We herein report a case of a 21-year-old female patient treated for fibrodysplasia ossificans progressiva. The symptoms of the disease first appeared at age 6 and was diagnosed as fibrodysplasia ossificans progressiva by biopsy at the age of 7. Trismus appeared at age 12 and ossification progressed gradually. In September 2001, she visited her oral surgeon due to severe tooth pain in the lower right region of the first molar. The surgeon suggested (recommended) surgical transection of the bony fusion as treatment for trismus under general anesthesia. The patient was referred to our clinic for a second opinion. In account of her poor general condition and diminishing reserve capacity, it was impossible to administer general anesthesia. After obtaining informed consent, the tooth was extracted under local anesthesia. At present, the patient's postoperative course of recovery is stable and uneventful.
This case underlines the importance of understanding both the patient's systemic disease and general condition during the course of treatment.

View full abstract

We experienced a 61-year-old man with unmanaged atrial fibrillation, who suffered cerebral embolism following dental scaling. The patient visited his dentist with chief complaint of periodontal swelling in the first premolar region of the right maxilla. The dentist diagnosed the lesion as a gingival abscess, and prescribed antibiotics and NSAID. In addition, full-mouth scaling under blood pressure and heart rate monitoring was planned for the treatment of periodontitis.
Past medical history revealed that the patient had arrhythmia and the patient insisted that this condition required no treatment although he arbitrarily withdrew from the medical treatment for his atrial fibrillation. Consequently, the dentist did not consult any medical doctors on (for) the patient's arrhythmia (atrial fibrillation) prior to scaling. During scaling, the patient's heart rate was stable. Blood pressure was also stable but it was temporarily enhanced with preoperative local anesthesia.
Approximately 1 hour after scaling, the patient experienced numbness and motorial disorders (disturbances) of the right pharyngeal region and motorial disorders of the right arm and leg. He immediately sought medical attention at Fujieda Municipal General Hospital Department of Oral and Maxillofacial Surgery, since he speculated that the symptoms were caused by the intra-oral local anesthesia. We suspected cerebral embolism due to atrial fibrillation and referred the patient to the Department of Cardiology and Neurosurgery where immediate anti-thrombotic treatment was commenced. As to the results, the symptoms completely disappeared within a week. At six-month followup after the incidenct and under medical management, there were no overt signs affecting the patient's ADL's.
In this patient, it is unclear whether the cerebral embolism was caused by scaling. In any case, when treating the so-called medically compromised patients, we must consult their medical doctors to understand their systemic conditions. Furthermore, it is very important that we establish a medical network for unexpected systemic events that may occur in our patients.

View full abstract

Insanity, cerebrovascular disease, and Parkinson's disease have been noted to cause temporomandibular joint luxation. We herein describe an effective surgical treatment for recurrent luxation of the temporomandibular joint associated with cerebral infarction. A 73-year-old woman was referred to our Department of Dentistry and Oral Surgery at Toho Hospital with the chief complaint of masticatory dysfunction, closure of mouth. Hippocrates's operation was performed after the clinical diagnosis of bilateral anterior luxation of the temporomandibular joint. Postoperative recurrence of luxation was noted and we fabricated a chin cap for prevention of further reluxation. But it was ineffective. Therefore blocking of the condylar translation was achieved by performing a Leclerc's operation. Nine months postoperative follow-up revealed no evidence of recurrence.

View full abstract

We herein report a case of infective endocarditis (IE) resulting from multiple and recurrent dental infections leading to mitral regurgitation (MR) requiring mitral valve replacement (MVR) surgery. A 32-year-old female patient was admitted to the Infectious Disease Department of our hospital diagnosed as IE. During the course of hospitalization, she was referred to our department for investigation and identification of a possible oral route (source) for her IE. Oral examination revealed that connected temporary crowns were place over her dentitions and upon removal, there were no teeth (crown) remaining, only the alveolar roots remained. We speculated that the source of her IE was due to oral bacteria and recommended teeth extraction but the patient denied further oral (dental) treatment. Her heart condition improved without oro-dental treatment and was discharged from the hospital 43 days after admission. Four months after discharge, she was readmitted for MR resulting from IE. As a preoperative oro-dental treatment, she underwent complete teeth extraction. After completion of dental treatment, MVR surgery was performed. Postoperatively, she made considerable progress and was discharged from the hospital 58 days after admission.

View full abstract

We herein report a case of multiple myeloma diagnosed due to persistent hemorrhage after tooth extraction. A 75-year-old woman sought medical attention at our hospital on August 19, 2003, for incompatibility sensations in the maxillary molar region. Bleeding time was confirmed since past medical history revealed persistent hemorrhage after tooth extraction at her former dental clinic. Laboratory data revealed prolonged bleeding time, prothrombin time and activated partial thromboplastin time. After bilateral maxillary molars and left lateral mandibular incisor were extracted, persistent bleeding from right maxillary molar area was noted. Additional examination by the staff of the internal medicine department revealed elevated immunoglobulin A, and increase of plasma cells was demonstrated with bone marrow aspiration. Therefore, diagnosis of IgA type myeloma was made. The deficit of bone in the right maxillary molar area was confirmed with computed tomography. Clinical course and the results (findings) of the examination suggested that the myeloma of the right maxillary molar area resulted in persistent (hemorrhage) bleeding after tooth extraction.

View full abstract