Purpose and Method: The definition and concept of the oral psychosomatic disorders is not established. Therefore, we created a “concept of oral psychosomatic disorders（2021）” based on the definition of psychosomatic disorders by the Japanese Society of Psychosomatic Medicine （1991）, ICD-10 （F54）, and DSM-5 （code316）.
Conclusion: All diseases should be considered by a bio-psycho-social model. For an oral psychosomatic disorder, psychosocial evaluation and approach are critical, and the following two criteria must be met.
1. The physical disease （organic or functional disorder） is present.
（Note） Organic disorders include temporomandibular disorders, such as temporomandibular joint disc disorders. On the other hand, the term “functional disorders” is diverse and ambiguous because, it includes glossopharyngeal neuralgia, glossodynia, diseases with a relatively precise pathogenic mechanism and unexplained pathological conditions. Careful discussion is required when considering the kind of pathological conditions that should be included in physical disorders （functional disorders）.
2. Psychosocial factors have a significant influence on the onset and course.  （Note） It is not preferable to identify a specific disease as oral psychosomatic disorder, because the degree of the effect of psychosocial factors varies according to the disease, individual patient, and time.

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Purpose: The effects of sustained jaw opening during dental treatment on the masseter muscle and stomatognathic functions are unknown. The aim of this study was to investigate the effects of sustained jaw opening on masseter muscle pain and jaw-opening function in endodontic patients in whom rubber dam dry field technique was used.
Methods: A total of 41 endodontic patients in whom rubber dam dry field technique was used participated in this study. Before and after rubber dam dry field technique, all participants were assessed for pain free opening, maximum unassisted opening, maximum assisted opening, and palpation of both masseter muscles according to the Diagnostic Criteria for Temporomandibular Disorders （DC/TMD）.
Results: Pain free opening and maximum unassisted opening after rubber dam dry field technique were significantly higher than before rubber dam dry field technique. Although masseter muscle pain was not detected in four patients （4/41participants; 10％） on palpation before rubber dam dry field technique, masseter muscle pain was detected in these patients on palpation after rubber dam dry field technique. In seven participants （7/41participants; 17％）, the masseter muscle pain on palpation disappeared due to the sustained jaw opening associated with rubber dam dry field technique. Thirty participants （30/41participants; 73％） did not change the masseter muscle pain on palpation between before and after rubber dam dry field technique.
Conclusions: These findings may suggest that sustained jaw opening during dental treatment contribute to extension exercise on masseter muscles and change the pain sensation on the masseter muscle pain.

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Case Summary: A 76-year-old man presented with a bilateral temporal headache and bilateral masseter muscle pain. Intermittent swallowing difficulties and double vision were also noted. Although no trismus was present, hypertrophy and tenderness of the bilateral temporalis and masseter muscles were observed. He was diagnosed with temporomandibular joint disorder and was instructed to perform mouth-opening stretches and correct his tooth-contacting habit. Two weeks later, the patient sought consult due to the rapid deterioration of his headache and masseter muscle pain. Swelling of the bilateral superficial temporal arteries and hypopulsatility of the right superficial temporal artery were observed on physical examination. His masseter muscle pain was observed to worsen during mastication, and was relieved by rest. Blood tests were conducted under the suspicion of giant cell arteritis, revealing an increased erythrocyte sedimentation rate. Under close surveillance of the Department of Internal Medicine, he was admitted the following day and was initiated on pulsed steroid therapy. An arterial biopsy confirmed the diagnosis of giant cell arteritis. His temporal headache and jaw claudication promptly improved upon starting pulsed steroid therapy, and he was discharged after 10 hospital days. Since then, the patient has continued his oral steroid treatment, and no recurrence of symptoms were noted.
Discussion: Clinical symptoms similar to temporomandibular joint disorder may occur in the early stages of giant cell arteritis. Giant cell arteritis should be considered in patients with acute pain, swelling of the superficial temporal artery, and jaw claudication. A thorough physical examination should be done for these patients.
Conclusion: Giant cell arteritis may be misdiagnosed as a temporomandibular joint disorder. Dentists should understand the pathophysiology of giant cell arteritis to differentiate it successfully from temporomandibular joint disorder.

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Patients: After a 38-year-old female underwent extraction of tooth 38, which was in close proximity to the mandibular canal, she presented with mental nerve dysesthesia. She was then prescribed vitamin B12. However, her symptoms remained unchanged one month after starting the medication; thus, she requested treatment at a pain clinic. Under the diagnosis of trigeminal neuropathy, she was treated with a stellate ganglion block and acupuncture. After 20 sessions of stellate ganglion block treatment, the pain shifted from dysesthesia to paresthesia; however, there was no significant improvement in subjective symptoms, and the patient was unsure about continuing the treatment. Improvement was observed in the precise tactile function and the electric current perception threshold tests, and these positive results were conveyed to the patient. The patient wanted to continue treatment. After 10 sessions of acupuncture, she was again re-examined. Further improvement was observed in the precise tactile function and the electric current perception threshold tests, and these positive results were conveyed to the patient. As the patient was satisfied with the treatment results and the improvement in her symptoms, she requested treatment cessation.
Discussion: As in the present case, there are cases in which laboratory values improve despite no change in patient complaints about symptoms.
Conclusions: Therefore, for patients, particularly those with orofacial pain, who are hesitant to continue treatment due to a lack of observable change in symptoms, a qualitative examination and provision of feedback on test results showing improvement can be useful in enhancing their decision-making regarding the treatment, thus contributing to the overall improvement in patient satisfaction.

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Patients: For a duration of 5 years from January 2016 to December 2021, we examined 195 patients who visited the Department of Pain Clinic, Suidobashi Hospital, Tokyo Dental College, and were diagnosed with trigeminal neuralgia. Of the 195 patients who were prescribed carbamazepine （CBZ）, we report on the progress and treatment of 5 cases in which rash was observed.
Discussion: CBZ is the drug of choice for treatment of trigeminal neuralgia and is also used for diagnosis and differentiation. Pain control is often difficult when alternative drugs are used due to side effects. Thereby, stereotactic radiotherapy, and nerve blocks are indicated. In our department, when CBZ cannot be continued, we administer pregabalin and amitriptyline alone or in combination, and request surgery and stereotactic radiotherapy to other hospitals. Since trigeminal neuralgia requires an increase in the dose of CBZ as the condition worsens, side effects such as liver damage are more likely to occur. The study therefore was able to reconfirm the necessity of conducting regular hematological tests over a long period of time and confirming general conditions such as liver function status and blood image for detection.
Conclusion: Although the administration of CBZ does require caution, it is the concluded that CBZ can be used safely as the first-choice drug for the treatment of trigeminal neuralgia.

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Case summary: A 73-year-old woman complained of numbness of the left upper lip and facial paralysis. After placing two oral implants in the maxillary left molar region, directional malposition and implant misalignment in the maxillary sinus were diagnosed, and two oral implants were removed. Immediately after that, the patient became aware of symptoms of discomfort in his left upper lip, abnormal movement, and water leakage from his nose. Steroids and clarithromycin were prescribed for the maxillary sinus fistula, and maxillary sinus mucosal closure was performed. The patient was referred to our department for improvement of remaining symptoms. The patient was diagnosed with left infraorbital neurosensory disturbance and left peripheral facial nerve palsy. Treatment with methcobalamin prescription, low-level laser stellate ganglion irradiation （SGL）, and near-infrared irradiation were not particularly effective, so acupuncture was further performed. Facial nerve palsy was recovered from 24 to 40 points by the Yanagihara method, and sensory neuropathy was also confirmed to be clearly improved from 1.0g to 0.008g on the affected side in the static tactile threshold test （Semmes Weinstein Monofilament Test: SW test）. The patient was satisfied with the perceived improvement in both sensation and movement.
Discussion: Phototherapy, stellate ganglion block, steroid drugs, and vitamin preparations are the main treatments for peripheral motor nerve palsy and sensory disturbance, but acupuncture can also be one of the treatment options. it was thought.
Conclusions: Acupuncture appears to be useful for recovery from peripheral nerve injury.

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