Abstract
We report on the dental treatment with systemic management throughout the life of a patient with Down syndrome, who was diagnosed with Eisenmenger syndrome, where general anesthesia was determined to be difficult. The patient had had dental caries since childhood, and was receiving dental treatment under body restraint. However, with the progression of age and growth, treatment refusal and gag reflex became stronger, which rendered treatment without the use of general anesthesia difficult. After being diagnosed with severe Eisenmenger syndrome at the age of 20 years, the patient was refused treatment at numerous other facilities since dental treatment under general anesthesia posed a high risk, and hence the patient presented to our hospital. The patient expired at the age of 33 years due to heart failure. For eight years, between the ages of 25 and 33 years, the patient was treated 97 times. The patient had 96 dental treatments under administration of oxygen and monitoring, and one tooth extraction under intravenous sedation. SpO2 under room air, which was measured during each treatment, was 80-89% in the beginning, but gradually decreased over time. During the last year, it was often 70-79%, which indicated poor general condition. Eisenmenger syndrome when complicated with Down syndrome has a short average lifespan of around 18 years due to pneumonia or infective endocarditis；however, this patient maintained quality of life until the age of 33, which is 1.5 times longer than the average lifespan. This increased lifespan was due to the dental treatments under systemic management, such as monitoring under oxygen administration and intravenous sedation. Providing the safest dental environment for high-risk patients for whom general anesthesia is impossible is the most important role of a team approach with a pedodontist and a dental anesthetist.
