Clinicians administering maxillofacial implant treatment do not have many opportunities to address various problems of the patientsʼ psychological/mental condition. Postoperative complications of patients with oral/maxillofacial disease include chewing disorder, aesthetic disorder, morphological disorder, communication disorder, and dysphagia.
Whether these problems as incentive for the patientsʼ visit will immediately reveal the chief complaint is unclear. At initial interview, patients may not always present the chief complaint immediately. Hence, in daily practice, clinicians may have several opportunities to encounter patients with mental illness.
This study aimed to determine the relationship between physical disability and mental condition in patients with oral/maxillofacial disease who experience postoperative problems.
Among potential factors involved, such as physical disorder, psychological condition, implants treatment, incidental surgery, patientsʼ burden to treatment, support from medical personnel, and supportive care for mental condition, discussions have rarely focused on intention based on awareness and support for the mental state.
However, in the actual clinical setting, providing patients with expected answers is not often possible because of ambiguity in treatment indications, and explanation to patients on the ambiguity of implant treatment may be necessary on a daily basis. Therefore, studies that clarify such issues are important.
In this study, we clarify the cause of mental and physical disorders and determine effective treatment approaches.
Implant treatment from the perspective of complication of oral surgery and the patientsʼ psychological/mental state are discussed through the following questions.（1）In the clinical setting, is it possible to identify patients who are likely to be problematic based on medical interview?（2）How should a therapist respond to the awareness of masked mental condition? or（3）How is collaboration between the implant therapist and psychiatrist or dental psychosomatic expert implemented and can good patient outcomes be expected?
The number of patients receiving dental implants has steadily increased in recent years. Among these patients, we have found more than a few to be challenging. These are patients who—even though their implant treatment has concluded with no problems and no signs of dental complications—take their treatment as an opportunity to complain about poor general conditions, feeling unwell, or oral discomfort. The complaints are diverse and sometimes intensify as patients become increasingly stressed. This background to implant treatment shows the desirability of a holistic approach to patient management from both physical and mental perspectives. Information collected and support provided by dental staff who often communicate and interact with patients are especially important. In this paper, we described a team medicine-based risk management initiative to prevent the problems that can occur with patients.
Some patients treated with dental implants are sometimes bothered by having medically unexplained oral symptoms（MUOS）. Although oral surgeons tend to regard them as “psychosomatic problems”, patients seldom accept such explanation, instead, they keep on convincing some organic causes. Some dentists had tried to solve these problems by depending on psychiatrists. However, psychiatrists find it difficult to understand deeply the oral complaint. Consequently, a mere psychiatric referral is usually not helpful. In such a situation, explaining and discussing the unknown origin of the oral symptoms is necessary. Oral surgeons are expected to have capability to assess properly psychosocial condition of the patients. In this article, the author introduced the concept of PIPC（Psychiatry In Primary Care）and how to deal with MUOS.
Objective：Although dental implant surgery is an effective dental prosthesis technique, the management of patients undergoing antithrombotic therapy during this surgery remains unclear. The present study aimed to assess the management of such patients during the dental implant surgery and the occurrence of postoperative bleeding.
Materials and Methods：We examined 28 dental implant surgeries performed in 21 patients undergoing antithrombotic therapy between January 2007 and December 2016.
Results：Postoperative bleeding was recorded in 34.6% of patients undergoing antithrombotic therapy, and no serious bleeding complications were noted. The rate of postoperative bleeding was higher in patients undergoing therapy using warfarin than in those undergoing therapy using platelet aggregation inhibitor.
The number of implant insertions in a single surgery and the type of surgical method employed（single- or two-staged procedure）did not significantly affect the occurrence of postoperative bleeding.
During the observation period ranging from 10 days to 10 years, no implants were lost and no bleeding complications were reported.
Conclusion：These results indicate that antithrombotic therapy should be continued in patients undergoing dental implant surgery. However, meticulous follow-up of the patient following the dental implant surgery is required.