We treated 44 patients infected with human immunodeficiency virus (HIV) in the Department of Oral Surgery, Nagoya University Hospital. From these patients, we present three remarkable cases that highlight the problems of dental management for the HIV infected.
Case 1: CD4 95/μl, CD4/CD8 0.28 showed a hematologically severe stage of HIV infection and a clinically diagnosed AIDS related complex (ARC). Severe oro-pharyngitis and phlegmon of the oral floor suddenly appeared on the right side without any prodrome. Inflammation was resolved after seven days of administration of imipenem (100mg/day) and ganciclovir (10mg/day). Opportunistic infection originated from a pericoronitis of the right lower wisdom tooth. This case suggests that special attention should be paid to oral hygiene in HIV infected patients.
Case 2: Severe type Hemophilia A showed CD4 343/μl, CD4/CD8 0.26 and was clinically evaluated as an asymptomatic carrier (AC). Three wisdom teeth were extracted under administration of factor VIII. Unfortunately because anti factor VIII inhibitor transiently appeared, it was hard to achieve hemostasis. Consequently, as a countermeasure, it was necessary to admit the patient to a private room in order to prevent cross-contamination in the hospital.
Case 3: This was a HIV infected patient who could not see a dentist periodically in spite of several ongoing problems, especially an oral cavity infection, because the nearest hospital that would accept the HIV infected was far from the patient's place of residence. For fear of loss of employment and discrimination, it was impossible for this patient to disclose his HIV infection to colleagues. Therefore, he was often scolded in his company about seeing a dentist in another city and for being admitted to a hospital for treatment of dental problems. From the point of view of social support, providing a framework for the dental treatment of the HIV infected is urgent.

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Seven thousand nine hundred and eighty-eight patients who visited our department in the period from July 1986 to June 1990 were retrospectively analyzed.
1) There were 111 patients with neuromuscular diseases, an incidence of 1.4%. Among these, three patients (two with epilepsy, one with Parkinsonian syndrome) had jaw injuries. It suggested that injury was apt to occur in these patients.
2) There were 27 expectant and nursing mothers. More than a half of them visited during the period of the 5th month to the 7th month of pregnancy. But several patients visited during over 8 months pregnant. Most of them directly visited our hospital and complained of gum diseases or pericoronitis.
3) Two hundred fifty-eight patients, an incidence of 3.2%, had a history of allergy to drugs etc. Antibiotics were the most frequently encountered drugs, and then aspirinlike drugs followed. After our treatment 5 patients took allergic reaction to drugs which we used, and they all had had a hisotry of allergy to other drugs.
4) There were 49 patients (0.6%) who were suffered from collagen diseases and analogues. Systemic steroid therapy was used in 27 patients. Complications (infections and/or healing loss) were observed in 10 patients after our treatment.
5) Fifteen patients had a history of complications during dental anesthesia. And most of them were middle aged women.

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There were 5, 487 patients, who first visited Department of Oral and Maxillofacial. Surgery, Tokyo Women's Medical College during a period of one year from January to December 1990. Among them, 2, 467 patients (45.0%) had systemic diseases of some kind or the other.
There were 1, 214 male and 1, 253 female patients, and these were 47.9% and 43.1% of the patients of the first visit respectively. Average age of the medically compromised patients was 48.0 years, while that of normal healthy subjects was 34.8 years. In age groups, there were more patients of the fifties and sixties while there were few in the teens and twenties. The ratio of the medically compromised patients to the subjects who visited our department increased with their age and amounted to 76.9% in the patients of the seventies. In the number of the diseases per medically compromised patient, there were 1, 953 patients (79.2%) with a single disease, 514 patients (20.8%) with two or more diseases, and average number of diseases per patient was 1.26.
In the classification by types of diseases, the patients with circulatory diseases were overwhlemingly many, accounting for about 1/3 of all. Next followed endocrine and metabolic diseases, neoplasm and digestive tract dieseases, urological diseases, mental disorder, respiratory diseases, etc.

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Clinical and statistical observations during the year 1991 at the department of dentistry and oral surgery were made on the new patients of those who are the outpatients at the Keio University Hospital.
1) The total number of patients were 198, 80 males and 118 females.
2) Concerning age distribution, the majority was in their fifties and the average was 45.1 years old.
3) Concerning monthly distridution, most patients came in February and August.
4) More patients were from internal medicine.
5) On the patient numbers categorized by disease at other departments, the majority was circulatory disease.
6) On the number of patients categorized by disease at our department, the largest number was dental caries and marginal periodontitis, followed by disease of pulpitis and apical periodontitis.
7) Concerning the distribution of the medical treatment at our department, the largest number was medication, followed by unnecessary treatment and examination.

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Clinical and statistical observations during the year 1991 at the Department of Dentistry and Oral Surgery were made on the first visit patients of those who were the inpatients at the Keio University Hospital.
(1) The total number of patients was 595, 332 males and 263 females.(2) Concerning age distribution, the range of the patients were from 0 year to 92 years old. The majority were in their sixties and the average was 51.3 years old.(3) Concerning monthly distribution, most patients came in July and the average number of patients was 49.6 per month.(4) More patients were from internal medicin and surgery.(5) On the patient numbers categorized by disease at other department, the biggest majority was malignant neoplasm.(6) On the patient numbers categorized by disease at our department, the largest number was dental caries, followed by disease of related denture and periodontitis.(7) Concerning the details of the medical treatment done at our department, the biggest numbers on denture adjustment, followed by restoration and filling treatment, extraction then root cannal treatment.(8) The number of the visit to patient was 57 (9.6%).

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Allergy to local anesthetics is a disease with relatively low incidence at present. In particular, there has been almost no report on a “true” lidocaine allergy. In the present report, we will describe our recent experience on a case, which seemed to be lidocaine allergy.
The patient was a 20-year-old woman, who underwent tooth extraction at a local dental clinic when she was 18 years old, whereby she had her eyelids swollen and visual field contracted due to local anesthesia. Thus, for pulpectomy, intracutaneous reaction test using lidocaine and lymphocyte stimulation test (LST) were performed. The results of the tests were negative. Local anesthesia was performed with 3ml of 2% lidocaine or intravenous inqection. under intravenous sedation. After 2-3 minutes of injection, swelling of eyelids appeared. At this moment, allergy to local anesthetic not being subject to immunological system was suspected. Allergy test using placebo was performed later, but the result was negative. Further, as the result of load test with 2% lidocaine for intravenous injection, swelling of eyelids appeared by 100%, but no other allergic symptoms such as rashes did not occur. In view of the subsequent therapeutic program, hyposensitization therapy was adopted because there may be very low possibility to lead to anaphylaxis in the present case, and satisfactory results were obtained.

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Fibrinogen that is the first factor of thrombokinesis, is one of the most impotant factor among blood coagulation factors, and exist as matrix that relates to both blood coagulation and fibrinolytic system. Hypofibrinogenemia will occur when fibrinogen in the blood plasma reduces. However, this disease is uncommon.
In this paper, we report the experience of tooth extraction of patient with hypofibrinogenemia.
A 72-year-old woman visited our department on April 14th 1988, complaining of pain in occlusion at 26, 27. There is no hemorrhagiparono in her blood relation except for the patient. She had valvular disease of the heart, stenocardia, gastric ulcer, and hypertention in her history. She had been diagnosed as hypofibrinogemia in preoperative examination of gastric ulcer. Under diagnosing as 26, 27 chronic ostitis alveolaris, she admitted to our University Hospital on May 23th 1988, and then she was intended to transfuse fresh frozen plasma, originate in human blood pre and post operation and extract 26, 27.
Quantity of fibrinogen of preoperation was 39mg/dl, and so 5-units of fresh frozen plasma were transfused as aim of 60mg/dl and then it rose to 74mg/dl Result of examination about hemorrhagic diatheses improve, as usual way 26, 27 extract after extraction condensation of oxidized cellulose and sew up a wound, and then we used protective device, and we could get a good condition of stopping of bleeding. But out of consideration of fresh frozen plasma at 28 hours after operation quantity of fibrinogen was 42mg/dl and she get well without bleeding.

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Incidence of severe infection and osteomyelitis in the oral surgical field have decreased in recent years owing to development of drugs and improvement of oral hygiene. However, chronic osteomyelitis is one of the diseases we confront frequently even under the existing circumstances when antibiotics have been developed and diffused.
A report is made here on the summary regarding a case of osteomyelitis we experienced, which developed in a wide range in the maxilla and mandibular in the patient undergoing the prolonged renal dialysis.
In general, patients undergoing dialyses are liable to contract infections due to undernutrition and immunological hypofunction, because of which they induce severe symptom in oral infection in many cases. Our case was a female aged 49 who had developed right molar abcess concurrently in addition to gingival abcess expanding in wide ranges in the maxilla and mandibular and has also developed a fistula. A periodontal infection was suspected most strongly from the facts that the patient had not much dental caries, that the lesion was limited to the alveolar bone and that the condition of the oral hygiene was extremely poor.
As the therapeutic, it was cousidered from her roentogenographic findings that formations of sequesters were shallow and that the boundaries were clear. An operation for removing the sequesters under local anesthesia was performed accordingly. As a result, healing of the wound followed a favorable course without any systemic trouble developed postoperatively, and reduction of the fistula was observed.
At present, a prosthetic treatment has been terminated, and the patient is leading a pleasant diet life without any hindrance in her daily life.

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Submitting 1312 outpatients referred from hospitals and clinics from 1983 to 1988, the patient's introducers, introduction reasons, complicated systemic disorders, introduced diseases, and the diagnosis in the introducers were statistically examined. The results obtained were as follows.
1. In the patients submitted, 950 patients were referred from dentists, 93 from internists, 83 from orthopedic surgeons, 61 from surgeons, 57 from otorhinolaryngologists, and 35 from pediatrists.
2. Patients were referred for tooth extraction in the complexed local or general condition, and for treatment and diagnosis of the disorder. Except for impacted wisdom teeth, infections were most frequent (168 cases), followed by cysts (165 cases), tumors (52 cases), and oral mucous membrane diseases (35 cases).
3. The internists mainly referred infected patients and some patients with mucous membrane disease and tumor. The most orthopedic surgeons and surgeons introduced patients with trauma and temporomandibular joint dysfunction (TMJD). The disorders in patients referred from the otorhinolaryngologists distributed in many different categories.
4. In the systemic disorders which caused the referrance, cardiovascular disorders were most frequent (67 cases), followed by bleeding tendency (23 cases), metabolic diseases (17 cases), shock episodes (14 cases), allergy (11 cases), lever dysfunction (8 cases), and immune disturbance (8 cases).
5. Periodontal disorders, trauma (bone fractures) and TMJD were almost correctively diagnosed in the introducers. About half of the cysts were also correctively judged, but many other diseases had not been diagnosed before our clinic.
These results indicate that more intimate cooperation between oral surgeons and other medical and dental members is needed, and more intake of knowledge concerning oral disorders should be recommended for physicians and dentists.

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The prevalence of diabetes in Japanese people aged 40 years or older is higher as 10% in studies carried out in 1988-1990 (report of the Epidemiology Data Comitte, The Japan Diabetes Society). The high average of the prevalence rate is important for oral clinical practice. The diabetic patients untreated or inadequently controlled sometimes exhibit severe acute inflammation in oral region. Therefore, dentist must be aware of the risk of any oral complications for diabetic patients.
We presented three cases of untreated diabetic patients with oral acute inflammation and discussed on “social problem of diabetes”.

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