The UK hospital dental “consultant” has undergone longer training in the past than the hospital “specialist” in Europe. Now the training is shorter in the UK and more care is being provided outside hospitals where care perceived to be of lower cost. The medically compromised patient requiring dental care is however usually referred to hospital. Many consultants in different dental specialties continue to provide expert knowledge and care, especially oral and maxillofacial surgery consultants, but now there is also a new specialty of “special care dentistry” to complement the traditional specialties offering care.

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Oceania is meant by the area that covers Australia, New Zealand and 22 Pacific Island countries and territories (American Samoa, Cook Islands, Federated States of Micronesia, Fiji Islands, French Polynesia, Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, Niue, Northern Mariana Islands, Palau, Papua New Guinea, Pitcairn Islands, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Wallis and Futuna).
The considerable diversity among the Pacific Island countries and territories and the challenges they face are reflected by the fact that they:
·cover an ocean area of nearly 5, 000, 000km²,
·have over 1, 000 different languages,
·vary in population from just over 1, 000 to over 6, 000, 000,
·are all undergoing an epidemiologic transition from mainly infectious diseases to mainly noncommunicable diseases,
·are variously undergoing a demographic transition with gradually aging populations, and
·are generally with small populations that are particularly vulnerable to outward migration.

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We examined the correlation between the feeling of dry mouth as assessed by a questionnaire and the amount of salivation as determined by a chewing gum test in 122 inpatients (57 males and 65 females) with Type 2 diabetes mellitus who were enrolled in an educational program.
The results indicated that 65 subjects (53.3%) experienced dry mouth. The number of patients who had a salivation level lower than normal was high (101 patients, 82.2%). The salivation level was low in 84.2% of the patients without dry mouth and 81.5% of those with dry mouth; these percentages were similar. There was apparently no correlation between the amount of salivation and a feeling of dry mouth.
The effects of the following factors on salivation were examined: sex, age, diabetes treatment, and concurrent disease (diabetic retinopathy, diabetic nephropathy, and atherosclerotic disease). For all categories, the proportion of patients with a decreased salivation level was higher than that of patients with a normal salivation level, regardless of whether or not they experienced dry mouth.

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The purpose of the present study was to establish a system for the management of pincushion and cut wound accidents. A questionnaire survey was conducted among the members of the Midori Ward and Aoba Ward Dental Associations in Yokohama City (178 facilities).
A total of 72 accidents involving pincushion and cut wounds were reported. The occupational categories involved in the accidents included 36 dentists, 10 dental hygienists, and 6 assistants. Nineteen accidents occurred during recapping, and 15 occurred during root canal treatment, cavity preparation, and local anesthesia. In addition, 7 accidents occurred while washing instruments.
Most accidents were treated conventionally by washing the wound with flowing water and squeezing out blood. A wait-and-see approach was then usually taken (58 accidents). Five patients consulted physicians at hospitals, and 4 received intramuscular injection of interferon.
The Department of Gastroenterology, Showa University Fujigaoka Hospital has fully supported our association since April 2005.
Accidents involving pincushion and cut wounds are a common problem that are routinely diagnosed and treated. Safety measures during washing and sterilization are necessary to prevent accidents involving pincushion and cut wounds. However, safety measures after accidents have not been fully established. A contingency system is necessary not only for dentists, but also for medical treatment staff. Timely diagnosis and safe treatment are the ultimate goals.

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In Japan, renal transplantation in now performed in more than about 1, 000 patients per year. We describe our experience with general anesthesia in a patient who underwent orthognathic surgery after living-donor renal transplantation.
The patient was a 24-year-old man. He was scheduled to undergo orthognathic surgery of the maxilla and mandible under general anesthesia to correct upper and lower jaw deformities.
The patient had undergone renal transplantation with his father as a donor at the age of 12 years. He received an immunosuppressive drug and methylprednisolone preoperatively.
Hydrocortisone was administered intravenously before the induction of anesthesia and during the operation to provide a steroid cover. From the day after surgery, the patient received hydrocortisone intravenously and methylprednisolone orally. General anesthesia was induced by treatment with fentanyl, propofol, and vecuronium, and endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen, isoflurane, and fentanyl. A low dose of dopamine was used to maintain urinary flow intraoperatively. After extubation in the operating room, the patient was sedated with dexmedetomidine in the recovery room. Oral immunosuppressive therapy was resumed the day after the operation.
General anesthesia, surgery, and perioperative management were successfully completed in this patient because 1) immunosuppressive therapy was continued, 2) a steroid cover was provided and perioperative stress was reduced, and 3) management methods and drugs for anesthesia were carefully selected to protect kidney transplantation.

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