location of lesion, clinical diagnosis, the results of exfoliative cytology, presence of candida and histopathological diagnosis were analyzed. In 20 out of 24 cases （83.3％） which showed positive or suspicious cytology, epithelial tumor including cancer was detected. However, four cases showed false-negative due to enhancement by inflammation and lower cellular atypism. This study suggested that exfoliative cytology might be useful for detecting oral epithelial tumors including cancer.

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To evaluate the efficacy of long-term administration of M3 muscarinic acetylcholine receptor （M3R） agonists for Sjögren’s syndrome （SS）, we evaluated 62 patients with SS who were treated at our hospital for more than 8 years. Patients receiving M3R agonist therapy （n＝46） had significantly improved salivary flow rate at one year after treatment initiation compared with before treatment, and this improvement was maintained for 8 years. Patients without M3R agonist therapy （n＝16） had a significantly decreased salivary flow rate at 7 years after treatment initiation compared with before treatment. Multivariate analysis revealed that both the salivary flow rate and sonographic findings of the parotid glands before treatment were significant predictors of the efficacy of M3R agonist therapy in patients with SS （p＜0.05）. M3R agonists improve the salivary flow rate, especially in the early stage of SS. Our data suggest that early initiation and long-term continuation of M3R agonist therapy are important in the treatment of xerostomia in patients with SS.

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The patient was a 65-year-old female who underwent bilateral neck dissection and segmental mandibulectomy for right lower gingival squamous cell carcinoma. NST intervention was initiated from an early stage of postoperative chemoradiotherapy due to malnutrition. The nutritional status of the patient gradually improved through total parenteral nutrition and/or percutaneous endoscopic gastrostomy （PEG）. Dysphagia rehabilitation was conducted and oral intake was increased. The gastrostomy tube was removed 296 days after PEG placement. The postoperative course was uneventful without any recurrence during 1 year and 6 months follow-up. The nutritional status of the patient is well maintained.

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