(目的) 口臭を主訴とする自己臭恐怖症は, 我が国では歯科領域の代表的な心身症として, 多くの臨床的知見が集積されてきた。しかし, 本症の病態生理に関しては不明な点が多く, 未だ決め手となる治療技法は開発されていない。今回われわれは当科を受診した本症患者の治療成績を評価し, 薬物療法への反応から, その病態に関して若干の考察を試みた。
(対象) 1992年5月から1997年4月までの期間に当科を受診した口臭症患者のうち35名。本症のクライテリアは自己臭恐怖症を参考にし「他覚的には口臭が認められないにも関わらず, 本人が口臭がひどいと妄想的に確信し, 対人面で障害を有しているもの」として診断に用いた。
(方法) 治療は, 抗うつ薬と抗不安薬とを中心とした薬物療法と「感想文」などの心理療法を併用した。その診療録をもとに, 患者の年齢, 性別, 職業, 治療成績使用薬剤などを調査した。
(結果) 患者の平均年齢は34.2歳で, 約90%が20歳から49歳の範囲に含まれていた。男女比は2: 3で女性が多かった。職業は会社員や主婦が多かった。治療結果は35例中22例 (62.9%) が軽快, 13例 (37.1%) が不変のまま治療から脱落していた。投与薬剤は三環系抗うつ薬とベンゾジアゼピン系抗不安薬の併用がほとんどであった。
(考察) 本症の基本的な障害は認知面での障害にあると考えられる。抗うつ薬などへの反応から, ノルアドレナリンやセロトニンなど認知に関連している神経伝達物質が, その病態に関与しているのではないかと推測された。

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Is is well known that most patients at dental clinics feel fear or anxiety about dental treatment. This emotional response might be due to the stress caused by pain experienced during previous dental treatment.
In this study, we investigated the relationship between pain during dental examination and psychological inventories. Seventy-four dental students and clinical residents were employed for this study. All subjects were healthy and had no severe dental disease. Periodontal probing and electronic pulp testing were applied to the subjects as the stimulation, and the pain induced by the stimulation was evaluated using the Visual Analogue Scale (VAS). The anxiety of each subject was assessed by the State Trait Anxiety Inventory (STAI), Manifest Anxiety Scale (MAS) and Cornell Medical Index (CMI). The relationship between pain as expressed by the VAS score and anxiety as assessed by the inventories was analyzed.
A positive correlation was found between the VAS score and inventory scores. The STAI state anxiety and the VAS score showed a highly linear correlation. Trait anxiety showed a relatively low correlation with the VAS score, compared to state anxiety. The MAS and CMI high anxiety group had a higher VAS score, indicating amplification of the pain by anxiety.
The pain during the dental examination as evaluated by the VAS score was substantial. Anxiety appears to have the potential to amplify even the pain of routine dental examinations. Care should therefore be taken when treating patients with high anxiety to avoid complications or accidents. Psychological inventories may be useful for screening patients who are highly sensitive to stress during dental treatment.

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This paper reports on the relationship between questions on mental (sections M-R) and physical (sections A-L) states in a CMI health questionnaire, in order to investigate psychosomatic aspects of outpatients. The subjects were 30 female patients with oral psychosomatic halitosis.
The following results were obtained:
1) Mental section M (inadequacy) and physical sections D (questions referring to the digestive tract) and I (weariness) were found to have a high correlation (p<0.05).
2) N (depression) and J (frequency of illness) were positively correlated (p<0.05).
3) O (anxiety), B (respiratory system), C (cardiovascular system), and I and L (habits) had a high correlation (p<0.05).
4) P (sensitivity), B and D were positively correlated (p<0.05).
5) Q (anger) and I were strongly correlated (p<0.025). B, C, D and L were shown to have a significant correlation (p<0.05).
6) R (tension), C, D, E (musculoskeletal system), G (nervous system), J and L had a high correlation (p<0.05).

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Although 11 years have now passed since the establishment of the Japanese Society of Psychosomatic Dentistry, the membership has not increased.
In this study, we surveyed the views of dental practitioners on the field of Psychosomatic Dentistry. For this purpose a questionnaire was distributed to 151 practitioners.
The results revealed universal understanding of the significance and usefulness of Psychosomatic Dentistry, and also an interest in pursuing this field.
The Japanese Society of Psychosomatic Dentistry was established for the purpose of fostering the knowledge of Psychosomatic Dentistry, and clearly must endeavor to respond to the needs of dental practitioners.
The importance of a systematic instruction of both Dental Psychology and Psychosomatic Dentistry was also underscored, especially with regard to the systematization of dental care procedures for use by dental practitioners.

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Patients complaining of foul breath tend to visit either dentists/oral surgeons (A-group) or psychiatrists (B-group). In this study, the clinical characteristics of patients in these two groups (A: 19, B: 15) were compared.
1) The age of onset of the symptom in patients in A-group tends to be higher than that in B-group.
2) The belief that one's own breath is foul is more marked in patients in B-group than those in A-group.
3) Ideas on further references were more frequently seen among B-group patients than Agroup patients.
4) A few patients in group A had delusions of foul breath and of others noticing it. Further discussion on ways to cope with severe cases is needed among dentists/oral surgeons.

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A study was conducted on 27 adult males to determine the effects of abdominal respiration on sympathic artivily during dental procedures. One week prior to the experiment, blood was removed from the middle subcutaneous arm vein for estimation of the resuing plasma concentrations of adrenaline and noradrenaline using HPLC. Eight subjects were asked to take 6 consecutive breaths using their diaphragm abdominal museles once on each of 7 days before the experiment. The remainder was given either an anxiolytic (lorazepam, 0.5mg p. o., 9 subjects) or saline vehicle (10 subjects) 60 min prior to the experiment.
For the experiment, the subjects were seated in a dental chair, and blood samples were taken from the middle subcutaneous arm vein, 10 min before and 10 min after injection of 0.3m1 saline into the bucco-gingival part of the right maxillary premolars, and again for determination of adrenaline and noradrenaline concentrations. The first group was also asked to report the breathing exercise 5 min before the buccogingival injection.
The level of adrenaline was higher in the abdominal respiration group than in the controls one week before the experiment and before and after the injections, but not to a signifcant extent.
The noradrenaline concentration was higher in the controls after injection, but was reduced in the abdominal respiration group, and almost the same as that in the group given the anxiolytic.

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We report the cases of three patients with oral psychosomatic diseases whose glossal pain and other oral complaints disappeared with the maintenance of good oral hygiene. The patients were a 45 year-old female, 74 year-old female and 54 year-old male. They had various oral complaints and their oral cleaning was very poor.
Their Olery's plaque scores were 47% in Case 1, 45% in Case 2 and 45% in Case 3. After the diagnosis of oral psychosomatic disease, dental hygienists first began oral care with scaling, washing of the periodontal pocket, and guidance on brushing and flossing, etc.
Judging by the reduction of the swelling and redness of their gums, their oral complaints disappeared.

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We report a case of dental therapy on a patient with an abnormal personality who had an extreme phobia of dental treatment, in which treatment was performed smoothly under intravenous sedation with propofol.
The patient was a 21-year-old woman. Har mother had a history of schizophrenia, and she had a diagnosis of abnormal personality. She routinely used diazepam, amitriptyline, lormetazepam, and viamin A. The patient was introduced to the Department of Dental Anesthesiology, Nihon University School of Dentistry, because of the breakage of a maxillary anterior tooth crown.
The patient was very unstable emotionally at the time of referral, and complained of an extreme phobia of dental therapy. Oral examination revealed the need for tooth extraction, pulpectomy, and placement of a new crown. Since she was receiving the aforementioned drugs, intravenous sedation was scheduled to be performed. During the first session of intravenous sedation, dental therapy was performed smoothly under a propofol dose of 6 to 10 mg/kg/min. Two subsequent sessions of intravenous sedation were performed, and the dental thrapy was completed without any problem. The patient's trust gradually increased.

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Although much progress has been made in understanding the pathogenesis of temporomandibular joint disorders with various physical symptoms, the precise etiology of this syndrome remains unknown. In our serial clinical studies on TMJ disorders, functional disorders in the central nervous system have been found to play a bigger role in pathogenesis than occlusion. Tricyclic antidepressants have proven very effective for patients who received no benefit from occlusion therapy. “Psycho-social factors, such as the patient's character traits or gain from illness”, have been suggested as an important factor in this disorder, but they have not been incorporated usefully in the actual treatment of the disorders. Patients deny such factors or events, and are wrongly convinced that occlusion is the cause of many systemic disorders. According to these findings, we would like to propose the operation of two types of factor in the pathogenesis of TMJ disorders. One concerns disorders of neurotransmitter systems which may be associated with various physical symptoms. The other involves distorted cognitive processes which relate their symptoms to occlusion, psycho-social factors and so on. We propose that greater attention should be given to abnormal performance of the brain as a causative factor.
The case of a 38-year old housewife who complained of TMJ disorder and many symptoms is described as an example to discuss the efficacy of dsitinguishing between occlusion and character traits in treatment.

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The patient visited our dental clinic for therapy for ill-fitting upper and lower dentures, a depressive condition and a poor physical state related to her depressive condition. Patient: 50 years old in 1995. House wife.
Chief complaint: Languid feeling. Maladaptation of upper and lower dentures.
History of present illness and status presens: Patient had visited a gynecologist for therapy for menstrual irregularity and a poor physical condition and received drug treatment up to 20th October. Blood pressure standard but caldiopalmus, insomnia, early morning awaking, anorexia and claustrophobia abserved. Patient did not insert upper and lower dentures on defective parts, 7-4/7-4/2-7/4-7
Therapeutic progress: In the first period of therapy (95/7-10), the author administered mianserin, mild antidepressant, and alprazolam, a strong antianxiety drug with antidepressive effects, with counseling. Improvement to some degree in both of psychic and physical states was observed. However, considering the dependency problem of alprazolam, the author replaced it with bromazepam or flutoprazepam, both mild antianxiety drugs, in October. After that, the symptoms worsend again, so alprazolam administration was resumed. Mianserin was changed to maprotiline (a mild antidepressant) in November. The efficacy of this drug treatment worsened again when alprazolam was stopped once more. Counseling was continued. From the first month of the third period (96/2), the author began the administration of amoxapine, a strong antidepressant, instead of maprotiline, and from then the patient maintained good status without alprazolam. Counseling was terminated. The author took an impression of the denture for the upper edentulous part and set it in due course.

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