[in Japanese]

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Many orthodontists frequently overlook the pain associated with orthodontic tooth movement and fail to take any active countermeasures. This study investigated the pain alleviating effect of chewing on bite-wafers (KM Thera-Bite^TM, Lancer Co. Ltd.) for patients under orthodontic treatment.
The subjects consisted of 73 orthodontic patients (10-63 years old; 17 males and 56 fe males) at the Dental Hospital of Iwate Medical University who were to under go tooth alignment using a multi-bracket orthodontic appliance. These subjects were classified into a bite-wafer group (35 subjects; 7 males and 28 females) and a control group (38 subjects; 10 males and 28 females). In the bite-wafer group, subjects were treated with a bite-wafer with the instruction to chew for approximately 20 minutes each after the arch wire was initially set and replaced.
The subjects were then asked to fill in a questionnaire on the following items:
1) sensation when the arch wire was set, 2) sensation when the pain appeared, 3) sensation when the pain was at the maximum level, 4) degree of dietary limitation, 5) degree of sleep limitation, 6) difficulties in articulation, 7) nervousness, 8) their current sensation, 9) when the pain first appeared, 10) how long it took for the pain to reach the maximum level, and 11) how many days it took for the pain to disappear.
The Visual Analog Scale (VAS) was used to evaluate individual sensations quantitatively.
The results of this study indicated that VAS scores on the items of sensation when the pain appeared and when the pain reached a maximum were smaller in the bite-wafer group than in the control group.
It is speculated that chewing on bite-wafers is effective for patients suffering from orthodontic tooth movement.

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[in Japanese]

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The evoked potential (EP) elicited by electrical stimulation of the tongue was recorded in order to quantify objectively trigeminal paralysis and chronic pain due to a traffic accident. The subject was a female patient with paralysis and unstable pain in the lingual nerve, which had appeared on the left of the dorsum linguae. The differences of sensation between then ormal (right) and paralyzed (left) sides were investigated by EP.
The following results were obtained.
1) In the EP, four-phase waves showing components at N 1, P 1, N 2 and P 2 were seen during the post-stimulation periods, from 25 to 300msec.
2) In the EP of the first measurement, the N 2-P 2 amplitude involved in algesthesia was seen to be reduced in the paralyzed area, but the appearance of artifacts in the EP waves was observed.
3) In the EP of the second measurement, comparison of the EP waves of the normal and paralyzed areas was made difficult by the artifacts.
4) The generator of these artifacts was considered to be the action potential of the lingual muscles.
The results of this study suggest it is difficult to evaluate disturbances of sensation in the area dominated by the lingual nerve objectively in patients with oral psychosomatic disorder by EP measurement of the tongue.

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Recently, many cases have been reported of individuals who complain of having halitosis which no one else can smell and for which there is no local or systemic cause. We call this condition “Self-halitosis”. Self-halitosis can be caused by either psychosomatic or psychiatric disorders. We have been treating such patients with brief courses of psychotherapy without using drugs. For patients with psychiatric disorders, we emphasize the importance of psychiatric treatment, but such patients often refuse to be treated by a psychiatrist because they are convinced that they really do have bad breath.
In this paper, we report a case of self-halitosis considered to have been induced by skin disease. The patient was a 31-year-old man and his symptoms were relieved by a brief course of psychotherapy.

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Woman passing through middle age experience hormonal disorders due to the menopause and other somatic changes. These heighen their awareness of their age just at the time when they also experience such other major changes as the marriage or departure from the home of their children and the retirement of their husbands.
We encountered a 62-year-old woman who had developed depression because her husband, although an able man, was being treated coldly by his company immediately prior to his retirement. She complained of saliva-related cenesthopathy. She appeared abnormal in speech and behavior, and the dentist had difficulty in treating her.
Thereafter, the mental symptoms were treated by the department of psychiatry and dental treatment was also continued, but her symptoms increasingly became suggestive of late schizophrenia. Ultimately, she was found to have predominant extrapyramidal-system symptoms, associated with difficulty in walking, and dysphasia. Atrophy of the frontal and temporal lobes was detected, and Pick's disease was diagnosed.
With the rising average age of the population, dental treatment provides an opportunity for detecting abnormalities in patients, which may contribute to the identification of occult disease. In this regard, this case was instructive for future treatment.

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Care of patients who have attempted suicide is especially delicate due to the risk of unexpected movements and sudden surges of emotion caused by the anxiety of intense psychological stress. The practitioner must take special care with regard to the patients mental state for certain periods both before and after the administration of general anesthesia.
This study describes the case of a female patient of 20 years of age in 1998. She jumped from a footbridge in May 1997, and received first aid treatment at the emergency center where she was send immediately. After that, she was sent to our hospital for the open reduction of an upper and mandibular bone fracture. The author applied general anesthesia twice accompanied by psychological care both before and afterwards.
An anesthetist of the same sex as the patient was used both times and this also contributed to a good result.

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Patients under the treatment with major tranquilizer occasionary suffer from malocclusion due to the extrapyramidal symptom which is one of the side effects of the drug. The author propose to call this symptom as “drug induced malocclusion (DIMO)” and present here the two cases. Case 1 was a 24-year-old female schizophrenic patient. Her occlusion began to be wrong before one year after taking major tranquilizer, that is haloperidol. She was able to remember her past normal occlusion. Despite of her severe open bite, she did not worry and complained about it. She denied the treatment.
The second DIMO case was a 47-year-old male alcoholic dependent patient. His occlusion became wrong after the priscription of propericyazine before one week. Though his malocclusion was lesser than former case, he complained masticatory disturbance strongly. He asked me the treatment eagerly. The treatment by means of occlusal splint was performed and his occlusion was restored to normal after 4 months. To compair the attitudes toward DIMO between the cases, the bizzare attitude toward DIMO was remarkable in the first schizophrenic case.
In order to confirm the existence of bizzare attitude toward DIMO in schizophrenic patient, two groups of DIMO were compaired. The group 1 was composed of 14 schizophrenic patients and the group 2 9 patients with other mental disorders, that was alcoholic dependence, depression, and so on. The results clearly showed the difference between two groups. All patients in group 2 recognized accurately their DIMO, complained about it and desired the treatment. On the other hand, in the schizophrenic group 1, four patients did not recognized their DIMO, half of the patients did not complained about it, and only 5 patients desired its treatment. It was suspected that schizophrenic patients' bizzare recognition and reaction toward the DIMO were due to their cognitive deficit.

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Transient mental disorders sometimes occur for various reasons after surgery. In general, it is difficult to manage patients who, without having a history of psychiatric disorder or special signs thereof before surgery, suddenly develop mental disorders after surgery. We encountered a patient who, having undergone orthognathic surgery, complained of delusion and auditory hallucination after intermaxillary fixation. The patient was a 26-year-old woman who came to Kyushu Dental College Hospital with complaints of discomfort in the lower jaw caused by malocclusion and prognathism, and clicking sounds in the temporomandibular joint when opening the mouth. After consultation with the patient and family, during which we explained the need for orthodontic treatment before orthognathic surgery, the patient was referred to an orthodontic clinic. After completion of the orthodontic treatment, surgery was performed under general anesthesia. No abnormal findings were noted during or immediately after surgery. Three days after surgery, the patient began to complain of delusion and auditory hallucination. This was diagnosed as stressinduced emotional instability, and a minor tranquilizer was administered. We advised the family to take the patient to a specialist, explaining that a mental disorder was suspected, but could not obtain their approval. Nine days after surgery, the patient began to worry about the condition of her jaw. We repeatedly explained the surgical method and the reason for the condition of her jaw, but the patient did not understand. The symptoms persisted for some time after her discharge but suddenly disappeared. These findings suggested a postoperative mental disorder or paranoid schizophrenia. As causes of and contributory factors towards this disorder, we considered the effects of surgery under general anesthesia, restrictions on body movement immediately after the operation, and the intermaxillary fixation being more stressful than the patient had expected. For such patients, besides adequate explanation of the surgical method and postoperative condition, psychological counseling may also be necessary.

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Atypical facial pain is characterized by a continuous dull ache, which can be either bilateral or unilateral but frequently affects the maxilla. The pain generally fails to respond to simple analgesics. The pathophysiology of this pain is still unknown and little human scientific data is available. Counselling and reassurance may be all that is required by some patients, but others many need psychotropic medication, with or without psychotherapy. Tricyclic antidepressants have been used successfully for other forms of chronic pain, such as back pain.
We suppose the management of atypical facial pain should be undertaken in a hospital environment where the patient can be fully investigated and the response to medication and psychotherapy monitored.
This paper describes the alleviation of atypical facial pain through out the clinical course of a 49-year-old male patient who was unable to work for 10 years due to the severity of his symptoms.

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We often see patients who present various indefinite complaints in the orofacialregion and insist that their symptoms are caused by problems of occlusion and/or prosthesis. Generally, such complaints are obscure and fluctuate, making it very difficult to find any effective way to improve their condition through dental treatment, such as by adjusting the occlusion and/or modifying the shape of the prosthesis. Several articles have reported that the problems of such patients are psychosomatic expressions of depression. They frequently recommend pharmacotherapy rather than dental therapy as the most effective wayto ameliorate the complaints.
We report 3 cases of patients with such indefinite complaints in which we attempted to manage their problems by psychotropic medicine. Not all of the patients responded to the treatment. This article outlines the cases, discusses the difficulties and gives some tips on the management of such patients by psychotropic drugs.
The patients' responses to the medication were as follows:
Case 1 (32 year-old female): Although the patient did initially accept the medication, she was reluctant to do so from the first and refused it 2 months after the beginning of the medication. She strongly believed that her indefinite complaints were due to the prosthesis and clung persistently to occlusal treatment.
Case 2 (68 year-old female): An improvement of the symptoms was observed from the beginning of the medication. Though the patient was conscious of the efficacy of medication, her acceptauce of it remained low and she aborted it after 14 weeks of treatment.
Case 3 (37 year-old female): The patient initially tried to stop the medication but eventually chose to continue the treatment when she realized how her symptoms had improvedafter several weeks of medication.
These experiences suggested that psychotropic medical treatment might be the effective alternative for managing this type of problem. Such therapy is not always effective, however, especially for those who are convinced that the cause of their problems resides in theirocclusion and that their problems must be solved not by the psychotropic drug but by occlusal treatment. In order for pharmacotherapy to succeed with this kind of patient, it is most important that a thorough interview and counseling should precede the proposal of medication, in addition to choosing the appropriate dose and type of drug.

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