Numbers of dental outpatients presenting with systemic disease have recently been increasing, elevating the potential for unexpected events during dental treatment.
However, accidental symptoms can rarely be predicted during actual dental procedures. As slight changes in vital signs can easily be missed, the incidence of unexpected symptoms may not be as uncommon as initially thought. Determination of vital signs may identify fluctuations in parameters such as blood pressure and heart rate preceding actual symptomatic manifestation. However, the incidence of unexpected symptoms cannot be accurately assessed using standard monitoring techniques, even if changes in vital signs are detected and alarms utilized, and ascertainment can be made that convulsions have occurred.
The present research investigated the development of a dental monitor for predicting incidence of accidental symptoms. Improvements to software and hardware were donated by Life Scope L (NIHON KOHDEN Co.).
Clinical examination was performed in a randomized trial using this system on a total of 89 patients (age range, 8-80years) undergoing outpatient dental procedures with local anesthesia.
As a result, this system was found to be capable of monitoring the autonomic nervous system in real time, and fluctuations in vital signs were able to be detected.

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We report a case of disseminated intravascular coagulation secondary to residue of a dissecting thoracic aortic aneurysm with initial manifestation of spontaneous hemorrhage from the gingiva.
A female patient, 64years of age with persistent gingival bleeding at the right side of upper molars region was referred to our hospital on January 31st, 2001. The aneurysm was surgically replaced by synthetic vessel approximately a year ago at a department of cardiovascular surgery of a hospital. A hematological investigation as well as dental treatment were carried out because a coagulation disorder was suggested from the medical history and practical aspects. The blood test showed so much unusual score that she was referred to the physicians in our hospital. As a result, above-mentioned diagnosis was identified. The patient was recovered from initial state with performance of proper therapeutic regimen by physicians and dental management. Since then, she has been well under medical and dental control as an outpatient without sign of recurrence.
The results obtained through this case suggest us necessity and importance of laboratory investigation, consultation with physician and cooperative work between hospital dentists and general practitioners in dentistry for the medically compromised patients.

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We experienced a case of anesthetic management for 45-year-old male patient with a family history of malignant hyperthermia in tongue cancer resection. Premedication was performed atropine and midazolam. General anesthesia was induced with propofol 140mg and vecronium 8 mg with fentanyl 50μg. After nasotracheal intubation, anesthesia was maintained with nitrous oxide, oxide, and propofol (3-8 mg/kg/hr), intermittent fentanyl and vecuronium. Operation time was 2 hours 39 minutes and anesthesia time was 4 hours 33 minutes. Bladder temperature, breast core temperature, elbow core temperature, and thumb skin temperature were monitored during anesthesia. The intraoperative course was uneventful. The patient's bladder temperature increased 37.9°C in the seven hours after operation. He was treated with cooling and NSAID suppositories. His temperature slowly decreased. Intraoperative and postoperative blood myoglobin had increased to 94 and 111ng/ml, and postoperative CK had increased to 253 IU/l.

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We obtained the following results about 139 patients referred by the psychiatry department in our hospital.
1) These 139 patients accounted for 1.33% of entire out patients in the period of five years and seven months from January 1995 to July 2000.
2) As for a psychiatry diagnosis, there were schizophrenia of 46 cases (33.1%), manic-depressive psychosis of 44 cases (31.7%), and organic neuropathy of 16 cases (13.7%).
3) As a result of our strict examination, these cases were classified into the dental disease of 107 cases (77.0%), the normal state of 16 cases (11.5%), and the maxillofacial disease of 16 cases (11.5%).
4) In the course of our treatment, the maxillofacial disease of 2 cases (each psychiatry diagnosis of schizophrenia and dissociative disorder) committed suicide.
To avoid an accident or incident in the psychotic patient, we should do a careful observation of the mental status more than other medically compromised patient.

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A case of post-extraction hemorrhage thought to result from local DIC associated with a chest dissecting aortic aneurysm was brought in for examination. A 70-year-old man had received local hemostatic treatment with suturing and packing a oxycellulose to a wound after tooth extraction. Because the hemorrhage resumed, he was hospitalized, to stop the bleeding and to investigate the cause of the hemorrhage. The peripheral blood examinations on admission indicated that platelet values was in normal range (154, 000/μl), but a serum FDP was high level (over 200μg/ml), thus he was an abnormal fibrinolytic activity condition. Although a celluloid pack was used to stop bleeding, the wound after extraction had recurrent bleeding. He was diagnosed a chronic DIC caused by the residual alveus with detachment of vascular wall by a doctor of the cardiovascular surgery. Then there was a marked declined in the levels of FDP with gabexate mesilate and heparin from fifth day of admittance and was almost no evidence of hemorrhage. He didn't need to stop the bleeding with a celluloid pack at fifteenth day and was discharged on twenty-fifth, because his wound healing was in a good condition. It is difficult to stop the bleeding of those who has a chronic DIC, although platelet values had normal range.

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We report here two cases of transient ischemic attack suffered during dental treatment. Case 1: A 66-year-old female with hyperlipemia underwent tooth extraction. After neurogenic shock caused by the pain of extraction, she complained of dysarthria, lip involuntary movement and dysethesia. We immediately consulted a neurosurgeon about her symptoms. The symptoms disappeared the next day. Case 2: A 65-year-old male with hypertension and diabetes was being prepared for a cast crown and inlays. He complained of vertigo, nausea and vomitting following the dental treatment. He was transferred to a neurology ward, where the symptoms disappeared the following day. Hyperlipemia, hypertension and diabetes are all risk factors for brain attack. When a patient, especially one with a risk factor, displays warning symptoms of a brain attack during dental treatment, the dentist should immediately transfer him or her to a neurology ward as soon as possible.

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