The symptom of complaining of abnormal sensation in various parts of the body using curious expressions is called cenesthopathia. A case of oral cenesthopathia following tooth extraction is reported. The patient was a 63-year-old woman. In spite of having no objective abnormal findings of the oral cavity on extracting 78, she complained that the hollow of the alveolar bone after extracting teeth was swollen and had become red and that something felt as if it was moving, and that the nerve of the oral cavity was standing on end, and that the liquid around the nerve of the tooth seemed to flow into next tooth, etc. Though she visited many oral surgical departments and dental offices, the symptoms did not improve. When she treated, she had abnormal sensations. As she had strong anxiety because of the symptoms, she visited the psychiatric department after persuasion by her family despite her previous rejection of psychiatric treatment. Medical examination ruled out depression, schizophrenia, and dementia. Head CT scan showed no abnomalities. The value of TIQ of WAIS-R was 109. As she had no problems except abnomal sensation of the oral cavity, she was diagnosed as oral cenesthopathia. She was treated by oral adminstration of haloperidol and diazepam. Her symptoms improved after a few weeks, but some symptoms remained. This case emphasized the importance of liaison psychiatry in oral diseases and the cooperation of psychiatry and dentistry. The appearence of abnormal oral cavity sensations was discussed from the viewpoint of the characteristics of oral cavity and the special feature of dental treatment.

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In 1989, a 23-year-old man was referred to the author by his psychiatrist, complaining of severe nausea and fear of dental treatment. He was diagnosed as a case of dental phobia and treated with a combination of desensitization technique and autogenic training. Six months later, he underwent extraction of his upper molar teeth without gagging. But 5 months later, he had a relapse of dental phobia and could not accept any dental treatment at all. He could not clarify the object of his fear during dental treatment.
Because behavioral therapy only had limitations, an interview was held in a supportive atmosphere. This revealed that he had escaped from situations of his conflict by complaining of nausea. He could not reject verbally what he would not like to accept in his word, but expressed it by complaining of nausea. After this insight, he became able to accept various dental treatments without nausea, including full mouth impression, preparation and extraction of teeth. Almost four years after his first visit, his dental treatment finally ended successfully.
This case might be diagnosed as panic disorder, taking account of his symptoms which were considered to be a panic attack. This case suggests necessity of further evaluation of the concepts and criteria of dental phobia.

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Conversion reaction (conversion hysteria) is sometimes found as oro-maxillary syndrome, such as maladaptation of denture, mandibular arthritis, xerostomia, glossalgia, trismus or cervicobrachial symptoms. These reactions are presumed to be psychogenic in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships and are present in otherwise physically and neurologically healthy subjects.
The authors present a clinical case that is considered to be due to the tragic life-experiences of the patient. Patient: Woman, 40 years. First examination: December, 1991. Chief complaint: Difficult chewing of hard foods and insufficient salivation. History of symptoms: Following the placement of bridges in the upper and lower jaw in August 1991, temporomandibular arthalgia, difficulty with chewing and insufficient salivation appeared and remained since.
The patient visited the Department of Internal Medicine in November 1991. In order to check whether the patient suffered from the Sjögren syndrome, the patient underwent CT-and MRI-scanning: no abnormalities were found. Subsequently, the patient requested therapeutic treatment in the dental clinic of the first author of this case-report, K. I.
Her tragic life-experiences formed the basis for our hypothesis that the symptoms had a psychogenic origin. She had an extremely obstinate father, with whom she could not communicate since her infancy. She was fully bound to her mother, who directed her whole life. Furthermore, she was completely dependent on her mother. For instance, the patient who was older than fourty years, was still accompanied by her mother during the many visits made to the dental clinic in the first two years. In addition, she was divorced. Remarkably, whereas her husband informed us that this was due to problems which he had with her character, she simply denied it: instead, she ascribed her divorce to her sterility caused by amenorrhea. Apparently, she could not cope with that situation. The following supports our hypothesis.
As soon as the patient had received a maxillary splint (K. I.), the temporomandibular arthralgia started to disappear within two weeks, and her insufficient salivation became normal within two months. This unusually rapid recovery from her symptoms could only be understood in view of the fact the patient started to trust the dentist who continuously encouraged her to cope with her incomplete sense of occlusion and who, in addition, gave her ample time to discuss her private problems during her monthly visits for a long time. Ultimately, the patient was not only content with the dentist'(simple) treatment, but also very content his full understanding of her private problems. In our opinion, the patient became psychologically stable because of the psychological attitude of the dentist, who helped her to regain her self-confidence and independence.
Taken together, the tragic life-experiences, the unusually rapid recovery from the oromaxillary symptoms and the changed attitude of the patient after the psychological approach of the dentist led us to conclude that we were dealing with a clinical case of conversion hysteria.
Note: the patient did not receive any antipsychotic or antianxiety treatment, since this could have incapacitated the patient, self-control as indicated by DSM-III-R.

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The Jenkins Activity Survey (JAS) was invented in America in 1964 to understand how Type A behavior and related psychological traits contribute to health problem. The identification of the basic psychological traits that increase risk of coronary heart disease and other major illnesses of Type A patients should contribute to the improvement in health. However, due to differences of cultural and social environmental condition, to find out Type A behavior of Japanese different type of the survey was needed. Many Japanese researchers and clinicians cooperated to make a Type A behavior survey for the Japanese. In this study, we used one of the survey of the Japanese JAS edition, together with CMI and Y-G tests for 120 patients with temporomandibular disorders (TMD) in our department. We found that 81 patients were type B and only 39 patients were type A. Especially, all type V TMD patients were type B according to the JAS survey. We presume that the TMD type V patients are quiet, calm and do not pay much attention to the behavior of the other people, but on the other hand, they control their own emotions, act in moderation and are bad at reducing stress. From these results, we think that one of the causes of TMD is the character of the patient.

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We experienced 5 cases of mental agitation occurring after long-term operation. We studied how these patients were managed postoperatively with regard to mental treatment for psychological stress due to lengthy operation and doses of anesthetics.
Mental symptoms in these patients included excitation in 2 cases, depression in 1, delirium in and insomnia in 1 case. Anxiety due to malignant tumor was the greatest causative factor for these symptoms with transference to mental distrubances.
Because of the lengthy operations with a mean time of 14 hours 21 min, mental and physical stresses of anesthesia and operation combined to disturb the patient's organic metabolism, causing mental disturbances. 4 of 5 patients received heavy amounts (3-5) mg of fentanyl, during surgery, and thus excitation seen postoperatively in these patients was suggested as a withdrawal symptom of narcotic drugs.
Because the surgical time for maxillofacial malignant tumors tends to be long and the amount of anesthetics for operational maintenance tends to be large, these procedure cause more marked postoperative mental disturbances in comparison to surgical pocedures for other tumors. It is thus recommended to obtain a detailed anamnesis pre-operatively with careful perioperative psychological care, and to choose the most suitable method of anesthesia and anesthetic agent according to the psychological status of the patient.

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The effect of intravenous sedation on dopamine metabolism in rat striatum was examined by electric stimulation or formalin injection after administration of 0.15mg/kg midazolam using the method of microdialysis. In the group given electric stimulation after administration of physiological saline, the dopamine levels increased significantly after stimulation. In the group given both midazolam and electrical stimulation, the dopamine level did not change significantly. In the group given formalin after administration of physiological saline and the group given both midazolam and formalin the dopamine levels did not change following injection.

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We have been working on the treatment of self-perceived halitosis for 6 years. Self-perceived halitosis can be caused by either psychosomatic or psychiatric disorders. In most cases, brief psychotherapy is very effective for psychosomatic disorder, but not for psychiatric disorder. For psychiatric patients, we emphasize the importance of psychiatric treatment, however, patients generally refuse to be treated by psychiatrist because they would rather believe it is halitosis than a psychiatric disorder. In this report, we described a case of a psychiatric patient (a 64-year-old woman) who understood the necessity of psychiatric treatment and finally accepted it.

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A 41-year old male was too fearful of dental treatment to be treated at a dentist's office. Therefor he was referred to Tokyo Medical Hospital for treatment of the left 1st molar tooth.
Analysis of his behavior suggested that his fear of blood and injection was occured by the experience of injuring his older brother by accident in his childhood, when he saw blood spurting out. Systematic desensitization was used to decrease his fear of blood and injection, and the left 1st molar tooth was extracted on the 13th day of treatment. In addition autogenic training was used for muscle relaxation, which was also used as the second approach formula.

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We examined the effect of chewing gum containing Flavonoid and Chlorophyll on reducing bad breath. After subjects consumed gyoza (food with high content of garlic), consecutive measurement of the degree of smell using the smell-test method was performed after the following conditions, intake of:(1) coffee, (2) common chewing gum (F gum: containing Japanese green tea flavonoid 1% and Chlorophyll 1%), (3), trial chewing gum (Toku gum: containing Japanese green tea flavonoid + tea flavonoid 1%, Chlorophyll 1% and Hovenia dulcis Thunb. 1%) (4) Toku gum after gargling water. The results showed that a smell-reducing effect was observed in the following order, Toku gum after gargling water> Toku gum> Fgum> coffee. It was concluded that coffee did not contain ingredients for reducing smell, that Toku gum had ingredients for reducing, the smell of Tea flavonoid and Hovenia dulcis Thunb. which F gum did not contain, and that gargle by water removed food remains. Moreover it was considered that water-gargling prolonged the effectiveness of Toku gum.
This study suggests that Toku gum prevents to bad breath.

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In this study we used the so-called “tooth-cleaning” chewing gum (Hamigaki-gum), considered to be highly effective on reducing dental plaque, and examined its effectiveness with regard to: 1) effective ingredients 2) appropirate site per time 3) chewing method. Results were observed by using PCR and OHI.
1. Following the chewing of common chewing gum (containing calcium carbonate 2.6%) and chewing gum (containing secondary calcium phosphate 2.6%), it was observed that the trial chewing gum was significantly (p<0.05) more effective than the secondary chewing gum.
2. Comparison of chewing a piece of chewing gum (4.35g), two pieces of chewing gum (8.7g), and three pieces of chewing gum (13.05g), showed that two pieces of chewing gum was most effective, and effect reduced with three pieces of chewing gum.
3. The chewing method of finger-pressing the gum on the teeth from the buccalis was not shown to be effective.
4. From this study, it was considered that secondary calcium phosphate was highly effectiveness in reducing dental plaque. Therefore it was concluded that further improvement could be expected with this gum.

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We clinically studied 115 cases (46.7%) of oral and maxillofacial tumor patients treated at our department during 10 years from January 1985 to December 1994. The object of the study was to solve problems associated with the notification of cancer.
Only 10 cases (8.7%) were given notification of cancer using the Murakami's classification in the narrow sense, but numbers have increased in recent years.
There were many notifications of cancer in the 3rd stage of Murakami's classification. Differences in the percentages of patients notified of cancer was observed in the 80's and 90's.
There are 7 stages in the classification of notification of the illness and notification was made in 32 cases (27.8%) using this method.
No difference was observed in the classification of the notification according to stage in the 78 cases of primary oral squamous cell carcinoma.
After the notification of cancer, 40 cases (34.8%) expressed worry. This problem was solved by repeated explanations.
Only 40 spouses were notified, but the percentages tended to increase in the 90's compared to the 80's. In many cases the family especially wives or daughters did not want the patient to be notified of cancer, even in the 90's.

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