The number of patients with oral psychosomatic disorders has increased in recent years. Our department established a psychosomatic disorder group for liaison with psychiatrists in the diagnosis and treatment of such patients in 1999. In this study, we report the clinical statistics for patients of this type who visited our department in 2004.
Most patients were female, and 79 percent of them were passing through menopause. This suggests that hormonal instability due to menopause may have been involved in their condition. About 30 percent complained of prolonged symptoms that had lasted for more than three years. A psychosomatic medical approach was clearly needed for them.
In terms of dental diagnosis, 50 percent had glossodynia. Psychiatric diagnosis based on the DSM-1V-TR diagnostic standard revealed that 77 percent of all patients had a somatoform disorder, and 41 percent a comorbidity psychiatric disorder. Twenty percent of all patients displayed concomitance with a major depressive disorder. More than 30 percent of patients complaining of sleep disturbance were diagnosed with a major depressive disorder, indicating a strong relationship between these two conditions.
It follows that dentists require a knowledge of such psychiatric disorders as depression in order to refer such patients to psychiatrists and obtain appropriate advice. Even though the symptoms are observed in the oral area, attention does have to be paid to mental aspects of the patients. Our group adopts a psychosomatic approach based on both dental and psychiatric aspects, recognizing the importance of consultative liaison in medicine.
Twenty-five percent of the patients were cured after 6 months by a combination of medication, dohsa-therapy, and laser therapy, on this basis of providing supportive mental therapy.
We emphasize the importance of establishing a system of referral between general dentists and hospitals for patients who need a psychosomatic approach.

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We have treated a 42-year-old man who had, in June of year X-1, first noticed dizziness, nausea, heart palpitation and loss of appetite. He lost 8kg in weight as a result.In September of that year, he was still working but with an unnatural posture. He felt he could not move his neck smoothly and the right cervical area was tense. He visited various kinds of clinic and hospital, which prescribed him anti-depression, anti-anxiety and other medicaments. Due to side effects and insufficient efficacy, however, he interrupted the treatment on his own initiative. In February of year X, while at work, he began to have frequent bouts of death anxiety and breathing difficulty. In June, he visited a dental clinic, which also dealt with oral surgery, complaining of a burning pain in the right submandibular region. The examination found no abnormality in the oral region. He was referred, therefore, to Aichi Gakuin University, which he visited the following day.
Diagnosis: Temporomandibular disorder due to psycho-social factors
At the time of first examination, seeking to build mutual trust, we examined the patient's own drawing that he had made to illustrate his physical symptoms, listened to him carefully and explained about the correlation between mental and physical states. We prescribed only gargling and an anti-anxiety drug. As a result, he became able to recognize the mechanism of the mind-body correlation and regard his symptoms objectively. His symptom had almost completely disappeared within two weeks. In July of year X, at the time of his third visit to the hospital, he was transferred to a branch of his comnanv. He renorted that the svmntoms had almost gone.
The psychiatric examination produced a diagnosis of conversion and anxiety disorders. Afterwards, he continued to visit our hospital about once a month and receive supportive psychotherapy and medical therapy. His condition did generally improve but was liable to worsening depending on the contents of his work. Upon returning to another job at his company's main office, he began to visit our hospital once in two months and take the anti-anxiety drug only when needed.
The clinical diagnosis at the time of e first examination was possible fibromyalgia syndrome (FMS).

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In 1999, the authors organized a medical liaison group composed of dentists and a psychiatrist at the outpatient clinic of the Department of First Oral Surgery, Hospital of the School of Dentistry, Aichi Gakuin University, for the diagnosis and treatment of oral psychosomatic disorders. The practice has been for the dentists of the medical liaison group to examine each patient and diagnose his/her oral somatic disorder in the first stage of the examination, and the psychiatrist to examine each patient and make diagnosis according to DSM-IV or DSM-IV TR in the second stage.
The subjects of this study were 13 patients with personality disorders (PD) among 268 patients examined during a 5-year and 4-month period from 2000 to 2004. The diagnoses by the dentists consisted of five cases of atypical facial pain, three of burning mouth syndrome, two of oral malaise, one of dental phobia, one of temporomandibular joint disorder, and one of halitophobia. Those by the psychiatrist consisted of six cases of pain disorder, two of conversion disorder, two of somatization disorder, one of hypochondriasis, one of specific phobia, and one of adjustment disorder. On DSM-IV Axis II, the diagnosis/suspicion results consisted of three cases of paranoid PD, two of avoidant PD, two of obsessive-compulsive PD, two of borderline PD, two of narcissistic PD, one of histrionic PD, and one of dependent PD. It was very difficult for us to manage the patients with borderline PD and narcissistic PD in cases of invasive treatment such as a tooth extraction. It has been found that the comorbidity of not only mental disorders but also personality disorders does need to be diagnosed and dentists ought to plan their therapeutic strategy for patients with personality disorders under the supervision of psychiatrists

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The condition of having a normal physical sense of taste but finding flavors strange and unpleasant is known as phantogeusia and very difficulto treat. It has recently been reported that benzodiazepine (BZD) has not only anti-anxiety effects but also some influence on taste cognition. This study examined the efficacy and safety of ethyl loflazepate for use with phantogeusia patients. Four patients were prescribed ethyl loflazepate at a dosage of 1-2mg/day. The ethyl loflazepate was found to relieve phantogeusia and tolerated well. The onset of the response was usually observed within one week. The relief of phantogeusia following ethyl loflazepate treatment was independent of the response to treatment for depression. It is suggested that ethyl loflazepate may be effective in the treatment of phantogeusia in cases both with and without depression

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Osseointegrated implantation is a revolutionary therapeutic means to provide dental prosthesis that has been widely performed at dental clinics in recent years.
Most of osseointegrated implantation cases progress well, but some do not. This paper describes a case that was complicated by depressive status after osseointegrated implantation. It is suggested that the pre- and postoperative evaluation of bio-psychosocial factors is also needed in addition to obtaining satisfactory informed consent for osseointegrated implantation.

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