Head and neck cancer has the extreme aspects compared to cancer of other organs. The fact that the other persons can see the cancer lesion the patient will suffer psychosomatic stress.
As for the patients undergoing radical excision, functional disorders involving mastication, swallowing, and articulation in addition to facial deformity remain after the operation. It is therefore difficult for the medical staff to carry out comprehensive management of the patients due to their anxiety, and fear, especially in case of tumor recurrence.
The report describes 4 cases of oral malignant tumors who committed suicide with regard to the causes of suicide and possible preventive measures.
The following results were obtained:
All 4 cases were transferred from other hospitals and 2 of them had cancer. Adequate explanation and information about the patients should be supplied by the previous attending physician.
Overly optimistic expectations concerning functional and cosmetic recovery may damage the relationship of trust between patients and doctors.
Permission to spend the night outside of the hospital should be given with considerration of the patient's loneliness and isolation from the family, relatives and friends, therefore good communication between the patient's family and medical staff is important.
Careful observation is needed to detect suicidal tendencies (e. g. hints at suicide, excessive cheerfulness, sudden depression).
Whenever suicidal tendencies are noted, frequent visits, listening to the patient's complaints, and assistance from the patient's family are necessary.

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Objective and quantitative analysis of gustation was assessed in 10 healthy male adults by a visual analogue scale (VAS) as a subjective taste evaluation and cerebral evoked potential (CEP).
1) N1, P1 and N2 components commonly observed in CEP induced by stimulation with distilled water and various taste solutions were considered to be somatosensoryevoked potential (SEP) derived from tactile response.
2) P2, N3 and P3 components, induced only by stimulation with taste solution but not by distilled water were considered to be gustatory evoked potential (GEP) derived from the taste response.
3) GEP component induced by varied taste qualities (sweetness and sourness) showed different peak latencies, which was suspected to reflect chemotopic organization with the process of selecting taste quality in the brain.
The P2 component (N2- P2 amplitude) was closely related to the consistency of taste solution, while the N3 component (P2-N3 amplitude) was closely related to the gustatory intensity, indicating that P2 and N3 components reflect the cognitive processing system of gustation.
These results suggest that GEP may be used as an effective method for discrimination between organic diseases and psychogenic disturbances of taste abnomalities.

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We measured event related potential (ERP) by applying strong and weak electric stimulations to the lips of 11 healtyh adult male subjects to quantitatively analyze the relation between the target stimulation wave form component in relation to the subjective pain sensation.
1) Regarding the target stimulation wave form component, both the group highly sensitive to pain (high sensitivity group) and the group less sensitive to pain (low sensitive group) demonstrated a common waveform component of N100 and P300 against the Fz-and Pz-led waveforms, and regarding the standard stimulation waveform component, the common waveform component of N100 and P250 against the Fz-and Pz-led waveforms. The P300 component in the target stimulation waveform was the ERP component while the P250 component of the standard stimulation wave form was the pain-related late positive component.
2) No significant difference was observed in Fz-and Pz-led waveforms between the high sensitivity group and the low sensitivity group at P300 latency of the target stimulation waveform, but a significant amplitude increase was indicated in both the Fz-and Pz-led waveforms in the high sensitivity group (p<0.05) compared with the low sensitivity group.
3) Though no significant difference was observed in the Fz-and Pz-led waveforms between the two groups at P250 latency of the standard stimulation waveforms, there was a significant increase in the N100 P250 amplitude of Fz-led waveform (p<0.05) in the high sensitivity group as compared with the low sensitivity group. Although there was no statistically significant difference in the Pz-led waveforms, the high sensitivity group indicated a tendency of increase in amplitude (p<0.1).
4) N100-300 amplitudes may permit the objective determination of the fear, anticipation and anxiety of pain.

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Some of craniomandibular disorders (CMD) patients can be classified into psychosomatic patients due to the great participation of their neuro-psychological factors.
A case reported here is a CMD patient whose symptoms were seemingly caused by disharmonious occlusion, but was not improved by occlusal therapy but well treated by psychosomatic approach. The patient was 54 years old woman, and complained of unbalanced occlusion, pain in the head and neck and ringing in the left ears. She told that the symptoms appeared since she had a bridge in the left lower molars, and occlusal adjustment was carried out repeatedly but her mandible was unstable and showed a tendency to move to the left side. Then, we tried splint therapy but no clear improvement was obtained. Anxiety and distrust based on the previous unsuccessful dental treatment were thought to contribute greatly to the formation of the symptoms. After psychosomatic treatment, the symptoms disappeared gradually, and the states of occlusal disharmonies became clear and occlusal treatment was suitably performed. Consequently this case could be said to be placed in the category of dental psychosomatic disease.

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A case of masked depression with ulcer of the oral mucosa is reported. A 43-year-old female was admitted to our department with tongue ulcer and feeding disturbance considered to have been caused by a pain in the tongue for two weeks. A 30×40mm ulcer was observed on the back of the tongue. There were no abnormal hematological findings. The ulcer was alleviated by administration of gargle and nutrition, however the patient was hospitalized because of a disturbance in gait considered to have arisen from the feeding disturbance.
The feeding disturbance was diagnosed as having developed from masked depression by psychopathist and administration of antidepressant was started. The patient was discharged three weeks after admission because the ulcer had subsided. Ten days after discharge from the hospital, bilateral buccal mucosal ulcer appeared. The ulcers were alleviated by administration of gargle and oral irrigation for several days. After that the ulcers of tongue and buccal mucosa recurred twice during a period of three months. The symptoms subsided with treatment.
It was considered that the ulcer was induced by pernicious movement of the tongue and cheeks dealt and decreased oral mucosa by resistance due to undernourishment induced by masked depression.

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Bizarre behavior with regard to pain by a schizophrenic patient is reported. A 65 year old male schizophrenic patient suffered from two sort of pains at the same time. The one was slight and caused from irritation of the lowere denture and the other was severe one caused from suppurative inflammation of a maxillary cyst. For a week, he endured the severe pain and did not tell it to anyone. He persistently complained only the slight pain. So the author overlooked the suppurative lesion. When he ultimately complained the severe pain, the lesion was expanded severly, tenderness remarkable. Though the patient was familliar with handling his dentures, he had never tried to remove the upper one between this painful period. The upper denture exsert hard pressure upon the swelling lesion (Fig.1). Soon after the lesion was incised and pus was drainerged, the patient worried about the lunch for a picnic two days after. But the author could not understnad the reason. The bizzare behavior toward the pain was hardly exhibited between normal patients. It suggested the existence of cognitive deficit. In daily dental practice of schizophrenic patients, the author has often experienced their bizarre behavior to painful stimulation like this case. Since cogntive deficit is commonly found between schizophrenic patients, the dentist should always take into account its effect on the pain perception when he evaluates their pain.

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This study was designed to evaluate whether mental stress was decreased by candies and chewing gum chewing.
The subjects consisted of 10 male students without malocclusion at Tsurumi University School of Dental Medicine. The test material were a candy called Gummi (Meiji Seika Kaisha, Ltd., Gummi Grape 100^®) and chewing gum produced for this study. Stress was imposed by the addition test method. Electrodermal activity (EDA) was evaluated by the exosomatic method. The subjects rested for 10 min after starting the experiment. Once changes in EDA stabilized, a control recording was made. Changes in EDA were then recorded while the subjects performed a 1-minute addition test (addition test group). Then changes in EDA during a 1-minute addition test were observed while the subjects chewed Gummi (Gummi group). After resting for 10 min, they chewed chewing gum for 5 min, and the changes in EDA while chewing chewing gum were observed (chewing gum group). The values of resistance in each group were evaluated at 10 sec intervals. The EDA was evaluated as percent change, with the value at the start of the addition test taken to be 100. The statistical significance of differences in response between the groups was assessed by Student's t-test.
Although there was considerable inter-subject variation in resistance, the values at the start of the addition test were 768.1±208.5kΩ(mean±SE) in the addition test group, 436.1±98.5 kΩ in the Gummi group, and 425.5±88.7kΩin the chewing gum group. Maximal changes in these groups were observed after 10 sec and were 53.4±3.9%(mean±SE) in the addition test group, 76.4±4.1% in the Gummi group, and 68.8±6.7% in the chewing gum group.The rates of change after 60 sec recovered to 59.8±3.8% in the addition test group, 89.9±3.3% in the Gummi group, and 83.4±9.0% in the chewing gum group.The values in the addition test group were significantly different from those in the Gummi group and chewing gum group. The results indicate that mental stress during light activity is decreased by Gummi and chewing gum chewing.

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A 28-year old female presented with pain and left TMJ instability, headache, buzzing in her ears, pain extending from her neck, shoulders and chest to her back and waist and general fatigue.
She underwent orthogneatic surgery at another hospital five years previously. Subsequently she suffered from the above symptoms for four years. She had visited many hospitals but had obtained no relief.
Since she was severely depressed, we administered 40mg amitriptyline, 2.0mg lorazepam, 200mg sulpiride per day.
On the other hand, she was convinced that the cause of the symptoms was her occlusion, so psychotherapy was required to change her mistaken conviction.
The technique we used was “description of impressions”, and to use it more effectively we never treated her occlusion. We permitted her to leave hospital and stay out according to improvement of her symptoms.
We confirmed the recovery process without treating the occlusion based on her “description of impressions” on a daily basis. Finally her thinking changed and she said “when I was sick, I couldn't believe that the occlusion had nothing to do with my symptoms”.
It can be concluded that these somatic symptoms derive from depression because antidepressants were effective. However, it is impossible to change mistaken convictions by medicine. We consider that it results from the higher brain, because the “description of impressions” was effective in improving it.

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A total of 31 nurses were evaluated subjectively and objectively in terms of their stress condition. Subjective stress conditions were evaluated by all the commonly used types of questionnaires and objective stress condition was evaluated by hemodynamical reaction and catecholamines with Schellong's tilting test, A Stress Barometer (Kitasato Biochemical) was used, and serum coenzyme Q₁₀ was measured. Only the purpose in life (PIL) test showed a high score, indicating strong motivation but the other questionnaires showed no statistical findings suggesting a high level of stress Hemodynamic reaction showed a general hypotonic pattern type, catecholamines showed a pathological reaction, only 24% of the subjects showed normal results on the Stress Barometer and serum coenzyme Q₁₀ level was abnormally low Nurses did not recognize their own stress condition, but objectively they were severely stressed. To compensate for this gap, it is considered that the meaning of life as a care giver of a nurse is very demanding, was shown in the PIL test. Nurses are very far from being in an existential vacuum.

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The effects of the chewing gum containing the extract from Hovenia dulcis Thunb.(H.gum) on reducing alcoholic smell in the breath of men after drinking alcohol, that is, beer (concentration of alcohol; 4.5%, 500m1), whisky (45%, 50m1, 4-fold dilution), and sake (15%, 180ml), were examined.
When H. gum was chewed after drinking alcohol, the expiratory alcohol (ethanol) concentration was significantly reduced, alcoholic smell in the breath was almost suppressed in sensory test, the flushing was suppressed, and immediate recovery from the intoxcation was observed. These results indicate that chewing H. gum accelerates alcohol metabolism, and reduces alcohol and other components of alcoholic smell in the breath.

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Systemic circulatory and hemodynamical examinations were performed on intractable periodontal disease patients (PDP) with high PDI (periodontal disease index) and SRPS (self-rating periodontal score). Among PDP, abnormal findings on chest X-ray, ECG, and/or ECG with tilting test were sometimes found.
Those who had abnormal findings showed poorer scores on PDI & SRPS than those with normal findings. Hemodynamical feature in PDP resembled the hypokinetic type of dysdynamic syndrome. The reason was considered to be poorer inotropic action of the cardiac sympathetic nerve. Low serum coenzyme Q₁₀ levels were observed in PDP. Most PDP have some functional hemodynamical or circulatory diseases, therefore, for diagnosis systemic examinations should be performed in addition to oral pathology. After the administration of coenzyme Q₁₀ in PDP the PDI, SRPS, serum coenzyme Q₁₀ levels and hemodynamics improved simultaneously. It is considered that coenzyme Q₁₀ has some potential to cure intractable periodontal disease.

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1, 145 cases with halitosis who visited our clinic (Department of Oral Surgery, Tokyo Medical College) were classified into 2 groups (objective halitosis: OH and subjective halitosis: SH). SH was divided into 2 sub-groups according to social adaptation type; psychosomatic halitosis (PH) had good adaptation and neurotic halitosis (NH) had poor adaptation. SH (NH) was more frequent groups, and females outnumbered males in all age. Oral disorder were found in 27.5%, primarily consisting of periodontal diseases, dental diseases, and glonitis. Systemic diseases included gastrointestinal tract, hepatopan creatobiliary and otolaryngological diseases as well as asymptomatic cerebral infarction (4.3%). In a QOL questionnaire, answers concerning social role and the meaning of life were disturbed in NH. PEG A patient evaluation grid (PEG) for differential diagnosis and treatment was designed based on these data. To cure intractable SH cases (25%), almost all of whom showed anthropophobia (96.0%), cognitive behavioral therapy was effective in 68.0%. Cognitive behavioral therapy appear useful in the treatment of intractable SH.

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For the purpose of elucidating the cognitive processing system of pain, the event related potential (ERP) by trigeminal nerve stimulation was analyzed in the present stydy in 15 healthy adult subjects (13 males and 2 females). At the time of carrying out the task, the reaction time (RT) was also determined in an effort to find how the response processing system is involved in the cognitive processing system of pain in the oral and maxillofacial region. As a result, the following findings were obtained.
1) The latency of N2 and P2 which are common waveform components of ERP were significantly prolonged in difficulty of discrimination (intense and weak stimulation current) and, concentration of attention (regular and random stimulation) and reaction time determination task.
2) Processing P1 positivity which is the ERP of the subtraction waveform of regular and random stimulation waveforms demonstrated, strong attention and strong correlation to the stimulation.
3) The subtraction result of the waveform under RT determination condition and that under non-determination condition is likely to suggest that the organizing system is mediated by not only the output of response processing system but also from cognitive processing system.
4) No remarkable correlation was observed between the latency of each peak of ERP and RT which is a behavioral index.
5) The above results indicate that, from the viewpoint of psychosomatic dentistry, it is clinically useful to analyze the psychological process such as cognitive processing system of pain and response processing system in the oral and maxillofacial region using ERP and RT.

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