This paper describes the use of bibliotherapy to alleviate death anxiety in patients with oral psychosomatic disorders.
A book describing the near-death experiences of well-known people was used to alleviate death anxiety in 19 patients, (4 males aged 61-92 and 15 females aged 51-89). The subjects read the book and then answered a questionnaire. Replies showed 14 found it effective and 2 ineffective (with 3 not replying) in reducing death anxiety. Furthermore, of the 14 who found bibliotherapy effective, 6 replied that persistent complaints were also reduced (including 2 who found them so reduced that they were able to terminate treatment within a short time).
This study found bibiliotherapy to be a useful therapeutic tool in reducing death anxiety and persisitent complaints in patients with, oral psychosomatic disorders.

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Glossodynia is a clinical condition chiefly characterized by a painful tongue. It is reportedly associated with psychosomatic medical factors but patients with this condition are likely to visit departments of dentistry and oral surgery.
The subjects of this study were 50 patients who were clinically diagnosed as having glossodynia at our department during a 4 -year period from March 1993 to February 1997.
The patients ranged in age from 29 to 82 years (mean age 56.5 years), with those in their 50s and 60s accounting for 66% of the study population. The study population consisted of 5 males and 45 females, showing female predominance as reported by other authors (maleto-female ratio 1: 9). Of the 50 patients, 19 (38%) had been referred to our department: 16 by dentists, 2 by internists, and 1 by a neurosurgeon. Smarting was the most frequently reported kind of pain. The pain was located in the lateral margin of the tongue in 18 patients (36%), dorsum in 12 (24%), and tip in 8 (16%). Systemic factors that may predispose a patient to glossodynia include nutritional imbalance, such as iron or vitamin deficiency, and hormonal imbalance. 16 patients (32%) had cancerophobia and 13 of 20 female cases (65%) had experienced gynecological surgery under general anesthesia in the past, so psychological factors, such as anxiety and cancerophobias, may have played a significant role. Many patients were treated by psychotherapy and medication. Remarkable responses and changes were observed in 29 out of 50 patients.

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Physical, psychological and social complaints caused by rough chewing habits, which means habits of not chewing well, can be ameliorated by chewing instruction. Matters related to chewing habits are important indices for chewing instruction aimed at improving physical, psychological and social health conditions due to the chewing habits. We investigated 2, 505 junior high school boys and girls in northern Hyogo Prefecture as the subjects, regarding the frequency of careful and rough chewing habits and matters related to those habits, and here report the results of the statistical observation.
Results
1. Careful chewing habits were observed in 26.8% of the boys and 33.1% of the girls, and rough chewing habits in 73.2% of the boys and 66.9% of the girls. The frequency of rough chewing habits was markedly greater than that of careful chewing habits. The frequency of careful chewing habits was greater in girls than in boys.
2. As matters related to chewing habits, dental health, desire to chew, absence of chewing fatigue, consciousness of chewing, chewing frequency, meal times, consciousness of salivary secretion, intake of vegetables, and non-intake of snacks between meals were correlated with chewing habits in both boys and girls. A liking for strong or weak flavors showed a correlation only in girls.

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The eating characteristics of humans suggest that we are mainly adapted to the eating of vegetable matter, as judged from the relationship between the morphology and function of the temporomandibular joints and various aspects regarding their evolution from those of the other primates. The chewing style is that of careful chewing, which means chewing well.
A characteristic of the human canines is their shortness, which prevents interference with grinding movements. Human temporomandibular joints display the same movements as those of herbivores and anthropoids, the condyles are higher than those of carnivores, and humans have a well- developed ramus of the mandible. These findings indicate the morphology and function for performing careful chewing.
A correlation between the health of teeth and chewing ability was noted in this study. The correlation between healthy teeth and careful chewing habits was weak, however, and 70-80% of young people with healthy teeth had rough chewing habits. There was a slight correlation between chewing habit and chewing ability. Many people with healthy teeth and high chewing ability have rough chewing habits in their daily dietary life. This leads to a physiological in consistency between the rough chewing habits and the state of the masticatory organs that perform careful chewing.
In this study, we investigated junior high school students in northern Hyogo Prefecture as the subjects, using questionnaires, and performed a statistical comparison between the careful chewing group and the rough chewing group.
The results identified various characteristic items with regard to the health of teeth, features related to chewing habits, dietary habits, growth history, lifestyle, and psychsomatic health. These characteristic items have physical, psychological, and social content regarding health, with careful chewing reflecting good health and rough chewing poor health. These characteristic items had reliability by the linear discriminant function of multivariate analysis.
Chewing instruction to enable subjects to change from rough to careful chewing habits, as a way to improve lifestyle habits, are therefore, considered important for the improvement of the all-round health of junior high school students.

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The purpose of this study was to observe emotional changes in patients given pain stimulation during dental treatment. Galvanic skin reflexes (GSR) were used as the index of emotional change and the duration and frequency of such reflexes was analyzed. The subjects were 20 students of the dental department of our university who understood the project and were willing to cooperate.
The results were as follows:
1) GSR reactions were observed while the patients were resting, when uneasiness was exhibited and at the time of pain stimulation.The reaction was lowest during rest and increased in the order of uneasiness and pain stimulation. The frequency, too, was lowest at rest and also increased in the order of uneasiness and pain stimulation.
2) The duration of GSR reactions was significantly longer during uneasiness than rest, as well as the reactions being more frequent.These results indicate that even before actual pain stimulation the patient begins to feel worried about the pain due to visual stimulation.
3) The duration of the GSR reactions was significantly longer during pain stimulation than in the eeriods of rest and uneasiness, and the frequency was also greatest.
From the above, it can be seen that the method of observing a patient's emotions by means of GSR reactions can be very useful at the time of dental treatment and that evaluations can be made from both the duration and frequency of their appearance.

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The clinical profiles of patients with glossodynia were investigated using the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI of Japanese version 2 was adopted as the questionnaire for the first medical examination to evaluate the psychosomatic tendencies of ninety female glossodynia patients (Mean age= 53.6 years old; Question score < 55 points, Lie score < 11 points, respectively, according to MMPI points). The diagnosis of glossodynia was determined by a series interviews and a pyschomedical evaluation. The ninety patients consisted of 32 treatment-resistant and 58 treatmentsensitive subjects.
Individual examination by MMPI scales revealed that glossodynia patients have a tendency towards high scores in the Hypochondriasis (Hs), Depression scale (D) and Hysteria (Hy) scales, but all MMPI scales were within the normal range (40 <T-score <70). The individual scales of the treatment-resistant patients showed high score in not only the Hs, D and Hy but also the Psychasthenia (Pt), and Hypomania (Si) scales. The two point code examination of MMPI profiles gave 12/21 or 13/31, indicating the subjects had a tendency towards hypochondriasis, and the results were generally consistent with the clinical aspects of glossodynia.
These results suggest that (1) the two point code examination of MMPI profiles can supply clinically relevant information for the diagnosis of glossodynia and other psychosomatic disease in dentistry in which a psychological approach is needed and (2) the examination may also provide some indication of the efficiency of the treatment of the psychosomatic disorder.

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We investigated the clinical statistics of elderly persons needing a psychosomatic approach from October 1996 to August 1999.
The following results were obtained:
1) In the distribution by sex, women accounted for 78.7% of the total. By age, there were many patients in the 65 to 70 bracket and the numbers decreased with higher ages.
2) In the clinical diagnosis, glossodynia was most frequent with 12 cases 26%, followed by oral psychosomatic disease (7 cases), arthrosis of the tempolomandibular joint and illfitting dentures (6 cases each), suspected ostitis and osteomyelitis, xerostomia, ptyalism, abnormal gustatory sensation and others.
3) Regarding the psychological background, a depressive condition or depression was found in 19 cases (40%) and neurosis in 18 cases (38%), making the proportions equivalent.
4) Regarding the method of treatment, only brief psychotherapy was used in 18 cases, brief psychotherapy, the administration of antidepressant and minor tranquilizer in 14 cases, brief psychotherapy and the administration of antidepressant in 6 cases, brief psychotherapy and dental treatment in 3 cases, and others in 6 cases.
5) Liaison consultation therapy with psychiatrist and neurologist were carried out in 11 cases (21%).
6) In the course of treatment, both physical and psychological signs and symptoms were reduced in 26 cases (55%), and disappeared in 11 of these. Interruptions were observed in 10 cases. No reduction was observed in 6 cases and 5 cases were referred to psychiatrists etc.
From these results, we conclude that it is necessary to establish appropriate psychosomatic dental medical science for use with elderly persons in our rapidly aging society.

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Although the visual analogue scale (VAS) is utilized to evaluate changes before and after treatment, it has not been confirmed how bias could affect the subjective evaluation over a long period of treatment. To evaluate the validity and reliability of VAS, three categories of VAS were identified. The initial pre-treatment status (VAS-1), the recalled pre-treatment status (VAS-2), and the post-treatment status (VAS-3) were recorded by 46 outpatients with temporomandibular disorders in the Department of Fixed Prosthodontics, Dental Hospital of Iwate Medical University. VAS-1 was recorded at their first visit to the hospital, and the VAS-2 and VAS-3 recordings were both taken on the same day at least 6 months after the first visit. Higher scores for VAS-2 compared to VAS-1 showed the effect of treatment on the subjective evaluation of pain, level of inconvenience, and range of jaw motion. Although “spontaneous pain” and “pain on opening” showed a high correlation between VAS-1 and VAS-2 in terms of the correlation coefficient, Cohen's κ, “difficulty of opening” revealed little correlation between the two. Since the pain reports of VAS-1 and VAS-2 provided reliable data, it was concluded that VAS is an effective way to evaluate treatment outcome.

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One of the major causes of glossalgia is mental stress.
We had a patient complaining of persistent tongue pain and a tumor on the right upper lip, which we found difficult to treat.
The case was as follows: Case: A 52 year-old female patient complained of spontaneous pain in the proglossis and tumor formation on the right upper lip.
History: The entire tongue turned white in January 1998. After consulting many medical institutions for one year, she was finally referred to us. She also displayed a tumor on the right upper lip and requested treatment for this at our department.
Background: She had been divorced at 37 and raised her two children by herself. Her son was killed in a traffic accident at 24, which gave her a great shock. Since then, she had lived by herself and suffered from continuous sleeplessness, anxiety, and hypobulia. Eventually, she also started feeling pain in the tongue. She came to us after consulting with many other medical institutions.
Progress of treatment: She was referred to our psychiatric department and treated by both departments. Once her tongue pain had been slightly alleviated, we admitted her to hospital and excised the tumor on her upper lip. Her daughter nursed her while she was in hospital. This reduced her sense of solitude and alleviated the glossalgia.
The tongue pain shows signs of remission but has not completely gone.

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The Kreapelin test was used as the psychological tool to analyze the relationship between halitosis and psycho-social stress for the comparison of changes in salivation and oral breath. Measurements were made on one woman and six men with a mean age of 34.6 years old. We collected mixed saliva from each for 15 minutes before and after the Kreapelin test. Oral breath was measured just before the Kreapelin test, in the 5 minute rest period during the test and just after the finish.
The scores for oral breath were lowest before the Kreapelin test, medium in the rest period and maximal just after the finish of the test. The amount of mixed saliva in the 15 minute periods was lower after the finish of the Kreapelin test. From these results, it seems possible that psycho-social stress does influence halitosis.

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