Hemophilia typically becomes apparent in childhood when bleeding into hypodermis, joints or oral cavity, and uncommonly be revealed after intraoral management.
We experienced 2 cases found by a chance of intraoral management. Therefore we present these 2 cases with some discussions as follows:
Case 1 was 41-year-old male. He received gingivectomy of the lower right wisdom tooth in the dental clinic. After that, continuous bleeding was observed. He suffered anemia, so he was hospitalized to be transfused immediately. Finally he was diagnosed hemophilia A (FVIII: C 3.0%) in our hospital.
Case 2 was 68-year-old male. He received tooth extraction of the lower right incisor in the dental clinic. Over night continuous bleeding was observed after intraoral management. On the next day, he consulted our hospital, but after that frequent bleeding caused. Concerning blood coagulation test, he was diagnosed hemophilia A (FVIII: C 3.1%).
While as a result of our study, 12 cases of 249 hemophilias registered in our hospital had been diagnosed hemophilia A or B after intraoral management.
We think unexpectedly that it is difficult to diagnose and correspond precisely for bleeding after intraoral management.

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We have perfromed systemic management during dental treatment for medically compromised patients at our dental hospital for 21 years from 1975 to 1995. Among them, 18 patients, which are estimated to be 1.2% of all, are evaluated to be class III of New York Heart Association classification. In this article, we present 3 cases which required appropriate systemic management during dental treatment.
Case 1
The systemic problems of this patient were mitral regurgitation, old myocardial infarction, angina pectoris, obstructive arteiosclerosis, cerebral infarction and chronic renal failure. As he was suffering from toothache due to periodontitis of right mandibular incisor and lateral incisor, extraction of both teeth was scheduled. An hour before the procedure, we administered 1.5g ampicillin for the prophylaxis of infectious endocarditis. Just before the treatment, we established venous route and administered isosorbide dinitrate spray sublingually for fear sudden anginal attack or other systemic accident. Blood pressure and electrocardiogram were monitored and 5l/min oxygen was administered during dental treatment. Extraction of teeth was performed uneventfully.
Case 2
The underlying disease of this patient was dilated cardiomyopathy with transient ventricular tachycardia. She lost consciousness at least once a month. The preparation of resin facing crown at upper incisor and canine under infiltration anesthesia was scheduled. Blood pressure and electrocardiogram were monitored and psychosedation with nitrous oxide was performed because the mental stress could cause the deterioration of hemodynamics. At the same time, we also established the venous route. During dental treatment, there were not any systemic complications except the monofocal premature ventricular contractions of which frequency was between zero and four per minute.
Case 3
This patient was suffering from hypertension, angina pectoris, old myocardial infarction, abdominal aortic aneurysm, cerebral infarction and chronic renal failure. He complained of a chest pain even when he carried up a bag. Teeth extraction of left mandibular first and third molar was scheduled under the diagnosis of periodontitis. After measuring the blood pressure, we administered him isosorbide dinitrate sublingually to avoid ischemic attack. During dental treatment, there was no systemic complication.
Appropriate systemic management and skillful dental treatment are necessary to prevent systenmic complications in patients with severe cardiac diseases.

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Among 1536 new patients consulted at Meikai University Oral Surgery First Department from September 1993 to August 1994, the consultation records of randomly chosen 1000 patients were analyzed and obtained the following results.
1. 69.8% of studied patients noted that the dental disorders affected their general health.
2. 48.2% or studied patients were consulting medical doctors concurrently with the dentist.
3. 40.8% of studied patients were concurrently taking some kind of medicines.
4. 45% of studied patients had history of hospitalized treatment.
5. 22.6% of studied patients were diagnosed ill with most being circulatory diseases such as hypertension and angina pectoris.
6. 12.6% of studied patients experienced abnormal reactions against medicines, and 3.4% of them experienced abnormal reactions against the dental local anesthesia.
7. 63% of studied patients had taken health examinations. Examined rate in housewives in age 30's was notably lower comparing the rates in male groups.

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Medically compromised patients accompanying with systemic diseases are gradually increasing, because of the prolonged human life. Consequently, these patients with difficulties for dental treatments are increasing, too. In the present report, these complicated patients, who were introduced from other medical departments, were clinicostatistically analyzed (1990-1994). The conclusive results were as follows;
1. The compromised patients were often seen after 40years of age.
2. Systemic diseases of these patients were circulatory and/or metabolic diseases and so on.
3. Many patients needed treatments for oral and maxillofacial surgery. But, there were also many cases demanding general dental treatments to our department, because of difficulties of physiological control.
4. Highly advanced-ages make human-being weaken in the physiological functions. From above mentioned, it might be emphasized that general dentists should be trained more and more also in medico-dental control during dental treatments

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There were 3, 300 outpatients who visited 1st department of Oral and Maxillofacial Surgery, school of dentistry, Aichi-Gakuin University during a period of one year from April 1994 to March 1995. The medical compromised patients were 621 (18.8%).
They were classified to 252 males and 369 females, and the ratio of compromised patients were 19.0% and 18.7% respectively.
The average age of the medically compromised patients was 51.3 year old, while that of all subjects was 35.4 year old.
Among the underlying deseases, 265 patients (42.7%) had cardiovascular deseases, that were most common deseases. Next followed 140 patients (22.5%) had digestive tract desease and 93 patients (15.0%) had metabolic desease, etc. 124 patients had two or more underlying deseases, they were 20% in the all medically compromised patients.
Among the desease in our area, 305 patients (49.1%) had inflamatory disorders, next followed 63 patients (10.1%) had tempromandibular disorders and 52 patients (8.4%) had tooth deseases, etc.
As the treatment in our hospital, 402 patients (64.7%) recieved invasive treatment and 185 patients (29.8%) recieved noninvasive treatment, etc.

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Accuracy, reliability and clinical acceptance of continuous blood pressure monitoring system based on arterial tonometry were evaluated by comparing tonometric blood pressure (TBP) measurements with intermittent oscillometric blood pressure (CBP) measurements during dental treatments in 35 medically compromised patients.
A significantly high correlation was found between the two methods for systolic and diastolic blood pressure measurements. The limits of agreements (mean±2SD of bias) for the two methods were within the range which would be acceptable for clinical setting. The tonometric system provided real-time blood pressure measurements together with continuous display of the pressure waveform which was similar to the intra-arterial blood pressure waveform. This system was found to be especially useful during dental treatments in medically compromised patients.

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Recentry, prolonging of the life-span and complicating of the social organization, have given us more opportunities to treat patients with some complications or systemic diseases. Therefore, in our hospital there is the system that the patient to be treated on admission in cooperation with other fields is called to a “co-observed patient”. During past fourteen years from 1981 to 1995, 2932 patients totally admitted in our clinic, and the number of “co-observed patients” was 293 (10.0% of the admitted patients) ranging from 0 to 82 years old (means; 31.3 years). Classifying about“ co-observed fields”, 123 patients (42.0%) were co-observed with the pediatric field, following 65 (22.2%) with the internal medical, 31 (10.6%) with the neurosurgery, 28 (9.6%) with the emergency, 14 (4.8%) with the orthopedics, and 32 (10.8%) with the others. On the other hand, classifying about the disease in our field, 91 patients (33.3%) suffered from dental or periodontal diseases, following 77 (26.2%) from malignant tumour, 63 (23.1%) from facial injuries, 31 (10.6%) from inflamation, 11 (3.8%) from cyst and malformation respectively. From now on, the oppotunities of the “co-observation” with other medical fields tend to increase. Therfore, it is necessary to “co-observe” more closely.

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Steroid hormones have immunosuppressive and anti-inflammatory properties. Therefore, the drugs administered in the treatment of many diseases. Recently, we had the experience of treating the case of a 37 year old female patient with lip carcinoma. This patient had been prescribed steroid hormone for treatment of her ulcerative colitis extend over a long period time. She was admitted to our clinic for treatment of a lower lip ulcer. The clinical findings suggested that malignant neoplasmus, however some consideration was given to the possibility that the lip ulcer was complication of the ulcerative colitis and that the healing of the wound was affected negatively by the immunosuppress property of the steroid hormone. Therefore, antiulcerative ointment was applied locally. But the ulcerative legion began to increase in size so a biopsy was performed quickly. Histopathological diagnosis was squamous cell carcinoma, so after the radiotherapy tumor excision, bilateral supraomohyoid neck dissection and immediate reconstruction using forearm skin flap was performed. Postoperative course was uneventful, although the patient noticed some stiffness in the left upper neck region. Through the use of a CT examination, a metastatic legion in a deep part of the cervical lymph-node was suspected. A radical neck dissection was performed in the usual manner. One month after the operation, multiple metastasis occurred in the cervical and temporal regions, the lung and the acetabulum.
This case suggests there is the possibility that increasing incidence of metastasis occures in immunosuppressed patients.

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Diabetes mellitus (DM) is a metabolic disorder characterized by a relative or absolute lack of insulin and produces multiple systemic complications. Diabetic patients are susceptible to dental caries and periodontal disease due to decreased salivary flow, abnormal neutrophil function, microangiopathy, and increased salivary carbohydrates, especially those in whom the disease is undiagnosed or poorly controlled.,
We experienced infratemporal abscess, originating from chronic apical periodontitis, in a 71-year-old female diabetic patient. She received an endodontic treatment and medication for chronic apical periodontitis, but the abscess quickly progressed through the right buccal region up to the parapharyngeal space and the infratemporal space. The patient died of multiple viscerra insufficiency as a result of uncontrolled DM.
It is considered that the prompt drainage, systemic antibiotic treatment, and the control of DM by insulin treatment are necessary in such severe infections.

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We report a case of hypotonic hyponatremia, presumably due to desmopressin administration, during a dental treatment under a general anesthesia of a patient who was suffered from diabetes insipidus and mental retardation.
The patient, 11-year-old male, received an operative removal of cranio pharygioma at the age of 5 and because of secondary diabetes insipidus, he had been treated with desmopressin thereafter.
After the regular administration of desmopressin nose drop in the morning, we gave him gengeral anesthesia, and hypotonic hyponatremia presumably desmopressin-induced, was seen during the opration, although it was not severe. To prevent this side effect of desmopressin, preoperative evaluation of intake and output balance of water, serum osmotic pressure, serum electrolytes and diurnal variation of these values if possible, must be important. In this case, however, mental retardation and difficult venipuncture due to the serious degree of obesity made us to obtain these data only at one point of the day, and the venipuncture time might be unsuitable. Consequently, for the prevention of perioperative side effects of desmopressin, preoperative evaluation should be examined under the similar conditions with those of the operation day, namely water balance under fasting, time of desmopressin administration, and venipunctueres considering the period of anesthetic management for the operation.

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