In recent years, the use of new technologies based on information and communication technologies (ICT) for telemedicine has been under consideration. In this study, we explored the use of telemedicine-based instruction in the context of dysphagia rehabilitation in disability support facilities.

The participants were residents of disability support facilities who were receiving dental care in our department and required assistance with oral intake. We conducted four sessions of telemedicine-based instruction regarding the participants’ dysphagia and subsequently surveyed the caregivers using a questionnaire about their experience with online instruction.

The study included eight individuals with intellectual disabilities as participants and 29 livelihood support workers as consultees. The most common topic of consultation was “choking on food” but many other issues were observed during the telemedicine-based instruction, such as “eating quickly,” “inappropriate assistance,” and “inappropriate posture.” Adjustments and modifications to assistance methods, posture, and spoons and other eating utensils were made by the telemedicine-based instruction and consultant. Issues related to eating and swallowing function, such as “choking on food,” “spilling” “large amounts of food in one mouthful,” “swallowing without chewing,” and “sloppy eating” decreased, but some had not improved. According to the questionnaire survey, the telemedicine-based instruction was highly evaluated in terms of its usefulness and implementation methods.

In order to ensure that everyone can continue to receive equitable medical care amidst changes in living environments, such as admission to disability facilities, it is important to utilize online healthcare as a reasonable approach. By determining the benefits and limitations of telemedicine, we can expect telemedicine to be effectively used in disability support facilities alongside the development of ICT technologies.

This study attempted to identify the primary factors determining the adaptability of persons with autism spectrum disorder (ASD) when undergoing oral examinations and polishing using a rotary engine. The subjects were 90 people with ASD who visited the Nishio Municipal Special Needs Dental Clinic or Yokosuna Dental Clinic from April 2019 to March 2023 for the first time.

The study was planned as a prospective design. The calendar age, gender, developmental age, presence of strong behavioral disorders, disability characteristics, past dental treatment experience, and medical treatment experience were investigated. Thirteen steps of training from “getting out of the car” to “intraoral examination” and “polishing by rotary engine” were performed, and the subjects’ behavior was observed and evaluated. The analysis methods used were Fisher’s direct probability calculation or χ² test and decision tree analysis.

The factors that were found to be most predictive of the adaptability to oral examination and polishing were calendar age, developmental age in six developmental areas, severe behavioral disorder, “strong preoccupation,” “strong meal-related disorder,” “marked hyperactivity,” severe behavioral disorder total score, “stereotypic behavior,” and “strange voice.” The criterion for determining the suitability of oral examination and polishing in persons with ASD were as follows：the developmental age of the fields of basic habits and language comprehension was 3 years and 2 months or older. Those with disability characteristics and those who had experienced suppressive treatment tended to be unable to adapt. When treating persons with ASD, it is considered important to take disability characteristics into consideration in addition to developmental age and to avoid making them feel uncomfortable.

The purpose of this study was to quantitatively analyze the oral environment of residents based on the frequency of oral hygiene management guidance for special nursing home staff.

The participants in this study lived in a nursing home and were able to gargle. The participants were divided into two groups per living floor；similarly, the staff in this special nursing home were also divided into two groups per living floor. Each group was given oral hygiene instruction once a week and once a month, respectively, for two months.

After a one-month cleaning period, the once-monthly and once-weekly groups were exchanged, and oral hygiene management guidance was provided for two months. Ammonia from the Salivary Multi Test (SMT) and category from the Oral Health Assessment Tool Japanese version (OHAT-J) were used to measure the oral environment.

The ammonia of the SMT was examined before and after the intervention. OHAT-J categories examined the improvement pre- and post-intervention between the once-weekly group and the once-monthly group.

The SMT results showed significant improvement in the once-weekly group, but not in the once-monthly group. The OHAT-J results showed no difference in the improvement rate for most categories between the once-weekly group and the once-monthly group.

We postulate that weekly oral hygiene management guidance could improve the oral environment of residents in quantitative evaluations.

Agnathia-otocephaly complex is a first gill arch developmental anomaly characterized by a missing or hypoplastic mandible and may be associated with holoprosencephaly and visceral abnormalities. However, long-term survival is extremely rare, and thus methods of managing oral health in this rare disease have not been established.

An 11-month-old boy demonstrated low body weight and short stature, as well as delayed motor development during the course of growth up to the age of 2 years. Facial appearance was palpebral fissure-downslanted, low-set ears, small mouth, and no redness on the lower lip. Computed tomography (CT) images revealed a complete mandibular defect and peri-mandibular muscular dysplasia, while deciduous teeth and first molar calcification were observed in the maxilla. The major salivary gland structure was unclear on the CT image, but drooling was observed, suggesting salivary gland function. Although the patient had delayed tooth eruption, the mesiodistal widths of the maxillary deciduous central incisors were relatively large, approximately 1SD larger than the average value for Japanese children.

Few reports of long-term survival of agnathia-otocephaly complex have been reported, but this case survived by postnatal tracheostomy and tube feeding, and because of the eruption and salivation, it is necessary to be careful about aspiration pneumonia due to dental calculus deposition, as is generally the case with tube-fed patients.

In addition, because the mouth is very small, it is anticipated that it will be very difficult to check the oral cavity and perform dental procedures in the future；therefore, it is important to explain the prognosis to the family and to collaborate with the medical department.

Freeman–Sheldon syndrome (FSS) is characterized by whistling face, alinasal hypoplasia, and ulnar drift deformity. It induces various symptoms in the orofacial area. In particular, microstomia always appears, causing difficulties with food ingestion and dental treatment, articulation disorder, and poor oral hygiene；such symptoms are closely associated with the field of dentistry. In this study, we report a patient with FSS who consulted our hospital for the first time in adulthood, and underwent dental treatment.

As physical findings, flexion contracture of the bilateral fingers and bilateral congenital clubfoot were noted. The facial and oral findings were mostly consistent with common findings of FSS. A small oral fissure was observed, with a mouth width of 32.4mm. Perioral tension and contracture were marked, and maximal mouth opening between the maxillary and mandibular central incisors was 21.5mm. Concerning food ingestion, the patient was satisfied with the present situation, and there was no articulation disorder. In addition, plaque adhesion, dental calculus deposition, and slight gingival swelling were observed at the neck of teeth in both jaws. On the occlusal surfaces of the maxillary and mandibular molars, caries class I to II was noted. There was no intellectual disability. The patient cooperated with dental treatment, but extension of the lips was unfavorable. When trying to widen the buccal mucosa, tension was strong, and the mouth was closed, making treatment difficult. However, treatment was continued, and perioral tension was slightly reduced 2 years after the initial consultation. There was a 1-mm increase in mouth opening.

Continuous dental treatment for patients with FSS may reduce perioral tension, leading to an improvement in microstomia-related trismus. To establish and maintain a favorable oral environment and function, early, positive, continuous dental intervention may be important.

Risk assessment and response to bleeding have been reported for extraction of teeth in patients undergoing antithrombotic therapy. However, there are no reports on assessing the risk of reinfarction. We report the case of a patient undergoing antithrombotic therapy who suffered cerebral embolisms twice after tooth extraction.

A 60-year-old male patient with cardiogenic cerebral embolism was transferred to our hospital for rehabilitation. On the 46th day after onset of illness, the patient underwent extraction of a mandibular right second bicuspid with severe periodontitis under edoxaban therapy. Six days after the extraction, the patient had aphasia and MRI showed a relapse, so the patient was sent to an acute care hospital, and then later was readmitted to our hospital. On the 112th day after the initial onset of illness, the patient underwent extraction of a maxillary right central incisor with apical periodontitis under apixaban therapy. Three days after the extraction, the patient suffered a relapse with worsening dysarthria and so was again sent to an acute care hospital.

Considering the risk of bleeding and reinfarction during tooth extraction, the patient underwent extraction under antithrombotic therapy. However, reinfarction occurred six days and three days after tooth extraction. Inflammation induces hypercoagulability in the bloodstream, which leads to thrombus formation, so it is important to take anti-inflammatory measures before and after tooth extraction. Considering the possibility of recurrence of cardiogenic cerebral embolism a few days after tooth extraction, as in this case, it is necessary to check the patient’s physical condition for several days after invasive treatment. When performing invasive treatment, it is necessary to explain the procedure thoroughly, obtain consent, and collect information on the patient’s life circumstances, such as whether or not the patient lives alone.

Trisomy 18 is an autosomal abnormality syndrome and occurs in one in several thousand people. The life prognosis is extremely poor：the survival rate of 1 year or more is about 10％. We report a case of accidental ingestion of a deciduous tooth during gastric tube insertion in a child with trisomy 18 and its removal under fluoroscopy.

The patient was a girl aged 12 years and 2 months, diagnosed with trisomy 18 at birth, accompanied with esophageal atresia, ventricular septal defect, scoliosis, etc. She was medically dependent, with severe motor and intellectual disabilities, and nutritionally managed through a nasogastric tube. One day, there was a problem with the nasogastric tube. When it was reinserted, it was suspected that she had accidentally ingested a deciduous tooth-like foreign object. A detailed examination revealed a fresh wound in the gingiva corresponding to the upper right secondary deciduous molar, and a foreign body thought to be a fallen deciduous molar was lodged in the lower part of the esophagus. Initially, the patient was followed up for several days in the hope of spontaneous excretion, but no change in the position of the foreign body was observed. Thus, it was removed orally under fluoroscopy on the fourth day after accidental ingestion. The accidental ingestion of the deciduous tooth was thought to be caused partly by difficulty in inserting the nasogastric tube due to progressive deformation of the gastrointestinal tract due to scoliosis. After the operation, no serious complications occurred.

In patients who need daily medical care and are unable to express their symptoms themselves like this case, a more comprehensive oral management is needed considering the possibility that teeth may accidentally fall out for various reasons, or that a fallen tooth may go unnoticed.

Objectives：This report presents the case of an obstructive sleep apnea (OSA) patient with cerebral palsy (CP) and intellectual disability (ID), treated with an oral appliance (OA).

Therapeutic process：We treated a 15-year-old male patient with CP, ID and OSA, using an OA. Since birth, he had had innate severe respiratory failure due to mandibular hypoplasia. He underwent a tracheostomy at the age of 1.5 years, and an adenoidectomy at the age of 8. At 15, he still held his breath during sleep without tracheostomy stoma. The patient and his parents visited our hospital, and the parents desired respiratory improvement for their son. In order to improve his respiratory status during sleep, we attempted an OA.

Result：The degree and characteristics of his sleep apnea with and without the OA by polysomnography (PSG) showed that the OA improved his breath during sleep. The OA decreased AHI by 26.1％, and obstructive and mixed apnea by 38.9％. With the OA, the lowest SpO₂ value increased to 92.4％. The OA also decreased AI in the supine position by 51.4％, and AHI of REM sleep by 78.7％.

Conclusion：We improved OSA in a patient with CP and ID, using an OA.

PURA syndrome is a type of PURA-related neurodevelopmental disorder which is characterized by moderate to severe delay in intellectual and movement development. In addition, hypotonia, hypothermia, hypersomnia, dysphagia, excessive hiccups, apneas, epileptic seizures, abnormal nonepileptic movements （e.g., dystonia）, and vision impairment are identified as clinical features of this syndrome. There is a risk of complication of congenital heart diseases, urogenital malformations, skeletal abnormalities and endocrine disorders, however, these are reported to be infrequent. In addition, there are several characteristic facial features such as myopathic face and oversized incisors.

In this study, we report on the dental caries treatment, periodontal treatment and oral hygiene management under nitrous oxide inhalation sedation while administering midazolam for a patient with PURA syndrome.

The patient was a 10-year-old boy. He had refused dental treatment at General Dentistry, so he was referred to the Oral Health Center of the Kumamoto Dental Association.

We performed dental treatment and oral hygiene management by nitrous oxide inhalation sedation while administering midazolam, taking into consideration his hypotonia, dysphagia, excessive hiccups. The patient currently visits our Center every two months to receive dental training and oral hygiene management.

It has been reported that this syndrome is the cause of about 0.3-0.5％ of cases of delayed intellectual development. Clinical diagnostic criteria have not been officially published, yet the number of cases is increasing gradually due to widespread recognition that genome analysis is required for a definitive diagnosis.

Many children with this syndrome have relatively good receptive language skills and are expected to respond somewhat to dental disease prevention training. Therefore, it is necessary to collaborate with medical departments earlier and educate parents regarding dental caries and oral hygiene management.

Plasminogen deficiency is classified as type I and type II. Patients with type II generally show no clinical symptoms, whereas in type I cases, fibrin does not become degraded during wound healing, resulting in the development of ligneous pseudomembranous areas on mucous membranes. The most common clinical manifestation seen in type I is ligneous conjunctivitis, which causes the formation of recurrent pseudomembranous lesions on the conjunctiva. In addition, these lesions may also form on areas in the middle ear, oral mucosa, pharynx, duodenum, respiratory tract, and female genitalia, leading to congenital obstructive hydrocephalus. There are few reports on patients with pseudomembranous formed on the oral mucosa. We report a case in which pseudomembranous periodontal lesions were observed in the oral cavity of a patient with plasminogen deficiency. The type is unknown, though probably type I based on the symptoms.

The patient was a 4-year-old girl in Japan who had Dandy-Walker syndrome, hydrocephalus, epilepsy, and intellectual disability. Plasminogen deficiency was also noted, with ligneous conjunctivitis and gingival pseudomembranous observed as symptoms. Ointment application, antibiotic administration, and washing were performed, as well as Er：YAG laser irradiation to pseudomembranous areas of the gingiva. As a result, some of those areas showed some shrinkage, but they did not completely disappear. It is considered highly likely that pseudomembranous regions will form and expand if oral hygiene deteriorates, making it necessary to continue providing oral care.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria for autism spectrum disorders (ASD) include “excessive resistance to change, excessive adherence to routines, and ritualized patterns of verbal or nonverbal behavior”. Considering these typical characteristics of ASD, our department had been making special arrangements for patients with ASD by fixing the attending dentist and using the same chair for examination. However, one of our dentists who had been treating disabled children for more than 30 years retired from our department, and later, our hospital building required reconstruction. These changes prompted a questionnaire survey with parents of patients with ASD regarding their impact. The subjects were parents of 113 patients with ASD treated by the same dentist (questionnaire period: April-May 2014) and parents of 109 patients with ASD examined at our department around the time the hospital building was being rebuilt (questionnaire period：April-May 2019). The subjects were asked whether they perceived any changes in the general attitudes of dentists and department staff, and if so, what exactly those changes were. Additionally, the parents were also surveyed on their concerns and anxieties. The results showed that the vast majority （88.5％） of the patients were able to receive the same treatment as earlier under the new dentist, while some parents preferred to have the predecessor back. Meanwhile, 64.2％ responded that they were able to receive the same treatment as earlier after the change in the dental department environment. These results suggest that most ASD patients were not “obsessed” with their attending dentist, but they were relatively more “obsessed” with the examination site. Nevertheless, these factors may not have affected the dental examination as much as anticipated.