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Title: 義歯と関連した口腔内多愁訴症例に対しかかりつけ歯科医と連携して治療した1例
Other Titles: Case of multiple oral complaints related to dentures treated in collaboration with a family dentist
Authors: 三浦, 和仁1 Browse this author
新井, 絵理2 Browse this author
尾崎, 公哉3 Browse this author →KAKEN DB
近藤, 美弥子4 Browse this author →KAKEN DB
松下, 貴惠5 Browse this author
岡田, 和隆6 Browse this author →KAKEN DB
渡邊, 裕7 Browse this author →KAKEN DB
山崎, 裕8 Browse this author →KAKEN DB
Authors(alt): Miura, Kazuhito1
Arai, Eri2
Ozaki, Kimiya3
Kondoh, Miyako4
Matsushita, Takae5
Okada, Kazutaka6
Watanabe, Yutaka7
Yamazaki, Yutaka8
Keywords: 紹介元歯科との連携
Collaboration with family dentist
Burning mouth syndrome
Brief psychotherapy
Issue Date: 15-Sep-2022
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 43
Start Page: 70
End Page: 75
Abstract: 義歯治療を契機として舌を含めた口腔粘膜の疼痛を訴える患者に対し,かかりつけ歯科医と連携して治療にあたった症例を経験したので報告する. 患者は70代女性で,X - 4 年義歯不適合で近医歯科を受診し,残存歯の抜歯後に義歯調整を受けるうちに口蓋のヒリヒリ感を自覚するようになった.新義歯が作製された後もさらに上顎歯肉,舌,口唇とヒリヒリ感の範囲は拡大した.皮膚科での金属アレルギー検査は陰性で,以後複数の歯科で4 回にわたり義歯の再製作,調整を繰り返した.その経過中に近医口腔外科を受診し口内異常感症と診断され,立効散含嗽,ロフラゼプ酸エチル,小柴胡湯が投与されたが一時的な効果しか得られなかった.X - 1 年に新たに受診した歯科で義歯が再製作されてからは,義歯床下粘膜の異常感は軽快した.しかし,舌のヒリヒリ感は残存し口腔乾燥も訴えたため同科からの紹介にてX年当科を受診した.初診時,口腔内には特記事項を認めなかった.CMIはⅢ領域(特記事項なし)で,舌痛のVASは83であり,舌痛症と診断した. 床縁,研磨面形態の修正や床裏装などの広範囲に及ぶ義歯治療を行うと,口腔内の感覚を大きく変えることになり,それを契機に症状が悪化して当科の治療が奏効しない可能性があったため,義歯調整は咬合の微調整など必要最小限にしていただくよう紹介元歯科に依頼し,連携を取りながら治療を進めていくこととした.当科の治療では,簡易精神療法による認知の修正と漢方薬の投与を並行し,症状は一時ほぼ消退した.しかし,その後再燃したためエスシタロプラムの投与を開始した.これが著効を示し症状は消失したため減量を開始し,投薬終了後から現在まで症状は再燃していない.
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.
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Appears in Collections:北海道歯学雑誌 > 第43巻

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