Oral surgeons and psychiatrists performed coordinated treatment for temporomandibular disorders types III & W.
We worked with patients seen from April 1 to June 30, 2003. The patients were divided into two groups, one treated only by oral surgeons only (Group D) and the other by both oral surgeons and psychiatrists (Group P). Groups D and P were compared by Fisher's exact test and the T test, and no significant difference was observed.
The outcome was evaluated after three months, mostly in terms of the angle of the mouth opening and pain during opening, and the results for both groups were analyzed by Wilcoxson's signed rank sum test.
In group D, no significant improvement was noted in either the angle of mouth opening or the pain during opening. In group P, too, there was no significant improvement in the angle of mouth opening but a significant reduction of the pain experienced during opening (P<0.05) was observed.
The results suggest that the involvement of psychiatrists may be effective for the treatment of subjective symptoms such as pain, which could be particularly susceptible to influence from personalityrelated factors and psychiatric symptoms.

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We report a case of conversion disorder in which mother-child-related stress triggered the development of occlusal disharmony. A 49-year old housewife visited our hospital for treatment of occlusal disharmony. Her 21-year old daughter was exhibiting a coercion disorder. In the mother, the uneasiness caused by suppression of an unconscious inner conflict had transformed a conversion disorder into a somatic condition. Her emotional feelings of insecurity and impatience and unusual physical feeling in the mouth were the primary features. It is thought that the condition was identified and mitigated at an early stage. The patient consulted with both our department and that of psychiatry and has understood the stress correlation.

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Two cases are described in which stress-related glossodynia was identified, quickly understood by the patient and subsequently ameliorated.
Case 1: A 53 year-old woman, a full-time homemaker, exhibited the personality trait of a highlydeveloped sense of responsibility. Her mother-in-law went missing for about one month after being taken out by the patient's brother-in-law, from whom the patient was estranged, and it later transpired that the brother-in-law had used the mother-in-law's bank deposits in the intervening period to pay back his own debt. The family problems persisted and the patient began to develop glossodynia, insomnia, and a feeling of general malaise.
Case 2: A 55 year-old woman, a full-time homemaker, had a neurotic disorder. Her husband, a company manager, was diagnosed with liver cancer and admitted to a hospice by a medical institution. The husband's cancer diagnosis, however, was such that palliative treatment only was recommended. While worrying about the impending death of her husband, away from home, the housewife began to notice anxiety-related glossodynia with a bitter taste.

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We report a case of school-refusal with two planned attempts at suicide due to halitophobia. The patient was a 20-year-old man whose history of the present illness revealed that he had become concerned about his breath after being bullied in junior high school at the age of fourteen. He had become incapable of having personal contact with other people and refused to go to school. He later graduated without attending junior high school, and subsequently enrolled in a correspondence high school. When he came to our clinic, however, he was currently taking time off from school. He had planned to commit suicide twice, at 17 and 19 years of age, and been admitted to a local psychiatric hospital.
The patient was referred to our department by the psychiatrist in charge of his case because no objective evidence of halitosis had been detected during the initial examination. The patient became psychologically stable and hardly concerned about his breath any more after about 6 months of oral cleaning and phased counseling, provided on a regular basis.

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The post-war progress of medicine, medical technology, nutrition and sanitation has brought Japan the greatest longevity in the world. With people living longer and the birthrate in decline, the proportion of elderly people in the total population is rising fast. This situation has caused growing concern about such questions as pensions, medical treatment and care services in recent years.
Perhaps because of these changes in society, increasing numbers of patients have been complaining about persistent pains and abnormal feelings in the oral area with no obvious cause. Elderly people report a particularly wide variety of complaints of considerable complexity, and it appears that in some cases these cannot be resolved without first grasping their situation in the family and local community.
This paper describes a study of the stress and feelings of isolation experienced in old age, in view of the characteristics of elderly people, on the basis of three cases in which it was suspected that feelings of isolation in a cohabitation situation had disposed the patient towards glossodynia.
All three subjects were women and they had an average age of 79. They had recently lost a husband of friend through bereavement and were living with the family of a first or second son whose wife was excessively competent, leaving the elderly person with nothing to do in the home. In effect, they all had in common the loss of role. It is hypothesized that having lost the person who is thought to have provided them with psychological support, whether a husband or friend, their situation was exacerbated by their relationship with a daughter-in-law and gave rise to the symptoms described.
The elderly frequently manage to overcome the stress caused by various experiences of loss. Social and somatic changes may, however, make them more susceptible to psychiatric disorders than younger people. It is, therefore, especially important to understand the social situation of the elderly patient when responding to his or her psychiatric difficulties.
Medical, psychological and social support must be provided that can respond seamlessly to the stressful experiences of the elderly. Clinical data must be gathered and effective measures and techniques established on this basis.

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