Case of multiple oral complaints related to dentures treated in collaboration with a family dentist

We report a case of a patient complaining of pain in the oral mucosa, including the tongue. A denturetreatment that caused the pain was treated in cooperation with a family dentist. 　The patient, a woman in her seventies, had visited a nearby dentist four years before her first visit to our department. After extracting her remaining teeth and the denture adjustment , she became aware of a burning sensation in her palate. Even after the new denture was set, the burning sensation expanded to the maxillary gingiva, tongue, and lips. The metal allergy test was negative, and the patient had to have her dentures repeatedly remade four times by several dentists. During the case, she visited an oral medicine clinic and was diagnosed with oral dysesthesia. She was treated with rikkosan, ethyl loflazepate, and shosaikoto, but only temporary effects were obtained. The burning sensation in the mucosa under the denture base was mild after the denture was remade by a new dentist a year before her first visit to our department. However, the burning pain in her tongue remained. She also complained of xerostomia. Therefore, she was referred by the same dental clinic to our department. At the time of the initial examination, there were no specific findings in her oral cavity. The Cornell Medical Index showed I II regions (suspicion of neurosis), and the Visual Analog Scale for tongue pain was 83. We diagnosed her with burning mouth syndrome. Extensive denture adjustment would have significantly altered the sensation in the mouth, which could have triggered a worsening of the symptoms and interfered with the treatment i n our department. Therefore, we asked the referring dentist to keep the denture adjustments to a minimum and decide d to proceed with the treatment in cooperation with him. In our department’s treatment, cognitive modification by brief psychotherapy and administration of hangekobokuto were concurrently performed. Consequently, the symptoms almost disappeared for a while. However, the symptoms later flared up, and escitalopram treatment was started. Since the symptoms disappeared, the escitalopram dosage was reduced, and the symptoms had not flared up since the end of the medication.