With an increase in the elderly population and progress of medical service, the opportunity to treat dental and oral diseases of patients with systemic complications has grown. This study was conducted to analyze the present situation of patients referred to Department of Oral and Maxillofacial Surgery.
The subjects enrolled consisted of 1531 patients, including 1208 inpatients and 323 outpatients, who were referred to Department of Oral and Maxillofacial Surgery from other medical departments at Tsukuba University Hospital through the consultation system at the institution from October 1, 2001 to September 30, 2004. The age of the patients ranged from 0 to 92 years of age, with mean age of 50.3 years. The gender of patients was 777 males and 754 females, resulting in male to female ratio of approximately 1: 1. Of all patients, 828 (54%) were referred from the departmartments of internal medicine, 417 (27%) from the surgical departments, and 285 from other departments. The most predominant oral diseases of the patients were periodontal disease in the inpatients, and diseases or disorders requiring oral surgery diseases for the outpatients. Examination of oral diseases before transplant was significantly frequent in the Departments of Clinical and Experimental Hematology, and Gastroenterological Surgery. Periodontal disease was statistically frequent in the Departments of Metabolism and Endocrinology, and Cardiovascular Medicine. As referral from the other departments, diseases or disorders requiring oral surgery disease was significantly frequent from the Department of Otorhinolaryngology. Surgical intervention, including tooth extraction was the most frequent treatment modality, but many emergent, periodontal, restorative and prosthetic therapies were often performed. These results indicated that the department of oral and maxillofacial surgery in a hospital setting is required to treat almost all dental and oral diseases.

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Training on basic life support (BLS) with a total duration of 5 hours and 30 minutes was arranged for dentists at Tsurumi Dental Hospital, and 12 training sessions were held between July X, 2005 and July X, 2006 with the participation of 144 dentists. According to the questionnaire performed after the end of the sessions, 25% of the participants had encountered situations that necessitated an emergency resuscitation procedure. Of these situations, 43% occurred during dental treatment, 22% at home, and 35% at a station or in a train, on a bathing beach, in a restaurant, etc. Ninety-three percent of the participants replied that they would be able to perform resuscitation procedures should they encounter emergency situations thereafter. Ninety-two percent of the participants also replied that they want to participate in future programs. The program appeared to have been effective in increasing and spreading the knowledge and skills regarding emergency resuscitation.

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Dissociative identity disorder (DID) is a psychiatric disorder characterized by the existence of two or more separate and distinct personalities that recurrently control the behavior. We here report a case of a DID patient treated for mandibular fracture.
The patients was a 27 years old female. She has got diagnosis of DID at the age of 24 years and treated and managed with medication. She was injured from a traumatic fall down at home after taking hypnotic drugs and drinking heavily. She was referred to our department for evaluation of trismus and occlusal disturbance. X-ray examination revealed bilateral fractures of the mandibular body. After the consultation with the psychiatrist of our hospital, she was treated with maxillomandibular fixation for 2 weeks under hospitalization for medical care and custody. She was slightly depressed but mentally stable and discharged 3 weeks after admission.
Since DID patients is gradually increasing in Japan, we may encounter such patients for consultation for dental or surgical treatment. It is recommended that these patients should be treated in cooperation with a psychiatrist and if necessary, under hospitalization for medical care and custody.

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The clinical usefulness of KAMPO (oriental herbal medicine) in the treatment for intractable dental oral diseases (dry mouth, glossodynia, feeding, swallowing disorders, and intractable stomatitis, etc. ) was evaluated in 35 medically compromised patients who sought dental treatment in our department between May 2002 and October 2005. The age of the patients ranged from 34 to 87 years (mean age: 63.9 years), and gender distribution was 5 male patients and 30 female patients. The average concomitant (concurrent) disease (disorder) per patient was 2.8, and the average medication administered to the patient was 4.3. The main reasons for the patient to seek dental attention were unpleasant oral symptom (60.0%), 16 abnormal sensation of the tongue (45.7%), 13 intractable stomatitis (37.1%), 9 dry mouth (25.7%), 8 feeding disorder (22.9%), 6 gingival pain of unknown origin (17.1%), and 4 swallowing disorder (11.4%). Unpleasant oral symptoms were most common (with concurrent existence of concomitant diseases [disorders] ). KANPO for the treatment of each symptom was administered either singly or in combination with several drugs spanning 2 to 8 week. The clinical effect was evaluated with the amount of symptom alleviation and judgment of QOL (as a form of complication in daily activity) by self-evaluation.
The results of the KANPO were 20 cases with complete alleviation of symptoms (57.1%), 14 cases with improvement (40.0%), 1 case that was negligible (2.9%), and there were no cases in which the symptoms deteriorated (0%). The evaluation results of the QOL complications were 20 cases revealed no complications in (57.1%), 9 cases demonstrated small amounts of complications (25.7%), 5 cases with slight complication (14.3%), and 1 case with moderate severity of complication (2.9%), respectively. The overall outcome on the use of KANPO for treatment revealed the KAMPO to be extremely useful in 28 cases (80.0%), considerably useful in 3 cases (8.6%), slightly useful in 3 cases (8.6%), and not useful in 1 case (2.9%), respectively. Moreover, there were no adverse effects recorded during the treatment period.
As for the clinical usefulness of KAMPO in the treatment for intractable dental oral diseases for medically compromised patients as described (mentioned) above with a variety of oral symptoms, it is conclusive that KAMPO demonstrated (revealed) its effectiveness in the treatment of intractable dental oral diseases even if the patients require to take two or more medications concurrently.

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In this report, we describe the successful surgery in a hemophilia A patient suffering from maxillary gingival carcinoma.
A 58-year-old woman presented with the chief complaint of a painful sore in the left maxillary gingival region. The lesion had been diagnosed histopathologically as a squamous cell carcinoma by her doctor. She underwent subtotal maxillectomy following the preoperative chemo-radiotherapy. Preand intra-operatively, coagulation factor VIII concentrates, red blood cell transfusion and fresh frozen plasma were administered. Coagulation factor VIII concentrates was also infused up to 8^th postoperative day. Bilateral radical neck dissection was performed due to the cervical lymph nodes metastasis.

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