Clinico-statistical analysis on the patients who were hospilalized for dental treatments during years from 1990 to 1994 in our hospital, and their and their families' impressions were investigated in this study.
There was an average of 5 cases a year, and this occupied about 4 per cent of whole inpatients in our department. All patients were hospitalized for the purpose of tooth extraction (s). The patients with hemorrhagic diseases, heart diseases and cerebral infarction were frequently observed, and both young and old patients were equally included. Almost of the patients and their families accepted the treatments with good will, but they did not have the initiative. From the results of this study, some problems, such as a nuclear family, a low possession rate of home dentist and delayed complications, also loomed up.

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We have already studied the effect of severe dementia on a person's ability to wear dentures and the relationship of this to Activities of Daily Living (ADL). We calculated a ‘threshold’ score over which, a person with severe dementia could wear dentures. The scoring system was as follows. Firstly we divided ADL into 5 categories; going to the bathroom, eating, bathing, getting dressed and washing faces. Secondly we gave each person 1, 2 or 3 points according to their ability.
Calculating the total for each person, we made the conclusion that persons who got over 10 points could wear dentures, while persons who got less than 7 points were not suited to we aring.
This time the purpose of our study was to learn whether or not this score can be adapted to a person who suffers from moderate dementia and a person who is not suffering. We chose a nursing home where there are persons who suffer from relatively mild dementia and we studied the relation between the person's ability to wear dentures and their ADL.
There were 113 subjects, who all lived in a nursing home. Their average age was 83.9 years. The number of the subjects with severe dementia was 30. Moderate dementia 13 and mild dementia 18. The number of the subjects who were not suffering was 52. The method was the same as before. But this time the categories were walking, going to the bathroom, eating, bathing and getting dressed. We used Akaike's Information Criterion (AIC) to analyze the ADL categorical score as an indicator of each person's ability to wear dentures.
The results were as follows;
1. As regards the degree of dementia; the less the degree of dementia is, the higher the rate of wearing denture tends to be.
2. In the “getting dressed” and the “eating” categories, the higher the person's ability, the higher the rate of wearing dentures. While in the “going to the bathroom, ” the “bathing” and the “walking” categories, there was no relation to denture wearing.
3. In the subjects with non-dementia and mild dementia, we couldn't find any differences in ADL scores between denture wearing persons and non-denture wearing persons. However as regards, subjects with moderate dementia and severe dementia, “the guidelines for denture adaptation in severe dementia” was applicable in most cases.

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Purpose: A study of the effectiveness of the UV-101DS, that can measure the blood pressure (BP) at a finger.
Method: An object of the research are total 34 in and out patients who undergoing oral surgery of ASA Risk I-II and 10 healthy volunteers.
All patients were sedated by the Inhalation of nitrous oxide or by the intravenous administration of Midazolam.
Results: No significant difference were observed in BP between two groups.
The comparison of BP of senile group above 65 years with the group below 65 years indicated no significant.
Another study was made on 10 healthy volunteers at a sitting position whether the observed values were affected by thoracic sensor moved up and down.
The results showed that in case of moving a thoracic sensor by 10 cm down gave a rise of systolic BP by 6.1% and a rise of diastolic BP by 7.8%.
The difference being significant for descent the thoracic sensor.

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A total of 590 new patients who visited our dental clinic in Yagoto Hospital, a psychiatric hospital in the period of April 1994 to March 1995 were obsereved clinico-stastically. Of these 590, 375 (63.6%) were inpatients of our hospital, 43 (7.3%) were from neighbouring gerontic nursing homes, and 172 (29.2%) were outpatients, including hospital staff. A total of 229 (38.8%) were hospitalized in the locked wards, 93 (15.8%) were in general psychiatric wards, 41 (6.9%) were in psychogeriatric wards, and 12 (2.0%) were in wards for internal medicine.
The average age of the subjects was 47.2 years old (male: 44.1, female: 50.4). The youngest patient was 15 years old, and the oldest 92. Regarding age distribution, those in their fifties were most numerous (161 patients, 27.3%), followed by those in their forties (141 patients, 23.9%).
The number of patients who had systemic illnesses was 504 (85.4%). Patients with schizophrenia were most numerous (258 patients, 43.7%), followed by patients with alcoholism (43 patients, 7.3%).
A diagnosis of missing teeth was the most frequent among the patients' chief complaints (92 patients, 15.6%), followed by dental caries (88patients, 14.9%). Pulpectomy (82 patients, 13.9%) was the most frequent procedure performed with respect to the patients' chief complaints, followed by fitting with dentures (78 patients, 13.2%).

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We experienced 3 cases of the oral surgical treatment of the Patients with Psychiatric dIso rders, and we present the summaries. Case NO. 1, a patient with depressive neurosis, and case NO. 2, a patient with schizophrenia, both revealed traumatic fracture of the lower jaw, which was considered to be caused by psychiatric disorders. Case NO. 3, a patient with alcohol-depending melancholy, was an example of tongue gangrene injured by self-biting. The patients didn't give consent to treatment directly by themselves, but the satisfactory results were obtained with understanding and cooperation of the psychiatrists in charge and their families. Besides, Case NO. 3 was a request of another psychic hospital, so the Patient had an ambulatory treatment with attendance of a male nurse, and improved. In any case, it was considered that we couldn't give oral surgical treatment without understanding and cooperation of the psychiatrist in charge.

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Cerebrovascular disease is a disorder which adversely affects the blood vessels of the brain functunally and organically. In recent years prognosis has improved but often there remains some type of after effects.
We experienced two cases of obsolete dislocation of the temporomandibular joint in patients suffering from the after effects of cerebrovascular disease.
Case 1 was a 75-year-old female and Case 2 was also female aged 66. Both were suffering from the after effects of cerebrovascular disease and were unaware of the dislocation of their temporomandibular joint. It was possible to reposition these locations manually under general anesthesia and they were treated by open reduction. During a period of 22 months for case 1 and 14 months for Case 2.
Since the operation, there have been no signs of recurrent dislocation. Since cerebrovascular disease produces a variety of symptoms, the general condition of the patient must be evaluated carefully, as this could have a significant influence on the choice of surgery.

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Antiphospholipid syndrome (APS) is a relatively new disease and reveals clinical symptoms such as venous thrombosis, arterial thrombosis, habitual abortion and thrombocytopenia. This disease is diagnosed based on lupus anticoagulant or positive IgG and IgM anticardiolipin antibody at the middle level or higher inlaboratory tests.
This report presents the data obtained from a patient with ITP complicated by APS-like disease.
The patient was a 70-year-old woman who suffered from wide-spread hypodermal hemorrhagic spots due to a blow eight years ago. She was examined at a nearby clinic, and found to have thrombocytopenia. Hence, the physician of the clinic introduced her to a university hospital, and she was diagnosed as having ITP.
Since some time in April 1994, the patient had toothache of a third molar. Although she wanted to extract the tooth, she had an experience of hemorrhage after extraction of another third molar in 1992.
In the preoperative examination, the platelet count was low and 4.6×104/μl. In the blood coagulation test, PTT was extended to 200 sec (100 sec for control). In the repeated examination later, APTT was 115 sec and abnormally long (50 sec for normal). In the examination of coagulation factors performed simultaneously, the level of every factor was very low: 25% in F VIII, 23% in F IX, 58% in F XI, and 18% in F XII were observed, indicating an apparent multiple deficiency of coagulation factors. In the APTT supplementation test, the activity of plasma from this patient could not be corrected sufficiently by addition of even 3/4 amount of normal plasma, while the activity of a plasma sample that was known to be deficient of coagulation factors was normalized by addition of 1/4 amount of normal plasma. Hence, the presence of some anticoagulant was strongly suspected. Then, the patient was examined for lupus anticoagulant (LA) and anticardiolipin antibody. LA was found to be positive and anticardiolipin IgG antibody was more than the middle level. Therefore, the illness was considered to be APS.

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With the recent progress in dialysis, the 10-year-survival rate of patients undergoing chronic hemodialysis has now exceeded 70%. Consequently, the opportunities for these patients to contract diseases requiring surgical treatmemt are on the rise. It is no longer rare that patients with kidney failure visit dental care facilities and it is necessary to treat them with due consideration given to their unique renal physiopathology.
In general, dialysis patients suffer from severely compromised renal functions, hemorrhagic tendencies, delayed wound healing, and easy susceptibility to infections. Thus prior to surgical treatment, they require through examinations, selection of the most suitable surgical procedure, and appropriate pie-, peri-, and post-operative management. Recently, we had opportunities to perform oral surgery on two dialysis patients who had been referred to us by other hospitals. We introduce an outline of the cases and discuss the therapeutic issues on stomatognathic diseases.

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Recently, as the average life expectancy of Japanese has become long, many aged patients visit the dental clinic. It is not unusual that they have various systemic basic disease.
In this report, we will describe a case of the cerebral infarction that occurred just before the dental treatment and died two months later. The patient was 69-year-old female. She had a medical history of hypertension, heart failure, premature ventricular constriction, thrombosis of inferior limb and atrial fibrillation.
She came to our clinic by car with her family and waited at the waiting room. She entered the treatment room by herself and sat. She lost her consciousness on the dental chair and snored. We suspected the apoplexy and requested the ambulanc car. Partial dentures were removed. We kept the airway and administered the oxygen. Arterial oxygen saturation and pulse rate were continuously monitored with a pulse oximeter. The venous route was kept for drug administration. The patient was carried to Nara Medical University Hospital after the nasopharyngeal airway was inserted.
The diagnosis was multiple cerebral infarction from the brainstem to the occipital lobe. She died after two months in spite of the medical therapy.

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Nifedipine which is the calcium antagonist is widely used clinically for the treatment of cardiovascular diseases such as hypertension and angina pectoris. However, gingival overgrowth has been reported as side effect of nifedipine treatment. Here we report three cases of gingival overgrowth induced by long-term treatment with nifedipine.
In case 1 and 2, nifedipine treatment was stopped, and gingival overgrowth was cured by providing instruction on tooth brushing and scaling.
In case 3, nifedipine was discontinued, and the patient received tooth brushing instruction and underwent scaling, but there was no remarkable change in gingival overgrowth. The patient underwent teeth extraction and gingivectomy, and effort was made to promptly restore masticatory function by a new prosthodontical procedure.
Following this study, at first the patient should receive tooth brushing instruction and undergo acaling, and nifedipine should be discontinued in nifedipine-induced gingival overgrowth. In no remarkable change case in gingival overgrowth by these preservative therapies and plaque control morphologicaly difficult case for severe gingival overgrowth, the patient should undergo gingivectomy, and tooth extraction in case of difficult preservation.
Furthermore it was condidered that the success of the treatment was accomplished by prompt prosthodontical treatment in oral hygiene and recovery of mastication.

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This paper report our recent experience of four patients who developed drug-induced allergic reactions.
Cose No 1 had a history of allergy to drugs and various foods. This patient underwent extraction of the left upper first and third molar teeth after preoperative allergy tests and prophylactic measures including steroid therapy, and exhibited only slight allergic symptoms in response to lidocaine used as a local anesthetic.
Case No 2 developed serious anaphylactic shock several minutes after an oral dose of talampicillin following alveoloplasty. The patient showed a temporary fall of bloodpressure, causing difficulties with treatment.
Case No 3 and 4 developed allergic symptoms in response to latamoxefsodium administered intravenously for resolution of acute inflammation. Case 3 had no history of drug hypersensitivity. Threee Case excluding Case 2 underwent preoperative intracutaneous tests.
Case 1 had a strongly positive reaction, showing facial flushing, even though the test drug was diluted.
Case 3 and 4 showed allergic symptoms even though their preoperative tests had been negative.
Our experiences indicate that intracutaneous tests are not wholly reliable, and that caution should be exercised when administering drugs during dental treatment.

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Hemorrhagic colitis due to drug is an iatrogenic disease that is charactrized by sudden colicky pain, intense loose stools and bloody diarrhea in a few day after administration.
We have experienced a case of suspected hemorrhagic colitis.
The patient was a 36-year-old female, whose impacted third molar was extracted. Aspoxicillin was administered by intravenous injection for preventing postoperative infection. After four days of administration, it was recognized that there was intense lower abdominal pain and the patient passed bloody diarrhea 15 times, and after five days 31 times. On the same day, bacteological examination of the patient's stool did not reveal Clostridium difficile D-1 toxin.
For treatment the administration of aspoxicillin was discontinued, and food was stopped and she was given drip infusion of electrolytes. After eleven days, she recovered.
According to these findings, hemorrhagic colitis due to aspoxicillin was suspected.

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This case reportdescribes an acute retention induced by extracting a hemangioma of the to ngue. The patient was an 83-year-old male with latent benign prostatic hypertrophy, who turmed an acute retention after extracting a hemangioma of the tongue. We performed the treatment of catheterization.
After a few days, the ballon catheter was removed, but retention was notimproved. The patient was consulted urologist. So the clinical diagnosis was a benign oprostatic hypertro phy. The patient received a prosta tectomy. The removed prostate was markedly enlarged.
In the present case, it was concluded that causes of an acute retention were dueto various factors such as draginduced retention, latent benign prostatic hypertrophy, postoperative pain and hypersthenia induced sympathetic hypertonia, or psychosomatic effects.

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