Glossodynia may be associated with such physical factors as candidal proliferation and/or lingual rubbing habits, together with several psychological profiles.
We compared sequential therapeutic effects (after one week, 2 weeks, and 4 weeks) in two groups, one that received some dental treatment for the physical factors and another that did not, in combination with the usual glossodynia therapy.
The sequential therapeutic effects in both groups were significant (Two-Way Repeated-Measures ANOVA: p<0.05). Therapy for the former group was more effective than that for the latter, and the difference in therapeutic effect after one week was more marked than after 2 and 4 weeks.
These findings suggest that such treatment can produce a rapid reduction of lingual symptoms through either psychological or physical action.
It is proposed that dental treatment for candida or lingual rubbing should be utilized as one of the psychosomatic approaches to glossodynia

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We performed an epidemiological study on the relationship between chewing habits and boody weighe according to age and obtained the following results:
1. Concerning the relationship between age and chewing habits, young subjects often exhibited rough chewing habits, but a larger proportion of subjects chewed well in middle age.
2. Concerning the relationship between body weight and chewing habits, subjects with standard weight more frequently chewed well while subjects who were overweight or obese more frequently chewed roughly. This relationship was observed from the age of 30 years, and became marked between the ages of 35 and 39, but was marked between the ages of 40 and 44 or 45 and 49. In every age group between 30 and 59, excess weight and obesity were more frequently observed in subjects who chewed roughly than in those who chewed well.
The habit of chewing well (chewing food 20 times before swallowing) may be effective for preventing obesity.

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Patients who come to dental clinics complaining of halitosis but in fact exhibiting no offensive oral odor have what is generally termed halitophobia (or psychosomatic halitosis, body odor psychosis). Clinicians struggling to manage halitophobia have long found the management of halitophobic patients challenging. This study was designed to analyze the clinical courses of medicated patients. The 399 patients included in the study had all visited the Breath Odor Clinic of the Department of Oral and Maxillofacial Surgery (Tokyo Women's Medical University Hospital) between April 1999 and March 2002. Thirty-one (mean age36.4 years old, range 18-59, 12 males/19 females) of the 399 patients were diagnosed by questionnaire and psychological testing as cases requiring prescription mediation on account of the psychiatric aspects of their disorder. They were prescribed antidepressant and anti-anxiety drugs and Japanese Kampo (herbal) medicine. Their age, sex, prescription, and compliance and the effects of treatment were recorded. Nineteen (61.3 %) of 31 patients reported that their oral odor had partially or completely disappeared, and 12 (38.7 %) that there had been no change or else had discontinued the treatment. Most patients were medicated with SSRIs, either alone or in combination with an anti-anxiety drug.

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We occasionally encounter atypical facial pain which is notoriously chronic and refractory to treatment. In this paper, a case of long-standing atypical facial pain is reported.
The patient was a 45-year-old woman, who was referred to our clinic on March 7, 1997 due to severe mandibular pain of 54 months duration. The pain appeared 6 months after a mandibular fracture caused by a traffic accident that occurred on March 9, 1992. Since the onset of pain, she had visited many medical facilities but could find no suitable one that could treat the pain.
On her first visit, she complained of not only severe mandibular pain but also lassitude, appetite loss, nausea and insomnia, and had a depressed and neurotic psychological status. In addition, she showed signs of exhaustion due to the persistent long-term pain.
We gave her psychosomatic therapy in addition to the dental treatment, including modality, mind drugs, brief psychotherapy and other treatment, over a period of 55 months. On July 12, 2001, she expressed her determination to discontinue drug therapy and return to society.

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We report on the case of a patient who suffered from cenestopathy in the oral region.
The patient had first visited the dental office and received dental treatment three months earlier. Cenestopatic symptoms, such as the illusion of strange substances emerging from the eeth, the arose in the oral region.
In this case, the cenestopathy in the oral region was not thought to be a prodromal or partial manifestation of schizophrenia. We thought that it was a kind of delusional disorder. We treated the patient with brief psychotherapy and drug therapy.
When treating cenestopathy, attention must be paid to the possible development of schizophrenic symptoms. Since patients with cenestopathic symptoms similar to those found in this case frequently first seek dental treatment for their symptoms, dentists should be aware of the signs of cenestopathy and advise such patients to see a psychiatrist when appropriate.
The patient has recently been visiting the hospital about once a month and we encourage him to talk about his anxiety and ask questions on the cenestopathic symptoms in order to dispel the fear that they will recur.

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We recently treated two patients with tongue laceration and tongue ulcers due to automutilation.
Case 1: A 7-year-old male visited us with the chief complaint of ulceration of the tongue. He had experienced repeated episodes of tongue ulceration since the age of about five. We applied a mandibular splint and advised the family to modify the family environment. Automutilation of the tongue decreased 4 months after the beginning of the intervention, and the lesion became treatable.
Case 2: A 21-year-old male with tongue ulceration visited us with the chief complaint of acute weight loss associated with food intake disorder. His past history included autism and mental retardation. We explained the relationship between the habit of automutilation and psychogenic factors to the family and obtained their understanding and cooperation in treating the disease. The ulcers healed on day 14, and food intake disorder disappeared with the recovery of body weight.

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We report on difficulties encountered in perisurgical management of an oral cancer patient with mental retardation. The 30-year-old woman patient had moderate mental retardation and was suffering from advanced tongue cancer. We scheduled a subtotal glossoectomy with radical neck dissection together with rectal abdominal free flap reconstruction. Prior to the surgery, preoperative chemoradiotherapy was performed. We tried to explain why she needed the operation and what would happen afterwards using the simplest terms possible and frequent repetition in a step by step manner. We thought that she had acquired a certain level of understanding and consented to the surgery because of the questions she asked in response to our explanations. A couple of days before the date scheduled surgery, however, she developed severe nausea and vomiting with no evident physical cause. This seemed to be a maladaptive reaction due to strong anxiety about the surgery, and the date of the operation had to be postponed. The operation was eventually performed with the help of an antianxiety agent, the use of which was continued to reduce the postoperative mental and physical stress. We sought to develop a better doctor-patient relationship by means of much more frequent communication than usual, but postoperative depression eventually developed about 10 days after the surgery. The experience again demonstrated the difficulty of perisurgical management of mentally retarded patients who need major oral surgery. We suggest that it is especially important to use holistic management techniques, including collaboration with psychosocial specialists during the perisurgical period, when treating patients of this kind.

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This paper reported a case of mandibular fracture in a 24 year-old male that was accompanied by unfortunate postoperative occlusal and aesthetic damage due to an MRSA infection contracted in another hospital. The surgical accidents induced psychosomatic disease and he was referred to our department for amelioration treatment. His mental disorder was alleviated and disappeared rapidly after the reconstructive surgery was completed. The operation procedures are reported in detail and accompanying psychosomatic aspects described.

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This paper reports a case of cenesthopathy managed by our dental department and psychiatrists for a period of five years. A sixty two year old male patient visited our office on the recommendation of his psychiatrist, complaining of oral malaise on the left palatal region of the mouth due to a “foreign body”. He believed that this “foreign body” was present in his mouth, describing it variously as a string, a club, a ring, a wire, or a sausage. There was, however, nothing in his mouth that corresponded to his complaint. He had been already diagnosed as having cenesthopathy by his psychiatrists.
The author applied the qualia concept to management of the patient. Recognition of his oral malaise as an example of intentional qualia brought two advantages to patient management. The first was that it became possible to regard his oral malaise as the reality. The second came in the sympathetic acceptance of his frustration. The author was able to clearly refute the existence of the “foreign body” at the place described in the oral region. The patient was gradually convinced that the “foregin body” did not really exist in his mouth. The author suggests that the dentist's role in the management of a patient with cenesthopathy is to find ways to assure the patient of the non-existence of the foreign body, as a trusted professional.

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A 30 year old woman patient came to our hospital for dental treatment on the recommendation of another dental surgery surgery in December, 2000. The patient came to the hospital in a wheelchair accompanied by her mother and a male acquaintance, but her mental state was unsettled and conversation difficult. Her mother explained that the patient was distressed on account of torment at her place of work. During an X-ray scan, the patient felt poorly and entered a condition of clouded consciousness. We therefore referred her to a municipal psychiatric hospital. The patient revisited our hospital with her mother, again to receive dental treatment, in April, 2001. The author extracted a second premolar tooth in May, but the patient collapsed immediately afterwards in the rest room in the same clouded condition. We therefore again transferred her to the same psychiatric hospital. In October, the patient again collapsed in the rest room after having an impression taken of a mandibula and visiting our hospital's internal medicine department. We transferred her to the cardiac department of a general hospital suspecting A-V block and epilepsy. A doctor of internal medicine recognized bradycardia, and transferred her to the cardiac department of a municipal hospital. In December, a psychiatrist reported to us as follows: the patient had # 1 Dissociative disorder, # 2 Medium-level intellectual retardation, # 3. Wenckebach type A-V block. It was a case of dissociative disorder compounded with maladjustment due to intellectual retardation. We were infomed that there was no medical hindrance to dental treatment. The psychiatrist and a doctor of internal medicine agreed in this respect on dental treatment. A consciousness disorder that occurs after dental treatment is, however, a big problem for the dentist. Furthermore, the patient did have Wenckenbach type A-V block. The indicated treatment methods were intravenous sedation and general anesthesia, but these methods do not solve the basic issue.
The treatment of this patient has been interrupted, but this case clearly highlighted the difficulty of performing dental treatment on a patient wiht dissociative disorder.

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従来, 舌痛症に対して三環系抗うつ薬が使用されてきたが, その効果の反面, 口渇や眠気などの副作用のため, 十分なコンプライアンスが得られないこともしばしば経験された.今回我々は舌痛症に対する選択的セロトニン・ノルアドレナリン再取り込み阻害薬であるmilnacipranの効果と安全性を検討した.当科を受診した11例 (男性2例, 女性9例) の舌痛症患者に対して6週間のオープンパイロット試験を行った.効果の判定にはvisualanaloguescales (VAS), Zung'sSelf Rating Scale for Depression (SDS), Clinical Global Impression score (CGI) を用いた.11例中8例が症状改善し, 2例が不変, 1例が脱落した.VASとSDSとの問には明らかな相関は認められなかった.重篤な副作用は認められなかった.milnacipranは舌痛症に対して有効であることが示唆された.また本剤の鎮痛効果は抗うつ効果とは別の機序があるのではないかと考えられた.

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It is very rare for a schizophrenia patient to suffer delusions related to dental treatment, but such delusions do cause many difficulties for the dental treatment and management of the patient when they do arise. The authors present a case of a 60-year-old female suffering from untreated schizophrenia and complaining of delusional toothache combined with persecutory delusions, who has moved from dentist to dentist for the past 10 years. It is suggested that dental treatment for delusional patients becomes very difficult when the delusion involves elements of the dental practice itself, and that such patients demand inappropriate dental treatment due to their delusions.

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Tics are defined in the DSM-IV manual of the American Psychiatric Association as being sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. We report on the treatment of a patient with tic symptom, a cleft lip on the left side and skeletal anterior cross bite. Clinical record: The patient, a girl with a cleft lip on the left side, was referred to us at the age of 5 months by Department of Plastic and Reconstructive Surgery, Iwate Medical University School of Medicine, for the purpose of performing preoperative orthodontics.
Our plastic surgery department performed the cheiloplasty at the age of 6 months. This was followed, at the age of 6 years, by work on the rhinoplasty and secondary cheiloplasty. From the age of 3 years and 6 months, due to poor upper jaw development and as a result of examination of skeletal anterior cross bite, work was commenced as the maxillary protraction, the upper dental arch expansion, and improvement of the rotated central incisors on the upper jaw.
The patient continued to visit the hospital without problems until the age of 7 years and 10 months.
At her next half-yearly visit, at the age of 8 years and 4 months, the patient was observed to have symptoms of blinking, facial twitching, coughing, and strange vocalizations. Her mother had considered these symptoms to be nose-related and taken her daughter to an otorhinolaryngologist, but the examination there produced no improvement and she was thinking of going to another hospital. The authors suspected Tourette's syndrome and introduced the patient to a child psychologist. Tourette's syndrome was diagnosed on the basis of the vocal tic and effectiveness of haloperidol. A year later, the multiple tics had continued with changes of place, type and frequency with no apparent regularity of pattern in either transformation or frequency. Minor incidents, increases of anxiety etc. were thought to precipitate change in and expression of the symptoms, but the patient was extremely cooperative with the orthodontic treatment.
Discussion: Pediatric patients suspected of having a genetic predisposition towards tics may be liable to develop symptoms in response to triggers experienced in the home or school. In this case, the orthodontic treatment did not become a source of stress and the patient's psychological state was observed to be good. It is supposed that the condition was probably precipitated by a latent feeling of inferiority or stress experienced at school or in the children's home. Close coordination with a medical specialist is essential in the case of tics. It is important for the orthodontist to provide not only occlusion-related treatment but also psychological support.

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