We have been conducting mass screening for oral cancer at the Department of Oral Surgery, Medical School, Kurume University since 1982. Analysis of the results revealed that many middle-aged and elderly females had close relatives who died of cancer. Thus, we conducted mass screening using questionnaires compiled by our department for the purpose of compiling background information of the examiness, and studied the analytic results and usefulness of the questionnaire.
The subjects consisted of 355 persons who lived in 4 areas of the Southern part of Fukuoka Prefecture in 1990, who underwent mass screening for oral cancer which were conducted twice a year. First, the examinees filled out the questionnaires, a medical history was taken, and then a physical examination was carried out.
Many subjects were unemployed females whose ages ranged from 50 to younger than 70 years. Gynecological diseases were conspicuous among the findings in the medical history (16%). 62% of the examinees had close relatives who had cancer, and 72% of the examinees regularly received mass screening regularly underwent for cancer at site other than the oral cavity. More examinees were examined because of inconsistent complaints rather than for the specific purpose of cancer detection. Inconsistent complaints which were not limited to the oral cavity were seen in many subjects who exhibited neurotic tendercies. Organic complaints consisted mainly of diseases of the teeth or oral mucosa, indicating that there might be problems in the referral procedures used by dentists in general practice. No case of oral cancer was detected.
The above results showed that many examinees had neurotic tendencies and needed psychosomatic medical consideration. Therefore, further studies will be necessary to investigate how to shorten the screening time for this population of examinees.

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Fourteen patients underwent minor oral operation and combined psychotherapy. Age distribution (15-85 years). 7 males. 7 females. 5 radicular cysts. 1 dentigerous cyst. 1 impacted tooth. 1 postoperative maxillary cyst. 1 mouth floor inflammation. 1 chronic maxillar osteomyelitis. 4 mandibular fractures (2 subcondylar fractures, 1 body fracture, 1 alveolar fracture).
Applied intention:
A. As preanesthetic medication
B. As anesthetic aid
C. 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)
3. Yoga 'Sava Asana
III. Behavior therapy (Modified Cautela's Covert Positive Reinforcement)
IV. Hypnosis

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Through evaluation of 123 dental patients with schizophrenia, it was shown that 31% of them complained of pain, 18% complained discontent with their denture, while 15% had no chief complaint. Almost half of the diagnoses concerned to teeth and periodontal disease, such as periodontitis or gingivitis, pulpitis, dental caries followed by fracture of dentures and maladaptation of dentures. There was one case of tongue cancer.
In the treatment of these cases, problems were experienced in 48%. Insufficient communication and accessibility was found in 20 cases, and strong anxiety in 20, false confidence in six, and self centered behavior in six.
The dental treatment was completed in 80% of patients. It was terminated in 18 cases (15%), due to problems in the doctor-patient relationship or strong anxiety on the post of the patient.
This evaluation suggested that in the dental treatment of schizophrenic patients the dentist should consider holistic management based on careful comprehension of the patient's complaints. In addition, continuous treatment based on sufficient informed consent and a good doctor-patient relationship are important.

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We distributed the “Questionnaire for halitosis” to 100 halitosis patients who visited our clinic. We compared and analyzed the results of the questionnaire between two types of halitosis, self halitosis patients (dental psychosomatic disease without bad breath) and real halitosis patients with bad breath.
Some differences were revealed between the two, such as age, treatment experience, brushing time, oral symptoms, and daily disturbance because of halitosis. It was also revealed that all the halitosis patients had some grade of psycholosical problems.
It was concluded that to treat any kind of halitosis patients, not only the dental treatment but also the psychosomatic approach was necessary.

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Many temporomandibular dysfunction patients do not have the proper occlusal position. This can be caused by simple mechanical problems but may also be psychosomatic in origin. When treating such patients, it is important to make them recognize the stable occlusal position which agrees best with balanced muscle physiology. The present study aimed at delineating the most suitable EMG feedback technique for these patients. Both the temporal and masseter muscles were studied to determine whether subjects could learn to respond to shifts in occlusal position.
Fourteen subjects with normal occlusion were instructed to perform submaximal clenching maintaining equal activities between the right and left muscles for 30 seconds with a portable electromyographic monitoring (MBM). Then asymmetry indices (AI) were calculated for each muscle.
In this feedback training it was shown that the masseter and temporal muscles did not behave similarly. After a number of training sessions, for the masseter muscle, the mean value of AI approached zero. However interindividual variation remained despite training. On the other hand, for the temporal muscle, in addition to the mean value of AI approaching zero, intersubject variation also declined with training. Furthermore, in the case of the temporal muscle, the efficiency of feedback training increased with time. The authors concluded that this feedback training method for the temporal muscle may be the useful. It may well help patients to become more aware of stable occlusal position and assist them in learning to maintain an appropriate level of muscle tension.

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In order to effectively relax the masticatory muscles through EMG biofeedback training (BFT) of the frontal muscle in cases with craniomandibular disorders, it is necessary to investigate the training terms of this training.
Data were obtained from 16 healthy adults (8 males and females) who underwent a 3-day training trial of auditory BFT using an EMG biofeedback instrument that consisted of 2 min. of rest and 10 min. of BFT on the frontal muscle. Furthermore, non-BFT data which included pre-BFT, post-BFT and follow-up values were also recorded.
To evaluate changes of body response, data including EMG activity of the respective muscles (frontal, temporal, masseter, sternocleidomastoid), electrocardiogram, plethysmogram and pneumogram were obtained and analyzed.
One session, excluding the 1 min. rest period was divided into 11 equal one-minute segments.
The EMG activity increased during the first minute, but then showed a relaxation effects the following 3-7 minutes, indicating that the adequate range for the BFT trial is around 7 minutes.
Autonomic response based on feedback signals showed that ANS was hardly affected, indicating that feedback information was adequate.
The post-BFT and follow-up values of frontal, temporal and masseter muscles showed approximate changes of EMG activity during BFT, indicating that a learned effect took place.
The effect of muscle relaxation upon the sternocleidomastoid muscle was not observed.

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Many dental patients, when feel anxiety, fear or strain during treatment. This fact increases their sympathetic nerve activities and also amplifies their endocrine system functions. We investigated depressive effects of both autogenic training (AT) and antianxietic drugs for sympathetic nerve activity functions, and compared these two methods based on the values of plasma glucose and free fatty acid (FFA). Volunteers, consisting of 38 males ranging in age from 23 to 28 were divided into three groups as follows AT group (15 males); antianxiety drug group (11 males); and the control group (12 males) Lying on dental chairs, all volunteers were injected with 0.3m1 physiological saline in the upper right side of the premolar oral mucosa.
Before this step, the following pretreatments were performed: The AT group volunteers were given AT guidance once a week by three psychologists. We confirmed that they learned AT up to the level of Second Standard Exercise confirmation was performed based on introspective and indications comments of the volunteers and by a biotrainer (OG-Giken Co., Tokyo). The antianxiety drug group lorazepam (received 0.5mg) 60 minutes before injection. After injection, mean plasma glucose values in the antianxiety drug group were lower than those of the AT group and the control group. Before and after injection, mean FFA values in the AT group were lower than in the antianxietic drug group and control group. In particular, after the injection there was statistical significance (P<0.05) between the AT group and the after two groups. In this study, plasma glucose and FFA were lower in the AT group after the injection, suggesting that increase in sympathetic nerve activity due to dental treatment can also be inhibited through AT.

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It is said that EMG biofeedback training of the frontal muscle (BFT) has the ability to create an antagonistic effect against stress. To better understand this relationship, the effects of psychological stress on physiological responses were studied using experimentally induced stress.
Subjects, consisting of 16 adults with no craniomandibular disorders or autonomic nervous system abnormalities were studied and asked to go through two sessions, namely one with no biofeedback training (Pre-BFT) and another after having gone through biofeedback training (Post-BFT). The training consisted of a 2 min rest period, followed by 2 min of arithmetic memorization (i. e. stress period). In the Post-BFT session, the subjects were asked to relax their frontal muscle during the stress period. During the entire session, the pneumogram, electrocardiogram, plethysmogram, and the electromyogram of the facial - neck muscles (frontal, temporal, masseter, sternocleidomastoid) were recorded.
Results showed an elevated autonomic response and stimulation of the sympathetic nervous system in the Pre-BFT. Muscle activities also showed an increase in EMG activity for all 4 muscles.
Post-BFT showed similar autonomic response to that of Pre-BFT and since the activities of the frontal, temporal, and masseter muscles during the stress period were similar to that of the rest period, it was thought that BFT was able to lighten some of the stress load. However, the muscle activity controlled by BFT does not affect the autonomic responses.

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This paper describes the care of case of self-perceived halitosis using a previously reported method. The results of completed questionnaires obtained from 50 patients in our clinic who were diagnosed as having self halitosis as well are presented with a discussion of brief psychotherapy. Additionally, a case of self halitosis who was checked by the Y-G and CMI psychological questionnaires is discussed.

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The author examined increases in blood catecholamine concentrations and circulatory aspects under conditions of local oral anesthesia, pain and emotional stress.
Subjects consisted of 16 healthy adults. Local anesthesia consisted of 1.8 ml of either 2% lidocaine or 2% lidocaine containing 1/80, 000 epinephrine injected into the gingivobuccal fold of the maxillary premolar and palatum for 2 minutes. The pain stimulus was induced by injection of 1 ml of physiological saline solution into the gingivobuccal fold of the maxillary premolar for 1 minute. The emotional stress was given by using an unfunctional electrical pulp tester to the subject for 1 minute. Serum concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA) were measured before anesthesia and stress and 0, 1, 3, 5, 10, 20 and 30 minutes after completion of anesthesia and stress, using the radioenzymatic assay. Blood pressure, heart rate, rate pressure product (RPP), and fingertip plethysmogram were measured simultaneously.
1. At the time of infiltrative anesthesia with the 2% lidocaine containing E, the blood levels of E, NE and DA all showed significant increase and peaked after 1 minute of anesthesia gradually decreasing thereafter. However, blood E concentration alone had not returned to normal resting values 30 minutes later.
2. When performing anesthesia with 2% lidocaine, the blood DA concentration showed significant increase at 1 minute after anesthesia, reaching a peak at 1-3 minutes after anesthesia.
3. When applying pain stress, blood concentrations of NE and DA showed significant increases and peaked at 1 minute of stress.
4. When applying emotional stress, the blood concentrations of E, NE and DA showed significant increases and peaked at 1 minute after the stress.
5. When using infiltrative anesthesia employing 2% lidocaine containing E, the heart rate and the RPP increased but plethysmogram wave height decreased.
6. The RPP increased using 2% lidocaine infiltrative anesthesia but the diastolic blood pressure and plethysmogram wave height.
7. Systolic blood pressure and plethysmogram wave height decreased under stress pain.
8. The heart rate increased at the beginning of the emotional stress but plethysmogram wave height decreased.
The above results showed changes in the blood concentrations of E, NE and DA upon application of emotional stress. However, when infiltrative anesthesia was performed with lidocaine containing E, the blood E concentration reached levels 5.7 times that of pre-experimental resting time values within 1 minute, and even after 30 minutes the levels were still high, being 1.8 times as high as pre-experimental resting stage. Consequently, when performing dental treatment or oral surgery in cases in which the underlying disease involves cardiovascular and circulatory disorders or endocrine abnormalities, it is extremely important to obtain a mentally calm state to control increased secretion of endogenous catecholamine and also to select a local anesthesia with vasopresser effects.

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In recent years, simple physiological diseases have decreased.On the other hand, more complicated disorders with no clear ethiology or those implicating psychological factors are on the increase.
We have taken a psychosomatic approach for these patients during the past twenty years, and have been doing research as well.
In the present study, we have considered the recent tendency of psychosomatic patients of the oral region from vital statistics and pathology as welll as yearly changes of the past ten years.
Although psychosomatic patients in the strict sense were few, cases with physiological ethiology but psychological factors intervening in the course and prognosis of the disease, and those normally called neurotics but with physical symptoms mainly, in other words those psychosomatic patients in the broader sense represented a great majority.

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We studied the efficacy of etizolam (Depas^®) in 20 patients diagnosed as having glossodynia at the Department of Oral Surgery of Nagano Red Cross Hospital between February 1989 and January 1991.
To investigate the effects of this drug, we monitored 13 physical symptoms, 10 oral cavity symptoms, and four psychological symptoms. The CMI, Y-G, MAS and SRQ-D psychological tests were performed before and after administration to determine the psychological background of the subjects and any changes due to drug therapy.
There was a high efficacy rate of 94.1% for the overall improvement of symptoms. Most of the symptoms investigated showed a statistically significant improvement. Psychological testing showed a high incidence of neurotic tendency, emotional instability, and anxiety in the subjects. Side effects were noted in three out of 20 patients, but they were all mild and disappeared when administration was stopped.
These results suggest that etizolam is useful for the treatment of glossodynia.

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