We report a case of an oral surgery administrating general anesthesia for a 76-year-old female patient with thoracic aortic aneurysm (TAA). She was refered to our hospital because radio gram shows multilocular radiolucency in her mandible. She was diagnosed as TAA four years ago. The aneurysmal size is about 7 cm in diameter so that the emergency vascular surgery was required. However, since there was infection in her mouth. We determined to perform the oral surgery first in the presence of her cardiac surgeon, after discussion with him. We needed to pay careful attention to change in the circulatory responses.
The cyst was treated by enucleation, and the circulatory response during the operation was stable. About a year later, vascular surgery was performed.
Four years have passed since the operation and the patient's progress has benn good, without any signs of recurrence.

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We investigated the systemic diseases and systemic conditions of the patients who initially visited to 33 private dental clinics from Hokkaido to Kyusyu for 1 month. The subjects comprised 828 patients (male 352, female 476), and we analyzed 33 items of the questionnaire to these patients. The patients ranged in age from 4 to 100 years with an average age of 54.2 years. The sixth decade was most frequent. Most chief complaints were toothache or denture trouble. Four hundreds and thirty-five patients had a medical history of some systemic diseases and 187 patients were under the treatment of the disease. Among systemic diseases, hypertension was most frequent showing 20%, followed by gastro-intestinal disease, allergic rhinitis, heart disease, asthma, liver disease, respiratory disease, kidney disease and blood disease. Seventy-four patients showed some systemic abnormalities such as headache, high temperature, cold, dizziness, pulsation etc. Three hundreds and seventeen patients had been treated with medications, and 8 patients had used Warfarin and 3 patients Panaldine. One hundred and twenty-two patients had some allergies, although antigens were not clear in most patients. Since the frequency of aged person and that having some systemic diseases were high, detailed examinations on the systemic conditions of the initial patients must be very important to perform safety dental treatments in the private dental clinics.

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A clinical training program emphasizing emergent aspect of care was designed in a postgraduate dental course in Kumamoto City Hospital combined with Ito Dental Clinic. The overall objectives were to provide the trainees the opportunities to promote their capabilities as a primary care dentist by caring for the patients who visited emergent room of two facilities.
The results were as followed:
1. The averaged numbers of age of the patients were 46.3 in the hospital and 28.7 in the dental clinic.
2. Approximately 60% of the patients were hospitalized just after visiting the emergent room in the hospital.
3. The trainees challenged dental treatment for many patients who had been suffering from spontaneous toothache, swelling of the gingiva, traumatic injury, and so on in the dental clinic.
4. The trainees had significant experience in varieties of general examinations with clinical instructors.
5. This program supported their attainment of 40% of requirements which were proposed by Ministry of Health and Welfare.
Through progressing this program, it was found that young dentists were able to accomplish a lot of primary care for their patients and motivated to continue their following professions.

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Tooth extraction in patients receiving oral anticoagulant therapy is controversial issue. Continuation of anticoagulation exposes the patient to serious hemorrhage, wherease cessation of therapy increases the risk of thromboembolism. We have recentry carried out a study on tooth extraction of the patients undergoing oral anticoagulant therapy. The subjects consisted of 51 patients who had been treated with warfarin, and they were classified into 3 groups due to the condition of medication at the tooth extraction, i. e. group 1: 34 patients treated by tooth extraction with continuation of warfarin, group 2: 13 patients treated with cessation of warfarin and group 3: 4 patients treated with reduction of warfarin. We compared the value of thrombo test (T. T) at the tooth extraction, postoperative bleeding and the hemostatic procedure among 3 groups. The average value of T.T of group 1 was 23.3 %, that of group 2 was 49.1 % and that of group 3 was 58.9 %. There was no severe postoperative bleeding in the all patients, and there was no difference in the hemostatic procedure among 3 groups.
Our results show that in the cases of simple tooth extraction of the patients undergoing anticoagulant therapy cessation or reduction of warfarin must be unnecessary.

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We experienced a case of submandibular cyst of untreated diabetic patient who requires blood sugar level management under hospitalization. The patient is a woman of 57 years old. The patient chief complaint for the swelling and the pain a left submandibular and consulted a physician on August 18, 2000. The blood sugar level management was defective in fasting blood sugar 339mg/dl, HbA1c 12%, glucose in urine (+++), and ketone in urine (-). As a result of the close examination, it was diagnosed as left submandibular cyst. There was a multiinfarct dementia and patient's blood sugar level management home was difficult. The blood sugar level was managed under hospitalization. The art of the cyst extirpation was done during general anesthesia because it had stabilized with fasting blood sugar 152mg/dl and HbA1c 10.1% 30 days after hospitalization. Passage excellently became leaving hospital on 9 days after the operation.

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