Regardless of age or sex, psychological normalcy or abnormalcy, all people do seek dental care.
Consequently, in dental care, viewing the whole patient is important; namely, the object of dental care is not only the mouth alone, but rather the whole person with oral cavity problems. Especially, with regard to the humanistic approach. The doctor-patient relationship, which is based on the understanding of the patient's needs, emotions and psycho-social aspects is important.
In this lecture, the following topics about dental care for the whole patient were discussed.
1. The patient's needs and the doctor-patient relationship.
2. Tatrogenic disturbances.
3. Polysurgery.
4. Glossodynia.
5. Myofascial Pain Dysfunction Syndrome.
6. Pain.
7. Fainting resulting from cerebral ischemia during dental treatments.
8. The significance of the teeth and mode of chewing that are most beneficial to the whole patient at each stage of life.

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Mental disturbance can be added as a complication of oral cancer therapies. Long and lonely hospitalization is generally necessary for suffering aged subjects, and each of the patients receives therapies which possess many undesirable side effects. Physical stress resulting from the treatments may add to the patient's anxiety about the nature of the disease, and some of the patients could become mentally disturbed to a symptomatic level. From out of 64 male and 31 female patients with head and neck cancers who had been treated in our clinic, in this paper we dealt with cancer patients who had refused the treat-ments and had developed into psychopathic conditions.These subjects were distributed predominantly in female and highly aged group.
In 3 refusal cases, a 80 year male had refused therapy for the maxillary carcinoma com-plaining painful stomatitis.A seventy-five year male with tongue carcinoma could not bear hospitalized living for loneliness caused by separation from his family and his hometown. Another female had rejected glossoectomy by taking cancerphobic attitudes.All these cases were discharged with only insufficient effects of the treatments.Five cases showed depressive and anxious reactions.All were female and over 60 years old.Three of them had each a medical history of delusion, Parkinson's disease and alcoholism, and they fell into delusional conditions and sleeplessness along with the side effects of cancer therapies.The two remaining cases, who had no psychic history, fell into depression with sensory aphasia in one case and fear of her life in the other.By these experiences, it can be stressed that physical stress which necessarily acompanies cancer treatments may actively harm the patient's mentalstate.So, in the treatment of oral carcinomas.care for avoiding the occurrence of psychic disturbances should be taken in old subjects, especially in females and patients with psychopathic history.Importance of an appropriate medical care and sincere familial kindness in order to overcome stress was also discussed.

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The patient, a 22 years old man, came to us hoping to receive dental treatment under general anesthesia on account of his extreme dental treatment phobia.
The symptoms had been manifest since primary school. On the first medical examination day, the patient found it impossible to sit in a dental chair.
We diagnosed a severe dental treatment phobia from his symptoms. As a result of six hours of interviews, at the rate of two hours a day, we recognized the possibility to cure the patient of his symptoms.
Although a long period would be required, we decided to proceed with systematic desensitization.
In systematic desensitization, we utilize autogenic training for reciprocal inhibitation. In the early stage, we used desensitization by image, then in-vivo desensitization.
At the same time, we combined assertive response and modeling therapy.
As a consequence, we were able to successfully alleviate the dental treatment phobia itself, although a total treatment period of 11 months was required.

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In this paper, the case of trismus of a 10 year-old boy is reported and the pathogenic cause is considered. It was induced in a traumatic accident while playing football. The patient had complained of severe trismus and speech difficulties but no special organic changes were found in the oral region by clinical and radiological examinations. From investigations of family circumstances and articulation tests, it was judged that the abnormal conditions were caused by psychogenic conversion disorders. The most decisive factor was thought to be the excessive parental expectation towards him. In this case, brief psychotherapy and clinical exercise of breathing and reading based on operant method were effective.

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Danger of overlooking organic diseases and difficulty of a dentist's situation in treatment under a diagnosis of masked depression are discussed in this article. We propose the utility of introducing the concept of psychogenic overlay into the diagnosis and treatment of dental patients suspected to be depressive.

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We now report about treatment principles of temporomandibular arthrosis and 3 cases of temporomandibular arthrosis V type. Variable treatment of temporomandibular arthrosis was performed on 85 cases.
(1) Symptomatic treatment was performed on 26 cases.
(2) Treatment of the tooth (teeth) considered to be involved in the symptom and/or prevention of its recurrence was performed in 20 cases.
(3) Reversible occlusal treatment was performed on 32 cases.
(4) Nonreversible occlusal treatment was performed on 26 cases.
As to therapy results, 64 out of 85 cases showed a favorable course, while 21 cases are still under observation. Moreover the 3 cases who were diagnosed as temporomandibular arthrosis V patients and received chemotherapy as well as psychotherapy are showing a good course.
We are looking for an improvement in therapeutic results based on a firm establishment of rapport.

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We had 20 glossodynia patients (16 females and 4 males) and started the treatment by giving the guarantees against malignant tumor, explaining the normal shape of tongue, and showing our understanding and sympathy for their tongue-pain; because we thought that tongue-cancerphobia might be the cause of glossodynia.
In one group (5 females) the tongue-pain disappeared after one or two dental inspections, and in the other (10 females and 3 males), we tried brief-psychotherapy and/or drug therapy.
55 % of the total were female patients of 40-50 years, suffering tongue-pain when alone and had their hands free. On the other hand, 3 of 4 males complained that their tongue was painful during and /or after speaking;their adaptaion to society was very good.
In 13 patients, we could recognize a variety of personalities, such as depressive, asthenic, obsessive, attention seeking, infantile and nervous character through psychological interviews. Slightly obsessive patients tended to be resistant to the pain treatment. In many cases, when patients manifested their anxiety, the tongue-pain seemed to alleviate.
In 12 cases, antidepressants and minor tranquilizers were tried and showed to be effective in 3 and 8 cases, respectively.
It could be concluded that the glossodynia patients had various anxieties, and that their psychological dynamism was similar to that of hypochondriacal people. Finally, it was discussed if there was sex-difference in the way of appearance of glossodynia.

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The term liaison in liaison psychiatry means connection between patients and a medical treatment team and implies cooperation between psychiatrists and other specialists.
Recently, handling of patients in the borderline domain between dentistry and psychiatry has begun to be studied. It includes how best to refer patients from the Dentistry Department to the Psychiatry Department. However, many patients continue to refuse treatment even after being referred to the Psychiatry Department. Dentists sometimes find themselves in a situation where the patients is best treated by both departments together.
The case presented here is a woman with an obsessive-compulsive neurosis who primarily manifested maxillofacial and oral symptoms after dental trearment. This patient was referred back to the Dentistry Department from the Psychiartry Department, and eventually the symptoms significantly improved by long-term cooperation between the two departments
At the time of the first consultation the patient was 26 years old and suffered mandibular protrusion and odontoparallaxis. During dental therapy, which was initiated when she was 20 years old, an obsessive-compulsive neurosis developed secondary to her timidity and the authoritative approach of the dentist. The patient was referred to the Psychiatry Department but psychiatrists found it difficult to guide the patient in the treatment of her somatic problems. Therefore, the patient was referred to our department.
In our hospital, we formed a therapeutic term comprised of dentists from the Oral Surgery Department and the Prosthetic Department.
The following guidelines were developed, and the patient was treated accordingly:
The patient's assumption that all dentists are high-handed must be changed, and moreover patients must be trained to be treated by more than one therapist.
Patients should be treated without major surgery if they are unduly afraid, as was the patient in this case. Dental treatment should be coordinated with the Psychiatry Department by consultation and consensus. Brief psychotherapy cannot be ignored even in the Dentistry Department.
As a result, prosthesis treatment has gone well in this case, and mutual understanding and confidence has been achieved.

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Introduction: We observed the differences in the blood flow of the lingual arterial branches of healthy subjects versus patients with glossodynia, and between the healthy sides and the affected sides of patients with glossodynia using an ultrasound blood flowmeter, and basing this observation on our assumption that glossodynia was a kind of blood stagnation. Changes in lingual arterial blood flow due to acupuncture treatment were then determined as well as the degree to which pain and incompatible feelings in the tongue were reduced bases on reports from the patients.
Methods used: The blood flow in the lingual arterial branches of the tip and root of the back side of the tongue on both right and left sides were first measured in 10 healthy subjects and 4 patients with glossodynia using an ultrasound blood flowmeter. Using the obtained mean wave heights of the arterial blood flow as indexes, changes in the blood flow in the lingual arterial branches were then observed before and after acupuncture treatment of (1) the points of meridians in the legs and arms related to thetongue and of (2) the points in the shoulder and neck, (3) finger-pressure cures or massages in the shoulder and neck and (4) low-frequency.
Elecrical stimulation generated through electrodes placed on the tongue. The degree to which pain and incompatible feelings in the tongue were reduced after acupuncture or low-frequency electrical stimulation was evaluated based on the patients'verbal replies.
Results:(1) There were no differences in the blood flow of the right vs left side of the tip and root of the tongue.(2) There was a decreased blood flow (mean wave height) in the patients with glossodynia and it was lower on the painful side as compared to the healthy side.(3) The decreased blood flow in the lingual arterial branches improved to nearly the value of the healthy side after performing acupuncture, finger-pressure massage on the neck and shoulder, and low-frequency electrical stimulation on the body of the tongue.(4) The patients reported a reduction of glossodynia.

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To find the role of psychosomatic characteristics as a factor of mandibular dysfunction, personality tests given to two groups of mandibular dysfunction patients were analyzed. These patients were divided according to the following mandibular dysfunction state; the first group being patients with unstable occlusion such as interference, premature contact, infraocclusion, open bite, and cross bite. The second group being patients with normal occlusion.
1) 25. 6% of the malocclusion group and 54. 5% of the normal occlusion group belonged to region III or N of the CMI test.
2) 18. 0% of the malocclusion group and 45. 5% of the normal occlusion group belonged to type B or E of the Y-G test.
3) 15. 4% of the malocclusion group and 54. 5% of the normal occlusion group belonged to the high anxiety group.
4) 16. 2% of the malocclusion group and 27. 3% of the normal occlusion groupb elonged to the “I'm not-OK, you are not-OK” group.
These results showed personality characteristics to be one factor in the ethiology of mandibular dysfunction.

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Oral Psychosomatic disorders are in a tendency to increase by the overflow of stressors and the complexity of contemporary society, and it is not seldom to find cases difficult both to diagnose and to treat.
Realizing the need of an approach based on psychosomatic medicine for such disorders, we have been practising brief psychotherapy, autogenic training, as well as medication for more than a decade.
Here we report on administration of KakkontO, Hange KObokutO, and Kami Shoyosan as positive results were obtained for 22 halitosis patients.
3 out of 4 patients with detectable halitosis showed an symptom improvement, out of whom 2 were treated with Chinese herbal remedies alone.
10 out of 18 halitosis patients with psychogenic factors, that is, not objectively detectable, showed decreased in symptom, 3 treated with Chinese herbal remedies alone.

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This study classified 30 patients of halitosis with psychogenic factor, who terminated psychotherapy using the egogram as a tool, into four groups according to therapeutic results. The four groups were those whose complaint of halitosis disappeared as 1) cured cases and 2) improved cases, and those whose complaint did not disappear as 3) cases that did not change and 4) drop-out cases. Each case group was studied in base of their egogram characteristics and clinical observation, and it was inferred that the majority of cases of halitosis with psychogenic factor could be considered to be in a neurotic level, but that some cases could be suspected to be in the borderline level.
Moreover, some factors considered to be important in the therapy of patients with halitosis of psychogenic factors were discussed, and these were:
1) a firm therapeutic structure, 2) enough acceptance of the complaint, 3) need of interpersonal experience for which the egogram as a therapeutic tool was useful to mirror characte-ristics of human relationships both in events of daily life as well as with the therapist, and lastly 4) awareness that such characteristics are rooted in early life is desirable, especially in lighter cases.

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A discriminant function of the outpatients with psychosomatic disease seen in the clinic of our department from psychologically normal patient was obtained from the multivariate analysis of the results of a CMI questionnaire. We investigated the differences between that function and the current classification by Dr. Fukamachi and obtained the following findings:
1. Both female halitosis patients and patients with neurosis tended to make almost similar complaints in CMI as compared with psychologically normal patients.
2. Female halitosis patients had relatively stronger gastrointestinal system complaints.
3. A discriminant figure showed that in a certain interval, female halito sis patients were more inclined to complain of physical matters than patients with neuro sis.

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Alexithymia is a concept proposed by Sifneos to express psychological characteristics of some psychosomatic disorders which are different from neurosis. These psychological characteristics are:
1) distorted emotional functioning
2) distorted cognitive functioning
3) distorted object relationships
Case: As the patient, a 20 year old female nursing student, complained of coldwater pain in the left first molar lower tooth, she was given ordinary oral treatment. However as oral discomfort, anxiety and asthenia were complained at each therapy session, the Pt was referred to the author for a psychosomatic approach. Though expressing some fear of intraoral injection, the Pt was requesting prompt treatment. However, the actual treatment did not progress as weariness and difficult breathing were experienced by the patient.
Desensitization by image also proved to be difficult, thus therapy was switched to desensitization in-vivo, and according to the Pt, her discomfort varied according to her physical condition. Upon further listening it became clear that one of the factors influencing this condition was the conflicting relationship with her mother.
Moreover, it was observed that she tried to confirm the rightness of her perceptions for feeling the irrationality in some events, which indeed, were irrational. She would also talk about other events with her mother but only in a matter of fact way and emotion lessly, where normally an emotional outburst would be expected. Presently, oral treatment through in-vivo desensitization is becoming more practicable through a process of acceptance and support.
According to our experience, patients who react with discomfort at dental treatment are usually full of anxiety and express their fears of oral treatment overtly.
However, this patient had no complaints at the beginning of therapy & seemed to be a normal patient. But once starting the treatment she would overreact through ANS responses to oral treatment stressors, and the degree of such responses was influenced by events in the family, as it was later found through interviews. Those above mentioned characteristics suggest the possibility of a personality with alexithymic tendencies.

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