The purpose of this study is to clarify the relation between psychological factors and stomatognathic dysfunction. 37 patients without radiographically abnormal bone change of TMJ with stomatognathic dysfunction who had pains about TMJ masticatory muscles, head, neck, or shoulder were selected and divided into two groups. Group A was composed of 19 patients whose pains disappeared within six months from the start of treatments. Group B was composed of 18 patients whose pains did not disappear within six months from the start of treatments. The two groups were compared on the CMI test, chief complaints, symptoms, and period from occurrence of symptoms to patients visiting our hospital.
The results obtained were as follows;
1.5.3% of group A and 38.9% of group B belonged to region III or IV of the CMI test.
2. Chief complaints of group A were narrowed down to four but those of group B were many.
3. As for location of pains, 94.7% of group A and 50% of group B had TMJ pain, 63.2% of group A and 66.7% of group B had masticatory muscle pain and 21.1% of group A and 55.6% of group B had neck and/or shoulder pain.
4. The patients of group B tended to visit our hospital later than those of group A after occurrence of symptoms.

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In order to grasp a better understanding of the role of psychological stress upon mandibular dysfunction patients, a questionnaire concerning information of the individual's life events and life changes were given out. The patients were classified into 3 groups, namely those mandibular dysfunction patients with occlusal problems (Group A), mandibular dysfunction patients without occlusal problems (Group B), and those not having experienced any mandibular dysfunctions in the past (GroupC). The results were as follows;
1) The average life score in descending order was Group B>Group A>Group C, indicating that mandibular dysfunction patients experienced more psychological stress.
2) The value of this questionnaire was indicated by enabling one to easily evaluate and better understand in detail the degree of psychological stress the patient is currently undergoing.

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A questionnaire concerning life events and life changes of those patients whose psychological stress was thought to be the major cause for their mandibular dysfunction was undertaken, to determine and better understand the content and degree of their stress. The affirmative answers to the questionnaire were tabulated as their life score, and was expressed in terms of their stress index. However, it was noted that the degree of stress varied according to each question. Thus, a rating scale was developed and placed on each question to take into consideration the influence upon the individual in relation to the various occurrences. Results showed the degree of psychological stress of the mandibular dysfunction patients to be different when comparing the outcome from the new rating scale to that of the conventional method. Thus, a better understanding and accuracy of the degree of psychological stress may be obtained with the addition of applying the new rating scale to the life score value.

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This study evaluated nonspecific psychosomatic factors influencing masticatory performance. The patient population consisted of 60 males and 60 females, each with normal dentation, functionally normal occlusion, a healthy periodontum, and without temporomandibular joint dysfunction. The mean age of the males was 25.5±3.8 years (S. D.) and that of the females was 27.1±4.9 years.
Masticatory performanoe was assessed on the basis of the degree of pulverization of a test material when chewed. The test material was 5.0gm of ATP particle. The material was chewed 50 times and then pulverization was measured by absorbance.
The following results were obtained:
1. The mean value of masticatory performance was 1.12±0.33 Abs in males and 0.86±0.29 Abs in females. Statistical analysis by t-test showed the males masticatory performance to be significantly higher (p<0.05) than that of the females.
2. The masticatory performance significantly was higher in: 1) individuals with strong desire for mastication, 2) individuals who enjoy the taste of food, 3) individuals with a strict lifelong tooth brushing habit and 4) individuals who are more patient than the control group. The masticatory performance was also higher in: 1) individuals in the habit of chewing sufficiently, 2) individuals who enjoy solid foods, 3) individuals who notice the aroma of the food, 4) individuals with good oral hygiene habits, and 5) individuals in good health. Masticatory performance was significantly lower than in the control group. However in: 1) individuals incapable of controlling their own health and 2) individuals who tend to suffer from abdominal discomfort after overeating. Groups with a tendency towards values not achieving statistical significance were noted in: 1) those with a habit of incomplete chewing, 2) those who prefer soft foods, and 3) those with a propensity for gastrointestinal disturbances in response to environmental changes.
3. Over the course of five observations within one week, masticatory performance was seen to gradually improve. The results at the fifth measurement revealed an improvement of 32% in males and 35% in females. This suggests a learned effect.
It can be concluded that psychosomatic factors such as patterns of daily life, general health, personality, and learned patterns of mastication can influence masticatory performance.

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Temporomandibular arthrosis was found in 236 (5. 7%) of 4120 patients who consulted the Oral Surgery Clinic of Tokyo Medical College Hospital during a year. Through interviews, psychological tests, radiographic studies of the temporomandibular joint, and tests on the status of occlusion and masticatory function, 14 of these 236 patients were found to have psychosomatic problems.
Based on the principles of psychosomatic medicine, these 14 patients were further divided into two groups, those with so-called psychosomatic disorders and those with neuroses. The degree to which the psychogenic factors contributed to the development of disease was further evaluated through use of the CPI-test and the information obtained was used to guide future therapy. Favorable results were obtained with this therapy.

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The records of five oral cancer cases that committed suicide were studied psychosomatically. 4 were diagnosed as S. C. C. histologically and treated by oral surgeons and radiologists between 1959-1980 at the Uni. Hospital of Tokyo Medical and Dental University by Shimizu and others, and the remaining case was treated at a cancer center in Japan and the case history was examined for this study from the book written by the patient herself.
The first case was a 50-year-old female with cancer of the upper left gum T4N1M0, which was treated with radiotherapy. Just one year later after the radiation, she committed suicide by jumping into a river, because of jaw pains due to tumor remains.
The 2nd case was a 53-year-old male with cancer of the right cheek mucous membrane T3N2bM0, which was first treated with bleomycin, then with radiotherapy for 1. 5 years. After finishing radiotherapy successfully, the patient killed himself by hanging in the hospital due to the pain, although the tumor had clinically disappeared.
The 3rd case was a 48-year-old female with cancer on the left side of the tongue T3NOMO. She was treated with interstitial radon seed radiation with success. After discharge from the hospital, she committed suicide by hanging herself at home afler complaining of pain and anxiety.
The 4th case was a 55-year-old male with cancer on the right side of the tongue T3NlaMo. He was referred to the tumor conference, where the treating plan was decided to be radiotherapy. Before admission to the hospital, he killed himself by jumping into the Pacific Ocean from a ferryboat because he became pessimistic about the planned radiotherapy.
The 5th case was a 59-year-old female novelist. She suffered from cancer on the right floor of the mouth and visited a cancer center, where a surgeon examined her and excised the tumor as a benign lesion. After that she was referred to the radiological department. The result of the radiotherapy was effective, but she thought her tumor would not disappear and hung herself at home due to severe mouth pain and great depression over the imagined future course of the tumor following the first failure of diagnosis and treatment.
As causes of suicide by the patients with oral cancer, the side effect of pain during and after radio-therapy was pointed out at first, then the anxiety of the disease as cancer and distrust of the doctor played very important roles. For the future it should be stressed that we must not ignore these points as we examine and treat oral cancer patients.

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Two mandibular fracture patients visited our clinic near the same time. One (hereafter referred to as “A”) was diagnosed as having a subcondylar fracture. The other (“B”) was diagnosed as having a mandibular body fracture. A was treated with intermaxillary anchorage apparatus, whereas B was not. As days passed, A exhibited symptoms of depression, while B did not. It is suspected that the discomfort brought on by the intermaxillary anchorage apparatus was the cause of the depression. Therefore, A was given various psychotherapies as postoperative care.
Psychotherapies used:
I. Breathing (Modified abdominal breathing)
II. Relaxation
1. Autogenic training ; Formula I & II
2. Jacobson's Progressive Relaxation Method (Wolpe's Modified Method)
III. Cautela's Covert Positive Reinforcement
IV. Hypnosis

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Clinical statistics were made about 77 patients (12 males and 65 females) treated with psychotropic drugs in our department during the period from January, 1983 to December, 1989. The results obtained were as follows;
1. Patients in their 50's were the most common in both males and females. Three of the males and 20 of the females fell within this age group. The most frequent patient complaint was pain, accounting for 59 cases (77%). The most frequent pain was glossodynia, which was found in 50 cases (65%). The treatment period in our clinic after symptom of onset was for at least six months in 43 cases (55%). The average patient had visited three other medical institutions prior to coming to our department.
2. Anti-anxiety drugs were administered in 53 cases, antidepressants in 6, and a combination of these two drugs to 17. One case received an antipsychotic drug. The mean dose of the anti-anxiety drug was 1-2mg daily and that of the antidepressant was 10mg daily. The period of administration was less than three months in 80% of the cases.
3. Thirty cases (41%) experienced excellent results, 26 (36%) experienced good results, and 17 (23%) experienced no effect. Treatment was discontinued at midpoint in 4 cases. In as much as 77% of the cases experienced a beneficial result, administration of psychotropic agents to psychosomatic dental patients complaining of dental and oral surgical symptoms appears to be useful.

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This paper describes the care of self halitosis patients using a previously reported method. We would like to report the results of the completed questionnaires obtained from 24 patients in our department who were diagnosed as having self halitosis as well as to briefly, discuss their psychotherapy. Additionally, we report a self halitosis case and a psychotic patient who tried to kill himself.

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Patients complaining of halitosis are on the increase in recent years in our department. We have treated these patients for more than a decade and are now reviewing our approarch.We established the first step of this approach a diagnosis of organic halitosis (Tashusho) and psychogenic halitosis (Jishusho) for which we made through physiological examination in which an organic base in one case was found.On the other hand, an extension in the range of delusions of reference in the case of psychogenic halitosis is an index for referral psychiatry.
Regardless of the nature of halitosis, namely whether it has an organic or a psychogenic basis, the patient dose suffer by not knowing it's cause, therefore, it becomes important to understand his complaint.It is then that the patient is given psychotherapy, autogenic training, or behavior therapy according to his need.

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Patients of psychogenic halitosis were classified into six groups according to existence of delusions of reference, degree of attachment to a specific organ for its etiology, and level of social adaptation. These three parameters were extracted from interviews and test batteries.
The percentage of patients classified in group I was 21.1%, in group II: 14.4%, in group III: 23.9%, in group IV: 18.9%, in group V: 19.4%, and in group VI 2.2%.
Therapy approaches to these patients ranged from administration of oral deodorizers and/or tranquilizers to autogenic training, behavior therapy and psychodynamic psychotherapy after initial interviews.
Among the patients, although few in number, are those considered to be borderline were referred to psychiatry.
We stand on a holistic view for the treatment of patients with psychogenic halitosis, where the function, the relative weight and the interplay of somatic and psychological factors are thought to play an important rol.

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We discussed the clinical features and psychotherapy process of a female patient with psychogenic halitosis, and the following points were concluded:
1) the existence of a psychogenic factor along an organic basis for halitosis in this patient.
2) diagnosis of borderline personality organization as manifested especially through a temporary but obvious decrease in reality orientation.
3) no major acting-out was observed during the therapy period due to a firm therapy structure and supportive psychotherapy aiming only at the level of social adaptation without touching deeper personality layers.

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We have discussed the theme of referral to psychiatry concerning a 17-yr old female patient complaining of halitosis. The clinical features of the case fulfilled the diagnostic criteria of Yamashita's typical fear of interpersonal relationships and was considered to be within the neurotic level.
However as therapy relationships became closer, several factors led to the conclusion that this case deviated from the neurotic level and thus was referred to psychiatry.
Some problems arise when treating halitosis patients in the department of oral surgery, the first is when the clinical features of the patient are not enough as to decide personality level, thus at times resulting in delayed referral to psychiatry.
Another problem arises when the patient is strongly attached to a physical etiology of the symptom, therefore resisting referral to psychiatry.
At present, a liasion-consultation system with psychiatry seems to be absolutely needed.

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