Oral cenesthopathy

Abstract

Cenesthopathy is characterized by abnormal and strange bodily sensations and is classified as a ‘delusional disorder, somatic type’ or ‘somatoform disorder’ according to the DSM 5. The oral cavity is one of the frequent sites of cenesthopathy, thus the term ‘oral cenesthopathy.’ Patients with oral cenesthopathy complain of unusual sensations without corresponding abnormal findings in the oral area, such as excessive mucus secretion, a slimy sensation, or a feeling of coils or wires being present within the oral region. They usually visit multiple dentists rather than psychiatrists. Without a proper diagnosis, they repeatedly pursue unnecessary surgical procedures to remove their ‘foreign body’. This sometimes creates a dilemma between the dentists and patients. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. This review focuses on the various aspects of oral cenesthopathy.The estimated prevalence of cenesthopathy was 0.2 to 1.9 % in a study done at a Japanese university psychiatry clinic and 27 % in a study done at a Japanese psychosomatic dentistry clinic. Oral cenesthopathy do not have clear disposition, while some studies reported that elderly women were most commonly affected. Its pathophysiology has not been fully elucidated. However, recent studies have suggested a right > left asymmetrical pattern of the cerebral blood flow of patients with oral cenesthopathy. Antidepressants, antipsychotic drugs, electroconvulsive therapy, and psychotherapy might be effective in some cases, though it is known to be intractable.To date, the epidemiology, pathophysiology, etiology, classification and treatment of oral cenesthopathy are unknown due to the few reports on the disorder, though there are a few case reports. To overcome this difficult medical condition, clinico-statistical and case–control studies done under rigorous criteria and with a large sample size are required.

Clinical characteristics and course of oral somatic delusions: a retrospective chart review of 606 cases in 5 years

“…Cenesthopathy is characterized by foreign body sensations despite the lack of any medical evidence for them. 1 , 2 Oral cavity is the most affected region of cenesthopathy, and it is called “oral cenesthopathy,” 3 – 5 “oral somatic delusions,” or “oral dysesthesia.” 6 There are various complaints of oral cenesthopathy. Some patients complain of unusual oral sensations, such as excessive mucus secretion or a slimy sensation, and others complain of a bizarre oral sensation, such as a feeling of coils or wires being present within the oral region.…”

Prefrontal modulation during chewing performance in occlusal dysesthesia patients: a functional near-infrared spectroscopy study

“…As routine practice, oral medication [3,4] and cognitive behavioral therapy [5] are recommended for treatment of OD patients. Recently, neuromodulation therapy has been clinically recommended for treating cognitive deficits in psychiatric disorders [64][65][66][67][68].…”

“…Persistent occlusal discomfort is a common complaint among occlusal dysesthesia (OD) patients [1][2][3][4] who, in the presence of depression, schizophrenia, panic, or somatoform disorders [5][6][7][8], present with numerous neuropsychological associations. From a clinical standpoint, Tsukiyama et al [2] recommended a psychosomatic evaluation for diagnosis, and Reeves JL and Merrill RL [5], and Toyofuku et al [7] also recommended cognitive behavioral therapy and antidepressants for the treatment of OD patients.…”

Minireview on the Connections between the Neuropsychiatric and Dental Disorders: Current Perspectives and the Possible Relevance of Oxidative Stress and Other Factors

“…Classical risk factors for teeth decay and periodontal problems are represented by various body dysmorphic disorders [ 9 ] and psychosomatic delusions (e.g., halitophobia or even phantom bite syndrome [ 1 , 10 , 11 ] together with cenesthopathies (e.g., various types of abnormal sensations without somatic aberrant findings—some of these complaints being listed in Umezaki and his team's article and classified according to the Diagnostic and Statistical Manual of Mental Disorders—5 (DMS-5) criteria as delusional disorders, somatic type (DDST) [ 12 ] as well as anxiety and panic-attacks-associated dryness (xerostomia) of the oral mucosa and reduced saliva [ 13 , 14 ]. A specific example is the paper of Takenoshita's group from 2010, which clearly demonstrated that from 162 patients presenting burning mouth syndrome (BMS) and atypical odontalgia (AO) (both somatoform disorders referring to pain without a clear organic cause) most of them were likely to exhibit mood or affective disorders in the AO case versus neurotic and stress-related manifestations—more common in BMS patients [ 15 ].…”