We herein report our clinical study that the oromandibular symptoms closely related to he extrapyramidal syndromes induced by antipyschotic agents. The subjects enrolled were 85 patients (42 males, 43 females, mean age 37.5 year old) under antipsychotic treatment due to psychiatric disorders. Sixty-eight percent of the subjects were schizophrenic and 14% had problems associated with substance abuse.
The results are as follows:
1. The oromandibular symptoms observed were: toothache (44%), occlusal discomfort (25%), malocclusion (18%), denture trouble (7%), TMJ luxation (2%), TMJ pain (2%) and tooth mobility (2%).
2. The method of management in 79% of all subjects was observation only while others included denture adjustment, administration of occlusal splint, tooth extraction and occlusal adjustment.
3. The management period was within 4 weeks in 67% of all subjects. On the whole the management period for subjects with malocclusion was longer than those with toothache.
4. The symptoms subsided in 61% of the subjects and diminished in 7%. The percentage according to specific oromandibular symptom was 73% for the toothache group, 72% for occlusal discomfort, and 40% for malocclusion.
5. The antipsychotic agents administered were haloperidol for 39% of the subjects and 21% for risperidone. Phenothiazine and butyrophenone derivatives were administered in 52% of all subjects where malocclusion and TMJ luxation were mainly identified in these cases.

View full abstract

We introduced and evaluated the team approach for oral care management system consisting of dental hygienist, nurse and dentist as the professional team in general hospitals.
All patients enrolled in our study had difficulty of oral-self-care due to disturbance of consciousness or poor activity of ADL. Number of patients under our care between June 1998 and June 2004 during the period of six years were 772 (average age: 72.9) ; males and females.
In our management system, 3 of 4 dental hygienists are always on duty in the ICU/CCU and/or the wards to provide oral care to the patients and/or guidance to their familly.
We have successfully provided oral care management in maintaining the patient's oral health. Providing professional oral care by dental hygienist is extremely important in our management system, in addition to the data obtained from periodic bacterial culture examination of the oral cavity for other oral care staff members, nurses and medical doctors, by the dentist. The aqdvantages and importance of the team approach for oral care management in our hospital is discussed.

View full abstract

In 1998, we introduced the oral care management system consisting of dental hygienists, nurses and dentists as the professional team. As of 1999, we started the bi-monthly bacterial culture examination by swabbing the surface of the tongue as a guideline for evaluating the effect of the oral care management. We provide the result of the bacterial culture examination to the other medical staffs as a countermeasure for controlling nosocomial infection and as a clinical information of oral microbial substitution. After incorporation of bacterial culture examination in 1999, the detection ratio of bacteria of all inpatients has decreased by 36% for MRSA and 35% for Pseudomonas aeruginosa. As for opportunistic pathogen, like Klebsiella or Serratia, decreases were also noted. Conclusively, the factors involved in this change are: (1) increase in awareness of infection (nosocomial or the other) by the oral care management staff, (2) providing immediate professional oral care during the acute stage, (3) recognition of correlation between nutrition control and oral care, all of the above mentioned factors are related with our study findings.
Bacteriological evaluation of our oral care management system is reported.

View full abstract

Myelodysplastic Syndrome (MDS) describes a group of hematological disorders characterized by peripheral cytopenia and dysplastic changes of hematopoietic cells. There are no effective treatments without bone-marrow transplantation which is limited to young patients and the prognosis of MDS is poor due to development of bone-marrow complications or leukemia.
A74-year-oldmale, referred to Asahi University hospital for comprehensive examination of _??_. Because of recurrent periapical infection, dental extraction of _??_ appeared to be the best solution. Past medical history revealed, MDS and drug allergy and pancytopenia (WBC: 1, 130/μl, RBC: 218×10⁴/μl, Plt: 1.9×10⁴/μl). According to his medical doctor's recommendation, perioperative management was focused on prevention and/or avoidance of hemorrhage and infection. Topical application of oxidized cellulose cotton and extreme care during suturing resulted in hemostasis within 1 hour after dental extraction. Telithromycin was selected for post extraction infection control after sensitivity test for this drug more than satisfactory results were attained.

View full abstract

Three cases of cystic lesion of the mandible with difficulties in establishing definite diagnosis and understanding its pathogenesis are presented. All cases were radiologically identified as a unicystic radiolucent lesion involving the apex of the molar or premolar root and thus resembled that of a radicular cyst, however, the involved teeth were vital determined with pulp electrodiagnosis. These lesions were clinically associated with a cyst-like cavity, containing pus-like fluid, which was lined by a relatively thick granulation tissue without epithelium in two cases and with epithelium in one case. These findings are consistent with neither those of radicular cyst nor typical simple bone cyst even if infected. One of the patients had another unicystic radiolucent lesion involving the apex of the premolar root, which was non-vital as determined with pulp electrodiagnosis but had no apparent reason to devitalize the pulp. All patients had undergone relatively long-term high dose steroid therapy for rheumatoid arthritis or Behchet's disease, possible involvement of steroid-induced osteonecrosis in the development of these lesions is discussed.

View full abstract

The purpose of the present study was to survey the prevalence of medical abnormalities, cardiovascular diseases and medication profile of home-visit dental treatment.
A total of 203 patients were enrolled in this study in which 84 patients were inpatients in an intermediate care facility for the elderly (geriatric health care institution), and 119 home bound patients under home care treatment provided by the Midori Ward Dental Association in Yokohama City from April 1999 to December 2001. Mean disease association was 3.5±1.1 (mean±SD) and 2.3±1.3 for the inpatients and outpatients, respectively. The frequency of the abnormalities was greater among the inpatients at the geriatric health institution than among the home bound patients under home care treatment.
Cerebrovascular, cardiovascular and metabolic disorders are important in general management for home-visit dental treatment. Among the patients with cardiovascular disease, hypertension was most prevalent (Table 1).
The percentage of the subjects under medication was high: 96.4% (81) for the inpatients at the intermediate care medical facility, and 54.6% (65) for the home bound group receiving home care treatment. The patients were administered multiple pharmaceutical agents and it was mandatory to take into consideration the effects caused by combinations of medicines.
On the average, the patients in the inpatient and home bound groups were identified to be taking 4.3±2.8 (mean± SD) and 3.2±3.8 different pharmaceutical agents, respectively.
Cardiovascular agents administered were mainly vasodilator, hypotensive and diuretic agents (Fig. 1).
Antihypertensive agents were the most commonly administered pharmaceutical agent representing 46.9% of the drugs in the intermediate medical care facility were Ca channel blockers and 31.8% in the home bound group were administered diuretics (Fig. 2). Over 70% of the patients had medical history of hypertension with circulatory complications: 71.8% (28) and 73.7% (28), respectively, mainly cerebral infarction (Fig. 3). Metabolic complications associated with hypertension were: diabetes mellitus, hyperlipemia and hyperuricemia (Fig. 4).
As the number of elderly population increases, individuals with diseases also increase. Collecting and analyzing data of diseases and use of medications are through comprehensive interviews are important measures that compensate for the diagnostic process in evaluating the general state of the patients.
Our study revealed the importance of a comprehensive evaluation of the patient's general state, including the information concerned with administration of medication which is indispensable for providing proper dental treatment for the home care patients.

View full abstract