Extreme weight gain and loss due to anorexia, overeating, vomiting, etc. are symptoms of eating disorders and are often reported to be accompanied by swollen salivary glands as well as strong psychological factors. A 47-year-old female patient presented to our department with a chief complaint of painless swelling of the bilateral submandibular areas. Psychologically, she had been hospitalized twice at the Department of Psychiatry due to depression, vomiting, and overeating. BMI index was 15.4, and the patient was thin. Bilateral submandibular glands were elastic and soft with walnut-sized swelling, but there were no abnormal findings on ultrasonography or CT scan.
We explained to the patient that there was no obvious salivary gland disease, but she persistently appealed for surgical resection. We explained to the patient that her eating disorder was the cause of the submandibular gland swelling and that it would be difficult to improve the condition unless she stopped vomiting and overeating, and we decided to follow up the patient. The challenge for the therapist is how to avoid becoming entangled in the patient’s unrealistic demands for surgical treatment when the patient stubbornly insists on it. It is important not to begin dental treatment until the patient’s life history and medical history are fully understood, and it is important to be relaxed enough to take a step back when the patient’s psychological factors are understood to be deep-seated. However, in this case, we had the opportunity to obtain detailed information on the patient’s life history, including psychiatric hospitalization, and we were able to obtain information on the patient’s treatment history going back to the past.