I carry out the dentistry health business that I take trust of Niigata in the Niigata dentistry Medical Association, and intended for at-home caretakers required in 1993 or more. I plan the improvement of the oral cavity function by this intends for all at-home caretakers in the prefecture required, and performing dentistry medical examination and prevent the aggravation of the care state required and am for the purpose of building the offer system of the dentistry health service for the improvement of the quality of life. The enforcement subject is Niigata and the Niigata dentistry medical association which took trust gets the cooperation of the county City dentistry Medical Association and carries out a business. The contents a, (1) visit dentistry medical examination business is divided into only 2 to intend for the, (2) oral cavity care practice training institution staff that intend for a caretaker required, and the person of object is the person whom area Promotion Bureau health welfare (environment) director recognized and an institution. The visit dentistry medical examination business of (1) visits the home as contents and it is assessment by the dentistry medical examination, a protector and oral cavity care guidance for caretakers, health education and dental treatment and home medical treatment management guidance are recognized with need more and perform guidance for the person. (2) The oral cavity care practice training performs the training such as oral cavity care, the rehabilitation aimed for knowledge for the oral cavity function improvement, the technical acquisition for the staff concerned in authority of appointment place care business establishments.
In 1993 of the business start year, I am aimed for the spread of visit dental treatment ahead of the whole country, and an every prefecture presents a business and I start business contents as a dentistry medical examination business by introduction of the nursing care insurance method of 1989 newly and reach it at the present. The improvement of the main complaint is reported by caretakers of 80% of the testee total number required and gets high evaluation from local inhabitants.
It is expected that this business is the most important, and the needs rises rapidly nationwide in this prefecture where aging advances to again to promote the improvement of the dentistry health standard of the at-home caretaker required and handicapped person that a dentistry disease is aggravated.

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Internal jugular vein stenosis and thrombosis are major complications of neck dissection. However, thrombosis of the internal carotid artery is very rare. We report a case of left internal carotid artery thrombosis following an operation for left maxillary carcinoma, including neck dissection. A 70-year-old man visited our department because of palatine swelling. He had a history of gastric cancer, esophageal cancer, and lung cancer. An indurative tumor mass was seen in the palate, and squamous cell carcinoma of the maxilla (T4N2bM0) was diagnosed on biopsy and computed to mography. The patient received preoperative chemotherapy with TXT 86mg and CDGP 144mg. He then underwent partial resection of the maxilla and left-side total neck dissection. He received postoperative irradiation in a dose of 1.8Gy/day. After 50.4Gy of irradiation, he complained of a dull pain in the left side of the neck. Ultrasonography (US) and angiography of the neck demonstrated a mobile thrombosis, about 2mm in diameter, in the internal carotid artery above the bifurcation, accomparied by stenosis (30%) of the artery.
The patient received Byaspirin^® (100mg/day) for a month. After treatment, US revealed on thrombosis. At present, the patient also has no evidence of cancer or thrombosis.

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There have been very few clinical studies reviewing dental examinations and treatments requested by emergency medical facilities. We studied 125 patients who were referred for the evaluation and treatment of oral diseases to the Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University Medical Center East by the Department of Emergency Medicine between January 2000 and December 2005. The study group comprised 82 males (65.6%) and 43 females (34.4%). The age range was 1 to 89 years (average, 40.2±19 years), with a peak in the third decade. As for orofacial disease, 85 patients (68%) had maxillofacial injuries, 22 (17.6%) had dental caries and marginal periodontal disease, and 4 (3.2%) had denture problems. As for treatments, 23 patients (18.4%) received maxillofacial fracture osteosynthesis, 18 (14.4%) had teeth extracted, 10 (8%) were treated for dental caries, and 37 (29.6%) were only examined. As for general complications, 87 patients (69.6%) had multiple traumas, 13 (10.4%) had emergency diseases involving the central nervous system, and 7 (5.6%) had conditions requiring emergency treatment. Emergencies due to respiratory disease and digestive disease were present in 6 patients (4.8%) each. There are many serious cases of oral disease and associated problems in emergency medical facilities. Dentists should participate in providing emergency care.

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We describe our experienced with a case of maxillary osteolysis associated with osteomyelitis after extraction of the left upper canine in a 76-year-old woman who had had rheumatoid arthritis since 1992 and was receiving methotrexate (MTX) and prednisolone (PSL).
The patient noticed mild pain of the left upper canine in August 2006, but ignored it until the toothache worsende. She then consulted a dentist on October 23, 2006. A diagnosis of apical periodontitis was made, and the left upper canine was extracted on the same day. She was treated with cefaclor at a dose of 1, 000mg/day. However, her symptoms worsened further, and the patient was referred to us on October 31.
On initial examination, the left maxillary gingiva was swollen and showed several fistulae. A CT scan revealed osteolysis of the maxilla at the same site. The white cell count was 8.1×10³/mL, the erythrocyte sedimentation rate was 41mm/30min and 86mm/60min, the CRP was 3.74mg/L, and the ALP was 238IU/L.
On the same day, oral administration of faropenem (FRPM) was started at 600mg/day. On November 2, her treatment was switched to intravenous ceftriaxone sodium (CTRX) at 2g/day. After switching to CTRX, biopsy was performed for a suspected tumor. The diagnosis was osteomyelitis of the maxilla. MTX was withdrawn, and the acute symptoms resolved on November 21. Intravenous administration of CTRX (2g/day) was started immediately before surgery, and the infected part of the left side of the maxilla was removed with the patient under general anesthesia. MTX was restarted, and there has been no recurrence of maxillary osteomyelitis or osteolysis as of April 2008.
In patients with rheumatoid arthritis, the possibility of serious infection must be taken into account at the time of dental or oral surgical procedures, including tooth extraction. Physicians should be aware of the need for prior treatment of dentigerous infection and for periodic dental care in patients who require simultaneous treatment with drugs that affect immunity and bone metabolism, such as MTX and PSL.

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Recently, numerous cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have been reported. Patients who receive oral bisphosphonate therapy are at a considerably lower risk for BRONJ than those who receive intravenous bisphosphonate formulations. However, because several cases of BRONJ have been related to oral bisphosphonates, dentists should cautiously perform oral surgical procedures. The American Association of Oral and Maxillofacial Surgeons recommends that the placement of dental implants is avoided in patients who are receiving bisphosphonates intravenously according to a frequent dosing schedule.
We describe the placement of dental implants in a patient who was receiving an oral bisphosphonate (risedronate) to treat osteoporosis. We obtained written informed consent from the patient before surgery. After discontinuing the drug for 2 months before implant surgery, 2 dental implant were placed in the mandible. The implants were successfully integrated and are functioning well.

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We describe our experience with general anesthesia in a patient with a diagnosis of hypertrophic cardiomyopathy (HCM). The patient was a 63-year-old woman who had been given a diagnosis of HCM and hypertension and was receiving oral medication. She was scheduled to undergo radical maxillary sinus surgery for a diagnosis of maxillary sinusitis. A preoperative resting ECG showed a pulse rate of 45 beats/min and ST depression. A Holter ECG revealed occasional SVPCs and VPCs and 6 consecutive SVPCs. Echocardiography (ECG) demonstrated wall thickening, and chest x-ray films showed cardiac hypertrophy with a CTR of 56%. Atropine and midazolam were injected intramuscularly as premedication. Anesthesia was gradually induced with nitrous oxide, oxygen, sevoflurane, SCC, and vecuronium. Anesthesia was maintained with nitrous oxide, oxygen and sevoflurane. There were no major hemodynamic changes intraoperatively, and the scheduled procedure was completed with no alterations in the ECG. It is important to diagnose the presence and evaluate the severity of HCM in advance to safely administer seneral anesthesia to patients with HCM. It is necessary to maintain a favorable pressure gradient in the left ventricular outflow tract to ensure effective anesthesia management. We decided to perform general anesthesia in our patient on the basis of the results of the preoperative tests, and the scheduled treatment could be completed without any serious complications.

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We describe our experience with intravenous sedation in a patient with a history of panic disorder who exhibited a restless state postoperatively. The patient was an 18-year-old girl who had panic disorder associated with hyperventilation attacks and was receiving oral medication. We decided to perform tooth extraction and dental treatment with the patient under intravenous sedation. The first time that intravenous sedation was used, extraction of an impacted right lower wisdom tooth was scheduled. Optimal sedation was achieved with midazlam 5.0mg, and treatment was completed in 15min. A hyperventilation attack occurred after the patient returned to her room, but her condition improved when a vinyl bag was used to breathe exhaled air. The second time that intravenous sedation was used, extraction of an impacted left lower wisdom tooth was scheduled. Because the patient complained of pain and showed hyperventilation despite optimal sedation with midazolam 5.0mg, she was additionally given a local anesthetic and midazolam, and the procedure was completed in 30min. A hyperventilation attack occurred after the completion of treatment, and the patient was given midazolam 3.0mg. We waited until the patient's condition improved before allowing her to return to her room, but a restless state and hyperventilation attacks recurred after she returned to her room. The stress of changes in the environment, pain, and other factors can trigger panic attacks in patients with panic disorder. This case made us keenly aware of the need for exercising caution with regard to anxiety, pain, and other symptoms throughout the perioperative period.

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In recent years, 12-lead electrocardiography (ECG) with automatic analysis function is used in many hospitals for medical evaluation and treatment. In general hospitals, the proportion of patients with disease is higher than that in dental hospitals. Many patients require surgery in our department of oral and maxillofacial surgery. Operations in patients with cardiovascular diseases have a particularly high risk of complications. We preoperatively performed standard 12-lead ECG using a CARDIOPRO-FCP-4266 electrocardiograph equipped with automatic analysis function (Fukuda Denshi) in 55 dental patients (28 males and 27 females, average age 63.4) who required local anesthesia and were receiving treatment for cardiovascular diseases or were suspected to have cardiovascular diseases between October 2006 and November 2007. Medical examination by interview showed that 47 patients, had underlying cardiovascular discase. The total number of diseases was 49, with hypertension in 28 patients (49%), angina pectoris in 3 (5%), myocardial infarction in 3 (5%), irregular pulse in 2 (4%), valvular disease in 2 (4%), and others in 11. Eight patients were normal (14%). ECG abnormalities were present in 31 patients (56.4%), including inferior myocardial infarction in 7 patients (9%), latent inferior myocardial infarction in 4 (5%), atrial fibrillation in 4 (5%), complete right bundle-branch block in 4 (5%), mild ST-T abnormalities in 4 (5%), and ST-T abnormalities in 4 (5%), counterclockwise rotation in 4 (5%), negative T waves in 3 (4%), flat T waves in 3 (4%), and others in 16 (21%). The ECG was normal in 24 patients (32%). Four patients (7.3%) who had ECG abnormalities but no apparent disease on medical examination by interview visited cardiologists; 1 of these patients (1.8%) required medical therapy. Because the analytical accuracy of ECG with data analysis function is very high, patients who are unaware of their diseases can be screened. ECG with data analysis function is thus considered very useful for evaluating risks in dentistry.

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