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There is a present trend towards so-called alternative methods in medicine and dentistry, which is increasing despite the undeniable successes of established "scientific" medicine. The neglect of psychological and psychosomatic aspects of diseases by established medicine since the second half of the last century is identified as one of the major causes of this development.

Pain is always a subjective experience. Therefore the term "psychogenic pain sensation" seems to be a pleonasm at first sight. In fact, however, the dentist's attention should not only be focussed on the removal of the objective causes of pain, but the fact itself, i.e. the patient's subjectivity, must be considered, too. Unless this is done, the results are serious diagnostic and therapeutic errors.

Nowadays dental implantations are highly successful if individual indications are taken into consideration. From our experiences with patients from the Research Institute for Psychopathology and Psychosomatics, we would like to point out a contraindication for the treatment of dental implants, which until now has been hardly considered. A special case report shows that psychosomatic problems and pains in the maxillofacial region can be the cause of failure of dental implants.

Elderly people form a very large portion (43.2%) of the out-patients of the research institute for dental psychosomatics and psychopathology. Abnormal personality developments could be observed in the group of 40-60-year-old patients as often as in the over-60 group, whereas there was a noticeable rise in the number of depressions and abnormal reactions in the older age group. As one case demonstrates, the situation and life-history of an elderly patient, too, are important factors influencing his psychosomatic disturbance, in some cases however, an organic psychosyndrome may supervene, thus further complicating psychotherapy and psychagogical measures. These therapeutical methods have to be made suitable to the personality of a patient of advanced age, while medicamentous therapy and prosthetic care have to be modified in the same way.

The kernel of the patient's motivation for oral hygiene should be the conversation which the dentist has with his patient. He should conduct this conversation factually, carefully, without loud or shrill tones. The patient must be told: concerns your own personal interest. The necessary detailed information and technical hints may be left to the assistant or the dental technicians, additional leaflets and even audiovisual aids may supplement the patient's information. The members of the practice must be in agreement on the questions of motivation and information of the patient, so that one does not destroy what another has built up.

3291 patients with facial pain and/or complaints in the orofacial region were examined from 1972-1988 by both the maxillofacial surgeon and the neurologist at the departments of maxillofacial surgery and psychosomatic medicine of the Zentrum für Zahn-, Mund- und Kieferkrankheiten of the University of Münster. Only 27 cases of genuine trigeminal neuralgia could be found in those 17 years. At the same time, however, 31 patients presented with anaesthesia dolorosa after various operations on the fifth cranial nerve. Referring to the criteria set up by Marxkors and Müller-Fahlbusch (1981) these findings were based on psychosomatic diseases. Thus, any indication for an operation on the trigeminal nerve should be very carefully reconsidered.

After numerous attempts to provide an endentulous patient with a dental prosthesis had failed, the insurance institution posed the fundamental question of the patient's ability to be fitted with a prosthesis. The personality of the patient in addition to the local findings and the dental prosthesis itself were included in the consideration.