In 2012, Japanese health insurance started covering perioperative oral management (POM) for patients with malignant tumors, cardiovascular diseases, and who require organ transplants, etc. Thereafter, the number of patients who have undergone POM has been increasing, as people become more concerned about oral health care. Good oral management should reduce systemic diseases caused by oral bacteria. The purpose of this preliminary study is to assess whether the introduction of health insurance coverage for POM has had a positive effect on reducing the incidence of bacteremia caused by oral bacteria.
  The results of blood cultures were reviewed through the period from 2007 to 2013. Prevalence of bacteremia was constant, ranging from 12.6% to 17.0% during the study period. Before the introduction of POM insurance (during the years 2007 to 2011), the incidence of oral bacteria in the positive blood cultures was also uniform, ranging from 5.7% to 8.7% (mean 7.1 ± 1.2%, 95%C.I. 5.69-8.59%). However, the incidence of oral bacteria dropped to 4.1% (2012) and 2.6% (2013) after insurance coverage for POM was introduced. There was a statistically significant difference in the prevalence of oral bacteria between the periods 2007-2011 and 2012-2013. In addition, a significant increase in patients who underwent POM after the insurance coverage began was observed.
  The results of this study suggest the possibility that the introduction of insurance coverage for POM, which might bring favorable influence upon the management of oral health care, consequently brought a positive effect upon the reduction of systemic infection caused by oral bacteria.

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  In today’s rapidly aging society, the number of patients with femur fractures has been increasing. Femur fractures in the elderly occur readily in minor accidents, such as falls at home. A Patient’s mobility is decreased after suffering a femoral fracture, and their oral hygiene worsens quickly as they are unable to care for their teeth and mouth. The most common postoperative complication in these patients is pneumonia. The purpose of this study is to evaluate the effectiveness of perioperative oral care in the prevention of postoperative complications in elderly patients with femur fractures. The research was conducted on 165 patients aged over 70 years, with femur fractures.
  The patients were classified into a group of 79 people that were given perioperative oral care (care group) and a group of 86 people that did not receive perioperative oral care (non-care group). For one month after surgery, the following conditions were monitored in the patients: the presence of high fever, high fever that lasted for 3 days, the onset of pneumonia, and wound infection. The frequency of high fevers that lasted for 3 days after surgery was higher in the non-care group than in the care group. However there were no statistically significant differences. The onset of pneumonia, however, was observed in only one case in the care group, compared to seven cases in the non-care group. Therefore the prevention of pneumonia in the care group was more successful statistically. Postoperative wound infection was only found in one case: in the non-care group.
  The results therefore show that perioperative oral care is useful for the prevention of post-operative pneumonia in elderly patients with femur fractures.

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  Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelet count despite normalcy in bone marrow. Here we present a patient who developed severe ITP after surgery. A 74-year-old man with a squamous cell carcinoma in the lower gingiva received a segmental resection of the mandible, supraomohyoid neck dissection and a reconstruction using pectoral major myocutaneous flap and titanium plates. Preoperative blood test data showed no abnormalities, and blood loss during the operation was 310mL. On the first day after surgery, the patient presented with thrombocytopenia (1.9×10⁴ platelets/μL) and was referred to a hematologist. Drug induced thrombocytopenic purpura (DITP), heparin induced thrombocytopenia (HIT), disseminated intravascular coagulation (DIC), ITP and leukemia were considered as differential diagnoses of thrombocytopenia. As the platelet count decreased continuously despite the immediate withdrawal of medication, DITP was excluded. Due to normal values of the HIT antibody, fibrin degradation product (FDP) and D-dimer, HIT and DIC were excluded. A bone marrow biopsy revealed normal blood cells, thus leukemia was also excluded, and the patient was diagnosed with ITP. On the 6th day after surgery the patient was given steroid pulse therapy for 4 days, and was administered Romiplostim (Romiplate^Ⓡ), which caused the platelet count to return to the normal range.
  In most cases ITP can be managed by preoperative treatments. In this case, however, critical thrombocytopenia occurred in the perioperative period. Acute ITP can cause severe bleeding, so early diagnosis and effective treatment are essential.

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  Congenital factor V deficiency is a rare inherited incomplete autosomal recessive disorder. The condition is characterized by hemorrhagic diathesis, including nasal bleeding, hypermenorrhea and bleeding after extraction. Laboratory tests reveal prolonged prothrombin, activated partial thromboplastin times and reduced activity of factor V.
  We report a case of congenital deficiency in factor V in a patient undergoing a tooth extraction.
  A blood transfusion with fresh frozen plasma is the accepted treatment for arresting hemorrhages in patients with a factor V deficiency, as there is no pharmaceutical preparation of coagulation factor V available.
  In this case, as the clinical examination results were significantly better than the pre-extraction examination, a good outcome was able to be obtained by using local hemostasis.
  Congenital factor V deficiency clinical examination results may show great variation, so clinicians should conduct thorough preoperative evaluation and observe the patient carefully after treatment.

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  Intensity modulated radiation therapy (IMRT) enables the calculation of the distribution of radiation doses along a 3-dimensional outline of the cancer. It requires highly precise treatment plans based on CT images. However, in the treatment of head and neck cancer, dental metal prostheses often make accurate planning difficult by inducing metal artifacts in CT images. We report the case of a patient who underwent the removal of dental metal prior to IMRT for Hypopharyngeal Cancer. The removal allowed for the reduction of metal artifacts in the CT images used for IMRT planning.
  The patient was a 79-year-old man. In May 2014, he was referred to our department for oral management, including the removal of his dental metal prostheses. The number of residual teeth was 17 and metal crowns were attached to all of them. The number of teeth, including lost tooth parts, with metal crowns was 20. Before receiving dental treatment in our department, the metal crowns had induced widespread metal artifacts in CT images of the upper and lower jaws. The treatment included the removal of 9 metal crowns from mainly posterior parts, the replacement with temporary resin crowns for three abutment teeth of the maxillary denture and two others, and the extraction of 3 molar teeth with poor-prognosis and the lower right cuspid which had an apical lesion. The treatment spanned 34 days (6 visits). After the procedures, metal artifacts in the posterior parts were reduced in the IMRT planning CT images, when compared with the pretreatment CT images. IMRT (2Gy×35～70Gy) under hospitalization was carried out 14 days after the second CT scan. Some dental risks and financial issues can arise with the removal of dental metal prior to radiation therapy of the head and neck. However, it is thought that since the scope of the removal can control the position and degree of artifacts in CT images, it has a big influence on the precision of the treatment plan. We believe that the close cooperation of specialists in radiation therapy and dentistry is necessary for IMRT with a high curative effect. Furthermore, the dental treatment should be carried out as efficiently as possible so that the treatment of the cancer can be started earlier.

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  We encountered a patient who suffered angina and whose treatment was difficult. The patient was an 82-year-old man who had vasospastic angina, spasm-related angina, old myocardial infarction, and paroxysmal atrial fibrillation, and was under oral medication for these diseases. An emergency call was made for the patient who complained of acute chest pain. After sublingual nitrate was administered by the emergency ambulance staff, the patient was lucid, his blood pressure was 80/45 mmHg, pulse rate 47 bpm, and his percutaneous oxygen saturation was 98%. On account of the unremitting chest pain, shallow and fast respiration, and facial pallor, we started hemodynamic monitoring and oxygen supplementation. The chest pain, as well as the unpleasant sensation, resolved gradually. However, the patient needed to be transported to an internal medicine ward, due to significant circulatory suppression. The symptoms completely resolved during transportation, and cardiac catheterization was performed one week after the patient was hospitalized. Thereafter, it was found that the patient did not adhere to his prescribed treatment regimen. In this case, the patient was elderly and did not always comply with his prescribed dosage regimen. This case highlights the need for physicians and other medical staff to confirm compliance with the prescribed medication, and to share such information between each other.

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