Objective: This study evaluated clinical conditions， methods and results of treatment for anti resorptive agents-related osteonecrosis of the jaw （ARONJ） in cancer-bearing patients．

Patients and Methods: Among 62 patients diagnosed with ARONJ in our clinic during the period from January 2012 to December 2016, 25 cases have malignant tumor as the primary disease. The kind of anti-resorptive agents, cause of onset，stage classification at the time of the first visit，methods and results of treatment were examined in enrolled patients.

Results: Bisphosphonates were used in 16 cases （64%）, whereas denosmab was in 9 cases （36%）. The site of ARONJ was mandible in 20 cases （80%）, maxilla in 4 cases （16%）, and upper and lower jaw in 1 case （4%）. General risk factor except for cancer was diabetes mellitus in 8 cases （32%）. The most frequent local risk factor was tooth extraction in 10 cases （40%）. Five （20%） had ARONJ stage 1, 18 （72%） had stage 2, and 2 （8%） had stage 3. In stage 1, conservative therapy was undergoing in all 5 cases. In stage 2, conservative therapy was undergoing in 12 out of 18 cases, and surgery was selected in 6 cases. In stage 3, conservative therapy was undergoing in all 2 cases. The proportion of cases with therapeutic effect was 42.1% for conservative therapy and 66.7% for surgical therapy．

Conclusion: In this study，the efficacy of the surgical therapy was high. Since the prognosis of cancer-bearing patients varies greatly among individuals, it is necessary to select a treatment method after fully assessing the general and local conditions．

5p-syndrome is a hereditary disorder caused by the partial deletion of the short arm of the fifth chromosome. It is characterized by a cat-like cry during infancy. We experienced a case of dental treatment under general anesthesia for a patient of 5p-syndrome with ventricular septal defect （VSD）. A 37- year-old male （height 150 cm, weight 40 kg） patient, diagnosed with horizontal eruption of wisdom teeth in lower jaw right-hand side, was scheduled for tooth extraction under general anesthesia. He was diagnosed with 5p-syndrome after birth and had congenital heart disease. He was only treated with medications by symptomatic therapy and there was no radical operation performed. He had a severe mental retardation and could not cooperate for dental treatment, so dental treatment under general anesthesia was scheduled.Anesthetic induction was induced by intravenous administration of midazolam 2.5 mg, fentanyl 50 ㎍, continuous infusion of remifentanil 0.1 γ and the plasma-targeted target-controlled infusion （TCI） of propofol 5.0 ㎍/ml. Endotracheal intubation using a normal endotracheal tube was facilitated by intravenous administration of rocuronium 40 mg. Intubation grade difficulty identified at laryngoscopy was grade 2. Maintenance of anesthesia was accomplished by Air, O2　and propofol. His hemodynamics were almost stable in intraoperative period. The SpO2 and ECG were within normal range and may not have been a clinical problem. The duration of general anesthesia was 80 min, duration of surgery was 20 min, and concluded uneventfully. The management of patients with congenital heart disease is necessary for perioperative management according to the progress of the stage of the disease. We must also establish a cooperation system with cardiovascular medicine to prevent for complications and so as not to incur serious condition when complications occurred in the perioperative period.

Recent advances in basic and clinical research of cancer have improved the outcomes. In cancer management, not only safe and effective treatment but also the maintenance of quality of life by reducing the toxicity is required. The Iwate Medical University Hospital Cancer Center has promoted the medical-dental collaboration as a multidisciplinary approach to cancer management. To extract the current problems on the collaboration, we conducted questionnaire survey for medical doctors who are involved in cancer chemotherapy. Although the majority of them recognized the importance and necessity of collaboration, one-third of them did not recognize the system for utilization in our hospital. The other problems were difficulty in access to collaboration and a shortage of dentists and hygienists in collaboration. It is necessary to strengthen the collaboration by solving these problems to provide better managements for many cancer patients.

Recently, the morbidity and mortality rates of oral cancer are increasing; therefore, changing our way of thinking about oral cancer is required. An ordinary individual may not be familiar with oral cancer; thus, their interest in screening tests may also be limited. We aimed for the early detection of oral cancer with a mutual understanding in cooperation with related organizations. 1.Oral cancer screening test Oral cancer screening tests for the cohort were performed in a certain area in Iwate prefecture. In Ohtsuchi Town, oral mucosal screening tests have been performed as a cohort study once a year since 2011. Furthermore, in Hanamaki city, dental hygiene conventions with oral cancer screening tests have been conducted since 2016. Performance of oral mucosal screening tests in wider areas is desirable. 2.Cooperation with the Iwate Dental Association A clinical manual demonstrating the checkpoints of oral cancer screening tests was generated, which was used by members of the Iwate Dental Association. This resulted in the smooth introduction of patients to our hospital. 3.Treatment system of our hospital Full oral inspection of mucosal surfaces is effective for the early detection of oral cancer. However, oral cancer screening tests were only performed in 43.6% of our hospital dentists at the initial diagnosis. Since then, we have newly established the lecture course of oral cancer screening tests for the clinical residents. This will improve their awareness and skills and spread knowledge of screening tests. 4.Enlightenment for general public We want to draw people's attention to oral cancer not only for dental treatment but also for health services of local government or companies. Introducing ordinary individuals to self-checks for oral cancer was logical. The “Akanbe” test, which was developed by Emeritus Professor Yoshiki Sugiyama, is one of the effective methods. In these clinical activities, personal oral cancer screening tests performed by members of the Iwate Dental Association were the most effective for early detection of oral cancer. We aim to improve the checkup rate of personal oral cancer screening tests in dental offices in association with a strong cooperation with the Iwate Dental Association.