著者

竹之下 美穂 吉川 達也 加藤 雄一 佐藤 智子 豊福 明

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.23, no.1-2, pp.46-50, 2008-12-25 (Released:2011-09-20)

参考文献数

11

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Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause and hypersensitivity to stimuli in radiographically normal teeth. Patients complain of continuous pain even after extended endodontic treatment. This report presents two cases of AO in patients who visited our clinic in 2007 from the psychosomatic perspective. We examined their medical histories, treatment procedures and prescriptions as described in their medical records.(Case 1)Female, 39 years old. Chief complaint: Pain on the right maxillary second premolar. The patient felt pain on the right maxillary first molar and the crown of the tooth was removed. She subsequently changed clinics and the tooth was extracted. Laser therapy and a pulpectomy were provided on account of the pain but she again changed clinics because of the constant toothache. She visited our clinic while receiving treatment at a pain clinic. SAIDs and milnacipran were ineffective. The pain was alleviated by amitriptyline.(Case 2)Female, 38 years old. Chief complaint: Post extraction pain on the right maxillary molar and right orbital pain. The right maxillary molar was extracted after repeated root canal treatment (RCT) but the pain remained following tooth extraction and she next visited oral surgery. She was diagnosed as normal by the oral surgeon, and then visited our clinic. She refused to take antidepressants at first in spite of repeated counseling to do so, but did agree to take the medicines after three months. The pain was relieved by amitriptyline.It is very difficult to diagnose AO due to the very nature of dental treatment. Despite the reports that some antidepressants are effective against AO, dentists often have difficulty in treating AO patients due to individual variations in the response to medicines. Further, as the patients themselves believe that their pain is caused by dental problems, they sometimes refuse antidepressants. Patients are inclined to become angry or distrustful because of their prolonged pain and repeated dental treatment, so it is important both to prescribe appropriate medications and to be receptive and listen attentively to what they say.

著者

豊福 明

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.55, no.4, pp.163-168, 2009-04-20 (Released:2012-08-28)

参考文献数

25

被引用文献数

1 2

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In dry mouth clinic, there are many patients who complained of subjective feelings of dry mouth despite their normal salivation. This dry mouth frequently comorbid with glossodynia or oral dysaesthesia. So far, these complaints have been thought to be ‘psychogenic’. Namely, psychosocial factors and/or individual factors have long been considered as main cause. Even if oral surgeons referred patients to psychiatry clinic, a majority of them wished to avoid consultation, or, would sometimes complain that the dry mouth got worse after medication. Therefore, it is very important and difficult problems for clinical oral surgeons to see how look at these patients and to learn how cope with them.From my own years of experience in psychosomatic studies, I think ‘distorted cognition ’ is central to these pathogenesis. These distorted cognition cause dissociations between subjective and objective findings. Moreover, I have propose a hypothesis that neurochemical dysfunction of some sort of neurotransmitter systems and distortions of information-processing in cerebral association area related to thought and memory underlie the distorted cognition.Patients with subjective dry mouth never tell a lie about their symptoms, but they have just ‘ neural network error’ in their brain. We should take up to problems of oral discomfort at the root of their complaint.If we suspect their complaints as the cause of psychogenic, it might be often unsuccessful in treatment. First of all, to listen carefully to complaints from them is very important, and then we have to do differential diagnosis. If patients are diagnosed the symptom form with distorted cognition, medication using SSRI or SNRI is necessary for reconstruction of impaired neuronal network. Of course oral surgeons have to receive advanced education and training to use psychotropic drugs. At the same time, it is needed for sensitive response to patients and family members.The distorted cognition with these patients are associated with dysfunction of neurotransmitter systems and information-processing in peripheral to higher central nervous system. Strange complaints and persistent therapeutic demand are representatives of the distorted cognition. If we regard queer complaints as neural network errors, we can see the psychogenic complaints as distorted cognition.At present, this hypothesis cannot be shown objectively, but it might be possible that some new approaches such as brain imaging make mechanisms of the distorted cognition more clear. It is very important to collect evidence-based diagnosis, therapies and pathophysiological mechanism for dry mouth as an oral psychosomatic disorder.

著者

高橋 宏昌 豊福 明 池山 尚岐 斎木 正純 松永 亜樹 喜久田 利弘

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.21, no.1, pp.23-26, 2006-06-25 (Released:2011-09-20)

参考文献数

10

被引用文献数

1

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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

著者

豊福 明

出版者

一般社団法人 日本心身医学会

雑誌

心身医学 (ISSN:03850307)

巻号頁・発行日

vol.54, no.11, pp.1020-1025, 2014-11-01 (Released:2017-08-01)

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顎関節症という疾患概念は,顎関節部の疼痛,関節雑音,開口障害を伴う慢性疾患の臨床診断名として使用されてきた.口腔外科領域では外来患者の約10〜15%と比較的頻度が高い.頭痛・頸部痛や肩こり,耳鳴りなど多彩な周辺症状を伴う患者も多い.線維筋痛症や慢性疲労症候群などとの合併も多い.本症の原因はいまだ解明されたとはいえないが,従来重視されてきた咬合(歯の咬み合わせ)の関与は否定されてきている.にもかかわらず,咬合と顎関節症状や周辺症状とを関連づけ,歯科治療の泥沼に陥るケースはいまだに後を絶たない.顎関節症そのものより咬合関連の愁訴のほうが大きな問題になることがはるかに多い.羮に懲りて膾を吹くように,咬合は「最も歯科的な症状」であるにもかかわらず,当の歯科医師が過度に敬遠する風潮が蔓延している.従来型診断では神経症圏に包含されたであろうこれらの患者は,歯科と精神科の間で譲り合いが続いている.医療システムより,これらの患者を誰が責任をもって診療するかの問題であるように思われる.

著者

豊福 明

出版者

口腔病学会

雑誌

口腔病学会雑誌 (ISSN:03009149)

巻号頁・発行日

vol.74, no.3, pp.161-168, 2007-10-31

参考文献数

59

被引用文献数

3 1

著者

豊福 明

出版者

日本歯科薬物療法学会

雑誌

歯科薬物療法 (ISSN:02881012)

巻号頁・発行日

vol.36, no.3, pp.117-120, 2017 (Released:2017-12-27)

参考文献数

13

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Historically, chronic oral pain with unknown origin had been treated as a “psychogenic” condition in dentistry. Although tricyclic antidepressants have been widely used to treat chronic oral pain such as glossodynia or atypical odontalgia, the mechanisms on how they work is not precisely elucidated still now. Strong evidences have been accumulated on pathophysiological interactions between chronic pain and psychosocial factors. Dopamine system has been found to play a key role for bridging chronic pain and psychosocial factors. To treat chronic oral pain better, we dentists should search for a new pharmacotherapy based on brain function, especially with a focus on the relationship between chronic oral pain and dysfunction of mesolimbic dopamine system.

著者

豊福 明

出版者

口腔病学会

雑誌

口腔病学会雑誌 (ISSN:03009149)

巻号頁・発行日

vol.74, no.3, pp.161-168, 2007-10-31 (Released:2010-10-08)

参考文献数

57

被引用文献数

4 1

著者

扇内 秀樹 豊福 明 星 佳芳 宮崎 秀夫 永井 哲夫 角田 正健

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.17, no.2, pp.137-142, 2002-12-25 (Released:2011-09-20)

著者

豊福 明 梅本 丈二 内藤 温友 喜久田 利弘 都 温彦

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.15, no.2, pp.197-202, 2000-12-25 (Released:2011-09-20)

参考文献数

15

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The authors employed behavior restriction therapy for a 19-year-old female delusional halitosis patient under hospitalization. She had been complaining of halitosis for 4 years and visited several psychosomatic specialists. She had also been hospitalised in a psychiatric ward for treatment but her complaints of halitosis had not been reduced. She gave up high school and tended to stay indoors.We started by using the description of impressions and prescribed her amitriptyline as an outpatient. Symptoms such as delusion of reference or depression were ameliorated and she became fairly cheerful. But her poor social adaptation hindered her from forming a full social identity.We introduced her to behavior restriction therapy upon her admission to our hospital. Under condition of general social deprivation, she experienced many warm emotional exchanges with other inpatients, and gradually gained confidence in personal relations. We also administerated fluvoxamine, a selective serotonin reuptake inhibitor (SSRI). The fluvoxamine was as effective as amitriptyline, and fewer side effects were observed. Finally, she became able to talk with others and go out freely, in a manner suited to her age.It is suggested that behavior restriction therapy was useful in this case.

著者

豊福 明 都 温彦

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.18, no.2, pp.99-101, 2003-12-25 (Released:2011-09-20)

参考文献数

7

被引用文献数

2

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外科的顎矯正治療後に, 咬合の異常感の他, 姿勢のねじれ, 全身倦怠など多彩な全身的不定愁訴を呈していた39歳, 女性の顎関節症患者に, SNRIであるmilnacipranによる治療を行った. SNRIを6ヶ月かけて30mg/dayから120mg/dayまで増量したところ, 咬合の異常感, 広範囲の疼痛や随伴症状の睡眠障害, 慢性疲労, 全身のこわばり, 痺れ感, 抑うつ気分などが, 経時的および用量依存的に改善していった. 本症例は線維筋痛症の診断基準も満たしており, 両者の随伴症状の重複や抗うつ薬への反応の共通性から, このタイプの顎関節症の背景には線維筋痛症と類似した中枢性の病態生理学的機序が存在するのではないかと考えられた.

著者

豊福 明 吉田 美紀 嶋村 知記 古賀 勉 瀬戸 富雄 清水 敏博 中小田 直子 松原 聖子 有吉 祐二 喜久田 利弘 都 温彦

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.11, no.1, pp.88-95, 1996-06-25 (Released:2011-09-20)

参考文献数

5

被引用文献数

1

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We have proposed that the management of serious psychosomatic TMJ disorder should be undertaken in a hospital environment where the patient can be fully investigated and the response to medication and psychotherapy monitored.This is not only because they are too tired to do anything but also they wander about many hospitals having wrong conviction that occlusion is the cause of many systemic disorders.To release the oral function from this pathological attention of brain, we reduce their symptoms by antidepressants without dealing with their occlusion. In this process, we take a psychotherapeutic method to make them notice their changes to understand that occlusion had nothing to do with patient's symptoms.A 34-year old man, complaining of TMJ disorder and systemic fatigue and many symptoms, was shown as a case example in the process of improvement of wrong conviction.Once he came to our department, but was lost to follow-up, and wandering many hospitals including neuro-pcychiatry. 8 months after the last visit, the patient came to our hospital again for admission.In the process of therapy, constant stimuli were provided to patients in the therapeutic frame, in which the therapist tried to maintain an emotionally steady attitude toward him and gave active support to his healthy mind, through stable and proper comments without being affected by perpetual and entrapping inciation of his ill mind.Comstancy not only in psychological stimuli but also bodily sensation was evaluated as one of the most important factors for the cure of the disorders. Psychosomatic therapy by the dentist made it possible for this patient to resusciate his own bodily (especially oral) perseption.