Standard precautions have been exercised to prevent nosocomial infection in our department. Given such measures, it appears to be reasonable to conclude that screening for infectious diseases on individual basis is unnecessary. However, it is unclear whether screening for infectious diseases should be performed to prevent transmission of infection from patients being treated in the dental and oral surgery departments. In the present study, we investigated the prevalence of syphilis, hepatitis B, and hepatitis C in patients who sought dental treatment in our department to examine the necessity of screening for infectious diseases.
Subjects: A total of 2, 460 patients who were treated in our department (6, 514 treatments) during the 4 months period in 2005 were enrolled in this study.
Method: Patients were surveyed for syphilis, hepatitis B, and hepatitis C positive.
Results: The prevalence of infection was confirmed in a total of 1, 043 patients (42.4%) involving 3, 647 treatments (56.0%). Among these patients, syphilis, hepatitis B, and hepatitis C were found in 23 (2.2%), 18 (1.7%), and 56 (5.4%) patients, respectively (56, 54, and 138 treatments, respectively). The total positive rate was 9.3%, which was higher than the rate estimated by interview (1.8%). These results indicate that it is difficult to assess the actual prevalence existence of infection by simply taking the patient's medical history with emphasis on infectious diseases.
Conclusion: The present study showed that the actual positive rate was higher than the rate estimated by interview, indicating that dental and oral surgery should only be performed after taking standard precautions and screening for infectious diseases.

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Keratocystic odontogenic tumor usually occurs in young patients, and it is rare to occur in elderly patients. We herein report a case of keratocystic odontogenic tumor in an elderly patient in the maxillary incisor region. A 92-year-old male patient was referred to the Department of Dentistry and Oral Surgery, Toho Hospital due to abnormal sensation in the right maxillary incisor region. Radiographic examination revealed bone resorption in the right maxillary incisor region measuring 20×15mm. The lesion was enucleated under local anesthesia. Histophathogical diagnosis was keratocystic odontogenic tumor. After surgery, there are no signs of recurrence.

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Although various methods of treatment including invasive and noninvasive therapies are available for the treatment of habitual temporomandibular joint dislocation, invasive therapy can be considered to be difficult in elderly patients or patients with systemic disorders. We recently experienced a case of anti-phospholipid antibody syndrome (APS) with repetitious cycles of remission and relapse of cerebral infarction, accompanied by recurrent TMJ dislocation.
The patient was a 34-year-old woman. She visited out facility with a chief complaint of recurrent bilateral TMJ dislocation. She had suffered from a cerebral infarction about one month before her first visit to our clinic. The woman was therefore treatment conservatively, with restriction imposed on the opening of her jaw. TMJ dislocation was alleviated with this therapy.
However, she suffered from another cerebral infarction 3 years later, accompanied with relapse of habitual TMJ dislocation. Again she received conservative treatment, enforcing restriction to her opening of her jaw. She however did not respond to this therapy since she was receiving anti-coagulant therapy for APS, invasive treatment was judged to be difficult for this case. We therefore advised the patient to accept the consequence of occasional TMJ dislocation and taught the patient and her family members how to manage TMJ dislocation upon onset. As a result, the frequency of TMJ dislocation decreased, and the patient was able to reduce and manage TMJ dislocation by herself. Thus, her condition was successfully controlled to the level not to cause any significant disturbance to her activities of daily living.

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We herein report a case of complication resulting in atrial fibrillation during induction of venous sedation. The patient was a 64-year-old male with hyper-tension and diabetes mellitus. He was referred to our department complaining of swelling and slight pain of the right cheek. Based on these clinical symptoms, past medical history and CT finding, diagnosis of postoperative maxillary cyst was established. Preoperative examination did not reveal any remarkable cardiovascular complications other than hypertension. We planned the removal of the cyst under local anesthesia assisted with intravenous sedation. After injecting diazepam and pentazocine intravenously and consecutive maxillary nerve block locally, atrial fibrillation occurred. Although anti-arrhythmic agents were not effective, cardioversion was successful, and the cardiac rhythm normalized. Hypertension and mental stress were thought to be the trigger mechanism for the onset of atrial fibrillation.

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Congenital protein S deficiency is a disorder associated with increased risk of thrombosis resulting from defect of protein S, a vitamin K-dependent anticoagulant protein.
We experienced an extraction of impacted wisdom teeth in a patient with protein S deficiency and deep venous thrombosis (DVT). A 21-year-old male patient was referred to our hospital complaining of pain in the lower left wisdom tooth region due to incomplete impaction of the wisdom tooth. Diagnosis of congenital protein S deficiency and DVT of the lower extremity were established when he was 17-year-old. He received warfarin potassium anticoagulant therapy.
Prior to the extraction of the wisdom teeth, we consulted and discussed anticoagulant therapy and anesthesia with the staff of the Departments of Cardiovascular Surgery and Anesthesiology. As to the results of the clinical examination and ultrasonography, the existing thrombotic lesion was considered to be an old thrombotic lesion and, thus, the possibility of fragmentation or detachment of the thrombosis from the present location was regarded as minimal. We decided that the ultimate method for having the extraction of his three impacted wisdom teeth was under general anesthesia with continuation of his anticoagulant therapy with heparin calcium. There has been no evidence of postoperative complication such as excessive hemorrhage, thromboembolism or swelling of his lower extremity.

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The following two problems were brought forth to our attention in patients with autoimmune hepatitis (AIH), idiopathic thrombocytopenic purpura (ITP), and systemic sclerosis (SSc). The first problem is the bleeding tendency due to thrombocytopenia, as well as adverse reactions caused by oral corticosteroid therapy during perioperative management. The second problem is early recurrence or metastasis and the development of malignant tumors at other sites during the postoperative follow-up course because of the high frequency of malignant tumors associated with SSc.
We recently experienced a patient who was diagnosed as having AIH and ITP during preoperative work up for carcinoma of the lower gingival and buccal mucosa. Then the patient was diagnosed for SSc during the postoperative follow-up course. The platelet count of this patient improved with platelet transfusion immediately prior to surgery combined with postoperative corticosteroid therapy. As to the result, the operation was performed safely with no postoperative bleeding or infection. At present, 18 months after surgery, there is no evidence of recurrence, metastasis or development of new malignant tumors at other sites.

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In our department, surgical procedures of patients while under systemic care and management were conducted. A survey was conducted on 69 patients who were being treated with antithrombotic agents and their outcomes were investigated. Among them, the antithrombotic regimen was suspended in 38 (55.1%) cases, all under the instructions given by their attending internists. The remaining 31 (44.9%) cases underwent surgical treatment while continuing their antithrombotic medication; of these 26 (83.9%) patients received their instructions from anesthetists and surgeons and the remaining 5 (16.1%) patients from their attending internists. Among those patients whose antithrombotic medication were suspended, postoperative hemostasis was difficult to achieve in 3 cases (4.3%). Hemostasis was however, achieved within 24 hours in all these 3 cases. None of the patients experienced any particular discomfort.
Consulting the attending internist is essential; but following their instructions alone may not suffice. Dentists need to consider the results of the pre-operative tests and the circumstances of the treatment. If antithrombotic agents are to be withdrawn, perioperative care with particular attention directed to the prevention of thrombosis is necessary.

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National-wide survey concerning measures administered during minor oral surgery for patients managed with antithrombotic therapy was conducted. Questionnaire was sent to 583 institutes and replies were obtained from 239 (41%) institutes.
The survey revealed the following results:
1. Of the 239 institutes, 142 have fundamental concepts idea that antithrombotic drugs should not be interrupted or decreased during oral surgery such as tooth extraction.
2. In routine practice, 108 institutes declared that they interrupt or decrease the antithromboitic drugs for surgery depending on the necessity while 91 institutes replied that the antithrombotic drugs are continued in general and 43 institutes reported that they discontinue the drugs in principle. In case of interruption or decreasing of the drugs, many institutes considered the instruction or suggestion by medical doctors of the patients.
3. Postoperative bleeding was encountered at 120 of 239 institutes . The occurrence of bleeding complications revealed no relationship to the routine managements of antithrombotic drugs, which suggested that there might be many kinds of causes of postoperative hemorrhage.
4. In 23 institutes, they experienced severe complications, such as cerebral thrombosis, angina, myocardial infarction, etc, which were suspected to result from the interruption of antithrombotic drugs.
5. Suture, use of local hemostatic agents and accurate pressure on the wound were employed in most institutes for postoperative management for hemorrhage.
6. Many clinical examinations have been utilized for determining whether antithrombotic drugs should be continued or discontinued at each institute and the ideal standard examination and the standard value for making the decision could not be verified in this study.
7. Actual procedure of drug interruption varied among the institutes, although 3 or 4 days interruption of the anticoagulant agent and 7 days discontinuation of the antiplatelet agent were most pre dominantly employed. Therefore, a recommended procedure was not proposed in the study.

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