It has been revealed that the oral management, for example oral care and dental treatment, is one option for preventing postoperative complications such as pneumonia and has been increased that the number of referral patients with systemic diseases from the medical doctors before medical treatment. Therefore, the dentists need to be correctly diagnosed imaging about the presence or absence of a dental disease which is problematic for patient’s systemic treatment. Depending on the systemic diseases, the diseases itself or medications may evoke the oral symptoms. The oral surgeons need sufficient knowledge about the image findings of these systemic diseases.
With advances in health care and increased life expectancy, the population of older adults is increasing in most countries. Japan has been considered a “super-aged society” since 2007. It is predicted that by 2030, Japan’s aging rate will rise to 31.6%, indicating that one-third of Japanese people will be a senior citizen aged 65 years or older.
Advancing age is the strongest risk factor for the development of dementia and dementia has been identified as a major current health care challenge. It is expected that the number of elderly people with dementia will exceed 8 million by 2030. Considering these facts, it is reasonable to expect that the number of dementia patients undergoing oral surgery will rapidly increase.
There are many different forms of dementia. Alzheimer’s disease is the most common form of dementia and may contribute to more than 50% of cases. Dementia patients show diverse symptoms, which are classified into two categories, core symptoms and behavioral and psychological symptoms of dementia (BPSD). Core symptoms are caused by loss of neuron in the brain. The pathogenesis of BPSD is complex and multifactorial and probably the result of a complex interplay of psychological, social, environmental, and biological factors.
Preoperative assessment regarding cognitive and functional status and the presence of preoperative delirium is essential in geriatric patients. Cognitive dysfunction is relatively common during the postoperative course of older adults. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), both of which occur more commonly in older adults after surgery and anesthesia. POD has been defined as an acute change in cognitive status characterized by fluctuating attention and consciousness, which typically occurs soon after surgery, while POCD is characterized by more persistent cognitive difficulties, including memory and attention problems, as well as executive dysfunction, and occurs commonly after surgery. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased risk of cognitive dysfunction.
The aim of this review is to identify an evidence-based perioperative management for patients with dementia that are scheduled to undergo oral surgery. This review also reflects on both general considerations concerning geriatric patients with dementia and on the specific features of perioperatively used drugs and anesthetics that might have an impact on patients with cognitive dysfunction.
Oral surgeon and dental anesthesiologists should be fully aware of the systemic management in patients with dementia. The risks and benefits associated with surgery and anesthesia need to be well-considered.
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. The T-cell marker CD5 is positive in 5% to 10% of cases of DLBCL. We describe a rare case of CD5-positive DLBCL presenting with swelling of the mandibular gingiva. The patient was a 78-year-old-woman with a chief complaint of swelling of the mandibular gingiva. Biopsy was performed, and the patient was given a diagnosis of DLBCL. Moreover, analysis of the immunophenotype demonstrated that the lymphoma cells expressed CD5. The final diagnosis was CD5-positive DLBCL. The patient was treated with R-CHOP. There have been no signs of recurrence after the chemotherapy.
We present a case of adult-onset xanthogranuloma in the buccal mucosa. An 80-year-old woman was referred to our department for a mass in her buccal mucosa in July 2016. On clinical examination, a well-circumscribed, elastic-firm mass measuring 19 × 18 mm was detected on the right side buccal mucosa. A diagnosis of xanthogranuloma was established through biopsy, and the tumor was surgically removed in September 2016. Histopathological examination revealed sheets of histiocytes with foamy cytoplasm. Immunohistochemical examination demonstrated that the histiocytes were positive for CD68, but negative for S-100 protein. Thus, a diagnosis of xanthogranuloma was established based on the histopathology. The postoperative course has been uneventful for 2 years and 8 months, without tumor recurrence.
We describe our experience with case of secondary peripheral ameloblastic carcinoma in a very elderly patient. The patient was a 94-year-old man who became aware of discomfort in his right cheek and was seen at the referring doctor’s clinic in late May 2017. He presented at this department for detailed evaluation and treatment the same month. We found a 40 × 20 mm mass in the right buccal mucosa. On biopsy, a diagnosis of extraosseous/peripheral ameloblastoma was established. Subsequently, the patient underwent tumor resection in July 2017. The histopathological diagnosis was secondary peripheral ameloblastic carcinoma. One year and five months have passed since the operation, and there is no evidence of recurrence or metastasis.
The side effects of peroral bisphosphonate may cause mucous membrane disorders and oral exulceration if individuals dissolve the drug inside the oral cavity on oral administration. We experienced two cases in which we strongly suspected mucous ulcurs due to this drug. Finally, the oral exulceration disappeared after providing instructions on correct administration.
An 83-year-old woman was referred because of exulceration of the right mandible. She suffered from osteoporosis, thoracic vertebra compression fracture, and dementia, while taking alendronate weekly. The exulceration appeared from the right lower lip to the right mandibular molar gingiva when we absorbed pooled saliva in the right oral cavity when the patient was lying down. We instructed the patient to confirm that the tablet was completely swallowed. The ulcers in the oral cavity completely disappeared 17 days after presentation.
A 74-year-old woman with osteoporosis presented because of bleeding and pain in the gingiva of the right mandible. She was taking monthly minodronate while wearing incompatible dentures. Exulceration occurred with peripheral redness ranging from the right buccal mucosa to the right molar gingiva of the mandible and the tongue/floor of her mouth, along with a ventrolateral tongue. We taught her how to swallow minodoronate correctly without dentures, and the ulcers healed 4 weeks later.
Epithelioid hemangioma (EH) is also called angiolymphoid hyperplasia with eosinophilia (ALHE) and is classified as a benign vascular tumor accompanied by chronic inflammatory cell infiltration. EH of the tongue is uncommon, and only 12 cases have been reported in the literature. We reported a case of EH of the tongue in a 73-year-old man. He had complained of a reddish mass on the left margin of the tongue and was referred to our hospital. The mass was elastic hard and tender. Contrast computed tomography and contrast magnetic resonance imaging of the mass showed a higher signal than that of the surrounding tissues. As a diagnosis could not be made on an incisional biopsy, the entire mass was excised with the patient under general anesthesia. Histopathological examination showed pseudoepitheliomatous hyperplasia, and the result of immunostaining was CD31 positive, and a diagnosis of EH was made. One and a half years after surgery, no recurrence has occurred.
Polycythemia vera (PV) is one of myeloproliferative neoplasms characterized by a remarkable increase in myeloid cells caused by abnormality of the hematopoietic stem cells. In patients who receive surgical treatment for PV, conflicting complications such as thrombosis and hemorrhage develop frequently. We report a case of PV diagnosed after postextraction hemorrhage. A 75-year-old woman was found to have polycythemia on a health checkup two years previously, but did not receive any treatment for it. She had her left maxillary wisdom tooth extracted at a dental clinic, but was referred to our hospital immediately to manage postextraction hemorrhage. We performed hemostatic treatment with the patient under local anesthesia. Because of the severe hemorrhage, blood examinations were performed and showed increased counts of white blood cells, red blood cells, and platelets. Therefore, we consulted a hematologist, and she received additional examinations. JAK2 gene mutation was positive, bcr/abl t (9;22) translocation was negative, and decreased erythropoietin was revealed. From these results, she was given a diagnosis of PV according to the WHO diagnostic criteria in 2016. Now, six months after tooth extraction, she is being treated by regular phlebotomy, daily oral aspirin, and hydroxyurea to control the blood cells.