This document discusses various psychosomatic disorders that can present with oral symptoms. It focuses on burning mouth syndrome, which affects mostly middle-aged females and can have psychological components like anxiety and depression. Other disorders mentioned include idiopathic xerostomia, dysgeusia, glossodynia, glossopyrosis, and delusional symptoms. Investigations and treatments are outlined, including addressing potential nutritional deficiencies, salivary hypofunction, candidiasis, and psychological factors. Stress is discussed as a potential trigger for conditions like recurrent aphthous stomatitis, oral lichen planus, psoriasis, and erythema multiforme. Eating disorders like anorexia and bul

1. psychosomatic disorders
part 3

2. ORAL DYSESTHESIA
Disorders related to altered oral sensation
• Burning mouth syndrome
• Idiopathic xerostomia
• Idiopathic dysgeusia
• Glossodynia
• Glossopyrosis

3. BURNING MOUTH SYNDROME( BMS)
• Stomatodynia.
• Patient complaint of generalised soreness or burning sensation of mouth.
• Normal appearance of oral mucosa
• Mainely tongue >> denture bearing area >> lips
• Females>>>. 7 females: 1 male
• Middle aged

4. • The psychological aspects of burning mouth syndrome can be
categorized into
 chronic somatoform dysfunction,
 chronic vegetative disorders,
 chronic pain phenomenon
• Burning mouth syndrome is a multifactorial disorder
associated with psychological components such as anxiety,
depression, and cancerophobia

5. Rule out:
• Haematinic deficiencies: vit b12, folate, iron
• Salivary gland hypofunction
• Candidiasis
• Parafunctional habits- chronic trauma
• GERD
• Depression
• Allergy to denture
• Cancerophobia
Investigations:
• Detailed history
• Detailes examination
• Blood test: CBC, serum B12, folate, RBC Folate, Serum
ferritin, blood glucose
• Quantitative assessment of candidal growth
• Salivary gland function

6. Confirming clinical diagnosis
Diagnostic analgesic blocking
Utilization of diagnostic drugs
Consultation
Trial therapy

7. • Medications that act in the brain
 Benzodiazepines,
 Tricyclic antidepressants (e.G., Amitriptyline),
 Anticonvulsants (clonazepam)
 SNRIs and SSRIs
 Respond better to low-dose combinations

8. • quantitative and qualitative changes in saliva
• salivary hypofunction (dry mouth).
• Depressive symptoms are usually evident.
Idiopathic xerostomia

9. Disturbances in taste
Dysgeusia is defined as a distorted gustatory
perception or persistent gustatory sensation in the
absence of gustatory stimulants.
Sour/metallic/bitter taste.
Middle aged females
Dysgeusia

10. • Quite obsessional about the condition
• Associated with Halitophobia / false halitosis
• Oral dryness irrespective of normal salivation.
• Delusional symptoms: sand/ grit in mouth, excessive
mucus discharge.
• Associated with detrimental changes in diet & lifestyle.

11. • It is usually associated with Candida associated
lesions (CAL), burning mouth syndrome (BMS), or
a mixed combination of CAL and BMS
Glossodynia
Glossopyrosis
• Lengthy periods of depression tend to be seen before the manifestation
of the full clinical picture of glossopyrosis.
• Lingual burning in patients with glossopyrosis is consistent with
hyperalgesia.
• neurogenic inflammation is observed in patients and animals with
magnesium deficiency and in magnesium-deficient tissues

12. Dental
conditions
(Periodontal
diseases
Carious lesions
Discharging dental
sinus
Marginal
restorations
Dry socket )
Associated
structures
(salivary gland
hypofunction,
sialadenitis,
sinusitis)
Systemic
diseases
(uraemia,respirator
y disease, GERD,
neurologic
disorders like
Bells’s palsy,
damage to chorda
tympani, brain
tumours)
Deficiencies
(zinc)
Drugs (ACE
inhibitors,
lithium salts,
gold,
carbimazole,
metronidazole,
penicillamine,
xerogenic drugs)
Others (
smoking)

13. • Zinc supplementation is believed to aid in treating
taste disorders by promoting proliferation of
normal taste bud cells, even in patients without
zinc deficiency .
• The tricyclic antidepressants such as amitriptyline
and nortryptyline are often generally helpful

14. • Body dysmorphic syndrom
• Delusional halitophobia
• Cancerophobia
• Phantom bite syndrome
Delusional symptoms:

15. Abnormal belief from which individual cannot be dissuaded
& which is not in keeping with his/ her cultural backgrounds.
“Phantom bite syndrome”
• Complains of abnormal bite / lumps under oral mucosa
• Avoid unnecessary treatment in such patients.
• “occlusal discomfort” or “occlusal dysesthesia”

16. • Various MUS, including headache, dizziness, shoulder
stiffness, low back pain, and fatigue, often accompany
PBS and worsen after even minor dental adjustments,
which the patients have requested

17. Delusional halitosis
• Form of monosymptomatic hypochondriacal psychosis
• Halitophobia is an olfactory reference syndrome
• A psychological condition that the dental surgeon is illequipped to treat alone.
• Delusional halitosis may present clinically as a spectrum ranging from an
overvalued belief to a frank delusional disorder in which the individual can
hardly be dissuaded from his or her belief of mouth odor
• The person will be presenting with false offensive mouth odor.
• Both pseudo-halitosis and halitophobia patients must be referred to
psychological specialists

20. • Treatment for delusional halitosis is challenging:
Type of anthrophobia.
Mainely in adolescents

21. • Disorder caused by altered perception of dentofacial form
and function.
• Body dysmorphic disorder (BDD) is a psychological
syndrome which results in patients seeking treatment for
an imagined defect in their appearance.
• Aesthetic dental treatment for such patients is not
beneficial and
carries some potential risks
Dysmorphophobia

22. • Not a phobia.
• Serious preoccupation with an aspect of their physical
appearance that they feel is defective.
• Minor problem/ imaginary.
• Acceptable or abnormal appearance are open to
subjective interpretation , but when suspect psychologic
problem seek specialist opinion.

23. Self injurious behaviour

24. • Bruxism is the parafunctional clenching and grinding
action between the upper and lower teeth
• create many dental problems, such as abfractions,
hypersensitivity, periodontal distraction, and
temporomandibular dysfunction .
Dental and periodontal diseases
caused by bruxism

25. • Factitious disorder/ self mutilation behaviour
• Psychologic / psychiatric disorder charecterized by
compulsive, voluntary production of signs & symptoms
of disease for sole purpose of assuming a ‘patient’s role’
and in absence of other secondary gain.
• Also seen in children who seek special attention from
family.

26. • May or maynot intensional.
• Physical/ developmental/ learning disabilities.
• (epilepsy/ profound neurodisability/ cerebral palsy/ autism/ lesch-Nyhan syndrome, Riley –
Day syndrome
• Trauma to lips/ cheek/ tongue.
• GINGIVITIS ARTEFACTA: often caused with finger nail.
• FACTITIOUS STOMATITIS
• DERMATITIS ARTEFACTA

27. LOCAL
• Topical anesthetic
• Topical antiseptic
• Suture to close wound
• Bite raising appliance
• Occlusal guards/lip bumper
• Restorations of broken teeth
• Extractions
• Occlusal adjustment to teeth
SYSTEMIC
• Analgesic & antibiotic

28. • Oral lichen planus
• Recurrent aphthous stomatitis
• Psoriasis
• Mucous membrane pemphigoid
• Erythema multiforme
Auto immune disorders

29. • Chaudhary has reported higher scores of anxiety, depression and
stress in patients with OLP in comparison to healthy controls .
• Burkhart et al. (1997) assessed medical history, lifestyle and
health habits and pointed out to the occurrence of stressful
events at the onset of OLP in 51 per cent of the subjects.
• More recently Rojo-Moreno et al. (1998) in a controlled study
on 100 patients using different psychometric tests found greater
anxiety and depression in OLP patients than the controls .
Oral lichen planus

30. • Factor potentially related with RAS exacerbations is
stress (Natah et al. 2004; Keenan and Spivakovksy
2013; Scully et al. 2003; Sook-Bin and Sonis 1996;
Volkov et al. 2009; Zadik et al. 2012) [34].
• Psychological stresses induces immunoregulatory
activity by increasing the number of leukocytes at
sites of inflammation; this is a characteristic often
observed during the pathogenesis of RAU
Recurrent aphthous ulcers

31. • Psoriasis is a papulosquamous exfoliative
dermatitis which presents as discrete flat-
topped papules or plaques covered with thin,
white, loosely adherent scales.
psoriasis

33. • Role of stress is evident with deregulation of T-
lymphocyte activity
Erythema multiforme

34. • Recurrent herpes labialis
• Necrotizing ulcerative gingivostomatitis
• Chronic periodontal diseases
Miscellaneous disorders

35. • In recurrent herpes labialis, Emotional stress apparently
serves to prevent the antibodies from acting at the
local mucosal site

36. The temporal relationship of psychosocial stress to
cellular immunity and herpes labialis recurrences.
Schmidt DD, Schmidt PM Fam Med. 1991 Nov-
Dec;23(8):594-9
• significant inverse correlations between stress level scores and
percent CD4 helper/inducer T lymphocytes in both subjects
: two individuals with positive antibodies to the herpes
simplex virus, one with recurrent herpes and one without a
history of recurrent herpes; for 32 weeks.

37. Mechanisms through physiologic pathways may
influence periodontal tissues :
• alteration in saliva,
• changes in gingival blood circulation,
• Endocrine imbalances and
• altered host resistance
• Depressed immunity and enhancing infection
Chronic periodontal disease

38. Eating disorder

39. • Anorexia nervosa: food avoidance, underweight,
distorted body image . Self induced vomiting.
• bulimia nervosa: binge eating, purging, normal body
weight.
• Abuse of laxatives, enemas, diuretics, exercise

40. • Anorexia less common than bulimia.
• Age : average 17 yrs( as early as 8 yrs
• Comorbidity with depression, social phobia, obsessive
compulsive disorder.

41. • Wearing of teeth.
• Parotid gland enlargement.
• Mucosal lesions, particularly in soft palate.
• Stomatitis due to nutritional/haematinic deficiencies.
• Dentist: identification/ prevention & management
Oral findings

42. • Biological and Biomedical Reports, 2011/2012, 1(1), 13-16 Effect of stress on oral
mucosa (PATHOPHYSIOLOGY).
• Tyldesley’s textbook on oral medicine.
• Bell’s oral and facial pain , 7th ed.
• Burket’s textbook on oral medicine. 11th ed.
• Fam Med. 1991 Nov-Dec;23(8):594-9.
• The temporal relationship of psychosocial stress to cellular immunity and herpes
labialis recurrences.
Schmidt DD1, Schmidt PM, Crabtree BF, Hyun J, Anderson P, Smith C.
REFERECES