A prospective cohort study was conducted on healthy volunteers with no current or past history of temporomandibular disorder (TMD) in order to identify psychological factors that contribute to the condition.
TMD is most common in patients aged in their twenties. This study was, therefore, performed with the cooperation of 207 freshmen (139 males and 68 females, average age of 20.4 years) of Iwate Medical University Dental School. At the start and 5 years later, all subjects were requested to fill out a questionnaire on mandibular functions together with the psychological questionnaires of CMI, SDS, MAS, Y G. The incidence of TMD symptoms was evaluated after 2.5 years and again after 5 years by self-reported questionnaire.
129 subjects completed the study over the whole 5 years. They included 32 (19 males and 13 females) who were experiencing pain in the tempromandibular joint and/or masticatory muscle and/or mouth opening problems at the times of the 2.5-year and 5-year follow up surveys.
Logistic regression analysis was performed to identify intrinsic factors. It produced an odds ratio (OR) of 2.65 (95% CI=1.07-6.56) and adjusted OR of 7.00 (95% CI=1.45-33.79) in Y-G. These results imply that emotional instability may be a contributory factor to TMD.

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This study investigated patients with dento-facial deformities who worry about their facial appearance, in order to identify such patients' psychological tendencies.
The subject group consisted of 25 adults (16 females, 9 males; average age 25.7 years) requiring orthognathic surgery. Questionnaires and MINI automated psychological tests (MINI) were used to measure the psychological status of each patient. The subjects were classified on the basis of the questionnaire results and compared by sex and MINI-scales.
The following results were obtained;
(1) 17 patients (68.0%) (12 of 16 female, 75.0%; 5 of 9 male, 56.0%) answered that they had worried about their facial appearance when they first became aware of their dento-facial deformity.
(2) 17 patients (68.0%) (10 of 16 female, 62.5%; 7 of 9 male, 78.0%) worried about their facial appearance when other people pointed at them.
(3) 15 patients (60.0%) (12 of 16 female, 75.0%; 3 of 9 male, 33.3%) regarded their dento-facial deformity as a constant source of stress.
(4) Patients identified in each of the above cases exhibited significant scores for Pa (paranoia), Sc (Schizophrenia), and Ma (Hypomania).
(5) Patients exhibited high levels of psychosis and dislike of inter-personal relations.
The findings suggest that more than 50 percent of patients with dento-facial deformities are obsessed with their facial appearance. Such patients are always anxious about how they are regarded by other people, and extremely self-conscious about their body as well. They exhibit a tendency toward weakness in inter-personal relationships. Females had a stronger tendency than males to view their dento-facial deformity as a source of stress. Males generally worried less about their face except when being pointed at by others.

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We have recently observed an increase in the number of patients exhibiting oral psychosomatic disorders in the oro- maxillofacial area. The revision of dental fees by Japan's Ministry o Health, Labour and Welfare, in April, 2006, has caused dentists to refer such patients to a psychosomatic physician or psychiatrist when a fee is required for psychosomatic dental treatment. This revision appears to have denied dentists the discretion to treat oral psychosomatic disorders.
We report on patients of this type referred from dentistry to psychosomatic medicine since the 2006 revision of dental fees. The diagnoses and prognoses of 20 patients are reviewed in terms of both dental and psychosomatic medical aspects. This is followed by a discussion of salient points in the treatment of oral psychosomatic disorders. Ins conclusion, we assert, first, that dentists ought to have the independent discretionary power to treat oral psychosomatic disorders. Second, it is observed that broad and profound coverage of medical subjects, notably in the fields of internalmedicine, surgery, emergency medicine and psychosomatic medicine/psychiatry, needs to be provided during the undergraduate course of dental school. It is also noted, in this respect, that oral medicine is an important subject of study prior to the study of oral psychosomatic medicine. Third, dentists who have a broad grounding in both basic and oral medicine are the clinicians best placed to treat oral psychosomatic disorders. Regarding dentistry as a part of medicine, we propose drastic reform of the dental educational system in order to win back the independent discretionary power of dentists for the treatment of oral psychosomatic disorders.
We propose that departments of oral medicine and psychosomatic medicine should be established at dental schools. New systems are needed to assist the many patients who suffer from oral psychosomatic disorders.

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It is generally recognized that patients with halitophobia must be treated with great care. When only told the results of breath care measurements, such patients tend to feelmisunderstood by the doctor. A 34-year-old female attended our hospital complaining of oral malodor. She had been worrying about her breath odor for about 5 years. She first noticed the malodor through the attitude of others, including touching of the nose and covering of the mouth. Her concern was reinforced by an offer of chewing gum from a friend. She had attended a breath clinic but had not overcome her anxiety about the malodor. She was worrying excessively about her breath odor and this was restricting her contact with others. She could not even ride a bus.
At our breath clinic, we performed organoleptic measurement, a halimeter test and gas chromatography. We could not detect any measurable malodor but she could not accept those results and insisted that she had a strong malodor nonetheless. Instead of trying to make her accept the results, we simply told her that we understood her concern and anxiety about her malodor. We repeated these objective breath odor measurements and medical interviews and also explained, little by little, that she might be misinterpreting the attitude of others. She did, gradually, begin to accept both the results and our explanations. By the fifth visit, she was almost free of the anxiety and said that she could now ride the bus.
The anxiety of this patient, who had been worrying about her malodor for a long period, disappeared during the course of repeated objective breath odor measurements and accepting, non-confrontational medical interviews.

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Although it is normal to swallow air, excessive air swallowing is liable to produce discomfort in the stomach, stomachache, the post-prandial feeling of fullness and belching. This condition is called pneumophagia and is a form of functional dyspepsia. We report a case of functional dyspepsia due to malocclusion in a woman in her sixties who complained chiefly of malocclusion and breathing difficulty.
The patient first sensed malocclusion after receiving a bridge in region (5) (6) (7) at dental clinic A in the autumn of year X-1. She asked the dentist of A dental clinic about this condition and he answered that there was no occlusion problem. She next visited dental clinic B, where she asked the dentist to remove the bridge. A temporary bridge was provided but her condition worsened with insomnia, breathing difficulty, flatulence of the stomach and decreased appetite. She visited doctors of internal medicine and the ear, nose and throat but even thorough examination by them revealed no cause. She then returned to dental clinic A to inquire about her condition. The dentist advised her to receive an examination at dental hospital C, which she visited in year X. A dentist of the department of dental prosthesis adjusted the occlusion but her condition still worsened, so the dentist referred her to the chief author of this paper. We provided combined treatment together with a psychiatrist from the first examination, providing both reasoning and medical treatment in the form of supportive psychotherapy and checking of occlusion at the department of dental prosthesis. Her sense of malocclusion gradually receded and her condition improved.

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