Dental treatment of medically compromised patients has become routinized in the current society with a large aged population. We statistically analyzed compromised patients, the result of the analysis are herein reported. There were 2422 outpatients who visit Dentistry and Oral Surgery of Tokuyama Central Hospital during a period of two years from April 1996 to March 1998. The medical compromised patients were 570 (23.5%). The average age of compromised patients was 57.2 year old, and 473 patients (83.0%) were referred from other medical department. Regarding the under lying diseases, cardiovascular diseases were prodominantly often observed. (204 cases; 26.3%), and the majority of these patients had hypertension. Among the disease in our area, 183 patients (28.3%) had inflammatory disorders. As the treatment in our area, 239 patients (36.8%) recieved in basive treatment.

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The patient was a 69 year-old male who underwent surgery for oral cancer in this department. He was suffered from hepatopathy as an underlying disease and developed hyperbilirubinemia postoperatively. He first noticed dysphagia and masticatory disturbance in early April 1995, He visited anearby clinic and was referred to this hospital for further evaluation. He presented himself at this department on April 12, 1995. According to the results of the complete medical examination, we made a diagnosis of carcinoma of the floor of the mouth (T₂N_2bM₀, StageIV). Considering the fact that this patient was suffering from chronic hepatitis C, we employed preoperative radiotherapy. In order to control the general physical condition, we started to administer total parenteral nutrition and fresh frozen plasma infusion 5 days before the surgery because there was a danger of complications due to postoperative liver failure. In view of the high risk of the secomplications developing, we attempted to reconstruct the oral cavity using a pedicle flap so that we could shorten the time of the surgery. The surgery, however, lasted 8 hours and 37 minutes and the estimated blood loss was 2, 522g. In addition to these unexpected results, the patient developed severe hyperbilirubinemia and transiently showed symptoms of liver failure. The life-endangering event was successfully prevented by the prompt administration of GI therapy, intramuscular injection of phenobarbital and intravenous infusion of fresh frozen plasma. The patient made favorable progress and was discharged from the hospital 42 days postoperatively.

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Oral function, especially occlusion and mastication, may contribute greatly to the general maintenance of good health. In this study, we compared oral diseases and masticatory function between obese patients and healthy controls.
32 patients with obesity were enrolled in this study. 10 parameters were used to evaluate oral conditions. Their parameters for obese group were compared to those of a control group using significantly test.
The mean number of teeth missing because of other than caries and the mean CPITN value were significantly higher in the obese group than in the control group, it was recognized that the onset of periodontal disease and its severity score in the obese group. In the obese group, periodontal disease tended to worsen with age, severe obesity, smokers.

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A case of mediastinal emphysema associated with the use of dental air-turbine drill and air-syringe during the mandibular second molar extraction procedure was reported. A 49 years-old man was referred to our department. His chief complaint were a swelling in the left side of his face and neck, disturbance of opening mouth and dyspnea. His chest X-ray and CT scan showed a picture of subcutaneous emphysema and mediastinal emphysemafrom the left side of his face, neck and pectoral area. He was treated immediately with antibiotics and rest in bed. His subcutaneous emphysema and mediastinal emphysema disappeared after one week.

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The purpose of this study is to survey an experience of accidents/complications during and after dental treatment at general dental clinics. Questionnaire was administered to 247 dental practitioner who worked in general dental clinics in the middle part of Nagano Prefecture. Hundred and five (42.5%) sent back the answer. The rate for the experience of accident during treatments was 59% and that after treatment was 45%. Cerebral anemia, including neurogenic shock, was most frequently reported, followed by allergic reactions to drug and postoperative bleeding. The experience rate for each accidents/complications was as follows: 55% for accidental swallowing, 49% for allergic reaction to drugs, 45% for neurogenic shock, and 30% for worsening of general diseases.

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We made a clinico-statistical observation of infective patients undergoing general anesthesia or monitored anesthesia care during a ten year period (1990-1999) in the operating room at Okayama University Dental Hospital. The preoperative prevalence of syphilis, HBV, and HCV seropositivity, MRSA infection and other infections were retrospectively investigated in 2, 246 cases. In result, the total infective cases were 160 cases (7.1% of all), and the seropositivities of syphilis, HBV, and HCV, and MRSA infection were 0.6%, 1.6%, 4.6%, and 0.3% of all, respectively. HCV seropositivity was the most common and 64.4% of the infective cases. Elderly patients (>=65 yearsold) were 20.4% of all, and the percentage of infective cases in the elderly patients was high (10.7%), resulting from the increase in HCV seropositive elderly cases. Compared with the HBV seropositive cases, the percentage of the cases of liver dysfunction was significantly higher in the HCV seropositive cases . These findings suggested that a strong attention must always be paid to preoperative infection as a preoperative risk factor.

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The purpose of the present study was to assess dental status of inpatients with internal medicines in Kumamoto City Hospital to improve their oral condition and prevent following complications. Although the study population comprised 119 patients in initial stage, oral examination was not provided to 20 patients because of several reasons.
The results were as follows:
1. There were 27patients who had unconsciousness. Approximately 40% of the patients were in medically compromised conditions.
2. There were 18 patients who had already lost their teeth from their dentitions. Half of the examinees had some types of dentures. The number of the patients who had oral candidiasis and bad odor was 14, 47 respectively.
3. The number of the patients who could not clean their own oral cavities was 32, and only 30 patients had good oral hygiene.
4. There were 25, 13 patients respectively who needed oral health care by nurses and dental personnel.
Through this investigation, it was found that many patients with internal medicines in a hospital had several oral problems. They have to receive more adequate oral health care in an individually designed program by dental personnel.

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To promote the hospital-clinic collaboration, a survey by inquiry was performed to meet the needs of local dental society, evaluating the stand of dental school affiliated hospitals and role oral surgery department in particular. The survey gives the following conclusions.
1. Supporting hospitals must be able to treat medically complex cases and provide the advanced dental care services using the latest technology.
2. The referred patients had complex disorders most frequently in circulatory system related areas.
3. There is a demand for dental wards specialized in such as disease-confined, handicapped, geriatric patients.
4. It is essential to employ such tool as Internet to collaborate hospital and clinics in future.
5. Both at-home and in-hospital care system are essential for bedridden patients.
6. Sooner organization of medical support system for dental emergency patients is in urge.

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There were 433 aged patients (over 65-year old), who were the outpatients at department of oral and maxilla-facial surgery and dentistry, Kawamura hospital from October, 1998 to May, 2000. Among 355 patients (82.0%) had systemic diseases of some kind of others.
In the number of the diseage per patient, there were 45 patients (12.7%) with a single disease, 310 patients (87.3%) with two or more diseases, and average number of diseases per patient was 2.7.
Among systemic diseases, cereberal infarction accounted for the largest fraction, followed by hypertension, gastroenteritis or stomach ulcer, depression, Parkinsonism, diabetes mellitus and myocardial ischemia.
In the classification of diseases in the oral region, the majority were dentally related diseases, seen in 323 patients (74.6%) and 110 (25.4%) were oral surgery related diseases.
The most frequent provided was restration and prosthetic treatment, followed by dental caries treatment and periodontal treatment.

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A statistical study of systemic management of compromised patients during dental treatment was conducted.
The subjects were 116 patients who received dental treatment at Tsurumi University Dental Hospital during 1998. They were 66.6±18.2 years (mean±SD) in age and those aged over 70 accounted for 81% (Fig .1). The most common preoperative systemic diseases were hypertention, which 49% of them suffered from, and ischemic heart diseases, major arrhythmias, and diabetes mellitus (Fig. 2). Habitual drugs such as Ca blockers, vasodilators, and diuretics were taken by 87% of the patients (Table 1). Local anesthesia was performed on 85% (99 cases) of patients; propitocaine containing felypressin was used in 78 cases, lidocaine containing epinephrine was used in 19 cases, and, in two cases, the both anesthetics were used (Table 2). As procedures, extractions of the tooth were performed in 67% of the patients, and pulpectomy and prosthetic procedures were the next most commen (Table 3). The duration of procedures was 27.6±22.0 min, and the duration of systemic management was 50.8±24.0 min (Table 4). Prophylaxic nitroglycerin buccal tablets were administered to 32 cases of hypertensive patients, of which 24 cases did not require further cardiovascular drugs during their procedures. Twenty-eight cases required drugs for systemic complications (Table 5); in 19 cases, drugs to decrease blood pressure were administered; nicardipine in 16 cases and midazolam 1-2mg in 3 cases. In 5 cases, a decrese in Spo₂ was tereated with oxygen through a nasal cannule.
As the number of elderly patients increases, compromised dental patients also increase. The needs for systemic management and treatment for cardiovascular changes during dental treatment thus become more important. Decisions about the discontinuation of anticoagulant therapy, administration of prophylaxic antibiotics, and selection of the kind of local anestehtics, should be based upon the dental interventions as well as the systemic condition of the patients.

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