Dental education in the various European countries, including aspects related to medically compromised patients, has followed the curricula of the approximately 200 dental schools in the EU. Since dental health needs differ greatly between the EU countries, there is no unity in the contents, structures and methods of this teaching; however, under the lead of the Association for Dental Education in Europe (ADEE), great efforts have been made to converge towards higher global standards of dental education. Therefore, firstly, some examples of dental undergraduate education related to patients with associated systemic diseases are presented, followed by some agreed guidelines for further harmonization of the dental school curricula in EU.
In the Johannes Gutenberg University located in Mainz, Germany-which is one of the 6 founding members of the EU-dental management of patients with associated systemic diseases is mainly taught during the Oral Surgery curriculum, but knowledge on this subject is also given during the study of Internal Medicine, Otorhinolaryngology, Dermatology, and Pharmacology. The main topics taught are: bleeding disorders, cardio-vascular disorders, immuno-compromised patient, autoimmune disorders, diabetes, hepatic cirrhosis, infectious diseases, patients after irradiation, etc.
In the Faculty of Dental Medicine at the “Carol Davila” University of Medicine and Pharmacy located in Bucharest, Romania, which is one of the 2 newest member states that joined the EU in 2007, the undergraduate students learn about patients with systemic diseases mainly in the Oral Surgery discipline, when anesthesia is taught, but related knowledge is also gained during the study of Internal Medicine, Endocrinology, Pediatry, Otorhinolaryngology, Dermatology, Infectious Diseases, and Pharmacology.
Since1990, the School of Dentistry in Malmö (Sweden, EU member since 1995) has implemented an origimal curriculum, in which biomedical science is integrated with clinical dentistry based on problem-based learning (PBL). Education about patients with associateds ystemic diseases is carried out mainly in the integrateda rea Medicine, in the Oral Surgery and Oral Medicine studies.
Although there are differences between universities and countries of the EU, there seem to be a general agreement for a need to strengthen the education on integrated medical sciences in the undergraduate dental curriculum. The AADE, recommends, as a minimum, to have knowledge of disease processes, including infection, inflammation, disorders of the immune system, degeneration, neoplasia, metabolic disturbances and genetic disorders. Besides, it recommends study on the pathological features and dental relevance of common disorders of the major organ systems, and the oral manifestation of systemic diseases.
Since the process of further harmonization of dental education in EU is still ongoing, important changes of the dental education in the EU might evolve in the near future.

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Myelodysplastic syndrome (MDS) includes a group of hematologic malignancies characterized by dysplastic abnormalities of hematopoietic stem cells. An awareness of signs and symptoms related to MDS, such as malaise, pancytopenia, anemia, bleeding tendency, and susceptibility to infection, is essential for safe dental treatment, but there are few reports of infection or bleeding complications caused by dentures in patients with MDS. We report 2 cases of complications caused by ill-fitting dentures. A 73-year-old man was referred to our department because of petechial hemorrhages on the entire palate. Diffuse submucosal petechial hemorrhages caused by an ill-fitting maxillary denture were diagnosed. An 80-year-old woman was referred to our department because of swelling and pain in the right mandibular region. She was given a diagnosis of periostitis of the mandible due to denture-induced stomatitis associated with a red ulcerated lesion beneath the denture. These cases suggested importance of directing attention to prostheses that might cause unexpected complications and to the risk of the acute deterioration of symptoms in patients with MDS.

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We present a possible case of anaphylaxis associated with diclofenac sodium without redness or rash. A 66-year-old woman collapsed at the entrance of our hospital and was immediately treated by an anesthetist on emergency call. The patient was pale, diaphoretic, and incontinent, with impaired consciousness. Positive pressure ventilation was initiated with a resuscitation bag because the patient breathed shallowly and the SpO₂ was 80% during transportation to the emergency room. Her condition improved in response to positive pressure ventilation with 100% oxygen. An accompanying family member reported that the patient had numbness of all four extremities and discomfort after taking diclofenac sodium, and impaired consciousness developed. There were no dermal signs, such as redness and rash. However, the symptoms recurred soon thereafter, and the patient was transferred to the medical ward for a suspected diagnosis of anaphylaxis, based on the symptoms and history. Emergency medical care was initiated primarily to save the patient's life. The patient made a full recovery, although difficulty in diagnosis delayed treatment decision-making.

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We describe a case of alveolar osteonecrosis that developed after herpes zoster infection of the trigeminal nerve. An 83-year-old woman was referred to our hospital by her dentist because of illfitting dentures. The patient had a history of herpes zoster, which developed about 1 month after the first medical examination at our hospital. The intraoral findings were redness, swelling on the right side of the mandibular gingiva, and exposure of alveolar bone. Panorama X-ray films revealed both bone resorption and detachment on the right side of the mandible. Blood examinations showed no evidence of inflammation, but histopathological examinations revealed inflammatory cell infiltration of granulation tissue. After about 3 months of anti-inflammatory treatment for osteomyelitis of the mandible, exposure of the alveolar bone on the right side of the mandibular gingiva as well as bone resorption and separation on the right side of the mandible had resolved on the panorama X-ray films. At present, 1 year after initial presentation, the patient is making satisfactory progress.

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Twelve patients who had been treated with anticoagulant therapy and received oral-maxillo-facial surgery under general anesthesia were studied. All patients had been taking warfarin, an anticoagulant. Warfarin was discontinued 4 to 5 days before surgery and switched to an intravenous infusion of heparin so that the activated partial-thromboplastin time would be 1.5 to 2.0 times higher than that of normal subjects. Heparin was discontinued 3 to 6 hours before surgery and was restarted as soon as hemostasis was confirmed postoperatively. Once oral intake was resumed, warfarin administration was restarted. Heparin was discontinued when the prothrombin time/international normalized ratio reached therapeutic levels. Anticoagulant therapy should be withdrawn when patients undergo oralmaxillofacial surgery under general anesthesia because postoperative bleeding can be difficult to treat. However, 7 days were required on average for the prothrombin time/international normalized ratio to reach therapeutic levels after restarting warfarin postoperatively. Since anticoagulant activity during this period is unstable, the risk of thromboembolism increases. Our findings suggested that complications due to thrombus formation could be prevented by switching treatment from warfarin to heparin and controlling anticoagulant activity perioperatively.

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