Recently, there has been an increasing trend in the number of occasions when patients with some diseases visit the dentist, and patients suffering from certain systemic disease are not particulaly care. The authors thought that the investigation of the current medication profiles of those patients might be a useful measure for a clear understanding of dental patients diseases. Thus for the 2-month period from November to December 1996. We asked new patients to our department about their conditions, and investigated what kinds of medecine patients of 50+ suffering from certain diseases were taking, from which the following results were obtained.
1) We investigated the medication of 31 50+ patients.
2) A single patient was found to be taking approximatory. 4types of medicine on average .
3) The most frequency was drugs for the circulatory system, then those for the central nervous system andthose for the gastrointestinal tract in order.
4) Investigation of medication seems to be a useful measure to understand the pathological conditions of dental patients with some diseases.
5) Positive utilization of medication reports seems to be useful medium for obtaining a better understanding of medication profiles.

View full abstract

We have reported that platelet-transfusion have no effect for two cases of toothextraction in patients with aplastic anemia and also idiopathic thrombocytopenic purpura (ITP).
In case I, a reaction was not admitted to the platelet transfusion. Because of transfusing many time. the human leukocyte antigen (HLA) antibody had made. But, hemostasis was possible with the HLA-PC transfusion and also granulocyte colony stimulating factor (G-CSF) and erythropoietin (EPO). In case 2, althouth we use high doses of γ-globulin and ulatelet transfusion, the rise of blood platelet was not admitted. Therefore, hemostasis was possible with steroids and platelet transfusion and also local hemostasis.

View full abstract

We studied present situation of oral management for HIV-infected patients in several dentalschools and hospitals in USA.
The results are as followes:
1. The number of oral manifestations associated with HIV infection has been decreasing recently. It depends on prevailing of highly active antiretroviral therapy (HAART) and prevention of opportunistic infections.
2. General evalution, infection control and modification of dental treatment for HIV-infected patients have already been established.
3. The students in dental schools are educated about the special management of oral manifestations and modification of dental treatment for HIV-infected patients. They also have some experience of treating these patients in undergraduate.
4. In Japan, these education for under and postgraduate dentists will have to make the dental service for HIV-patients better.

View full abstract

In consideration of the fact that patients who want to die at home have increased as compared with patients who died in the hospital due to terminal cancer in recent years, the necessity of terminal care at home (referred to as home care below) is being discussed eagerly. In order to obtain enhanced QOL and improved terminal care, home care is considered to be essential. The administration tackles the home nursing program more and more actively with change in response to the patient's or family's need such as a establishment of a nursing station. In addition to a problem that there is a limit on pain management for patients with terminal cancer at home, however, several problems are encountered in the home care for patients with terminal oral cancer occurring at a specific site anatomically, that is, an oral cavity being an entrance of the respiratory and digestive systems, which include control of hemorrhage, ensured airway, and nutritive management from a dietary point of view. Recently, there were two cases who died at home despite of enforced home care. By referring to these two cases, the possibility of home care for patients with terminal oral cancer was examined with the following conclusions. In order to attain successful home care, it seems important to confirm that the patient or their family strongly desire home care and a hospital which will accept the patient at the time of emergency. In addition, it is important to provide telephone consultation for the family on a 24-hour basis.
In addition to the above-mentioned problems for patients with terminal cancer, factors hindering the enforcement of home care include cost-effect ratio, insufficient family support, lack of home doctor, complicated arrangement of apparatus and instruments, and possible burden on the family. For these reasons, carefulness seemed necessary when performing home care.

View full abstract

Infective endocarditis is a desease caused by microbial infection of the demaged heart valves or endocardium. Transient bacteremia after dental treatment most often result in infective endocarditis. We report a case of infective endocarditis caused by dental treatment. The patient was a-45-year-old man. He was pointed out hypertention and mitral valve regurgitation. After endodontic treatment of his left lower first maler at his home dentist, he began to feel low grade fever and general fatigue. His blood data showed infection and echocardiography revealed a vegatation of his mitral valve. These findings were suspected infective endocarditis, he was hospitalized emergency. γ-hemolytic streptococcus was detected cultivating bacteria of his blood. He was treated antibiotics therapy about two months. We performed extraction and root canal treatment simultaneously. The symptons were free, he was discharged succcessfully. We must take providing prophylactic antibiotics to prevent endocarditis for patients with congenital or acquired cardiovascular defect.

View full abstract

I present here, a case of speech disorder associated with neurogenic muscular atrophy and discuss the treatment. A 55-year-old female who complained of speech difficulty was referred to my speech clinic from the First Department of Internal Medicine in October 1982. The soft palate did not show an abnormal form but the mobility was very poor. Nasal emission was distinctly recognized and speech showed hypernasality. The speech pathological diagnosis was speech disorder with acquired velopharungeal closure incompetency and the use of a palatal lift prosthesis (PLP) was indicated. As the nasality did not disappeared by internal medicine, a PLP was made in November 1982. The patient began to wear the PLP in January 1983 and the nasality subsequently disappeared. Sound spectrography at pronouncing /p/ showed spike fill as the normal pattern. The PLP had been removed by the patient when she visited the clinic 9 months later. The speech after removal was evaluated by the speech test, sound spectrography and flow-nasalitygraphy. The results showed normal speech. I described here, a case of neurogenic muscular atrophy that showed nasality and was treated with a PLP. The PLP was removed after the patient acquired normal speech.

View full abstract