We have made an investigation on 135 inpatients who underwent dental extraction at First Department of Oral and Maxillofacial Surgery, Meikai University School of Dentistry, between November 1995 and October 1998: the result is as follows.
1. They were hospitalized because of coexisting disease. It was associated with circulatory disorder in many cases and with metabolic disorder in next many cases.
2. During surgery, urgent drugs were administered in 7.4% of all cases, which suggested that intravenous route is necessary.
3. The average hospitalization was 2.83 days with extraction of 2.9 teeth on average.
4. Cooperation between hospitals and dental offices is indispensable.

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It is an accepted fact that the patients with various systemic diseases are visiting dental facilities more often than previously owing to the increase in the elderly population in Japan. However, there were few reports that investigate the reality about compromised patients treated in general practitioner's clinic. This survey was conducted on the ratio among the new outpatients of Teijin-Kai Medical Corporation Onuki Dental Clinic.
There were 877 medically compromised patients among the 2385 new outpatients during 12 months, an incidence of 36.8 per cent. Allergic disease was the most frequent medical disorders, and next was cardiovascular diseases. There is a close positive relationship between the percentage of medically compromised individuals and age. About 31 per cent in subjects were administered at time of the first visiting.
These results indicated that the presence and detection of medical underlying disorders has significance in dental patient management, and general dental practitioners should be prepared for any emergencies which may also arise in such compromised patients.

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A case of post-extraction hemorrhage with chronic disseminated intravascular coagulation (DIC) due to dissecting aortic aneurysm is report-ed. The patient, a 75-year-old male was referred to our hospital with his persistent hemorrhage after extraction of 432_??_13 and the alveoplasty. He had received surgical replacement of artificial vessel for the aneurysm 5years ago. Hematological examination suggested his coagulation disorder and then we preformed local hemostasis at upper jaw. Investigation of blood coagulation factor and chest MRI diagnosed him as chronic DIC resulted from the aneurysm of inferior aorta.
The patient after evidenced gingival bleeding, and camostat mesilate was administered orally in a daily dose of 600mg.
When we take an invasive treatment to a patient with chronic DIC who has systemic background such as an aortic aneurysm, the post operative hemorrhage should be taken care.
It is suggested that oral administration of camostat mesilate is effective for the postsurgical bleeding because of chronic DIC.

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Pycnodysostosis is autosonal recessive inheritance. It feature makes low height, sluggish growth of body, short finger, flat fingernails, and easy fracture, etc. We experienced general anesthesia of the patient who complicated mandibular osteomyelitis and pathological fracture to Pycnodysostosis patient. Patient: 40 years old and male. (Fig. 1-6) Pathological fracture was pointed out by image inspection. Clinical diagnosis: Right mandibular osteomyelitis and mandibular pathological fracture. Operation proposed: Resection of low jaw, and re constructive operation by plate. This time, when general anesthesia was done to Pycnodysostosis, we should have examined it. The danger of airway obstruction is pointed out in Pycnodysostosis. The anatomical features of down the uvula, tongue subsidence, and mandibular retreat, etc. is given as a cause. Therefore, the possibility of easily falling into hypoxemia and hypercapnemia is reported. It is possible for the pulmonary vascular resistance to increase if hypoxemia continues for a long time, and to cause pulmonary hypertention and the right heart failure. Therefore, it is thought that upper airway management of after operation is necessary. NLA and Propofol is selected intravenous anesthesia. (Fig. 7) There is a possibility of the fracture by backing etc. Extubation is done at the early stage of after operation and we ventilate with mask. There is a report that you should awake after that. However, we thought that upper airway management was important. And, we judged that it was safer to do extubation after it had awoken enough.
We experienced Pycnodysostosis patient's general anesthesia. The necessity for doing the anesthesia preparation of understood the feature to manage this disease anesthesia before operation, and assumed all situations was suggested.

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Sebastian platelet syndrome, which was first reported by Greinacher et al. in 1990, is a hereditary disease that accompanies thrombocytopenia causing giant platelet, leukocyte inclusion body and bleeding. We conducted an extraction of a wisdom tooth in the mandible of a patient with Sebastian platelet syndrome. A 19-year-old man was referred to our department for extraction of a wisdom tooth by his orthodontist. After the medical examination by interview and preoperative examination, we suspected blood disease and found that he was suffering from Sebastian platelet syndrome . In order to control bleeding after extraction of the tooth, we decided to follow the standard procedure for patients with thrombocytopenia. After the tooth extraction under local anesthesia, we packed the affected area with atherocollagen and sutured it to stop bleeding . There was no notable bleeding during or after the operation.

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