A 28-year-old male schizophrenic patient was referred to our division for examination of a dental focus of pustolosis palmaris et plantaris (PPP) by a psychiatrist in August. His palms and soles were covered with skin lesions resistant to dermatological treatment. He had fourteen deeply decayed and seven missing teeth. He had almost no occlusion. The Xray photo showed many apical lesions. During examination, he was speechless due to his schizophrenia.
With his consent, three lower molar tooth with apical lesions were extracted. Several days later, the skin lesions began to improve. As extraction and root canal treatment of other teeth followed, skin lesions rapidly diminished. A close relationship between PPP and dental foci was suggested.
At the beginning of treatment, he did not want any prosthesis. In October, he accepted denture treatment. Proceeding with treatment, his difficulty of communication remarkably improved. In December, his prosthetic treatment was completed to his great pleasure.
The problems in the dental treatment of this case were summed up into three points; insufficient communication, strong anxiety, and false belief. The authors paid great attention to developing a receptive attitude, informed consent, steady pace of treatment, and minimum pain in the management of this case.

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A 50-year-old woman complained of pain in the left upper lateral incisor apex. A broken reamer and abnormal shadow in the apex of her lateral incisor was recognized roentgenologically.
The pain in the root apex subsided soon after apicoectomy. In spite of a subsequent favorable course, she complained of a violent headache and left facial pain 10 days after the operation, but for no known cause. Suspecting a mental disorder, we referred herfor psychiatric treatment during which she made gradual recovery from depressive psychosis as a result of medication and brief psychotherapy.
It is neceesary to consider a holistic medical approach based on a good doctor-patient relationship for the examination and treatment of psychosomatic patients whith oral problems. Psychiatric consultation is necessary for patients with psychosomatic symptoms.

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The purpose of this study was to evaluate the health of students who do not eat breakfast and compare it to the health of students who do. The munber of students who do not eat breakfast was determined among 1101 male and female students from all schoolyears of the Matsubase High School in the southern part of Kumamoto Prefecture in June 1990. A questionnaire was used to evaluate the food intake and chewing habits of the subjects. The questionnaire explored six areas: 1) teeth, 2) chewing habits, 3) meal patterns, 4) history of growth and development, 5) life style, 6) general health status. Differences which were statistically significant were emphasized to compare the general health status between students who eat breakfast and those who do not.
1. Number of students who do not eat breakfast
1) 41 boys (11.7%) and 38 girls (5.2%) reported that they do not eat breakfast. The higher number of boys not eating breakfast was statistically significant (p< 0.01).
2) The number of students who do not eat breakfast, by school year, were: 11 boys (7.9%) and 11 girls (4.7%) in the first year of high school, 16 boys (15.1%) and 18 girls (6.7%) in the second year, and 14 boys (13.2%) and 9 girls (3.7%) in the third year. The greatest frequency for both girls and boys occurred in the second year of high school.
2. General health status
Compared to students who eat breakfast, those who do not reported greater incidence of: 1) dental disorders, 2) inadequate chewing habits or snacking habits, 3) strict upbringing during childhood, 4) irregular life style charcterized by insufficient sleep and poor oral hygiene, 5) various nonspecific complaints including problems with their digestive systems.
The results of this study indicate that the habit of eating a good breakfast is an important influence on the general health of the students.

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In patients with chronic recurrent aphthous stomatitis a chinese herbal medicine (Unsei-in, Tsumura) was administered. The subjects consisted of 1 male and 5 female with ages ranging form 23 to 56 years. The disease had appeared continuously in 4 cases and once for 1 to 2 months in 2 cases. The duration form onset of disease to visiting our department was 3 years or more in 4 cases, 1 to 2 years in 1 case and within 6 months in 1 case. Nocase showed any anomalies in laboratory findings. Psychological tests revealed dispositions towards neurosis, autonomic imbalance and depression. Unsei-in was administered alone 2 cases and in combination with an and anxieatic agent (Lorazepam) and autonomic activator (γ-Orizanol) in 1 case. These drugs were administered for 2 to 15 months. Concerning the therapeutic results, 3 cases were evaluated as “complete healing”. Despite relief symptoms, the medication was halted in 1 other case. Another case showed a tendency to improve but was referred to the psychosomatic medicine clinic due to severe depression. In conclusion, the administration of Unsei-in in patients with chronic recurrent aphthous stomatitis was effective in 5 of 6 cases examined.

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We have introduced the therapeutic key words “Good myself” “Bad myself” into the treatment of an odontophobia patient who was diagnosed as suffering from panic disorder by a psychiatrist.
Dr. Ken Fukamachi named the ambivalent feeling in eating disorder patients as “Good myself” “Bad myself”. These key words were also very useful in the treatment of this case.
A 45-year-old female, complaining of toothache and odontophobia, was hospitalized for 99 days in our ward to improve her panic disorder through psychotherapy and extract her decayed teeth. She had avoided dental treatment because of fear of panic attack for 23 years. She went to a dentist only when she had an unbearable toothache.
At first, we listened to her carefully, then asked her, “Is there bad yourself tempting you to a panic attack?”. She said, “Yes, there is. And there is another myself, who is encouraging me to undergo medical treatment.”
Since then, we have interpreted her ambivalent feelings or behavior with these therapeutic key words. The patient herself also began to use these expressions in her “description of impressions”. Step by step, she come to be able to cope with fear by herself. Finally she was able to undergo the extraction of her decayed teeth.
It can be concluded that the therapeutic key words “Good myself” “Bad myself” may be effective in the treatment of odontophobia due to panic disorder.

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A 49-year old female patient suffered loss of consciousness following local anesthesia 15 previously. Frequent headaches and vomiting continued for a period following extraction of all 3rd molar teeth under sedation 10 years previously.
The patient was referred to our department because of the above-mentioned history by a practitioner to whom she went complaining of discomfort. She had been under treatment for angina pectoris from 7 to 8 years previously and suffered a light attack of angina in May, 1989.
The patient exhibited breathing difficulties, dizziness, increase in blood pressure and pulse, and complained of headache immediately after a subcutaneous injection of 0.5% xylocain^®, however no relation to angina was found by medical examinations. Results of allergy tests in the department of dermatology suggested that only the use of 1% carbocain^® was permissible (xylocain^® and procaine^® were not tested due to an antecedent of anaphylactic shock). However the same symptoms were observed using 1% carbocain^®. Under resumption of allergy tests to carbocain^® and xylocain^®, although slight increases in pulse were observed, not only administration but also gradual increase in concentration and dose became possible. This condition allowed the extraction of 7. However each treatment required considerabletime as the abovementioned symptoms occurred immediately after each administration of local anesthesia, and despite the distressed facial expression of the patient, only a slight increase in physiological responses was observed. The same condition was observed under 30% nitrous oxide sedation, yet the patient demanded a prompt ending of treatment. The observed inconsistencies, along with clinical observations from interviews and results of the Rorschach Test suggested a conversion disorder behind these symptoms.

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We report a case study of gingival pain patient who had undergone dental treatment, but still suffered from a stabbing pain in the right mandiblar gingiva, for the first couple of minutes at mealtime.
The patient was a 62-year-old retired male. He seemed somewhat obsessive but was not depressed or anxious.
With administration of the Kanpo herbal drug, called Keishikajutsubu-to, resulted in the stabbing pain changing to a sense of gingival discomfort. Nine weeks after beginning the medication, the patient felt a more unpleasant gingival sensation together with a feeling of anxiety that his teeth were not being treated. Dental treatment was restarted. During dental treatment, the patient showed progressive improvement in the clinical symptom. However the pain returned severely toward the end of dental treatment. We presented the Kanpo herbal drug Hangekoboku-to, for anxiety, because we thought the patient was reminded of his feeling of anxiety as he reached retirement. Symptons had improved 4 weeks after beginning that medication. For a follow-up period of 3 months, the patient was free of pain and did not reveal any clinical symptom.
We concluded that this case suffered from gingival pain as a defense mechanism in response to his anxiety about retirement.

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Oral malaise in one of the most treatment-resistant stats in oral complaint because there are no apparent physical findings in the oral region that appear to be responsible for the symptoms. In the present study, we focused on the fact that six patients who complained of severe oral malaise had previously undergone hysterectomy. To elucidate the relationship between oral malaise and hysterectomy, we analyzed these patients using a bio-psycho-socioethical approach. They were all older than 40 years old and complained of typical symptoms of climacteric disorders with severe oral malaise. We treated them with wholeperson psychosomatic therapy and found it to be effective in those patients. More information about the physical and psychological characteristics of such patients is necessary to understand the mechanisms of onset of oral malaise in patients who have undergone hysterectomy.

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‹Case Report› A 47-year-old housewife had had attacks of consciousness loss towards dawn for 20 years, and for which she had been under treatment with massive doses of anticonvulsants (phenytoin 3, 000 mg, phenobarbital 1, 000 mg, sodium benzoate 2, 000 mg, and carbamazepine 800 mg/day) under a diagnosis of epilepsy at the department of neurology at another institution. One year previously, she began to have oral cavity complaints such as “moving teeth” after she received treatment for dental caries by a local dentist. Since then, various symptoms including a heavy feeling of the head, reduction in thinking ability, finger tip numbness and general malaise appeared, for which she was introduced to the out-patient clinic of our department.
At the initial examination, no abnormalities or pathological conditions were found in formation of her teeth, with no abnormal growth of the gingiva. However, she was found to have hypotension (90/60 mmHg) and pronounced intracellular fluid retention. The patient's condition was understood from the standpoint of a dental psychosomatic medical approach and problems of her condition were diagnosed. Detailed explanations were given to the patient repeatedly. Instead of anticonvulsants she has been receiving low dose of a minor tranguilizer (bromazepam 6 mg/day), a circulation-promoting agent (CoQ₁₀, etc) and Oriental herbal medicine (Sairei-to extract 9.0 g/day) were administered, with gradual decrease in symptoms such as general malaise and numbness. Her complaints of the oral cavity disappeared almost completely in about one month. Subsequently, the dose level of anticonvulsants was decreased gradually. Presently, she is well controlled with about one half of the initial dose levels of anticonvulsants (phenytoin 1, 200 mg, phenobarbital 1, 000 mg, sodium benzoate 2, 000 mg and carbamazepine 200 mg/day).
With Oriental Medicinal practices, it is frequently that intracellular fluid retention and Oketsu syndrome are found in patients with oral cavity complaints. We consider it important to take the comprehensive approach that these patients should be assessed both from local aspects, the oral cavity, and from the general aspects of the disease entity.

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Recently, number of psychosomatic patients and neurotic patients complaining of oral problems have been increasing. Psychosomatic disease (PSD) and neurosis are sometimes confused, but the etiology and pathological physiology are quite different. Therefone much care is necesary to make a differential diagnosis. One very important point is that in psychosomatic patients they have a tendency to make adequate adaptation or over-adaptation to their social condition, whereas neurotic patients can show maladaptation. In psychosomatic patients, the problem involves their own intrapersonal communication of their bio-psychosocio-existential condition. Therefore, for problem solving, they must have the awareness of their own intrapersonal communication. But in neurotic patients, the problem is not in the sphere of biological condition, but in their own prejudiced ideas. Inability set themselves free from their prejudice causes maladaptation to social circumstances. For suffricent care of their cures, the growing model should be introduced and as the dependency on the doctor is high, the doctor-patient relationship is extremely improtant. Fully informed consent and contracts concerning treatment should be obtained. In pseudo-neurotic patients, the problem exists in their biological condition, but it can be overlooked, and they are regarded as neurotic patients. To make a differential diagnosis, the following items require special consideration.
1) functional diseases (unorganized diseases), 2) orthostatic dysregulation, orthostatic hypotension, hypotensive syndrome, 3) anemia, 4) latent congestive heart failure, 5) otorhinolaryngological diseases, 6) hypothyroidism, 7) diabetes mellitus, 8) Oketsu syndrome (blood stasis) or Suidoku syndrome (intercellar fluid retention), 9) depressive condition, 10) dementia, 11) long-temn and high dose usage of major or minor tranquilizers, anti-convulsants, analgesics, β- bloker, anti-arteriosclerotic agents.

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