Benzodiazepines are widely used clinically because of their antihypertensive, analgesic, anaesthetic, hypnotic properties and, in the psychiatric and neurological fields, for their anticonvulsant, anxiolytic and antidepressant effects. In dentistry, they are used to alleviate pain caused by surgical procedures including pulp extirpation, temporomandibular arthrosis and glossodynia, and to reduce oral symptoms in masked depression, denture neurosis and phobias. Their side effects are minimal but those with half-lives upto 30 hours can induce dependency.
Analgesics: Bromazepam and etizolam are particularly useful as analgesics, especially when combined with a non-steroidal (or antipyretic) analgesic.
Pre-anaesthetics: Bromazepam, cloxazolam and prazepam are used as premedicants. They are administered 1-3 h before local or general anaesthetics.
Denture adaptation: Diazepam, bromazepam and etizolam assist the patient to adjust to new denture.
Hypotensives: Flutoprazepam, bromazepam, etizolam and prazepam are suitable for use in patients receiving antihypertensive therapy accompanied with mental invasion.
Dental phobia: Cloxazolam and bromazepam are particulary effective and are usually given in combination with clomipramine, an antideprssant.
The very low drug tariff under the social security system poses an economical problem for the doctor. It is also necessary for the doctor to establish contacts with particular wholesale drug stores because many of these compounds are regulated by the Psychotropic Drug Control Act. Also, many pharmacists may only stock one or two types of benzodiazepine.

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Innovation in educational curricula for dental students before graduation is currently being promoted at School of dentistry, Aichi-Gakuin University. A discussion of our role in dental education and the methods used to teach psychosomatic dentistry would be timely.
From April 1996, dental students lectures on psychosomatic dentistry were given to fourth-year. The lecture of the psychosomatic dentistry were 66 male students out of 83 (79.5%) and 32 female students out of 35 (91.4%). And the total amount were 98 students out of 118 (83.1%).
Questionnaires filled out by the students at the beginning and the end of the program showed that the major reason for selection of the lectures was the content of the syllabus and knowledge of the psychosomatic dentistry would be essential for the dentists. And they admitted that their thinking about psychosomatic dentistry changed after hearing the lectures. Through these lectures we thought that our initial educational aims were adequately attained.
In summary, educational programs such as our that specialize in psychosomatic dentistry are considered necessary to provide not only special learning about psychosomatic diseases but also about the basic concepts of comprehensive medicine. It is important for specialists in psychosomatic dentistry to positively participate in dental education, since that will lead to further development of psychosomatic dentistry.

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Recent reports of allergies in dentistry have been mostly dealt with allergic reactions to metal. Orthodontic appliances include metal common to other dental materials, so the possibility of an allergic reaction to metal is high.
However, orthodontic appliances are also made from materials other than metal. So, we have to take into consideration allergic reactions to other orthodontic materials as well.
We therefore made a examination of patients with orthodontic appliances made of different materials in order to investigate the occurrence of material-specific allergic reactions.
This study showed that none of the investigated materials led to allergic reactions in the patients.

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Psychosomatic aspects and the previous history of 12 females with temporomandibular disorders (TMD) were who complain occlusal disturbances, occlusal in-stability or both (with a mean age of 47.4) were investigated. All patients had an interview concerning their chief complaints, medical and dental history, and underwent a functional examination and muscle palpation of temporomandibular region. Moreover, the Cornell Medical Index (CMI), which tests somatic and psychogenic consciousness, and the Manifest Anxiety Scale (MAS) were applied in each subject in order to test psychosomatic aspects.
The results were as follows.
1. Chief complaints except for occlusal disharmony were various, such as maxillofacial pain, shoulder stiffness, vomiturition, and tinnitus.
2. Symptoms were mainly initially caused by dental treatments given without full explanations and about which the patients complained and were distrusteful, subsequently becoming. The patients were suffering from their symptoms for 4 years on an average and changed 3.7 dentists for their problems.
3. There were 58% patients with a neuroticism disorder, whereas only 33% patients had manifest anxiety.
4. The distinctive somatic items, such as lassitude, gastric unpleasantness, gagging, and micturition, were identified from the CMI items.

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Psychological and immunological tests were performed on patients with tongue pain as a case of morbidity in the field of the oral cavity which might be related to psycho-social factors. Comparison were made with patients with other psychogenic diseases and normal healthy persons. The results were as follows:
1. In CMI, the groups of patients with tongue pain and other psychogenic diseases revealed more cases of territories III and IV than in normal cases healthy persons. Such cases were especially, numerous among the group of patients with other psychogenic diseases.
2. Using the MD survey (table) of Inoue and SDS, KMI, higher values were observed for the group with tongue pain than in the normal healthy persons. However there were low warks compared with the group with other psychogenic diseases.
3. The period from the occurrence of the disease up to the time of receiving the examination at this clinic was mostly 4-6 months for the group with tongue pain. There was a tendency for many cases to have lasted for over one year in the group of other psychogenic diseases.
4. Immunological tests showed that T-cells tended to decrease in the groups with tongue pain and other psychogenic diseases compared with normal healthy persons. The group with tongue pain showed a tendency for CD8 to decrease, while B-cells tended to increase in the group with other psychogenic diseases.
5. Noradrenaline in the blood showed great variations but tended to increase in the groups with tongue pain and other psychogenic diseases compared with the normal group. He would appear that in the case of tongue pain, and considering the influence on the immunological system and the excretion of catecholamine, there was less psycho-social stress, and also, less influence on the immunological system, than in the case of other psychogenic diseases.

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We studied 10 with women glossodynia from the physiological view point. We measured the changes in the intensity of pain when the patients chewed chewing gum.
They did not feel any pain during meals. Their age was between 38 and 70 with an average of 54.
We gave each patient 4 sugared chewing gum sheets and 4 sugarless chewing gum sheets. The patient was instructed to chew one sheet of gum when they felt tongue pain.
1. The pain disappeared or decreased in 78% after the chewing sugared gum and in 70% after chewing the sugarless gums. In the other cases, there was no obvious effect on pain.
2. There was no significant difference between the sugared gum and sugarless gum.
3. The effects of chewing gums were not always identical in the same subject.
4. Greater effects on the palliation of pain tended to be observed in the patients who reported a preference for the sugared gum over the non-sugared gum.
It is suggested that various sensory inputs from the oral structures to the brain regions dealing with pain informations are the important mechanism in reducing the pain in glossodynia.

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This study describes certain effects of flutoprazepam, an antianxietic benzodiazepine, and of sodium valproate, a GABA transaminase inhibitor, administered to a woman patient with an epileptic syndrome induced by a subarachnoid cyst and the course of dental therapy prescribed.
Patient: 24 year old woman (unmarried), office worker.
First examination: September 8, 1995.
Chief complaint: Decay in upper incisors, anxietic state and indefinite complaints.
History of present neuropathic illness: Since the incipient crisis at 17 years old, she had suffered frequently from anxiety and an unidentified clinical syndrome, involving petit mal one or two times a month and also occasional auditory hallucination. This did not progress to any grand mal due to the long-term administration of antiepileptic drugs, including zonisamide, carbamazepine and acetylpheneturide prescribed by a brain surgeon. She had not received any dental therapy for fear that she might experience a fit during treatment.
Status praesens: The author counseled the patient to accept and bear with her complaint through marriage and childbirth and sought to reassure her that these were possible even if her sickness did not heal. The Y-G examination and CMI-health questionnaire administered on the fourth visit to the clinic (one month after the first examination) produced AD results, suggesting a standard and/or emotionally stable character, in the 2nd range, and she was thus provisionally diagnosed to be normal. The author continued to provide dental therapy with great care during the period. No crisis occurred in the clinic, Finally, the author set metal bond porcelain jacket crowns on her upper central incisors and placed metal inlays in the lower wisdom teeth. The continuous administration of flutoprazepam improved the anxiety, hallucination and stereotyped way of speaking but did not help so obviously with the petit mal and indefinite complaints. Long-term sodium valproate treatment improved these considerably.

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It is important for pediatric dental treatment that we develop rapport with child patients. For that reason it is essential that dentists obtain the ability to communicate with child patients. In the Japanese dental educational system, however attention is focussed on the cognitive domain and the psychomotor domain, and is not focussed on the affective domain. There is little interpersonal skill training in Japan. The purpose of this case report is to show the process and the effect of the behavioral science training in managing a child's behavior. The subject was the dentist belonging to the Department of Pediatric Dentistry, School of Dentistry, Hiroshima University. In the first step, she had a leture concerning the child behavior management. She was provided brief descriptions of 20 problem situations. The second step was she received the individual videotaped feedback. The process of actual communication with the child was recorded on videotape. She watched the replayed process, and the situation was discussed with some members of the department. A prior ground rule stipulated that all feedback was to be positive. The individual problem in the communication was to be found by herself. The third step was role-playing related to the problem. The aim of this training was spontaneous behavior modification based on positive reinforcement. The training was given over a two-week period. She did the confidence scale in child behavior management before and after the training. She also did the questionnaire concerning the effect of the training. The following conclusions were obtained.
1. The problem of the behavior management for the child became to be clear and be settled through the training.
2. The total scores of the confidence after the training remained higher than those of the confidence before the training.
3. The high training effect on self-expression in the interpersonal skills was obtained. We came to the conclusion that the behavioral science training to manage the child's behavior was very effective for the dentist.

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The two prominent theories of behavior that address the problem of finger-sucking are the psychoanalytic theory of psychosexual development, as proposed by Freud, and learning theory. Despite differences, the psychoanalytical and learning theories are similar in that both describe factors responsible for the origin and maintenance of the habit. The concern about thumb-sucking and finger-sucking habits is evident by the number of articles that have appeared in scientific journals. Interest in this topic has been shared by psychiatrists, pediatricians, pediatric dentists, orthodontists, speech therapists and plastic surgeons. Even the lay public has contributed to this much-debated topic. Despite the extensive research that has been conducted, however, considerable controversy still exists regarding sucking habits.
We report a 3-year-old-boy twin who had malocclusion caused by his thumb-sucking habit. The overjet of this patient was 5.0mm, and the maxillary dental arch was v-shape. His twin brother had normal occlusion, and a overjet of 2.5mm. We did operant conditioning using positive reinforcers and negative reinforcers as the behavior therapy. We tried to adjust the communication within the family. After we did this approach for 5 weeks, there was no thumb-sucking. Moreover, after we observed for 12 days under conditions of no approach, he did not revert to thumb-sucking. We came to the conclusion that the behavioral science approach can be effective for the child who had the thumb-sucking.

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The gustation is thought that the combination of basic taste and primary taste. We report 1 case of anomalous gustation disorder caused by psychological factors. The patient was a 73-year-old woman. We used a filter paper for the gustation test. No organic change in the tongue was observed. And she worried about her denture. SO, we carried out a simple psychotherapy and made a new denture. In this case, we thought that making a new denture was useful treatment. We presume that a combined psycological, prosthodontical and pharmacological approach was an essential therapy in this case.

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A 64-year-old woman visited our branch complaining of various physical symptoms combined to bad condition of her dentures. She claimed that the symptoms had appeared after teeth extraction before 16 years. She visited many dental and medical fascilities, but her symptoms was not been cured despite of various treatment. The examination of her dentures could not explain her physical symptoms. The author diagnosed her condition as dentureassociated unidentified clinical syndrome and made a treatment strategy to correct her belief that the physical symptoms were caused with bad condition of her dentures. Under the liaison with psychiatry, new upper denture was constructed and the lower was adjusted. The author was always annoyed with her self-centered personality. Her belief was reinforced with gain from illness. In spite of the improvement of denture retention, stability and occlusion, she continued to complain of various physical symptoms due to her dentures. After several denture adjustments, listennings to her complains were only continued. Ten months after her first visit, meanwhile she complained of aggravation of physical condition, she was convinced to accept her dentures. The author stopped her treatment on the point with mutual understanding. This case showed the necessity of liaison with psychiatry in the treatment of sever denture-associated unidentified clinical symptom.

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A 64 year old man complaining of structured oral hallucination from that time ontaking Festal^® which was one of the digestive enzymes visited our clinic. Neuro-psychological findings showed delusional perception, and the patient was diagnosed coenasthetische Schizophrenie proposed by Huber at 1957. The problems of the case ware dystrust to medicine, and we could not prescribe any agents. All things we should do was to make good relationship between a doctor and a patient. In according to Balint method, we had listened attentively to the patient's complains without any criticism in our outpatients' department for some months. Consequently, the cenestopathy gradually showed a tendency to improvement. We concluded that his character, intrinsic schizophrenia and distrust of medicine participated in onset of the cenestopathy.

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The present authors intend to report the result of a 2-year observation of a case of myofascial pain dysfunction syndrome, wherein the patient received guidance for masticatory patterns and recoverd one month later.
A 33-year-old female. Her principal complaint consisted of fatigued left mandibular joint accompanied by pain in the bilateral masseters.
On September 4, 1989, the patient felt an abrupt shock to the portion around the left mandibular joint in the morning during breakfast. The above complaint occurred later when she took her lunch on that day. Thus, she visited the present Department on September 6 of the same year.
Radiographic findings: Orthopantomogram and orbitocondyle projection clarified no morphological abnormality in the structural components of the mandibular joints. Also, Schuller's method revealed no dyskinesia of the head of mandibule.
The diagnosis agreed with the criteria for myofascial pain dysfunction syndrome proposed by D.M.Laskin.
Guidance for masticatory patterns was performed according to the manual having been prepared at our Department. The essential requirements were as follows: For a morsel of boiled rice, twenty times of slow masticatory movements enjoying its taste were required before swallowing it.
After one month of this instruction, the sensation of incongruity and the pain accompanying bilateral masseters disappeard. After six months, the stiffness and pain having persisted in bilateral massters also disappeared.
Results of observation according to the checklist for the mode of mastication clarified the following items in which the relevant symptom disappeared; coarse mastication after 2 weeks, liability to constipation, etc. after 6 weeks. On the other hand, items in which relevant symptoms appeared included mastication, pleasant mastication while enjoying the food after 2 weeks, and the presence of patient's hope and volition after one month, and pleasant salivation on the lips and in the mouth and comfortable and regular fecal excretion after 6 months, and pleasant sensation of satisfaction after meals after one year, etc.
As stated above, our guidance for masticatory patterns resulted in the establishment of good habits of mastication, coupled with improvement in the various symptoms of myofascial pain dysfunction syndrome, and improvement in meal taking habits and general life style. Thus the health in term of the patient's whole personality both in mind and body was improved.

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A middleaged man recovery well after tongue cancer operation, but had a adjustmentdisorder in the general public return process. The patient was a 44-year old man, and he was a forester.
He had been treated by right heminglossectomy with radical neck dissection on a diagnosis of tongue cancer (pT2pN1M0) in June, 1991.
His progress after operation was so good that he could return to was approximately 2months hospitalization. But, he had been in chronic uneasiness of recurlance.
The patient was expected to work as a main worker in the family and it caused him psychorogical impatient and it brought him to a state of depressive.
So we had treatment by connection with psychiatry since March, 1995.
In a treatment in psychiatry, his condition was improved by antidepressant IVD and the family recognized that the patient had been in a serious state.
As a result, that reduce his psychological impatient and improve his condition.

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