As for the relevance of dental disease and diabetes mellitus and coronary heart disease, in recent dental medicine, treatment is not only limited to the oral cavity and head and neck regions but it is necessary to take total body management into consideration during treatment.
1) Cerebrovascular disorder: These disorders are represented by cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, transient cerebral ischemic attack. The patients with these disorders are often required to undergo pharmaceutical therapy which includes various drugs like anticoagulant and antiplatelet agents.
2) Coronary heart disease: Represented by diseases like angina pectoris and acute myocardial infarction where a tight correlation between metabolic syndrome and obesity is attracting attention.
3) Chronic obstructive pulmonary disease (COPD): In recent years, COPD due to bronchial asthma, chronic bronchitis and pulmonary emphysema has shown a trend to be increasing.
4) Diabetes mellitus, obesity, hyperlipemia: The basic disease state that is attracting the most attention is the metabolic syndrome.
5) Hepatic disorders: There are no effective treatment method available as of date for hepatic cirrhosis. Such disorders like hepatic failure and coagulopathy require particular attention since these disorders tend to be accompanied by bleeding tendency.

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We herein report our experiences of 12 cases, where dexmedetomidine (Dex) was continuously administered postoperatively for sedation. The method of administration was assessed. The 12 cases consisted of 9 male and 3 female patients. The mean starting dose of Dex was 3.5±1.2μg/kg/h. The mean maintenance dose was 0.2-0.5μg/kg/h. The mean total dose was 494.9±263.2μg. Two of the 12 cases revealed rapid increases in blood pressure. Postoperatively, one of the 2 cases had a blood pressure of 140/80 mmHg and pulse rate of 90 beats/min. Since elevation of blood pressure rose to 160/110 mmHg with the commencement of Dex administration at a starting dose of 6μg/kg/h, this dose was reduced to 0.6μgkg/h. As for the other case, the pulse rate was recorded as 90 beats/min and the blood pressure of 140/80 mmHg. As for this case also elevation of blood pressure to 165/90 mmHg was recorded with the commencement of Dex administration at a starting dose of 6μg/kg/h, this dose was also reduced to 0.6μg/kg/h. When Dex is administered after implementation of general anesthesia, as revealed by our present cases, it may be necessary to control both the commencement dose and the maintenance dose with utmost attention focused on the respiratory function of the patients. From our experiences in postoperative systemic management of these 12 cases, the appropriate rate for initial administration dose of Dex in postoperative sedation is suggested to be 3μg/kg/h for 20 minutes and the appropriate maintenance dose was 0.2-0.7μg/kg/h.

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Myelofibrosis is characterized by bone marrow replacement with fibrous tissues, splenomegaly, leukoerythroblastosis and extraosseous hematopoiesis. The cause is unknown but is speculated to be a hyperplastic condition resulting in fibrotic transformation of fibroblasts reacting to a cytokine excreted within the bone marrows.
We herein report a case of osteomyelitis of the mandible in a patient with myelofibrosis. A 55-year-old male patient was referred to our department with chief complaint of spontaneous severed pain and contact pain in the left lower molar region. Ulceration with circumscribed redness and bone exposure were identified at the left lower gingivobuccal fold and swelling was also identified in the left submandibular region, and paresthesia was identified at the left V3 region, which lead to the diagnosis of osteomyelitis. Extraction of unstable teeth was then performed after improvement of the patient's general physical condition. But during the course of hospitalization, the patient developed pneumonia refractory to antibiotic therapy. Because of the possibility of transformation of myelofibrosis to acute myelogenous leukemia (AML), the patient was transferred to another hospital for further examination. He developed severe fungal infection which was successfully treated. He underwent surgery for mandibular osteomyelitis when his general physical condition was improved and stable. No recurrence was confirmed after the treatment but the patient died of cerebral hemorrhage of unknown etiology.

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We herein present a case of habitual temporomandibular joint (TMJ) dislocation treated surgically by eminectomy. A 56-years-old female patient with cognitive impairment following cerebral tumor resection presented with bilateral recurrent condylar dislocation. Preoperative 3D-CT revealed that the condyle was located anterior to the eminence and there was no evidence of morphological malformation. We first attempted autologous blood injection however, this was not effective. Therefore, a surgical procedure under general anesthesia was planned. Intra-operative findings revealed that the lateral temporal muscle was atrophied resulting from previous neurosurgical procedure. At 6 months follow-up evaluation, there were no signs of recurrence of habitual TMJ dislocation. In order to obtain favorable or good outcomes for habitual TMJ dislocation, selection of treatment method must be based on the patient's social background, the cause and the patient's condition.

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The clinical course and follow-up evaluation of drug induced open bite resulting in extra pyramidal syndrome from administration of antipsychotic drug (haloperidol) in a young patient with schizophrenia was followed for two and a half years. The results of the observation are as follows:
1. The open bite state continued as long as the drug was administered to the patient.
2. Improvement of the open bite state was confirmed with decrease in drug administration and disappeared with cessation of the drug.
Dentists involved in the treatment of occlusal disorders for young patients with psychotic disorders like schizophrenia should note that there is an increased frequency in occurrence of drug induced occlusal disorders, open bite.

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We herein report a case of unavoidable emergency tracheotomy which occurred during a preoperative examination due to difficulty of intubation that we were unable to predict. The patient was a 70-year-old male diagnosed with carcinoma of the floor of the oral cavity and scheduled for tumor resection and reconstruction with an abdominal full-thickness skin flap graft under general anesthesia. After gentle and passive induction with N₂O+oxygen+sevoflurane, the larynx was exposed and nasal intubation was attempted. However, it was impossible to insert the tube beyond the vocal cords and bronchofibroscopy revealed thickening of the vocal folds. It was concluded that it is impossible to insert the tube and an emergency tracheotomy was necessitated. There were no ventilatory problems after the tracheotomy and no abnormal respiratory tract manifestations were observed intraoperatively. Postoperatively, a tracheal cannula was used for respiratory management and when decrease of vocal fold thickening was confirmed, the patient was extubated. There is a wide spectrum of causes in difficulty in intubation of endotracheal tubes and there are occasions where it is difficult to predict such episodes. Reinke's edema attributable to chronic smoking was suspected in our patient and this case was informative to clinicians of the importance of a rapid and appropriate response to unpredictable situations and episodes.

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When extracting a tooth or conducting surgery on a patient under treatment with an antithrombotic agent, the issue whether to interrupt the administration of the anti-thrombotic agent or to conduct the surgical procedure while the patient is still on this medication is a delicate enigma that an oral surgeon often faces. Recently, we experienced a patient who exhibited marked prolongation in bleeding time during the preoperative evaluation and analyses but underwent surgery while being treated with an oral anti-platelet agent.
The patient, a 73-year-old male, referred to our hospital with chief complaint of swelling and pain in the buccolabial and buccogingival regions of the right mandible. The causative factor was identified to be a denture retainer that had migrated into this region and had to be removed. His medical history revealed that he had previous episodes of angina pectoris, c erebral hemorrhage and cerebral infarction, for which he had been under anti-platelet therapy with aspirin and thienopyridine. Preoperative evaluation and analyses revealed a prolongation in bleeding time (greater than 20 minutes) but due to his overall general physical condition and discussions with his attending physician, the type of treatment selected was the removal of the denture retainer under local anesthesia in conjunction with intravenous sedation without interruption of his anti-platelet therapy. There were no complications such as abnormal bleeding or thromboembolism noted after surgery.
It is conclusive that careful peri-operative patient care management that suits the patient's systemic condition is important and essential.

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Thalassemia is a congenital hemoglobin anomaly that presents as a hemolytic anemia. The incidence in Japan is rare. We selected to perform dental treatments under general anesthesia for behavioral control in a Down syndrome patient with thalassemia. The patient is 20-years-old, male, 155.0cm in height and weighing 72.5kg. He was diagnosed with Down syndrome and thalassemia immediately after birth. We confirmed hypochromic microspherocytosis during the preoperative evaluation and analyses and a decrease in the reserve force for the hypoxic state was predicted. After nasal intubation, general anesthesia was maintained with N₂O+oxygen+sevoflurane. There were no complications encountered with anesthesia during and following the dental procedure. Careful preoperative evaluation and analyses, correct diagnosis and precautious anesthetic manipulations are required to administer general anesthesia in patients with Thalassemia.

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We herein present a case that developed endogenous mycotic endophthalmities following ambulatory dental surgery in our department's outpatient clinic. The patient is a 25 years old female patient who sought dental treatment trimus resulting from stomatognathic dystonia. Her medical history revealed concurrent multiple sclerosis and long-term steroid therapy of approximately 8 years. The patient was hospitalized and our objective for treatment was the correction of trimus. Postoperatively, the patient's nutritional management was conducted through the IVH but the patient developed catheter sepsis followed by the development of pulmonary mycosis. The patient was then referred to the Department of Internal Medicine for evaluation and consultation. The patient also developed endogenous mycotic endophthalmitis on the ninth day after commencement of MCFG treatment. Upon recommendations by the ophthalmologist the antifungal agent was changed from MCFG to VRCZ. After the change in antifungal agent, pulmonary mycosis and the endogenous mycotic endophthalmitis improved and subsided. Furthermore, for patients diagnosed with carcinoma, under treatment with immunosuppressive drugs and intravenous hyperalimentation, the time of onset and immediate medical evaluation and response are extremely important issues for management and determining the course of treatment for these patients and one must consider the possibility of the presence of a deep-seated mycotic infection.

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