In this study, we investigated dental complaints and medical backgrounds of 10, 530 new patients who visited department of dentistry, Kumamoto City Hospital clinico-stastically in the period of April, 1982 to December, 1992.
The results obtained were as follows:
1) The number of new patients increased gradually and the averaged number of them per year was 957.
2) They were classified to 4, 548 males and 5, 982 females. Regarding the distribution of age, the patients in 0 to 9 years old group were most frequent (1, 876), followed by the patients in 30 to 39 years old group (1483).
3) Comparatively high percentage (36.0%) of them was referred by others. The patients referred by other departments in our hospital were most frequent (2, 988), followed by the patients by dental practitioners (479).
4) We diagnosed dental caries mostly (2, 840) for their chief complaints, followed by marginal periodontitis (1, 034).
5) The number of patients with any systemic disease or handicap were 4168. The patients with neoplasm were most frequent (661), followed by the patients with digestive tract disease (410).
6) Regarding the annual distribution, the number of patients with neoplasm and cardiovascular disease increased gradually.
7) Regarding the distribution by the age, the patients with handicap (mental retardation and autism) were most frequent in 0 to 9 and 10 to 19 years old groups. In 40 to 49, 50 to 59 and 60 to 69 years old groups, the patients with diabetes millitus were most frequent, followed by rheumatism and hypertention.
8) Regarding the frequency of the systemic disease and handicap by referral, dental practitioners and the departments of dentistry and others in other hospitals referred the patients with mental retardation or autism to us mostly.
The patients with diabetes mellitus were most frequent (130) from other departments in our hospital, followed by ophthalmic disease (124).
9) Regarding the frequency of dental diagnosis by each systemic disease and handicap, dental caries was most frequent, except marginal periodontitis in metabolic and secretory disease. Additionally, gingivitis in pregnancy and prevention in mental retardation and autism followed dental caries in them.

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We were asked to perform an extraction on a patient (29-year-old female) who had been hospitalized at the age of 25 for about 6 months because of shizophreniz, and has been taking phenothiazine derivatives since then. The patient was given a thorough examination because we found an abnormality of activated partial thromboplastin time (APTT) in a laboratory test finding before the extraction.
First, in the mixing test of APTT, the blood plasma of the patient did not normalize even when mixed with normal blood plasma in a 1:1 ratio. In addition, we found no abnormality in coagulation factors of 8, 9, 11, 12.
According to these findings and her medical history, the presence of lupus anticoagulant (LA) was suggested. Therefore the method of dilution prothrombin time (PT) was carried out for the confirmation of L A.
In the result, the P T ratio (dilution PT/ordinary PT) was more than 3.
Finally, we made a diagnosis of L A positive.
After the diagnosis, we proceeded with the extraction as usual. We detected no abnormality during or after the operation.

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A 39 year old female with Pseudo-Bartter syndrome is reported. She was complicated with chronic hypopotassemia as a result of the long-term use of diuretic and laxative. She was managed in order to oparation of plastic of alveolar ridge.
In such a case, it is important to correct hypopotassemia preoperatively, in addition, it is necessary to cultivate a better understanding for the infomed consent, making inquiries in full as for her attitude of living and so forth not only to the patient herself but to her family.
For an anesthesia, it is imperative to prevent arrhythmia and hypotention, giving potassium carefully during and after operation. Furthermore, it is necessary to pay thorough attention to respiratory management because of presence of concomitatnt metabolic alkalosis. In this case, the patient extreamly clinged to the preservation of her beauty, so that we found the case as one of the cases to have caused much difficulty even in the management of her hospital-life.

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This time, we experienced a case of extraction of a patient with frequent attacks of angina pectoris and complications of right unilateral partial paralysis who had been subjected to artificial valve replacement surgery. The patient was 39 years old male who had been indicated valvular disease at 14 years of age and subjected to artificial valve replacement surgery. Thereafter, he had been suffering from attacks of angina pectoris sometimes accompanied with occurrences of cerebral thrombosis. This time, we were requested to perform extraction on this patient. Hematological findings at the first examination showed elongated hemorrhagic time of 6 minutes due to the treatment with ticlopidine hydrochloride. The medication was discontinued on the day before extraction. In ECG, a slight decrease in ST was observed. The patient was admitted to the hospital on the day before extraction. Nitrous oxide inhalation was used as the psychosedative therapy. By the inhalation of 7l of O₂ and 3l of N₂O, appropriate sedative condition was obtained. Then, a local anesthetic was used for anesthesia and extraction was started. Monitoring during extraction showed no marked changes in ECG, blood pressure, or pulse rate. However, nitroglycerine was administered intravenously as a prophylactic treatment. There was no marked change in the patient after going back to ward and he was relieved and left the hospital on the next day.

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This experiment was performed under clinical condition of a dental office to examine the suck-back occurrence, and also to report the efficacy of the AT/AR Clean System against suck-back in vivo. A new autoclavable device AT/AR Clean System (Morita Co., Ltd., Kyoto, Japan) was made to reduce cross-contamination by suck-back inside the air-turbine handpiece when it is stopped. For this study, the handpieces with or without anti-suck-back device were disinfected with 2% neutral glutalaldehyde and replaced with sterilized handpieces in an autoclave.
The samples were taken before and after dental treatment and after replacing a sterilized handpiece. Culture was performed for 72 hours aerobically to detect the residual microorganisms inside the handpiece. The results proved extreme efficacy to reduce bacterial contamination in compare with the conventional type of handpieces.
Furthermore suck-back may occur under present clinical condition of the dental clinics, but even without usage of anti-suck-back device the operator's skill and an appropriate management could reduce cross-contamination markably.

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