This report describes the relationship of recurrent aphtha (RA) to psychological factors.
The subjects were 33 RA patients (10 males: mean age 58.8±13.31, 23 females: mean age 43.6±19.97) and 33 individuals (10 males: mean age 48.7±11.42, 23 females: mean age 43.7±18.89) with no history of RA as the control.
Psychological factors were evaluated by means of the Self-Rating Questionaire for Depression (SRQ-D), Cornell Medical Index-Health Questionaire (CMI) and Minnesota Multiphasic Inventory-Alexithymia Scale (MMPI-AS).
The results were as follows: The SRQ-D scores obtained from the RA patients were significantly higher (p<0.001) than those from individuals with no history of RA. The CMI scores were slightly higher and MMPI-AS scores slightly lower than those of the control, but neither were significant. The SRQ-D scores and/or CMI scores obtained from RA patients were significantly (p<0.01) higher than those from individuals with no history of RA.
It was considered that some of the RA patients were depressed and/or neurotic, and, therefore, RA might occasionally need to be treated as a psychosomatic disorder.

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The respiration curve (RC) of volunteers (n=20) was monitored in order to study changes of emotional state during putative painful dental treatment. Local anedthesia was adopted as the supposedly painful dental treatment. The wave height (v) and latency (ms) of the RC were assessed individually, and the significance of the percentage changes from the baseline of the RC in the evaluation of psychological response to the dental treatment was investigated.
The temporal changes in the absolute height of waves, but not the absolute latency in the RC during local anesthesia, seemed generally to agree with perception of pain and anxiety. The percentage change in the wave height and the latency of the RC from the basal level revealeda similar correlation to that of absolute wave height. The subjects showed either one of two distinct patterns in the change of the RC after the injection of anesthetic. Either the RC, composed by the waves, were clearly reduced in size, or the waves in each unit had a clear spike followed by a round wave.
These results may suggest that both absolute and percent changes in the wave height of the RC are significant indicaters of the emotional state of the patient during dental treatment. The appearances of the dual RC pattern in subjects after local anesthesia implies that there may be multiple way to cope with the stress of dental treatment.

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In this study, related psychological factors were examined in 29 patients (6 males, 23 females) who complained of taste abnormality.
The results were as follows: 1) 26 of 29 patients exhibited psychological factors. 2) There were positive correlations with neurotic and depressive states, and these states were complicated in most cases. 3) Patients with only taste abnormality were more likely to be depressive, while patients with taste abnormality accompanied by other complaints were more likely to be neurotic. 4) In 25 cases, the measured serum zinc values were all within normal limits. 5) The therapeutic effects of a psychosomatic approach were excellent.
It was concluded that patients with such complaints may exhibit related psychological factors more frequently than has been reportd to date

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In the Pediatric Dentistry Department of the Nippon Dental University Hospital, Niigata, a training program for infant patients has been implemented to accustom them to their new surroundings. For pediatric dentists, it is very important to watch the behavior of infants in training. In a corner of the training room, there is a basin for mouth rinsing. The stainless cup receptacle is so designed that the user is supposed to placed the cup not just beneath the faucet but a little towards the front. In the present study, we observed the behavioral pattern of infants from filling of the cup with water to rinsing of the mouth. The subjects were 120 children from three years one month to eight years five months in age. From a viewpoint of ecological psychology, we thought it should be possible to determine the phase of development of each of the subjects through the observation of this behavior.Some children moved the cup under the spout before pushing the button, and others only after turning the tap on. The difference in the manner of filling the cup with water was related with age and the number of times they used the training room. The children's response to visual information was also investigated by observing when they stop pouring water into the cup, which had a marker groove cut in it beforehand. Some filled the cup to the brim; some stopped a bit above the groove; some stopped when the water came exactly to the groove; and others below the groove. These act were also correlated with age. From these findings, we concluded that the observation of the sequence of acts from the pouring of water into a cup to the rinsing of the mouth was useful for knoeing the stages of a child's development.

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This study investigated the relationship between psychological properties and treatment outcome. The visual analogue scale (VAS), Cornell Medical Index (CMI), Self Rating Depression Scale (SDS) and Modified Taylor Manifest Anxiety Scale (MAS) were used to evaluate 50 patients with temporomandibular disorder (TMD) (8 male, 42 female; mean age of 38.0 y). All the psychological questionnaires were recorded before treatment. The first VAS (VAS 1) was recorded before treatment and the second, VAS 2, representing subjective symptoms after treatment, 6 months after the initial visit to our clinic. Treatment outcomes were assessed in terms of the differences between VAS 1 and VAS 2 (VAS 1 - 2).
In VAS 1, the group with a tendency towards depression had higher scores for daily life disturbance than patients without that tendency (p<0.05; Mann-Whitney U-test). In VAS 2, the anxiety of the high-anxiety group remained as high as in VAS 1 in the categories of daily life disturbance, spontaneous pain, pain during mastication and pain on opening. In VAS 1 - 2, there were significant differences between groups in the normal range and groups outside the normal range in all psychological questionnaires in the categories of the daily life disturbance, spontaneous pain, pain during mastication and pain on opening, but no significant difference was observed regarding the difficulty of opening.
The cause-effect relationships between these psychological properties and TMD symptom are unclear, but prognosis was possible based on those properties. The likelihood of treatment succeeding was higher for patients who revealed no problems in the psychological questionnaires, using their own subjective evaluations.

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In order to characterize the severity of psychosomatic features of the patients who maintain the false conviction of the foulness of their own breath, thirty subjects (10 men and 20 women, aged 13 to 66) were interviewed by trained dentists and psychiatrists.
The patients were classified in three types (Class 1 to 3) according to the degree of their cognition of foul breath, ideas of reference, delusion of reference and social adaptation. Class 1 patients were those who were cocerned about foul breath but showed no idea or delusion of reference and had good social adaptation. Class 2 patients were convinced of the foulness of their breath and had idea of reference and problems of social adaptation. The patients most strongly convinced of the foulness of their breath were placed in Class 3.
The patients in this criteria had idea of reference, delusion of reference, and hallucination indicating poor social adaptation. The role of dentists in the treatment plan for imagined foul breath can be decided by the classification of the severity of the syndrome. Class 1 patients who sometimes need anti-anxiety drugs can be treated by dentists, but treatment of Class 2 patients who need antipsychotics should be conducted in cooperation with psychiatrists. The treatment of Class 3 patients should be mainly conducted by psychiatrists, but dentists can provide support for the continuation of the treatment.

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In general, myofascial pain dysfunction syndrome involves single or multiple clinical symptoms, such as pain at the temporomandibular joint during mastication, mandibular dysfunction, limitations of mouth opening, stiffness in the muscles used inmastication with related tenderness under pressure, and sound from the mandibular joint.
In this study, sources of this disease and methods of treatment were examined with regard to the disuse or degenerative lesions of the masticatory organ due to differences in people's eating habits, comparing the primitive vegetable-based diet and that of modern lines.
Regarding changes of eating habits in the course of human social evolution, the cooked soft foods of today reduce the effort of mastication in contrast to the effort required for primary hard foods, mainly of plant origin. These days, especially, both in Japan and abroad, many new processed foods and ways of cooking have been developed, making eating easier and reducing masticatory movement in general.
It is pointed out in this study that such changes of eating habits, involving less mastication, have invited stiffness and atrophy through disuse and degenerative lesions, and these are related to the onset of myofascial pain dysfunction syndrome.
This study presents the view that myofascial pain dysfunction syndrome should be counted as one of the present-day lifestyle-related diseases.
Tracing the problems back to the original lifestyles for which human beings evolved, it can be recognized that guidance for masticatory patterns refers to anatomical, dietetic, physiological and health science factors related to foods, teeth and mastication. This paper describes the process of reaching self-awareness on how reduced masticatory movement in.- vites disuse and degenerative lesions, involving atrophy, stiffness and tenderness under pressure of the masticatory muscles. A psychological interview technique for motivating patients to adopt good masticatory habits is also described.
In conclusion, it is suggested from our clinical experience of patients with myofascial pain dysfunction syndrome that guidance for masticatory patterns is itself a useful fundamental therapy.
As a concept of the cause and lesions of this disease, it is further suggested that this processed foods that require less masticatory movement.

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Pain in the bilateral lower molar regions and xerostomia with painless swelling and induration of the minor salivary glands on the lower lip and anterior tongue were reported in the case of a schizophrenic woman.
In two months' follow-up under conservative treatment, no improvement in the symptoms was observed in the either gland. A biopsy of the lower lip was then performed, revealing interstitial fibrosis with acinar atrophy, and relatively localized periductal lymphocytes infiltration compatible with Sjogren syndrome in the histopathological examination. The diagnosis of Sjogren syndrome was, however, rejected by some seroimmunological and immunological stainings.
The swelling of the above minor salivary glands had decreased half a year after the biopsy. In spite of the reduced amount of mixed salivary excretion in the gum-test, the complaints of pain and xerostomia had also disappeared spontaneously. Such subclinical inflammation might be related to the symptom of transient, painless swelling of the minor salivary glands.

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The patient was a 44-year-old male referred from the department of operative dentistry in our hospital. His chief complaint was inability to receive caries treatment because of gagging, although he had a lot of dental caries.
We selected behavioral therapy to reduce his dental phobia. This treatment was performed about once a week in the early stage. First of all, we encouraged him to become inured to the dental mirror, forceps and suction. He tried hard to overcome his dental phobia and accepted our treatment. After about a month, he was able to receive root canal treatment of the front teeth in the maxilla. He was soon able to wear the temporary bridge on the front teeth and was very satisfied with the result. For personal reasons, he finished receiving dental treatment at our hospital and looked for another dentist in his neighborhood. He particularly wanted a female dentist in his neighborhood whom he could trust to continue his dental treatment at her own surgery. He was finally able to have a molar tooth extracted under local anesthesia without any trouble.
He has recently been coming back to our department about once a month and we encourage him to discuss his anxiety and questions about dental treatment in order to assuage his fear.

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Cénesthopathie is a disease involving complaints of various strange feelings in the body, which are also expressed very strangely. Generally, patients with this disease resist every possible treatment and the condition mostly follows a chronic course. We have investigated two cases that followed a good course, one of narrow and the other of broad Cénesthopathie.
The first patient (case 1) was a 44 year old male who visited our department, complaining mainly that some starch-like substance was coiling round a tooth. One month before this visit, he had received a pulpectomy of the tooth at Dental Clinic A. He already had the strange feeling during that treatment. He claimed that eventually the starch-like substance came off in pieces, pushing the gingival, and that now he was holding the gingival on with his tongue. There were no clinical symptoms. We started brief psychotherapy and administrated anti-depression medicine and minor tranquilizer. Three months later, he said that if the starch-like substance really did not exist, he might as well undergo treatment. After talking over this opportunity, ordinary dental treatment became possible.
The second patient (case 2) was a 52 year old female who complained of paralysis, a sensation of movement in the left first premolar tooth towards the right premolar of the mandible and a ditch-like odor. We diagnosed the case as one of Cénesthopathie because there were no clinical problems. On her first visit, we explained that there were no problems whatsoever and, since she listened to us calmly, also explained Cénesthopathie to her. When we told her not to be too hard on herself, she suddenly burst into tears. One week later, the patient visited with her sister and talked to us about her past life history. She had grown up as the oldest daughter under a strict father and locked things away inside. Therefore, we again explained the disease and assuaged her anxiety and depression about her abnormal sensations. At present, we are performing counseling at three month intervals.
In the past, when diagnosing or suspecting Cénesthopathie, we had basically only transferred the patient to a psychiatrist or wnducted liason therapy, but such treatment is very difficult. We consider that these cases followed good courses due to the assuaging of anxiety and depression through brief psychotherapy.

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A 26-year-old female patient with schizophrenia was referred to us by her psychiatrist, complaining of the breakage of half of her bridge in the 5+5 region. Denture treatment was suitable for this case, in view of the long span of missing tooth in the 3+3 region, the condition of the abutment tooth, her mental problem and financial standing. She persisted, however, in demanding the bridge and never accepted denture treatment. All efforts to make her understand the suitability of the treatment proved useless due to the failure of mutual understanding. Her demands for the prosthesis were often unreasonable and bizarre.
The author gave her time to change her mind while performing other tooth treatment. Three years and 7 months after her first visit, her partial denture was completed. At first, she was not able to accept it because of her youth and for aesthetic reasons. Often, she revealed unreasonable and delusional reactions to her denture. However, she came to accept it a little more day by day and now wears it normally, although it remains unclear whether she is fully reconciled to its use in her heart.
The greater part of the difficulty in managing this patient was due to the lack of mutual undertanding and her bizarre thoughts and behavior caused by her schizophrenia. On the basis of this case, it is suggested that dentists treating such schizophrenic patients should try to 1) recognize the patients' mental pathology but not become involved in that, 2) understand the patient's desire for a certain treatment but reject it firmly if it is unreasonable, 3) sustain the dentist-patient relationship with patience, 4) wait for improvement in the patient's delusions and behavior regarding dental treatment, and 5) bring the treatment to the appropriate goal by these means.

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We report a case of psychogenic oro-facial pain with mysophobia and compulsive behaviors related to dental treatment.
The patient was a 36-year-old housewife. She complained of spontaneous pain in all teeth of the upper and lower jaws. The pain had appeared suddenly in the upper incisors, around 2 years before her first visit to our hospital. In spite of dental treatment, the pain diffused to all of her teeth and gingiva. She also suffered from oral mysophobia and compulsive behaviors in the form of prolonged teeth brushing.
There was no organic disease to cause her pain and no other abnormal findings were noted. The psychological tests showed that she was in a slightly depressive, anxiety state and had a psychosomatic disease type. The Yatabe-Guildford test and egogram showed her personality to be compulsive. We diagnosed her condition as psychogenic oro-facial pain with mysophobia and compulsive behaviors.
We treated her with drug therapy and brief psychotherapy. The antidepressant agent (amitriptyline, clomipramine) and antianxiety agent (bromazepam) were effective for pain relief, but not for the compulsive behaviors. We also performed brief psychotherapy. She was alarmed that she had grown old when her dentist diagnosed the pain as being due to periodontal disease and afraid that the periodontal disease would worsen. This led her to clean her mouth very earnestly. The dentist suggested that her excessive brushing was bad for her at every dental examination, but she slipped into mysophobia and compulsive behaviors, avoiding food intake in order to keep her oral cavity clean and engaging in prolonged brushing. These behaviors were related to her compulsive personality. We recommended that she change her lifestyle and work outside her house, because a person of her personality type needed a social activity. Fourteen months later, she began to work again and her compulsive behaviors had diminished.
This case suggested that her compulsive personality was a causal factor in her development of psychosomatic oro-facial pain and the dental treatment induced mysophobia and/ or compulsive behaviors. Psychosomatic agents and brief psychotherapy were effective.

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The authors employed behavior restriction therapy for a 19-year-old female delusional halitosis patient under hospitalization. She had been complaining of halitosis for 4 years and visited several psychosomatic specialists. She had also been hospitalised in a psychiatric ward for treatment but her complaints of halitosis had not been reduced. She gave up high school and tended to stay indoors.
We started by using the description of impressions and prescribed her amitriptyline as an outpatient. Symptoms such as delusion of reference or depression were ameliorated and she became fairly cheerful. But her poor social adaptation hindered her from forming a full social identity.
We introduced her to behavior restriction therapy upon her admission to our hospital. Under condition of general social deprivation, she experienced many warm emotional exchanges with other inpatients, and gradually gained confidence in personal relations. We also administerated fluvoxamine, a selective serotonin reuptake inhibitor (SSRI). The fluvoxamine was as effective as amitriptyline, and fewer side effects were observed. Finally, she became able to talk with others and go out freely, in a manner suited to her age.
It is suggested that behavior restriction therapy was useful in this case.

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Concern about foul breath has recently been increasing in society and specialist consultations are now provided for out-patients at many university hospitals. Still however few medical institutions also provide a psychological approach to the problem. This study introduces the case of a patient who failed to respond to teratment in successive clinics of dentistry, internal medicine, otolaryngology, psychiatry, etc., but for when improvement was observed under treatment involing “ accept-ance” and “support” on the basis of general mental healing.
The patient was a 28 year old female teacher at a school for the handicapped. Her chief complaint was foul breath. No disease that causes foul breath in the mouth was found and the level of hygiene was good. No foul breath was noted.
Treatment was provided using the discomfort index and objective observation within the mouth. The method made it possible to establish a good physician-patient relationship and improvement was observed after relatively few visits.

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