A 43-year old woman was given a stellate ganglion block (SGB) with 1% mepivacain 5ml and pharmacotherapy for left mental nerve palsy due to the oral implantation. No complications had appeared during the previous 12 SGBs performed by anterior approach. During the 13th SGB, however her blood pressure increased to 204/100 mmHg, and she developed a headache and suffusion in her chest. She remained clear consciousness and no abnormality other than Horner's syndrome was observed. Oxygen and intravenous hydrocortisone were administered and a nitroglycerin tape was applied. The headache and suffusion disappeared rapidly, and her blood pressure decreased gradually. Possible causes of severe hypertension after SGB include allergies, intoxication, misuse of the epinephrine contained in the local anesthetic and pheochromocytoma, but all were ruled out in this case. We suspect that the extreme increase in blood pressure was due to vagal nerve block associated with the SGB and also such factors as psychological stress, anxiety and autonomic imbalance. It is suggested that besides providing immediate care for emergencies and improved techniques, it is also important to consider psychological care for patients.

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Unstable pain in the oral and maxillofacial region is often treated with imipramine hydrochloride (IMP), a tricyclic antidepressant. Although this drug has been effective in a number of cases, the mechanism of the analgesic effect is not well-understood. This study used a visual analogue pain scale (VAS) to evaluate subjective pain, and a somatosensory evoked potential (SEP), induced by painful electrical dental stimulation, to evaluate objective pain. The results were used to analyze the analgesic effect of the study drug. The effect of drug on the CNS was also studied by determining the reaction time (RT) simultaneously with the SEP. For comparison, a placebo was similarly evaluated.
In the SEP, five-phase waves with components at N1, P1, N2, P2 and N3 were observed during the post-stimulation periods, from 40 to 400 msec. The peak latency of the N1 component was a tendency towards shortening and the N3 component was prolonged by the administration of IMP (p<0.01). The N2-P2 amplitude associated with algesthesia was reduced by the administration of this drug (p<0.05). Values determined on the VAS declined after the administration of the drug (p<0.01). RT was also prolonged after administration of the drug (p<0.05). No significant change was observed with administration of the placebo.
The results of this SEP study suggest that IMP suppresses the high CNS, and secondarily induces an analgesic effect.

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A health questionnaire was used at the Department of Dentistry and Oral Surgery, Tokyo Medical College Hospital, to compare female outpatients suffering from oral psychosomatic disease with normal patients. The differences were investigated for each item, and multivariate analysis of factors was employed to classify the results.
For this paper, building on the findings of a previous report and expending the research field, six factors were selected from the health questionnaire. We focus on the background of female outpatients with oral psychosomatic disorders.

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We report a case of a patient treated with comprehensive therapy for panic disorder considered to have been induced by occlusion therapy.
A 73-year-old man, who had elevated blood pressure and atrial fibrillation due to repeated occlusion therapy and temporomandibular disorder, gradually came to think that he might be killed because of the build-up of distrust and fear from previous treatments. He was referred to the pain clinic of our university hospital. We diagnosed his case as panic disorder without agoraphobia, likely to be associated with temporomandibular disorder and occlusal disharmony. We treated him with oriental medicine, using a psychosomatic medical approach together with prosthetic procedure and occlusion therapy for temporomandibular disorder. Takeing the comprehensive approach, logotherapy was also performed as psychosomatic medicine.
Following such treatment, the patients occlusion status has improved and marked pain in the temporomandibular joint has disappeared. His mental condition has also become stable.

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[in Japanese]

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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.

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We report the cases of 2 patients whose deep attachment to new religions abstracted the treatment advanced oral malignant tumor.
Case 1: 28 year old, single woman.
Clinical diagnosis: Malignant tumor of right cheek.
Case 2: 32 year old, single woman.
Clinical diagnosis: Advanced malignant tumor of tongue.
The patient of case 1 eventually withdrew from the new religion and her malignant tumor treated. She was cured and is still alive.
The patient of case 2 rejected treatment and died one mounth later.

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This study reports a case of myofascial pain dysfunction syndrome under 5 year-follow-up observation in which one month of guidance for masticatory patterns led to symptomatic improvement.
The case was that of a 61-year-old housewife. Her chief complain was right masseter pain on mouth-opening. She developed a pain in the right masseter region when opening her mouth wide in January, 1991. There was also trismus and right temporomandibular murmur.
She became very busy caring for, her mother after the latter was hospitalized in June, 1992. The above right masseter pain became stronger on mastication and opening from this time, and she came to our department for examination on July 20, 1992.
X-P finding: The orthopantomogram and orbitocondyle projection revealed no morphological abnormality of the teeth and the temporomandibular formation. Schulle's method revealed that the right mandibular head would not go beyond the articular tubercle on opening and a limited ROM. The left mandibular head was normal.
This diagnosis corresponded to myofascial pain dysfunction syndrome, as proposed by Laskin, D. M.
The guidance for masticatory patterns was made according to the manual prepared by our department, involving the slow and appreciative mastication of a mouthful of boiled rice 20 times prior to swallowing.
The right masseter pain on opening disappeared two weeks after the start of the guidance, but then reappeared 2 months later. Her mother had died by this time, and the pain disappeared 6 months thereafter. The trismus right temporomandibular murmur and stiffness and tenderness of the bilateral masseter disappeared, respectively, 1 month, 2 months and 1 year, after the start of guidance. Inquiries were also made about the rough masticatory habits and jaw fatigue due to long mastication, tiredness after work, etc. The rough masticatory habits disappeared 2 weeks after the start of the guidance, and the jaw fatigue after one month of guidance. Fine masticatory habits, appreciative eating sound digestion, a healthy natural appetite combined with sensible moderation in the choice of food and good brushing were all maintained for 1 month thereafter. As described above, in addition to the establishment of fine masticatory habits through guidance on masticatiry patterns, there was both symptomatic improvement to the temporomandibular arthrosis a marked improvement to the health of the whole person, including dietary and living habits. A psychosomatic profile was obtained. The pathogenesis of the present disease was thought mainly to involve the disuse or degenerative lesions of the masseter group due to rough masticatory habits.

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From our observations, about 20% of patients with pericoronitis of the third molars, an organic disease, complain of pain of a non-organic nature. The properties, degree and sensation of pain, regardless of the presence or absence of psychosocial factors in the patient, often express a few organic pain characteristics, and in some patients such are expressed completely. In this study, we compared patients with pericoronitis of the third molars who express many organic pain characteristics with those who express only a few.
Subjects: 140 males and 228 females wilh pericoronitis of the third molars.
Method: We classified the patterns obtained from a pain questionnaire of our own design, and constructed a classification chart of pain. Using this chart, the patients were grouped into those who express many organic pain characteristics and those who express few.
Results: The group showing many characteristics of organic pain in pericoronitis of the third molars possessed the statistical pain characteristics of organic diseases, while the group showing few characteristics of organic pain possessed the characteristics of pain due to non-or ganic, psychosocial factors. These findings indicate that a psychogenic overlay due to a neurotic personality may be involved in the background of patients with organic pain in pericoronitis of the third molars.

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Two cases of oral cenestopathy are reported in this article.
Case 1 was a 64-year old spinster complaining of vinyl tape in her oral cavity. She had been treatd by psychiatrists for more than ten years when she suddenly visited our department and loudly complained that there were vinyl tape, parasites and metal parts in her orale cavity. She said nothing about where they had come from, but persistently demanded their removed. Objectively ther were no abnormalities in her mouth. In this case, neither tricyclic antidepressants nor antianxiety medication were effective but a major tranquilizer, haloperidol did work.
Case 2 was a 71-year old housewife with no psychic episodes, Her hallucination of a parasite was removed by tetracyclic antidepressant and antianxiety medication (mianserin and oxazolam). Haloperidol was also effective in this case, but proved difficult to use because of its side effects.
Both patients had minor cerebrovascular disease, but who connection between this and the symptoms was identified.
It is considered that these cases depend more on disorders of neurotransmitters and receptors in the brain than on any organic mental disorder.

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This paper reports the case of a 45-year-old female who complained of serious pain in the temporomandibular region on the left side and of difficulty in opening her mouth. She could only open her mouth by 29 mm and the lower articulator on the left was skewed. She was classified as Type IV by MRI findings, according to the criteria proposed by the Japanese Society for the Temporomandibular Joint. In addition, she was classified as Category III by CMI and Category E by Y-G.
Acupuncture to the meridian point, “Gekan”, was used to treat the inferior articulator. Instead of using a needle, the author irradiates the inferior articulator several times with a low power laser for Type I and Type II patients from the first examination. For the Type III with closed lock and Type IV patients, we also use the low power laser and, after the pain in the temporomandibular region has been cured, we manipulate the mandible. The symptoms cease in several months, but MRI findings show that the disk position dose not change.
We used the same treatment for this case, together with counselling and medical therapy. After several month, the symptoms of temporomandibular dysfunction were cured and she could open her mouth by 40 mm. The skewing of the lower jaw when the mouth was open was also remedied.
This result suggests that low power laser treatment for TMD is effective not only for the Types I, II, III with closed lock and N patients, but also for the psychosomatic patients with TMD.

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We selected 557 cases (3.2%) from among those patients who had visited our department during the past 21 years, and about when it was thought that psychosomatic dental symptoms may have appeared, and conducted a clinical study to analyze their characteristies. The results were as follows:
1. By diagnostic category, patients with xerostomia and glossodynia were most frequent, with the sum of the two groups amouthing to 71.7% of all patients examined.
2. When the cause of xerostomia was examined, only 10 cases (3.9%) were revealed to have marked psychogenic participation at the onset of symptoms.
3. In the treatment of psychogenic xerostomia, a remedy consisting mainly of L-cystein ethylester hydrochloride, a bronchial mucous dissolvent, was fairly effective.
4. Regardery the amount of time that elapsed before the first visit to our department, 57.4%(78 cases) of patients with glossodynia came within one year and 11 cases (8.1%) did not visit until at least five years after onset of the disease.
5. As for family history and background disease in patients with glossodynia, 71 cases (48.6%) had no problem in their family history followed by 23 cases (15.8%) with a family history of cancer. Only 5 cases (3.4%) had a basic psychosomatic disease in the narrow sense.
6. The outcome for patients with glossodynia was evaluated as having been effective in 53.7% of cases ineffective in 9.5%, and indeterminable in 36.8%.
7. An inappropriate dental sharp margin or prosthesis was the most frequent local factor that induced glossodynia, and the grinding of teeth or adjustment of dentures was effective as treatment. When treating xerostomia of psychogenic origin or unknown cause the oral administration of antianxiety drugs and herb treatments consisting mainly of Saibokuto were found to be effective.

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It is known that the anxiety and sympathetically-medicated hypertension induced by dental procedures can be lessened by the hearing of music.
In the present study, we measured the physiological effects of music-listening, especially on digital prethysm.ography (PTG) and the heat rate (HR), and compared them with the effects induced by the administration of indenolol hydrochloride, a β-blocker for pharmacological anti-stress treatment. The stress was imposed by intraoral injection of a physiological saline solution at the gingival-buccal border near the upper right premolar. The subjects cosisted of 54 volunteers of sound mind and body. 10 heard music (titles ‘Memory’, ‘Misty’ etc.) and 27 were administered with 10 mg of P. O. indenolol hydrochloride prior to the stress-inducing treatment. 17 recoived only the stress-inducing treatment. The first group heard the music on headphones 5 mins before and after the stress-inducing treatment; the second group received the indenolol 60 mins before the stress-inducing treatment; and the third group simply left after the treatment.
Their PTG and HR were measured at the times of seeing the syringes, intraoral sterilization, and before, during just after and 1 min-5 mins after the stress-inducing treatment.The PTG of first and second groups showed 70-80% and 40-50% declares, respectively, up to the start of the stressinducing treatment. Both groups ther returned to about 100%(the normal level) at 5 mins after the stress-inducing treatment. The third groups had not yet returned to this level at 5 mins after the treatment. The HR of the first and second groups was hardly influenced by the stress-inducing treatment, while that of the third group rose markedly towards the time of treatment. These results indicate that music-listening, can ease the mental and physical stresses of dental procedures.

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