scleroderma , or systemic sclerosis , is a chronic connective tissue disease generally 
 classified as one of the autoimmune rheumatic diseases a 58-year - old woman was informed of her scleroderma , while receiving oral prosthetic 
 rehabilitation . the psychological load of the disease itself , along with dental treatment 
 cessation , resulted in patient s disappointment and social separation . three hypnosis 
 sessions were conducted for normalizing patient s psychological status primarily , and 
 for the facilitation of dental treatment , as well . the range of mouth opening changed 
 from 3.7 to 6.2 cm , allowing for easier entrance of dental appliances into the mouth 
 for completion of prosthetic rehabilitation . with the tooth prostheses in place , the 
 patient gained more social confidence and started sharing her experience with other 
 patients with the same condition . this case illustrates that hypnosis therapy may prove beneficial for patients with 
 limited mouth opening secondary to scleroderma , facilitating the prosthetic 
 rehabilitation programs for both dental specialists and patients , with a secondary 
 important impact on the patient s social perception of himself . scleroderma , or systemic sclerosis , is a chronic connective tissue disease generally 
 classified as one of the autoimmune rheumatic diseases . the word  scleroderma  comes from 
 two greek words :  sclero  meaning hard , and  derma hardening of 
 the skin is one of the most visible manifestations of the disease . the nose appears pinched and 
 thinned and the opening of the mouth might be decreased in size (  microstomia  or  small 
 mouth  ) . the development of dilated 
 small blood vessels , called telangiectasia , affects the face and other parts of the body . the appearance of the eyes can also alter , all of which can negatively impact the patient s 
 appearance ( 4 ) . the general tightening of the 
 skin over the face makes lip and mouth movements , as well as oral hygiene , difficult . microstomia may make it difficult to open the mouth wide enough for dental procedures or 
 even oral hygiene . therefore , preventative dental care through regular flossing and 
 brushing of the teeth and gums after each meal is of utmost importance ( 5 ) . the best approach to management is by means 
 of facial grimacing and mouth stretching exercises , performed daily . floss holders , pump toothpaste tubes , and 
 built - up handles on toothbrushes can help people with hand impairment , while an electric 
 toothbrush is strongly advised ( 6 ) . from the psychological aspect , a common reaction to being told that one has a disease such 
 as scleroderma is , it is not clear why only several people develop the disease 
 and others do not . one does not bring scleroderma upon him or herself , and therefore , 
 should not feel guilty or responsible for the illness . a person newly diagnosed with 
 scleroderma may feel alone and uncertain about where to turn for help ( 7 ) . psychopatologically speaking , the majority of 
 the sclerodermatic patients may manifest mild anxiety due to apprehension and vigilance 
 related to the perceived threat from the illness and the uncertainties over etiology , 
 prognosis and outcome . he , or 
 she , may experience a number of other feelings and emotional reactions from time to time , 
 including initial shock or disbelief , fear , anger , denial , self - blame , guilt , grief , 
 sadness , somatization , profound feelings of generalized hostility , and interpersonal 
 sensitivity , which may be due to the gradual disfigurement resulted from skin thickening . the severity of illness , and consequent disability , could be regarded as the central 
 factors contributing to the development of the psychiatric symptomatology . paranoid 
 ideation and psychoticism of the sclerodermatic patients probably reflect a vulnerability 
 towards the manifestation of more serious , psychotic , psychopathology . medication should 
 not be regarded as indifferent in this cumulus of psychological anxiety triggers ( 7 , 8) . feelings , in themselves , are neither good 
 nor bad ; one simply  has  them . sharing them with family members and friends , or with 
 others who have had the same experiences other 
 factors , such as social support , may also play significant roles ( 8) . professional counseling can also help people with scleroderma 
 and their family members who are having difficulty coping with their feelings . instead of 
  scleroderma patient  , the term  person with scleroderma the person 
 with scleroderma may be a  patient  in the doctor s office , hospital or clinic , but he or 
 she is much more than that . thinking of oneself as a total person , with a full life , may 
 help to cope with scleroderma and enable one to maintain a positive , and also realistic 
 insight ( 9 ) . hypnosis is defined as an attentive , receptive , focal concentration , with diminished 
 peripheral awareness . hypnotizability , expectancies , motivation , absorptive 
 capacity / fantasy proneness , and attitudes towards hypnosis are five psychological factors 
 most frequently mentioned as important . the rapport ( also referred to as  resonance  and 
  harmony  ) and social context are identified as social factors . evidence supports the usefulness of hypnotic treatments , to address biological , 
 psychological and social factors , and their interactions in any medical condition . the 
 biopsychosocial model of hypnosis can help in understanding complex issues , such as 
 scleroderma . importantly , this model allows the possibility for multiple factors to play a 
 role and contribute to hypnotic responding ( 10 ) . while receiving dental services for prosthetic rehabilitation , our 58-year - old patient 
 referred to dermatologist just because of limitation of mouth opening , which is essential 
 for the optimal performance of dental treatment . a comprehensive battery of tests revealed 
 that she was suffering from scleroderma . this was a major turning point , because both the 
 oral prosthetic service , and also several other aspects of her and her family life , got 
 affected . therefore , we changed our plan from a regular somatic to a more comprehensive 
 biopsychological approach . the first measure implied in the management of this case was to 
 conducting a team work , including an endodontist who has been trained as an advanced 
 hypnotherapist , a restorative dentistand also prosthodontist for dental treatments . although , at first , five sessions were preplanned to complete whole levels of treatment , 
 fortunately , prior to commencing the fourth session , treatment finished convincingly with 
 optimal results . as a first step , a simple interview was performed to see if there is the 
 potential for a hypnosis intervention . simultaneously , and also during pre - talk , several 
 myths in which the patients believed concerning hypnosis , were corrected . the spiegel 
 biological scale of the patient scored as 3 out of 5 . at the first one - hour session , all activity had been targeted just for relaxation , anxiety management , attitude correction 
 about the new encountered unusual somatic condition , correction of coping skills for new 
 life , increasing self - confidence , and , eventually , conditioning with light folkloric music 
 and also , her very kind mother s name . two - week intervals were considered between all three 
 hypnosis sessions . during the second hypnosis session , which lasted 50 minutes , she was 
 fallen more easily and more deeply into trance , using the conditioning keys and suggested 
 specially for her dental treatment procedure , particularly useful cooperation with the 
 dentist to gain suitable results . meanwhile , her attitude about her new facial appearance 
 and the others reactions were repaired . surprisingly , less pain and discomfort would have 
 been felt thereafter , due to any joint movement throughout the body , especially in case of 
 the shoulder and temporomandibular joints . the third session , lasting for 40 minutes , was 
 spent for reinforcement of previous inductions and conditions , and a new induction was 
 performed for increasing the intention to help the other persons newly and unexpectedly 
 faced with disturbing conditions , such as scleroderma , or any other . prior to the fourth 
 session , she obtained satisfactory psychological capabilities again , and hence , no need was 
 felt for continuing hypnotic interventions urgently . all the pre - desired dental treatments 
 were delivered to the subject , and she was also asked to use hypnosis any time needed . three follow up visits showed no relapse , although the disease itself had its ongoing 
 nature . nevertheless , it was not detrimental psychologically , since the subject had learnt 
 new copping skills for such circumstances , emphasizing that the hypnotic inductions and 
 treatments must be promising and real , as well . additionally , from that time on , the 
 subject herself did explain the benefits of hypnosis for the others in the society . participating actively in one s own healthcare is of prime importance to the person with 
 scleroderma . it is equally important to cooperate and communicate effectively with the 
 doctor who is managing the disease . while these two the person with scleroderma and the 
 doctor , are the focal point of the management  team  , multiple other individuals and 
 resources can be enlisted to form a health and support network ( 2 ) . several skin conditions are well appreciated to resonate with the individual s mental 
 climate . among them , there is scleroderma , which is sensitive to psychological pressures 
 and possessing recognized immunological components . using hypnosis , both somatic and 
 psychological elements of scleroderma can be covered and influenced by appropriate 
 suggestions ( 4 ) . regarding the facts mentioned , our hypnotic intervention could effectively cover the 
 complex issues related to the patient with scleroderma : somatically , to provide a suitable 
 situation for conduction of dental treatments , and psychologically , to return the patient 
 to an acceptable level of expectation , and acceptation . this case report hopefully 
 lightened the missed , yet necessary chain of actions required the in treatment of any 
 psychosomatic impairment .