It is well-known that most patients at dental clinics feel some degree of fear or anxiety, so use is made of music, pictures, dolls etc to relax the patients, especially in pediatric dentistry. It is also thought however, that many strong smelling agents, such as Fenol and Eugenol, may act to increase the patients' anxiety and psychosomatic pain.
This study was performed to evaluate the effects of odor during dental treatment. The questionnaires were sent to 8 general and 5 orthodontic dental clinics in Yokohama, Japan. Replies were obtained from 58 males and 130 females (12-78ys mean; 32.9ys).
The results were as follows; One hundred fifty-three (81.4%) were sensitive to the odors peculiar to dental clinics. Young patients were more sensitive than older patients, and females more than males. About half of the patients (48.4%) were aware of odors peculiar to dental clinics in the waiting room. On the other hand, most orthodontic patients (76.5%) did not recognize odors as in general dental clinics. Eight patients (6.7%) in general dental clinics experienced a gagging reflex to the odors of dental treatment. Some patients were reminded of toothache and complained of psychosomatic pain. Many patients commented on the odor during dental treatment. Such odors, including disinfectants are unavoidable in a clinic. Almost no patients reported foundness for the odors.
The results suggest that varions approaches are required in order to relay dental patients, including the careful management of drugs, especially these for endodontic use, and the positioning of suction apparatus, ventilators, air conditioners and the air currents of the dental clinic.

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Several kinds of traditional Chinese herbal (Kampo) medicines that contain Bupleuri Radix (Saiko) as one of the main ingredients have been reported to produce antinociceptive effects in mice after administration in drinking water for 14 consecutive days. Among these, Saiko-ka-ryukotsu-borei-to has been found to be the most potent. Kami-kihi-to, which has ingredients similar to those of Saiko-ka-ryukotsu-borei-to, has also been shown to produce antinociceptive effects after acute administration. We have therefore sought to determine the onset of antinociceptive effects induced by the chronic administration of Saiko-ka-ryukotsu-borei-to. Acetic acid-induced writhing in mice was observed on the 2 nd, 5 th, 8 th, 11th and 14th days after the start of administration. The amount of writhing observed was counted in consecutive 5 -min poriods for 60-min after the intraperitoneal injection of 0.6% acetic acid. The results showed that the highest dose of Saiko-ka-ryukotsu-borei-to (300mg/kg/day) produced its antinociceptive effects, assessed as a reduction in the amount of writhing, after 5 th day of administration. Slower onset (after the 8 th day) was seen with lower doses (60 and 150mg/kg/day), though the effects were not entirely dose-dependent. These results suggest that Saiko-ka-ryukotsu-borei-toneeds to be administered consecutively for at least one week to produce its antinociceptive effects.

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A number of patients are anxious and tense regarding dental treatment and these feelings are expressed in the form of facial expressions, behavior etc.
We used a visual analog scale (VAS) to study these emotions in patient (volunteers) receiving sham-treatments (demonstrating therapeutic instruments, sham-action of oral injection, inserting cutting instruments into oral cavity and taking impression) and also showed video tapes of such treatments to doctors. Both the patient and doctors evaluated the VAS and the results for anxiety were compared.
Results: The degree of anxiety as assessed by patient by VAS was 65 in pretreatment, 65 during showing of instruments, 90 in injection behavior, 80 in insertion of cutting instruments and 65 in impression-taking. The doctors' scores were 33, 39, 62, 58, 40 for each. The evaluation by doctors of the anxiety of patient was unfortunately much lower than that of the patient.

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A close relationship has been observed between mastication patterns, involving either much or little chewing, and physical, psychological and social health conditions.
In order to clarify the factors constituting mastication patterns, an epidemiological survey was conducted using “The Survey Questionnaire of Eating Mastication Patterns” prepared by Miyako (Department of Dental Oral Surgery, Faculty of Medicine, Fukuoka University) on high-school students in the southern region of Kumamoto Prefecture, where I was involved in local dental medicine. Their mastication patterns and related factors were observed statistically from the standpoint of psychosomatic medicine.
The survey was conducted twice in 1990 and 1994 so as to obtain as many subjects as possible and to avoid overlapping of subjects. A total of 2195 students, consisting of 693 male students and 1502 female students, who gave eligible answers were included as subjects.
The mastication patterns were classified according to the “Method of Classification of Thorough Chewing and Crude Chewing Subjects based on the Questionnaire of Masticatory Patterns”, prepared by Miyako, and the subjects were divided into groups, accordingly.
15 parameters of mastication patterns were examined, including dental health condition, chewing desire, chewing fatigue, awareness of mastication, eating time, breakfast, consumption of vegetables, snacks, liking of strong or plain, flavers, training in eating techniques and manners, home environment, sleeping, subjective assessment of saliva secretion, and systemic fatigue.
Results: 155 male students (22.4%) and 421 female students (28.0%) had the thorough mastication habit. 538 male students (77.6%) and 1081 female students (72.0%) did not chew a lot (crude mastication).
Factors that appeared to play a role in masticatory patterns were, in both male and female students, dental health condition, chewing desire, chewing fatigue, consciousness of mastication, eating time, and consumption of vegetables and snacks.

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A lack of concern about oral health contributes to the reluctance of patients to perform oral hygiene procedures. The personality of the patient thus has a significant role with regard to the patient's compliance with dental treatment. This study analyzed the relationship between the anxiety scale and the state of oral hygiene.
The subjects consisted of 41 periodontitis patients, 15 male and 26 female, who completed 5 or more sessions of oral hygiene instruction. Their anxiety was measured using State-Trait Anxiety Inventory (STAI) at the initial examination. Oral hygiene instruction was performed using the Bass brushing method. The use of an interdental brush was also encouraged. Their oral hygiene condition was evaluated by Plaque Control Record (PCR) at each appointment.
The low state anxiety group had a significantly higher PCR value at the initial examination than the high state anxiety group (p<0.05). There was no significant difference of PCR between the high and low trait anxiety groups. An improvement of PCR after 5 sessions of oral hygiene instruction was observed in each group, regardless the anxiety status of the patient at the initial examination. There was no difference in the degree of improvement of PCR between in each group.
The results of this study indicate that the anxiety scale at the initial examination may influence the initial oral hygiene status, but has no impact on the improvement of oral hygiene status following a series of sessions of oral hygiene instruction. Each patient's degree of concern about oral health care and attendance behavior at the clinic were probably more important than the level of anxiety at the first visit in securing the patient's compliance with periodontal treatment.

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We report on two cases of dental patients difficult to treat due to psychological stress.
Case 1 was a 45-year-old woman who had previously complained of palpitation and chest compression during dental treatment in 1996. Palpitation was again noted and the patient was referred to our hospital. In the initial examination, spontaneous pain was recognized and the patient described feelings of fear regarding dental treatment. She was diagnosed as having Γ7 acute pulpitis and dental phobia. Anti-anxiety drugs were administered and after an interview with a psychiatrist she rested quietly in a dental chair.Γ7 Pulpectomy was performed under local anesthesia. Psychological assessment revealed a history of lying to her husband since 1991. She noted feelings of uneasiness and irritation. The chest compression and palpitation probably occurred due to a hysteric reaction.
Case 2 was a 69-year-old woman who complained of denture pain. Her upper denture had broken and a new one was required. She had, however, previously complained of pain due to the denture in 1994. New dentures were made but they proved incompatible. She was referred to our hospital in September, 1997. The diagnosis was denture maladaptative disease and an interview was conducted by a psychiatrist to assess her psychological background. Psychiatric treatment was performed together with denture adjustment but still the patient requested a new upper denture. Psychological evaluation indicated a history of loneliness.
We concluded that the denture pain would disappear if her domestic problems could be resolved.

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We treated a female patient who complained of involuntary mandibular displacement to the right and protrusive position and inconvenience during mastication and conversation. She had received several treatments, including medication and occlusal splint therapy, from other dentists over a period of about 3 years but none had been effective.
She was fifty-two years old and had no children. She was living alone with her husband and apparently in awe of him, had perfectionistic tendencies and was devoted to a religious sect.
Together with conventional stabilization splint therapy, we also gave her instruction on mastication and conversation and counseling on the problems of her life. The signs and symptoms became much improved and the progress of the symptoms was observed to be closely related to her life events.
In addition to the physiological factors, the psycho-social factors were judged to be intimately involved in this case.

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Necrotizing sialadenitis, first described by Werning and colleagues in 1990, is an inflammatory, self-healing lesion of a minor salivary gland.
A 17-year-old female was referred to our hospital complaining of a painful bilateral ulcer of the hard palate. A histological examination revealed necrotizing sialadenitis. She had been dieting for 6 months before this lesion occurred. Her weight was 37kg, and she was suspected of having anorexia nervosa. It was thought that anorexia nervosa or a psychogenic cause had played a role in the development of this lesion. The patient had stopped dieting 3 days before visiting our hospital. Her lesion healed almost perfectly without treatment after 1 month.

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This paper describes a study on the use of the EGOGRAM (TEG- II) psychological questionnaire on patients with self halitosis. Most patients who visit our hospital complaining of halitosis have self-halitosis, a psychosomatic disorder, and not the real condition. They are not, however aware of their psychosomatic problem and are convinced that they have halitosis. When we advise such patients to participate in a psychological questionnaire, in order to clarify their condition, some refuse to take it. This study describes two female patients in their 50's with self-halitosis who were, however willing complete a “TEG” psychological questionnaire and became very interested in the test. As a result, they did not reject the use of other psychological questionnaire, either.

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About 10-15% of dental patients have so-called psychosomatic characteristics and, of these, 6-7 % reveal psychosomatic disease, neurosis and depression in close diagnosis.
This study describes a patient with some physical symptoms, identified pathologically and biochemically, and also slight depressive symptoms related to them. This is psychosomatic disease in a narrow sense.
The authors conducted the oral and psychosomatic therapy on this patient for about one year.
The patient was an elderly male, 69 years old in 1999. He had received therapy for enterogastric symptoms, low back pain, diabetes and hypertension at a clinic of internal medicine, involving major drugs but not counseling, for several years.
“In examination, we observed psychosomatic disease accompanied by disturbance of some of body conditions and oral disturbance; 6 2 1 C₃”, chronic suppurative pulpitis, 5 C₂, 4 missing, 3 root canel filled, and 7-4 ill-fitting denture.
The authors started brief psychotherapy 2 - 3 times per month and drug administration (manidipine, antihypertensive drug, and flutoplazepam, psychosomatic stabilizer) from May 1997. Blood pressure became normal and the disturbance of the body condition improved gradually in June. We terminated the administration of manidipine in July because patient was content with the therapy, including antihypertensive treatment by the new doctor of internal medicine who he started visiting from June. Oral treatments were performed: 5preparation for metal crown and 6infected root canal treatment, root canal filling, preparation for metal crown and (6) (2) 4 impression for thermosetting resin facing Au-Pd-crown bridge work, setting of this and gingival tissue conditioning of 7 - 4 in June, July and August, and an impression for 7 - 4 missing denture rebase with setting in September. The only therapy in October and November consisted of internal medicine except for the adjustment of the denture and flutoplazepam administration. Extraction of 2, root canal treatment → root canal filling of 1 and pulp extirpation →root canal filling of 3 I were conducted in December and January 1998, and crown preparations of 3 1, the impression of (3) 2 (1) for thermosetting resin facing Au-Pd-crown bridge work and setting in March.
The patient's general condition, including his psycho-neurotic state, had improved. Brief psychotherapy, once or twice per month, and drug treatment with flutoprazepam have been continued to the present.

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A 56-year-old woman was referred to our department by a doctor of psychosomatic medicine. She complained of various physical symptoms that she associated with the poor condition of her dentures. She sought bite correction treatment from a succession of dentists and visited many medical facilities but her condition only got worse. We diagnosed her as suffering from denture-associated unidentified clinical syndrome. She came to our hospital and we commenced treatment in accordance with behavior restriction therapy (Fukamachi, 1987). Various physical symptoms were quickly ameliorated by antidepressants, but her demands for new dentures continued. She left our hospital after five months but still had not recovered sufficiently. The authors found that noradrenaline and 5 HT blockers had little effect on the remaining symptoms, and that only perphenazine, which blocks dopamine was effective. The patient finally recovered almost sufficiently for everyday life. Liaison with psychiatrist is not always helpful for such a condition because such patients hate to be treated like someone with a psychosis. This case showed the necessity of deeper investigation of the pathophysiology of such conditions and of a more careful therapeutic approach by dentists.

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