In our country, the mortality of HIV patients is improved because of the development of highly active antiretroviral therapy, although the morbidity of HIV infection increases year by year. Therefore, it is no wonder that the number of HIV patients requiring dental treatment will increase. In order to recognize the actual situation of their dental treatment, we studied the HIV patients treated in Department of Oral and Maxillo-Facial Surgery, University Hospital, Kumamoto University School of Medicine during the past three years (2000-2002). Dental treatments were provided to 23 (40%) of 60 HIV-infected patients enrolled in Center for AIDS Research, Kumamoto University.
Among 23 cases, on the first visit, 11 cases showed more than 600/ul of CD4 cells, and 2 cases were immunocompromised patients with 100/ul or less of CD4 cells. As for HIV virus level, 7 cases with less than 50 copies/ul viruses, 13 cases with 50 to 10, 000 copies/ul and 3 cases with more than 10, 000 copies/ul were included. The chief complaints of the patients consisted of 6 cases of pain, 5 cases of swelling, 5 cases of dental caries, 3 cases of prosthetic need, 3 cases of dental care and a cases of hematoma. We experienced 266 opportunities for 23 patients during 3 years and under took 53 times of scaling and 18 times of wisdom tooth extraction. No postoperative infection was seen without prophylactic antibiotics.

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Fifty-three cases of the acute odontogenic infection requiring the hospitalization, from April 1996 to March 2001 at the our department, were examined chiefly to clarify the correlation between the value of CRP and the degree of infection. Results obtained were as follows;
1) The age at first visit ranged from 9 to 81 years old, with a mean age of 44.1 years old. Approximately 70% of all cases were distributed between 20 and 59 years old. The ratio males to females was 1: 1.2.
2) The cases were classified as 26 perimaxillary or perimandibular inflammation (49.0%), 17 phlegmon (32.1%), 4 maxillary sinusitis (7.5%), 3 pericoronitis (5.7%), 4 maxillary sinusitis (7.5%) and so on. The remaining 3 cases consisted of 2 cases of periodontitis and 1 case of osteomyelitis.
3) The underlying disease rate was a very high (47.2%). There were 6 cases of hypertension, 3 cases of diabetes, 3 cases of renal disease, 3 cases of liver disease and so on.
4) There was correlation between the value of CRP and the degree of infection (Y=0.44X+4.44, R=0.51, R²=0.26, P=0.0016, N=35). The values of CRP in two cases extending to the mediastini-tis were 26.2 and 28.4 mg/dl on the first hospital day.

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This report a case of brain abscess in which Porphyromonas gingivalis, an anaerobe and a major causative bacterium of adult periodontitis, was detected as the etiological agent. The patient, whose major complaint was repeated headache at the left temporal region, was found to have a 3cm diameter abscess surrounded by a markedly edematous tissue in the left tempo-parietal region. Since no focus of infection of Porphyromonas gingivalis, other than the severe generalized periodontitis lesion, the blood-borne transmission of the bacterium from the gingiva to the brain lesion was suspected. This case is of interest in terms of the proposed link between periodontal disease and cardiovascular diseases, indicating a need for routine anaerobic culture examination to detect Porphyromonas gingivalis.

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There is no secure manual for dental extraction without local hemorrhage and general complication on patients receiving Warfarin Potassium (WP). We studied the hemorrhage and complication retrospectively after dental extraction by the five WP controlled procedures in our department of Fukuoka University Hospital for 7 years and 4 months from January 1, 1996 to April 30, 2003. Subjects were 74 patients receiving WP (Maintained group: 16, Reduced group: 11, Reduced and suspended group: 4, Suspended group: 35, Heparinized group: 8).
There was no case with major general complication after dental extraction. The cases with local hemorrhage after dental extraction were one in 16 on Maintained group and 3 in 35 on Suspended group.
It is feasible for the patients maintained on WP therapy to have one or a few teeth extraction at a time. Heparinization is desirable procedure for dental extraction on WP receiving patients who have a data with INR of over 3, a plan of wisdom tooth extraction and a multiple teeth extractions at a time.
It should be need the connecting system of hospitalization for the local hemorrhage and general complication in all day long, when the patients receiving WP therapy have the dental extraction in clinic.

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The purpose of this report is to review the way of use of an agreement document for out patients in the oral surgery departments.
A questionaire was sent to 113 oral surgery department of the university hospitals. Questions was asked concerning an agreement document use, necessity of the document and plan of the document use when patients receive easy tooth extraction, impacted tooth extraction and oral surgery as an outpatient.
Seventy five departments (66.4%) completed a questionaire. The results are as follows;
1) An agreement document is used in 26% of the departments in a case of easy tooth extraction and in about 50% in impacted tooth extraction and oral surgery.
2) About a half of 75 departments are aware of the need of an agreement document for easy tooth extraction and about 80% for both of impacted tooth extraction and oral surgery procedure.
3) 90% of the departments have a plan to use an agreement document or consider to use it in the future.

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