生体は外界との絶えざるコミュニケーションの中に, 生体の状態をゆらがせることで, ある一定のまとまりを維持している.われわれは, その生体の状態はその外界とのコミュニケーションの仕方, 質いかんによって, 健全な状態ともそうでない状態ともなりうるものであり, そのダイナミックな関係性の質を捉えることこそが生体の健康度というものを明らかにする上で必要な過程であると考える.
本研究では, 生体のコミュニケーション能力を, 尾懸垂試験 (TST) における個々のマウスの行動選択のゆらぎを解析することで把握しようと試みた.この算出にあたり, ゆらぎにおける平均値と標準偏差の両値を反映させた新しい解析方法を考案し, この値を「ゆらぎの変化量」と定義した.
われわれはEnterococcus faecalisを接種したマウスのう蝕実験モデルにおいて, 抗E.faecalis抗体の高値は, 本菌の定着の進行を意味するものと考えた, 抗E.faecalis抗体と細胞性免疫能との問 (r=-0.9429, P<0.01), および抗.E.faecalis抗体とう蝕との間に有意な相関が認められた. したがって, う蝕がhostとparasiteのコミュニケーションの結果として表出する感染症であること, またう蝕がhostの適応能, すなわちコミュニケーション能力の指標となりうることを確認することが出来た.
う蝕と, TSTにおける行動選択のゆらぎの変化量との関係を解析したところ, r=-0.9429という非常に高い相関が認められた.以上の結果から, TSTにおけるゆらぎの変化量が個々のマウスのコミュニケーション能力の指標としであり, これにより個体の健康度を評価することができると考えた.また, 従来, 多因子性疾患として捉えられるう蝕の非特異的病因論を明らかにすることが出来た.

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This study sought to clarify the relationship between TMD and psychosocial factors, and to establish whether it is the psychosocial factors that cause TMD or the TMD symptoms that cause the psychosocial problems. The relationship between the pain scores recorded when palpating 38 masticatory areas of 160 TMD patients (106 arthrogenous, 54 myogenous, ages ranging from 20 to 59) and the results of their MAS and CMI tests was analyzed. The following results were obtained:
1. 60% of the TMD patients were in the normal range for both the MAS and CMI tests. 10.6% were in the normal range for the CMI test and the anxiety region for the MAS test. 11.3% were in the normal range for the MAS test and the neurosis region for the CMI test. 17.5% were in the anxiety region for the MAS test and the neurosis region for the CMI test. 28.1% of all subjects were diagnosed as anxious and 28.8% as neurotic.
2. The pain scores recorded in all areas palpated increased progressively from the normal group to the anxious group, neurotic group, and both anxious and neurotic group. Significant differences were found between the normal group and each of the anxious (p<0.05), neurotic (p<0.01), and anxious-neurotic (p<0.01) groups.
3. Looking at the results for specific palpated areas, all four groups had similar pain scores for the condylar region. For the masseter muscle, the pain scores increased progressively from the normal to the anxious, neurotic, and anxious-neurotic groups. Significant differences were found between the normal group and each of the neurotic (p<0.05), and anxious-neurotic (p<0.01) group. For the mental muscle, the pain scores increased progressively from the normal to the anxious, neurotic, and anxious-neurotic groups. Significant differences were found between the normal and anxious (p<0.05), neurotic (p<0.01), and anxious-neurotic (p<0.01) groups.
4. From the above results, it was concluded that the psychosocial factors did not cause the condylar pain that arose from the change in the condylar structure in TMD, and the TMJ pain did not create psychosocial problems. However, psychosocial factors were related to masseter muscular pain and mental muscle pain and the effect was especially significant in the case of mental muscle pain.

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This paper reports the results of a questionaire given to dentists treating patients with psychosomatic disorders (31 respondents from the Japanese Society of Psychosomatic Dentistry).
The main results were:(1) Only 7 out of 31 (22.6%) used hypnosis.(2) Hypnosis was applied by all 7 for the control of anxiety and fear during dental treatment. It was also applied for TMJ dysfunction syndrome, glossodynia, psychogenic halitosis and denturerelated complaints.(3) Regardless of whether they actually practiced it, 85.0% considered hypnosis to be effective.(4) 18 out of 31 (58.1%) had experience of using autogenic training.(5) The overwhelming majority (88.2%) used autogenic training for the control of anxiety and fear during dental treatment. Other popular uses, in order, were for TMJ dysfunction syndrome, gagging and bruxism, as well as other disorders.(6) Regardless of whether they actually practiced it, 86.4% considered autogenic training to be effective.
While acknowledging the difficulties facing dentists already busy upgrading their daily clinical knowledge, this paper emphasizes the usefulness of promoting studies on these two therapies, namely hypnosis and autogenic training.

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Dental clinics must sometimes treat patients who complain of foul breath but do not in fact have it. They can be perplexing for dentists. Such patients typically have depression, delusion of reference and poor social adaptation in addition to this false conviction of the foulness of their own breath. Such patients are diagnosed as having “phobia of emitting foul odor (mouth odor type)”. In this report, we developed a screening test to identify patients with this syndrome from among those complaining of foul breath, and evaluated the usefulness of this test.
The test consisted of a self-rating questionnaire, developed in cooperation with both dentists and psychiatrists. Composed of 10 items, it mainly rated the intensity of the belief in emitting foul breath, delusion of reference and disturbance of social adaptation.
The total score in the test ranged from 10 to 45. The higher the score, the higher was the probability of the patient having the syndrome.
This test was performed on 27 patients diagnosed as having “phobia of emitting foul breath” and the control subjects were patients who complained of foul breath and actually had it, (their mouth odors were diagnosed as being due to diseases of the oral cavity such as periodontitis). The average scores for each item and total scores of the patients were significantly higher than those of the control subjects.
It was concluded that a cut-off point of 21/22, at which the sensitivity was 0.93 and specifi city 1.00, should be used.

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We administered fluvoxamine, a serotonin selective re-uptake inhibitor (SSRI) to patients with oral diseases related to psycho-social factors and reviewed the effect of fluvoxamine on the results.
The oral diseases treated consisted of 9 cases of glossodynia, 2 of arthrosis of the temporomandibular joint, and one each of toothache, gingival pain and oral paraesthesia. Eleven were women and three were men. The administration was conducted for 2 weeks at minimum, 11 months at maximum and 5.5 months at mean. Daily doses of fluvoxamine were 25mg, 50mg and 75mg in 6, 5 and 3 cases, respectively. Of these, only fluvoxamine was administered in 6 cases (2, 3 and 1 cases at 25mg, 50mg and 75mg, respectively). In 4 cases (2 at 25mg, one each at 50mg and 75mg) it was given jointed with antianxiety drugs. Also in 4 cases (2 at 25mg, one each at 50mg and 75mg) it was given jointed with antianxiety drugs and kanpo-preparations. Fluvoxamine was effective in 13 cases in total, markedly in 2, mildly in 8 and slightly in 3 cases. It was ineffective in 1 case. Of 6 cases in which fluvoxamine was administered alone, it was markedly effective in 2 cases, mildly in 3 and ineffective in one. In the 8 cases of joint administration of fluvoxamine with antianxiety drugs or antianxiety drugs and kanpo-preparations, it was mildly effective in 6 and slightly effective in 2 cases. Side effects of fluvoxamine were observed in 2 cases but disappeared in one with the intake of a digestive drug.
From these results, it is suggested that fluvoxamine is useful for oral diseases related to psycho-social factors.

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The author has been applying Fukamachi's “Behavior restriction therapy” which was developed for eating disorders, to severe oral psychosomatic disorders since 1993. In this paper, 29 cases treated for oral psychosomatic disorders on an in-patient basis at our institute were surveyed with regard to their clinical features, treatment methods applied, their effect, treatment outcome and long-term prognosis. The author is seeking to establish a hypothesis on the pathophysiology of oral psychosomatic disorders through the investigation of the clinical characteristics of these patients from the therapeutic viewpoint. The subjects consisted of 16 cases of occlusal disease, 8 of atypical facial pain, 2 of glossodynia, 1 of oral malaisis, 1 of delusional halitosis and 1 of odontophobia. All the patients were hospitalized and their repetition of “doctor-shopping” was restricted. All the subjects were prescribed several kinds of antidepressants and minor or major tranquilizers as pharmacological treatment with the aim of alleviating the pain or other symptoms. The use of “Descriptions of impressions” and therapeutic keywords such as “Bad myself” were introduced as psychotherapy. According to the state of remission of the symptoms, patients were allowed step by step to leave the hospital ward. After confirming their recovery, final dental treatment was carried out if necessary. Treatment outcomes were evaluated from the following four aspects; the strength of subjective symptoms, the degree of impairment of daily activity or role functioning and the degree of dependence on medical treatments. Evaluations of the treatment outcome at discharge consisted of 1 excellent, 23 good, 3 fair and 1 poor. One case was transferred to neurosurgery. About 80% of the patients left hospital with remission in 3 months. Neither severe side effects nor adverse reactions were observed during the treatment. The follow-up studies of 26 cases after 10 months classified their level of social adjustment as “good”, “adequate”, “fair”, or “poor”. The results were “good” in 10 cases (38.5%), “adequate” in 10 (38.5%), “fair” in 5 (19.2%), and “poor” in 1 (3.4%). Evaluation of the long-term outcome showed good courses in about 80% of the patients. From the above results it appears that, Fukamachi's “Behavior restriction therapy” is an effective treatment for severe oral psychosomatic disorders as well as eating disorders.
On the basis of these findings, the author wishes to propose a hypothesis on the pathophysiology of oral psychosomatic disorders. From the clinical point of view, oral psychosomatic disorders may be due to several biochemical disorders involving neurotransmitters in the brain, poor connection between teeth (occlusion) and undefined complaints due to cognitive processes in the higher centers of the brain. Dental service often effects these patients iatrogenically for the worse. Increased attention should there fore, be focused on the role of centralis disorders as causative factors.

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Not much is known about the management of homeless or vagrant people with oral and dental injuries. These patients require public financial support, housing assistance and support, dental and medical care, and employment.
We treated a 60-year-old homeless man who had sustained a mandibular fracture. General communication and the obtaining of informed consent were difficult. He at first accepted our plan of surgical treatment under hospitalization, but then refused the operation after admission. Conservative treatment with maxillo-mandibular fixation was also discontinued after two weeks' stay in a ward. He showed some problematic behaviour and a troublesome lack of cooperation with other patients, medical staff and officials in the hospital, and it was recommended that he should be discharged. In spite of periodical appointments for follow-up, he almost always failed to appear at the agreed date and time. In the evaluation 11 months after his injury, the healing of the fracture and jaw function had progressed uneventfully.
Consideration needs to be given to making maxillofacial surgery services more accessible to the homeless population. The appropriate level of provision is discussed and considerations are proposed for future use in management.

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This paper describes the relationship between temporomandibular disorders type II and III (TMDs) accompanied by vague oral complaints and psychological factors.
The subjects were 6 female patients aged 48 to 73 years. The following clinical factors were investigated:(1) the relation between onset of TMDs and time when patients reported vague oral complaints, (2) psychosocial factors for one year before the occurrence of TMDs, (3) mental status at their first visit, and (4) clinical course of TMDs patients under psychosomatic treatment.
The results of the investigation strongly suggest that psychological factors are associated with the vague oral complaints that accompany TMDs, whether their main symptoms are clicking sounds or pain in the temporomandibular joint.

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今回の症例は, 数か所の身体症状が病理学的に認められ, それにうつ状態がかさなっているものである.
患者は, 1996年の初診時において78歳の女性である.彼女は20年以前から, 半身不随の夫の看病を続けており, 彼女自身も動脈硬化症, 高血圧, 狭心症, 脳梗塞等の身体症状に加えて, 不定愁訴, 悪夢, 不眠等で苦しんでいた.さらに娘の結婚による別居後, それらの症状に加えて, 自殺念慮, 発癌恐怖もおきてきた.かかりつけの内科医から, 末梢の治療薬に加えて, 抗不安薬も投与されて来たが, 充分な効果が得られないので投与量が増加されていた.
彼女の下顎切歯 (21112) の金属冠は, 破損していたが, 近くの歯科医に不信感を持っているため, 7～8年放置したままで, 治療を受けようとしなかった.今般, 彼女の娘に連れられて筆者らを訪れた時にはdrowsinessのため歯科治療を行える状態ではなかった.筆者らはこのdrowsineSSは, 現在服用中のアルプラゾラムのためと考え, その服用を中止させ, その代わりに心身症性の臓器および循環障害に著効を示し, しかもアルプラゾラムよりも依存性の低いクロキサゾラムを処方した所, 小量投与にもかかわらず, 3週間の服用で身体症状を含めて精神症状に際だった改善が認められた.勿論この間に心身医学的療法として, 臨床心理学的アプローチによりカウンセリングを定期的に行った.約1か月経過時から口腔内治療を始めた.まず21112の破損金属冠を撤去し, 根管充填物を除去した.X線診査によれば, 21112の根尖端に病変はみられなかったので, ただちに根管充填を行い, その数日後にメタルコアーを合着し, 印象を採得した.翌月には金銀パラジウム裏装の硬質レジン前装冠を合着した.現在まで経過は良好である.
クロキサゾラムの投与は1年間で中止した.それは患者が消化管障害の再発を訴えたためで, このため1997年10月から, 心身症性の消化管障害に著効を示し, 依存性の心配の少ないフルトプラゼパムの投与を開始し, 現在まで順調である.

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A patient with acutely symptomatic dental caries and extreme fear of dental therapy was treated under deep sedation and with a psychological approach. Even now, however, it is necessary to continue dental therapy under deep sedation because the psychological approach has not achieved sufficient results.
The patient is a 20 year old female referred from the oral surgery department of the hospital attached to a medical college. Her chief complaint was toothache but she had been un.-able to receive dental therapy at the other dental clinic due to her fear of treatment. She had received emergency treatment, including instillation, for acute extreme pain and palsy caused during dental treatment when she was in the fifth year of elementary school. Ever since, she had retained an intense fear of dental therapy. Her phobia appears to have worsened, as she had not complained of pain to her previous dentist.
We have treated her under deep sedation, in addition to intravenous analgesia, after obtaining insufficient effect with the standard dose. We also attempted psychological approach (counseling) because of inspiratory depression caused during this treatment. This was done sixteen times in total. Many counseling sessions and observation of therapy on other patients reduced her anxiety about dental therapy per se, but her phobia remains marked with regard to her own treatment, including looking at dental instruments. Our possible reason for the lack of success was that our counseling was counducted in the place for the general dental treatment of outpatients. At any rate we stopped the counseling with regret.

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