抄録
We report a case of psychogenic oro-facial pain with mysophobia and compulsive behaviors related to dental treatment.
The patient was a 36-year-old housewife. She complained of spontaneous pain in all teeth of the upper and lower jaws. The pain had appeared suddenly in the upper incisors, around 2 years before her first visit to our hospital. In spite of dental treatment, the pain diffused to all of her teeth and gingiva. She also suffered from oral mysophobia and compulsive behaviors in the form of prolonged teeth brushing.
There was no organic disease to cause her pain and no other abnormal findings were noted. The psychological tests showed that she was in a slightly depressive, anxiety state and had a psychosomatic disease type. The Yatabe-Guildford test and egogram showed her personality to be compulsive. We diagnosed her condition as psychogenic oro-facial pain with mysophobia and compulsive behaviors.
We treated her with drug therapy and brief psychotherapy. The antidepressant agent (amitriptyline, clomipramine) and antianxiety agent (bromazepam) were effective for pain relief, but not for the compulsive behaviors. We also performed brief psychotherapy. She was alarmed that she had grown old when her dentist diagnosed the pain as being due to periodontal disease and afraid that the periodontal disease would worsen. This led her to clean her mouth very earnestly. The dentist suggested that her excessive brushing was bad for her at every dental examination, but she slipped into mysophobia and compulsive behaviors, avoiding food intake in order to keep her oral cavity clean and engaging in prolonged brushing. These behaviors were related to her compulsive personality. We recommended that she change her lifestyle and work outside her house, because a person of her personality type needed a social activity. Fourteen months later, she began to work again and her compulsive behaviors had diminished.
This case suggested that her compulsive personality was a causal factor in her development of psychosomatic oro-facial pain and the dental treatment induced mysophobia and/ or compulsive behaviors. Psychosomatic agents and brief psychotherapy were effective.
