Sir, we read Drs Mijiti and Huojia's letter (Psychosomatic problems BDJ 2020; 228: 738) with deep empathy. Japan is gradually moving out of the emergency state but remains vigilant against the second wave of COVID-19. As the authors described, patients with chronic pain like Burning Mouth Syndrome (BMS) are at high risk for depression and anxiety with social isolation a possible risk for developing further psychosomatic symptoms.1

As of July 2020, two weeks after the re-opening of Psychosomatic Dentistry Clinic (Dental Hospital, Tokyo Medical and Dental University), we do not observe a growing number of patients with new oral psychosomatic disorders. Also, the pandemic chaos did not necessarily worsen our patients' condition. In contrast, some even told us that they felt better by being released from the stress of commuting and mental fatigue of workplace interpersonal relationships. We suppose here that BMS symptoms might not be simply connected with anxiety and depression, as do some psychiatric conditions. In most cases our BMS patients are coping well with this unusual situation, beyond our expectations.

The activities of our psychosomatic dental services were interrupted and reduced for several months, being considered as non-urgent. Almost all patients had to be followed up with telemedicine, including brief psychological counselling via telephone; continuing the prescriptions (mainly for antidepressants) via fax services, in cooperation with nearby pharmacies. Many patients expressed thanks for keeping up the medication while being able to avoid infection risks such that we suggest online consulting was useful for BMS patients during social distancing. It would also be useful in the event of a second wave of COVID-19 and other natural disasters, like earthquakes or typhoons.

Treating a dental patient with psychosomatic problems is always difficult.2 However, given the many fundamental changes to daily lives in the current pandemic, we suggest expanding telehealth and telemedicine to follow up oral psychosomatic patients at home. This also aligns with Dr Mijiti's idea of training dental hygienists to apply some psychological techniques of Cognitive Behavioural Therapy (CBT).3