This study examined the relationship between various vague oral complaints and psychological factors.
The subjects consisted of 165 patients (30 males aged 55.2±17.02; 135 females aged 56.2±15.57). Of these, 62 had glossodynias, 58 oral paresthesias, 30 taste abnormalities, 25 temporomandibular disorder-like complaints (TMD), 24 saliva abnormalities and 15 indefinite oral pains (overlapping in some patients).
The results were as follows:(1) Personality-related psychosomatic status and complex depressiveneurotic status were frequently observed in all patients.(2) Depression and/or neurosis were more severe in patients with indefinite oral pain, saliva abnormality, taste abnormality, and oral paresthesia, while a psychosomatic tendency was more common in patients with glossodynia and TMD.(3) Neurosis was correlated with multiple complaints, whereas a psychosomatic tendency (personality-related psychosomatic status) was correlated with a single complaint.
In such patients, it would appear that psychological factors may have some relation to the degree and number of the complaints.

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In this study, we investigated the sense of purpose in life of patients with vague oral complaints using the “Purpose in Life Test-Part A”(PIL-A).
The subjects consisted of 61 patients: 14 males aged 52.1±18.1 and 47 females aged 56.8±14.0, of whom 23 had oral paresthesias, 22 glossodynias, 13 taste abnormalities, 10 saliva abnormalities and 14 other complaints.
The results were as follows:(1) Over one third of the subjects had a low purpose in life score.(2) Male patients and those with multiple complaints tended to have a low purpose in life score.(3) Such patients selected such items as “distress about the monotony of daily life”, “death anxiety” and “history of suicidal thoughts” more frequently than other items.
The findings of this study suggest that patients with a low purpose in life score should be given support to find some purpose in life and relieve their death anxiety.

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This study analyzed the significance of psychological factors in patients with oral lichen planus.
The study involved 22 patients with oral lichen planus and 22 sex-age-matched control. We applied the Kyushu Medical Index health questionnaire as the psychometric test for both groups.
The patients with oral lichen planus were found to have significantly higher positive reactions. The 9 patients identified as belonging to the psychosomatic and neurotic categories by somatic and psychic criteria showed neurotic, psychotic and obsessive tendencies.
Despite the higher positive reactions observed in patients, it was not established whethe the observed psychological states constituted an etiological factor or merely a secondary overlay on the oral lichen planus. It is stressed, however, that psychological consideration must be given a place in the clinical management of oral lichen planus.

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To identify the psychological factors contributing to temporomandibular disorder (TMD), an investigation was conducted of healthy volunteers who had no current or past history of TMD.
The TMD patient population peaks in the 20's, so 68 freshmen (46 males and 22 females, with an average age of 20.4 years) at Iwate Medical University Dental School were examined in this study. At the initial stage of the survey, all subjects were requested to fill in a questionnaire to screen their mandibular functions and lifestyle, together with the CMI, SDS, MAS, Y G and TEG psychological questionnaires. Changes of TMD symptoms were evaluated 2.5 years later by a self-reporting questionnaire. Clinical examinations and interviews were also performed to confirm the state of symptoms individually, both at the initial stage and 2.5 years later.
Out of the 68 subjects, 7 (3 males and 4 females) were experiencing pain in the tempromandibular joint and/or masticatory muscle at the time of the 2.5-year follow up survey.
Logistic regression analysis was performed to identify the intrinsic factors. This revealed odds ratios of 24.20, 0.54, 0.17, 15.95 and 0.48 in CMI, SDS, MAS, Y G and TEG, respectively. These results imply that neurotic tendency and emotional instability could be contributory factors to TMD.

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Clenching during waking hours as well as grinding during sleep are known to be contributory factors to the perpetuotion of masticatory muscle pain.
Although studies have been conducted on nocturnal bruxism and daytime clenching in controlled laboratory settings, few reports have focused on the management of daytime clenching in natural environments with the utilization of biofeedback training. One of the reasons for the non-utilization of EMG biofeedback for patients exhibiting clenching behavior is that the biofeedback devices are too cumbersome to be carried around by the test subject. To expand the applicability of biofeedback training on a daily basis, the device should be small enough to be ignored by others.
This paper introduces a newly developed customized EMG recording device with two main components, namely the data-recording and auditory feedback portions. The dual-channel EMG recording system consists of on Ag-AgCl electrode pair unit and digital recorder with a 12-bit A/D converter. Hum filter of 50 Hz and band pass filter of 23-450 Hz are also equipped for EMG data collection. EMG activity is displayed on a small LCD on the surface of the device in root mean square values ranging from 0 to 1250μV. This unit permits continuous recording for 8 h 40 min at a data-sampling rate of 4Hz. An auditory feedback signal informs the user via a headset when EMG activity exceeds the arbitrarily defined threshold in each channel.
Since this EMG biofeedback device is easy to carry around, it should help to reduce daytime clenching behavior in natural environments.

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It is often reported that psychosocial stress many influence the autonomic nervous, endocrine, and immune systems. In this study, Natural Killer (NK) activity in oral patients with closely related psychosocial factors was measured in order to examine the relation to the immune function and psychological tests. The results were as follows:
Twenty-one patients, 2 males and 19 females with a mean age of 51.4 years, were used in this study. There were 8 cases of glossalgia, 7 of ulalgia, 2 of odontalgia, 2 of relapsing aphthous stomatitis, one of gnathoarthritis, and one of xerostomia. NK activity averaged 27.11±14.74. The subjects were divided into two groups, one of the 11 patients with NK activity below the mean and the other of the 10 patients with higher than mean values. Regarding the immune function, CD4 was 40.2±8.29 in the high and 50.76±10.86 in the low NK activity groups, showing a significant difference between the two. The CD8 figures were 29.36±6.29 and 21.05±5.17, respectively, also showing a significant difference. In the psychological tests, the rated score of the high NK activity group by Inoue's masked depression questionnaire was 17.89±4.27, showing a tendency towards depression in that group. In the low NK activity group, the score was 13.55±6.15, again revealing a significant difference between the two groups, though one of 10 % or below. These findings indicate that the strength of the depressive tendency may influence NK activity.

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Japanese society experienced rapid and supposedly substantial changes in the 1990's. It is thought that these changers may have exacerbated social stress and induced an increase in the number of patients suffering from psychiatric and psychosomatic diseases. In order to investigate changes in the characteristics of patients diagnosed as suffering from dental psychosomatic diseases during the 1990's, statistics obtained in the serial treatment of such patients in 1989 and 1998 were compared.
The subjects were patients who had visited the Department of Oral Surgery in the University Hospital of Kurume University School of Medicine, Fukuoka, Japan, in 1989 (n=44) and 1998 (n86). There was no profound difference in the male/female ratio of the patients. The number of patients older than 65 had increased, and those younger than 65 had decreased, in 1998. The time lapse between the onset of psychosomatic syptoms and the first visit to the hospital was shorter in 1998, possibly suggesting growing awareness among patients that oral psychosomatic symptoms can be treated at the department of oral surgery.
Fewer patients were diagnosed as having oral cenestopathy and psychosomatic halitosis, but the so-callde temporomandibular disorders, glossodynia and cancerphobia had increased. In 1998, the fear of cancer seemed to be an increasingly common factor in the induction of psychomatic symptoms. The treatments used in 1998, consisting of brief psychotherapy and medicaton, were more less the same as in 1989, but the results of treatment had improved. The importance of collaboration with psychiatrists on the further improvement of serial treatment for dental psychosomatic patients is discussed.

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Glossalgia is a condition in which patients complain of superficial, spontaneous pain or discomfort on the tongue in the absence of any observable organic change.
Psychogenic factors, menopause, poor oral hygiene and habits, allergies and vitamin or mineral deficiency have all been suggested as possible causes, but no definite cause is known. We present the results of a study on patients with glossalgia, examined at our hospital during the past three years.

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This study compared the psychological factors of referred patients and patients received without referral at the university hospital. Ninety-eight outpatients visiting the Clinic of Periodontics of Kyushu Dental College Hospital were used as subjects in this study. All of these patients were seeking treatment for periodontal problems. To measure the anxiety scale of the patients, the State Trait Anxiety Inventory (STAI) was taken at the first visit. Periodontal probing and other dental examinations were also performed. The criterion for severe periodontitis was the presence of more than 6 sites with a probed depth of 6 mm or more. The state and trait anxiety results for the referred patients and those received without referral were compared. Age, gender, smoking, periodontal status and referral were also analyzed statistically with resped to prevalence of high anxiety. The scores for trait anxiety of patients received by referral were higher than those for patients seen without referral. No difference was observed between the two groups for state anxiety. Age showed an inverse correlation between state and trait anxiety scores, but smoking status and periodontal status were not correlated with anxiety. Logistic regression analysis demonstrated that referral was a significant factor in the prevalence of high state anxiety after adjustment for age, gender and smoking status. Higher anxiety scores among referred patients may be a reflection of personality types which tend to rely on persons in positions of authority. The severity of periodontitis was not a significant factor in the onset of anxiety, even among these patients who were seeking treatment for periodontitis. The findings suggest that periodontitis is an unobtrusive disease about which patients can not perceive their own status easily.

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The authors have been using the measurement of individuals' eye movement to investigate how visual information is received. It has already been corroborated that visual perception plays an important role in determining people's behavior. The measurements of eye movement also reveal how people ready themselves for certain actions. “Microslip” is a term from ecological psychology refersing to exploratory behavior that is thought to precede some new behavior in the future. By finding the microslip, it should be possible to show how people prepare themselves to do what they intead to do next. Given this premise, the present study was conducted to observe the microslips of child patients during cleaning of the mouth. The findings are reported in this paper.

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We report the case of dental treatment for a patient of oral cenesthopathy followed by depression which appears to have been induced by the extraction of a tooth. The significance of the early discovery of depression in patients who require dental treatment and the adequate management of the mental status of such patients are discussed. This case suggests that the dental treatment that fails to take account of latent depression in a patient will not only obstruct improvement of the oral environment but also itself become a factor in making the depression worse.

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A sixty-four year old housewife complained of smarting of the tongue and taste loss. No major organic damage was observed in the oral cavity, including the tongue, but the decline of tasting ability was confirmed by the filter disk method. The patient suffered insomnia, depressive moods and psychomotor retardation, so antidepressant medication was prescribed by her psychiatrists. The medication cured the sleeping difficulty, depressive moods and smarting of the tongue within 5 weeks. The psychomotor retardation showed improvement at 7 weeks from the commencement of medication. At the 25th week, all psychosomatic symptoms had been suppressed. The restoration of taste was proved by the filter disk method in the 28th week. The significance of the filter disk method in the evaluation of the sense of taste of depressed patients is discussed.

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A 45-year-old female patient was referred to us from the Department of Endodontics at Aichi-gakuin University School of Dentistry with a long and complex dental history. Her chief complaint was chronic pain in teeth which had been pulpectomied at other dental clinics. We chose brief psychotherapy and chemotherapy with the use of just one anti-anxiety drug. While at the Department of Endodontics, root canal treatment had also been performed on the teeth with chronic pain. First, we had her come to the hospital once a week and listened to her account of the degree of chronic pain and the related anxiety experienced. Her chronic pain decreased gradually and she started coming to our hospital once in two weeks instead. Finally, root canal filling and prosthodontic treatment were performed without any trouble. She has recently been coming to the hospital about once a month. We let her consult with us about her anxiety and ask questions related to the experience of chronic pain in teeth to prevent the recurrence of her state of fear.

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我々は, 口臭症に対する三環系抗うつ薬の有効性を報告してきたが, 患者によっては副作用のため充分な量の投与や維持が困難で効果不良となる場合が経験された.今回, 本邦初の選択的セロトニン再取り込み阻害剤であるフルボキサミンを本症に使用し, その効果の検討を行ったので報告する.対象は口臭を主訴に当科を受診し, フルボキサミンを投与された19名である.診断に際しては自己臭恐怖症の診断基準を準用した.フルボキサミンの投与量は1日50mgから150mgで, 平均100mgであった.治療結果は, 著効例が56%, 中等度改善例が33%, 不変例は11%であった。全体の85%には特に副作用は認められず, 眠気, 吐き気, めまいを訴えたものが各5%であった.本研究では対照群を設けていないが, 文献的にも選択的セロトニン再取り込み阻害剤の有効性が報告されている.また, フルボキサミンの有効率と副作用の少なさから, 本症の病態生理に脳内のセロトニンが重要な役割を演じていることが示唆された.

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This study describes a case of psychogenic pain in the oral and buccal area related to past dental treatment. A 47 year old male had experienced problems due to accidents twice during earlier dental treatment. The first, which happened about 20 years ago, involved the loss of an anterior tooth during extraction of the third molar. No explanation for this was provided by the practitioner. Then, about 10 years ago, acute odontogenic maxillary sinuitis was caused by an infection contracted during root canal treatment. This inflammation was cured by long-term medication with an anti-biotic, but the pain remained even about 10 years later. X-ray photography, the periodontal evaluation and plaque control record were assessed, and the resulting diagnosis was psychogenic pain and moderate periodontitis. The patients psychosocial background was assessed by the Rorschach Test, P-F Study, CMI and MMPI. Several cognitivebehavioral therapies were also arranged for the psychogenic symptoms. After treatment for half a year, the psychogenic pain in the oral and buccal areas had decreased. The periodontal condition was also well maintained by periodontal debridements and oral hygiene instruction.

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A fifty-three year old housewife, who has been treated at a psychiatric hospital for anxiety and depressive mood, complained of incongruous occlusion. No major functional disturbance was observed in her occlusion to strongly support her chief complaint. In order to discover the psychological factors producing the phantom bite, the treatment was mainly focused on counseling, during which a series of efforts was made to convince her that her occlusion was functionally normal. The importance of establishing warm communication with patients of psychiatric diseases is discussed.

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A fifty-nine year old male office worker complained of smarting of the tongue. White neomembrane surrounded by rubor was observed on the dorsum of the tongue. The candida was identified by micrography of a sample collected from the tongue's surface. The result of the CMI test, an indication of psychological status, was class III, suggesting that the patient had a tendency towards neurosis. The organic symptoms of candidasis of the tongue were inhibited by the administration of an antifungal, but the smarting of the tongue remained unchanged. The smarting was generally suppressed by the medication for anxiety and depressive mood, which was prescribed by his psychiatrists. The significance of the psychological factors in the induction of glossodynia is discussed.

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Some patients visit a dental office with many complaints. It is important for the practitioner to identify the most pertinent information for making the correct diagnosis. Neurogenic diseases (such as trigeminal neuralgia and trigeminal neuropathy) are rarely accompanied by visible findings and are sometimes misdiagnosed. We report here two cases of trigeminal neuropathy that had been diagnosed as a psychosomatic condition for a long time.
The first patient was a 53 year-old female who visited our clinic complaining of hypoesthesia and a spontaneous bitter taste on the left side of the pharynx and the tongue. Her previous dentist, before she visited our clinic, had explained that she had psychosomatic problems and should not concentrate on the symptoms. It was further explained that the symptoms would completely disappear in time. Upon her initial visit, no abnormality was detected in her mouth by either macroscopy or radiological and blood examinations. The interview on her medical history revealed that her symptoms had appeared following the extraction of a horizontally impacted wisdom tooth. Quantitative sensory tests (QST) showed an elevated detective threshold with electrical stimulation (Electric Detective Threshold: EDT) in the left lingual nerve innervation, and a diagnosis of left traumatic lingual neuropathy was made. Treatment for neuropathy was started with stellate ganglion block (SGB) and oral paroxetine. Dysesthesia and the bitter taste had become attenuated two weeks later. The intensity of the complaint decreased from 80 to 45 mm in the visual analogue scale (VAS).
The second patient was a 25 year-old female complaining of dull pain on the left side of the mandible. Her previous dentist had thought, and explained to her, that she was having psychosomatic problems. She too, had a left impacted wisdom tooth extracted. Her initial symptom after the extraction had been hypoesthesia on her left menton. This was gradually ameriolated, but an abnormal sensation (dysesthesia) and dull pain appeared instead. On her first visit to our clinic, no particular findings were observed except hypoesthesia in the left mandible and tenderness of the left masticatory, neck and shoulder muscles. EDT was high in the left inferior alveolar nerve territory and oppressive pain was observed in the ipsilateral temporal, masseter, sternocleidomastoid, and trapezius muscles. Her condition was diagnosed as a combination of traumatic trigeminal neuropathy of the the left inferior alveolar nerve and myofascial pain syndrome (MPS). SGB was performed and antidepressants were prescribed. Amitriptyline was prescribed first, and later changed to paroxetin. The VAS of her complaint declined from 75 to 40mm.
We emphasize the importance of careful diagnosis and early treatment of traumatic trigeminal neuropathy. Visible symptoms are usually lacking, however, so the medical history of treatment in the affected area and QST are useful for diagnosis. Misdiagnosis of neuropathy and mistaken explanation of psychosomatic conditions to the patient undermine the relationship between the patient and the practitioner.

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We report here a case of oral pain and abnormal sensation associated with hypochondriasis and myofascial pain syndrome. This patient was a 70 year-old female housewife. She complained of continuous dull and uncomfortable pain in the molar part of the left maxilla. The pain had appeared suddenly in the right upper second molar. She visited a dentist and he extracted the tooth because an X-ray photograph revealed perforation in the floor of the pulp chamber. In spite of the extraction, the pain continued. Antibiotics, anti-inflammatory agents and analgesics had no effect on the pain. Curretage of the extraction wound was performed two weeks after the operation, but the pain persisted.
The patient had been suffering from hypochondriasis and depression caused by anxiety since contracting gastric cancer. She had received this diagnosis of her mental state from a practitioner of psychosomatic medicine and been prescribed antidepressants and anxiolytic agents for two years. The dental practitioner and physician both diagnosed that the hypochondriasis and depression were causal factors in her prolonged pain because no clinical problems were identified in the objective findings.
She visited our pain clinic one month after the tooth extraction. We found trigger points in the right temporal and occipitofrontal muscles that caused referred pain in the affected maxillary region. Secondary hyperalgesia was also found in the painful region of the maxilla. We made a diagnosis of myofascial pain syndrome. Stellate ganglion block and trigger point injection (1 % mepivacaine hydrochloride) were performed six times. Three weeks later, the spontaneous pain had been ameliorated (from 95/100 to 32/100 in the VAS), although secondary hyperalgesia still remained. We applied a drug stent (Fig. 1) with a local anesthetic (lidocaine ointment) to block stimuli to the affected area. She has not experienced any pain when wearing the stent.
Hypochondriasis and depression could be among the factors that cause orofacial pain but other conditions also need to be considered. We suggest that the dentist should be aware of myofascial pain as a possible causal factor in cryptogenic orofacial pain.

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