The identification of characteristic features of patients who complain mainly of maxillary or mandibular protrusion could provide useful information for orthodontic treatment.
We analyzed 14 female patients with maxillary protrusion and 22 female patients with mandibular protrusion using the MINI psychological analysis system.
Z tests were conducted in order to examine the deviation of each score from the standard score of the MINI system. In the case of maxillary protrusion, the scores for D (depression), Pt (psychasthenia), and Si (social introversion) were significantly lower than standard. Mandibular protrusion female patients scored significantly higher than standard for Hy (hysteria), and Pa (paranoia).
The X ² test was used to examine the deviation of dispersion values from the standard dispersion values of MINI. In the case of maxillary protrusion, no significant deviation from standard was observed. Mandibular protrusion patients showed significant deviation for Hs (hypochondriasis), Hy (hysteria), and Pa (paranoia).
These results suggest that, by comparison with the MINI standards, female patients with maxillary protrusion are apt to be optimistic and extrovert, showing fewer signs of anxiety and tension. They have lower levels of stress and tend to be sociable. Female patients with mandibular protrusion seem more liable to somatoform disorders (hypochondriasis and conversion disorders), tend to be hypersensitive and suspicious, and also display a variety of somatoform disorders (hypochondriasis, conversion, and somatization disorders) and hypersensitivity.

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Psychological tests were used to evaluate the stress condition of 205 patients with indefinite symptoms in the mouth, head and neck regions. It was found that many of the patients exhibited a medium degree of stress and high stress tolerance. The results suggest that many such patients are people who are only liable to exhibit stress symptoms under conditions of chronic stress, and that their stress condition is often already chronic.

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Reduced salivation and changes in the viscosity of saliva were examined in relation to oral dysthesia. The study was conducted on 62 patients visiting our hospital between April, 2003 and March, 2004, who complained of rasping or sticky feelings in the mouth, tongue pain and other such disorders without any clear organic cause, did not appear to suffer from burning mouth syndrome or neuropathic pain, and did not meet the standards for depression, integration disorder syndrome etc. The patients ranged in age from 32 to 84 years with and average of 64.6 years. Twenty-five were male and 37 female.
It was found that salivation in these patients was greatly reduced to much the same level as occurs in Sjogren's Syndrome. By Mann-Whitney test, the viscosity of saliva produced under stimulation was, for each age group, substantially lower than in healthy subjects without reduced salivary secretion functions who did not complain of subjective feelings of drying, rasping or stickiness in the mouth.
It was concluded that reduced salivary secretion and viscosity may contribute to oral dysthesia.

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The case of a 61-year old male schizophrenic patient who complained of occlusal disturbance after upper denture repair by the author is reported. The author found no problem with the denture and considered the blaming of occlusal disturbance on the denture repair unreasonable and misguided. The subjective symptoms were treated as qualia rather than delusions. A good relationship was established by listening to the complaint. Medical interviews and explanations by the author, in his role as dentist, were repeated for three years and the patient was finally convinced of the truth.

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The authors have managed a group psychotherapy club for patients with burning mouth syndrome for the past four years. Burning mouth syndrome is a psychogenic or idiopathic burning discomfort or pain that affects people with clinically normal oral mucosa in whom a medical or dental cause has been excluded. The patients suffer from oral pain, but other people can not understand the reason for this. Such patients tend to feel isolated as a result. The purpose of this exercise in group psychotherapy is to relieve their pain and improve their quality of life through the sympathetic experience of the group. One of the authors is a facilitator at club meetings, and another audits the activity through a process of reviews. The club's meetings are held in a room at our hospital for two hours each once a month. We have held 50 sessions during the last 4 years and 2 months with a combined total of 22 participants and average of 4.7 patients per session. Analysis of the group dynamics finds evidence of feelings of sympathy, catharsis, transference, insight, and self-help therapeutic functions. It is suggested that group psychotherapy for patients with burning mouth syndrome is a very helpful therapeutic method.

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A total of 41 patients aged from 19 to 84 (mean 49.2) underwent behavior restriction therapy for oral psychosomatic disorders at Fukuoka University Hospital between January 1993 and April 2004. The therapy was provided for 19 patients with occlusal discomfort, 11 with atypical facial pain, 4 with glossodynia, 3 with halitophobia, 2 with oral dysesthesia, and 2 with odontophobia. Follow-up studies on 26 of these cases after 5 years classified their level of social adjustment on a four-step scale as good, adequate, fair, or poor. The results were considered good in 10 cases (38.5 %) adequate in 10 (38.5%), fair in 5 (19.2%), and poor in 1 (3.4%). Thirteen patients (31.7%) had begun to make needless requests for dental treatment again. These cases were difficult to deal with and prognosis depended on how well each patient had learned to cope with feelings of guilt at the time of therapy. To improve the prognosis, new strategies for reducing the recurrence of oral psychosomatic disorders and forestalling such patients' requests for unnecessary dental treatment should be established in the future.

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Many psychosomatic dental patients, including those with glossalgia, also suffer from oral xerosis. Gum-chewing tests typically show that such patients have a normal level of saliva secretion, but the amount of saliva is often found to have fallen after a 15-minute rest. Studies have indicated that secretion by the submandibular gland in sympathetic dominance is only 20-30% of the level in parasympathetic dominance. We have already reported on the rising tendency of blood noradrenaline levels in psychosomatic dental patients.
In the present study, we administered cevimeline hydrochloride hydrate hydrochloride to 20 patients complaining of psychosomatic disorders and oral dryness. The results obtained were as follows:
1. After four weeks of medication, saliva secretion at rest had increased in all subjects.
2. The symptoms were substantially alleviated in 9 and slightly alleviated in five out of the 20 patients; two were relieved only of oral xerosis and the remaining two exhibited no change.
3. Five patients who had received of cevimeline hydrochloride hydrate hydrochloride alone, four experienced improvement and one mild improvement.
4. Ten patients with glossalgia, the most frequent disorder, the symptoms were substantially alleviated in six and slightly alleviated in two; one was relieved of oral dryness alone, and one remained unchanged.
The results suggest that the administration of cevimeline hydrochloride hydrate hydrochloride was effective in treating glossalgia and other psychosomatic disorders accompanied by oral xerosis.

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We report on difficulties encountered in the post-surgical management of a mandibular gingival carcinoma patient experiencing post-operative psychiatric disorder.
The 56- year-old man had received a partial mandiblectomy with radical neck dissection and reconstruction by major pectoralis myocutanous flap under general NLA anesthesia. The post-operative psychiatric symptoms of insomnia, removal of own catheters and tubes, excitation, delusion, the attempted self-injection of medication into a vein, and prowling were observed two days after surgery. No psychiatric disorder was evident after the removal of all catheters and tubes, and there was no recurrence.
This patient had some risk factors for postoperative psychiatric disorder: insomnia, a long operation, many catheters and tubes, stubbornness, alcohol withdrawal etc.
We suggest that it is very important to evaluate such diverse risk factors for each patient pre-operatively in order to prepare in an appropriate manner for the occurrence of post-operative psychiatric disorders.

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We report the case of a 52-year-old woman, who visited the hospital of Aichi-gakuin University in May, X year, unable to receive dental treatment due to a severe vomiting reaction. Her chief complaint was a dental phobia, which belongs in the category of anxiety disorder. We considered, however, that a conversion mechanism connected to her relationship with her stepmother might also be involved. We undertook not only cognitive-behavioral therapy for the dental phobia but also subjective and supportive psychosomatic treatment for a conversion disorder (hysteria). She was able to go to the dental hospital by herself six months after the first treatment in November, X year, and received treatment for the removal of a tooth stone at the incisor region of the mouth in May, X+1 year. One year after the first treatment, she was also able to receive the same treatment in the molar region of the mouth. We suspect, however, that the vomiting reaction may again prevent her from receiving dental treatment if she needs to spend more time with her stepmother or her own physical condition deteriorates. The psychosomatic treatment for the relationship of the patient with her step mother is being continued and, if necessary, the advice of psychiatrists on liaison shall be sought.

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Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral mucous membrane, usually in the absence of other abnormal findings. In many cases, it has been very difficult to treat. We recently observed the relief of symptoms in a case of BMS with psychogenic factors by psychotherapy provided during hospitalization.
The patient was a 77-year-old woman who came to our Orofacial Pain Clinic in January 2004. Her chief complaint was palatal pain caused by the sensation of a foreign substance sticking to the palatal membrane. She had felt the abnormal sensation after starting inhalation therapy for asthma with a steroid solution in 1999. She had often complained of this as a side effect and changed the medicine several times, but the sensation had not disappeared. The inhalation therapy was terminated in January 2003, but the burning pain recurred when she ate hot rice cakes. Her palatal membrane was normal. The burning pain and tingling worsened after meals, and she also complained of a dry mouth. Psychological tests revealed that she was mildly depressive and had a psychosomatic personality marked by dependency and anxiety. We diagnosed her symptoms as BMS and xerostomia.
We started brief psychotherapy and kanpotherapy with Bakumon-do-to. Four weeks later, she complained she had not been able to take anything for severe pain since the previous night. She also suffered from insomnia, loss of appetite and desperation, and alluded to suicide.
We decided to hospitalize her for treatment. There, we continued with brief psychotherapy and gave her SSRIs without analgesics. In view of her dependency and anxiety, because she lived alone, we chose supportive therapy in order to improve her adaptability. Her pain was gradually reduced and we then recommended music therapy, too, which proved effective for providing relaxation and pain relief. After 10 days of hospitalization, her pain was relieved, and her insomnia and loss of appetite had been ameliorated.
This case suggested that the psychogenic factors of her dependent personality and anxiety living alone had caused her to develop severe BMS. It is proposed that the provision of psychotherapy in hospital is useful in severe cases of BMS.

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[in Japanese]

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Tongue thrust is referred to as a habit in dentistry and a phenomenon in psychiatry. There is, however, no clear dividing line between the two fields.
In dentistry, tongue thrust is identified as a cause of apertognathia. In addition, tongue thrust patients use the tongue in a compensatory action to close the gap between the front teeth during articulation and swallowing.
In psychiatry, tongue thrust is characterized as a somatic expression of brain wave irregularity or functional disability.
We report a rare case in which prominent tongue thrust, a condition of the oral cavity, was treated on a psychiatric basis.
The patient was a female aged 24 years and 7 months. She developed frequent tongue thrust when speaking after having received dental treatment. She had difficulty speaking fluently and the dentist, suspecting apertognathia, introduced her to the department of orthodontics.
The tongue thrust was evident during the first examination to the extent that the tongue protruded visibly beyond the front teeth. The tongue thrust did not appear to be dependent on the situation.
The orthodontic examination found mild skeletal apertognathia but, judging from our own clinical experience, the tongue thrust exceeded the requirements of compensatory action.
As the tongue thrust did not appear to be due to the occlusion, an examination at our department of psychiatry was also requested on the same day. The psychiatric department found an unusual brain wave pattern and ameliorated the tongue thrust and brain disorder by drug prescription.
In this case, the particular symptoms of the oral cavity enabled us to judge that the patient might need psychiatric assistance. The orthodontist was able to recommend a course of action, on the basis of the state of occlusion and patient's main complaint, which led to improvement.
It is, however, extremely difficult for dentists, who have little knowledge of methods of psychiatric examination and testing, to identify such patients with confidence. We believe that it is important for dental treatment to be considered in a comprehensive manner that includes the psychosomatic perspective.

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