抄録
The management of two cases of schizophrenic patients with delusions is reported in this article. The first case was a 45-year-old man who was refered to our office by a psychiatrist. He had a cosmetic disturbance due to the dropping off and fracturing of the resin-faced cast crowns of the upper central incisors. During treatment, he suffered from a sensation of tightness on the tooth. He asserted that the sensation was caused by the temporary crowns, which he thought were too wide and long. The shapes of the crowns were, in fact, appropriate and the contact pressures between them and the adjacent tooth were loose. His sensation was therefore unfounded and seemed to be abnormal. His interpretation that the agony was caused by the crowns was judged to be a delusion. He demanded lighter and looser crowns. His claim, fouunded on this false belief, placed us in a dilemma. The author waited for such a time as when he would become mentally stable. During this wait, only reversible dental treatment, newly adjustments to the surface of the temporary crowns or trial sets of wax patterns, was repeated. In due course, with the progress of psychiatric treatment, he became calm and accepted his final prosthetic crowns.
The second case was a 45-year-old male schizophrenic patient who attributed his toothache to the machinations of an acquaiatance. The pain was due to pulpitis of a right upper first premolar. It was clear that his belief was unfounded, and it was therefore judged to be a delusion. The author listened carefully to his assertion but did not give it special importance. The treatment of his teeth was completed without trouble by ordinary procedures with his consent.
The evaluation of these two cases suggests that the dental treatment of delusional patients becomes more difficult when the delusion involves elements of dental practice itself and the patient demands inappropriate dental treatment because of the delusion.
