Nitrous oxide inhalation sedation are widely used in dental clinics as an effective means of mental sedation to reduce the stress in patients who do not cooperate with the dental treatment because of anxiety and fear. Nitrous oxide inhalation sedation evokes a variety of clinical symptoms. We assessed the onset of the symptoms in subjects under nitrous oxide inhalation was surveyed every minute.

The subjects was placed in the supine position, and they inhaled 100％ oxygen for 1 minute, and then inhaled 10 to 40％ nitrous oxide, for 20 minutes. During the inhalation, we asked them about symptoms every minute. Our questions included：①“My body feels warm”, ②“My limbs feel numb”, ③“My tongue or lips feel numb”, ④“My hearing seems abnormal”, ⑤“I feel comfortable”, ⑥“I feel like falling”, ⑦“I feel sleepy”, and ⑧“I feel uncomfortable”. The subjects were asked about their condition every minute. Nitrous oxide inhalation concentration was 10％, 20％, 30％, or 40％, which was investigated in each testing day, and the onset of clinical symptoms was recorded. Their first symptom was the warm feeling of their body；the result was the same for any nitrous oxide inhalation concentration. The onset of the symptom was seen earlier with the rise of inhalation concentration for any condition. Conventionally, optimal sedation requires inhalation for over 10 minutes, but it is suggested that the time can be shortened by using 40％ nitrous oxide.

This study examined the relationship between rinsing the mouth in children with autism spectrum disorder and developmental age. The subjects were 50 children aged 3–6 years old with autism spectrum disorder. Five categories of children’s mouth-rinsing ability were evaluated based on behavioral observations of mouth-rinsing. Acquisition of mouth-rinsing ability was further categorized into “no acquisition”, “moderate acquisition”, and “acquisition”. Relationships between mouth-rinsing ability and chronological age as well as developmental age were first analyzed. The cutoff value of optimal developmental age was calculated in order to distinguish the acquisition stage of mouth-rinsing.

A total of 14％ of children were “unable to rinse the mouth at all”, 18％ were “able to bring a cup to the mouth”, 10％ were “able to spit water from the mouth”, 34％ were “able to spit after holding water in the mouth”, and 24％ were “able to spit after holding and moving the water around the mouth”. There were positive correlations between these mouth-rinsing competencies and developmental age, suggesting that basic mouth-rinsing behavior had an acquisition stage that was associated with developmental age. In addition, the best cutoff value between “no acquisition” and “moderate acquisition” was 2 years 0 months and the best cutoff value between “moderate acquisition” and “acquisition” was 2 years 6 months. These results indicate that it is effective to begin to practice spitting water at a developmental age of 2 years 0 months, and to begin to practice moving the cheeks at a developmental age of 2 years 6 months.

A patient with cerebral palsy usually has a disorder of tongue movement, often accompanied by pharyngeal dysphagia. We describe the results of a doctor’s visit dental program for a 36-year-old Japanese male with cerebral palsy at a facility for severely mentally and physically handicapped people in our area. The patient had a disorder of tongue movement and we were asked by a speech therapist to make a palatal augmentation prosthesis because the patient’s accidental swallowing and cyanosis had worsened. We made a PAP and set it to the patient, after which the patient received dysphagia rehabilitation by the speech therapist. We evaluated swallowing function with or without the PAP by videofluoroscopic examination of swallowing. We also evaluated it using the oral function evaluation list according to Hironishi, et al. As a result, his oral function, especially tongue movement, improved sufficiently to enable him to spit out tea that he disliked. The number of times of choking and coughing during meals was decreased. By putting on the PAP, adhesion and residue of alimentary bolus on the posterior wall of the oropharynx were decreased and accidental swallowing was improved according to VF observation. The results of a blood test showed that the number of neutrophils and C-reactive protein had decreased. We conclude that a PAP may be effective for patients with cerebral palsy having pharyngeal dysphagia.

Aarskog syndrome is a rare X-linked recessive disease characterized by typical facial features, a shawl scrotum, and short stature. The phenotype varies among cases.

Here, we report the case of a 5-year-old boy with Aarskog syndrome and mental retardation who underwent dental treatment under general anesthesia. Oral examination revealed many decayed teeth and malocclusion （deep bite） caused by hypoplasia of the lower mandible and the small available arch length of the mandible. The patient was extremely fearful of dental treatment as he was mentally retarded and was unable to understand and cooperate with the dental treatment. Therefore, treatment was administered under general anesthesia.

Anesthetic considerations included difficulties in tracheal intubation due to lower facial deformities. Anesthesia was induced and maintained using sevoflurane and nitrous oxide in oxygen. Mask ventilation was easily performed：thereafter, we attempted laryngoscopy using a Miller blade and decided to intubate using the conventional method. Tracheal intubation was successful after the administration of a muscle relaxant. Dental treatment included composite resin filling, endodontic treatment, metal crown restoration, occlusal adjustment, and extraction of severely decayed deciduous molars. We conducted three sessions of treatment under general anesthesia. In all three times of treatment, general anesthesia was well maintained, the treatment was uneventful, and no perioperative complications occurred.

After these treatments, we started a monthly follow-up regimen to maintain his oral hygiene. For patients with mental retardation, repeated dental check-ups enable the patient to adapt to the conventional dental check-ups, and regular check-ups help in preventing dental diseases. In addition, for parents of children with mental retardation, guidance regarding oral hygiene and daily oral care is also important.

The restoration of occlusal function after tooth loss should be considered carefully in patients with mental retardation, because of their lack of understanding about oral hygiene and ability to adapt to removable dental prostheses such as partial dentures. Autotransplantation of teeth is one useful option for occlusion recovery after loss of teeth. However, autotransplantation is generally contra-indicated in patients with cardiac anomalies, poor oral hygiene and lack of self-motivation including mental retardation. We herein describe the successful autotransplantation of an impacted maxillary third molar tooth into the extraction site of a decayed mandibular first molar in a 22-year-old female patient with mental retardation and dental phobia. First, we repeatedly explained our treatment plan to the patient and her mother until they could understand it. Then we applied the behavior management “Tell-Show-Do” technique and intravenous sedation with midazolam and propofol to the patient for the dental treatment to alleviate her anxiety and stress. Three months after autotransplantation, dental treatment of the transplanted tooth was started and after 6 months, the treatment was finished successfully. In a patient with mental retardation, autotransplantation of teeth can be an effective treatment to restore the occlusion provided that such cases are carefully selected.

Leigh encephalomyelopathy is a type of mitochondrial encephalomyelopathy in which psychomotor retardation, high value of lactic acid or pyruvic acid in the blood or cerebrospinal fluid, and necrotic lesion of basal ganglia and brainstem can be detected by using CT or MRI images. Known causes of Leigh encephalomyelopathy include variation in the ATPase coding region of the mitochondrial DNA, or autosomal recessive disorder.

Initial symptoms are eating disorder and dysphagia. Furthermore, various symptoms such as muscle hypotonia, eyeball dyskinesia, optic nerve atrophy, visual disorder, convulsions, breathing disorder, and intellectual degradation develop. It is an intractable chronic progressive disease；most child patients die during infancy. There are few reports related to dentistry in Leigh encephalomyelopathy. We report our experience of sisters with Leigh encephalomyelopathy.

At the first visit，congenital absence of permanent teeth, prolonged retention of deciduous teeth, retarded eruption of permanent teeth, and microdont were found by intraoral examination. Furthermore, much plaque and tartar were found in both sisters. Reddening and swelling of the gingiva were markedly observed. The risk of aspiration complicated the oral cleaning of the sisters by their mother. When we treated the sisters, we introduced a toothbrush which had a suction tube. The head portion of the toothbrush had a hole through which a suction tube could be put. This was used to perform brushing and professional mechanical tooth cleaning. The tube also could be connected to the aspirator which was used in their home. This toothbrush decreased the risk of aspiration and improved tooth brushing with the assistance of their mother. The toothbrush was effective, both when we treated and when their mother brushed their teeth in the home. Oral management will be continued in future.

As there are more than one million patients with depression in Japan, major depressive disorder has become a relatively common mental illness. Symptoms of depression, including loss of energy and interest in activities, frequently result in poor oral hygiene in patients with this disorder. Therefore, it is crucial for dental professionals to have some knowledge of the illness to provide appropriate dental treatment to patients with depression.

Here, we present the case of a patient with major depressive disorder who was provided long-term oral health guidance by a dental hygienist, which consequently improved the patient’s oral hygiene despite frequent depressive moods.

The patient was a 56-year-old woman. She underwent pulpectomy of the maxillary left lateral incisor at a dental clinic. One week later, she experienced sharp pain in the maxillary palatal gingiva and the tongue. The pain persisted, and she was referred to our hospital.

During the initial medical examination, she was very agitated and anxious；she also showed symptoms of depression, including decreased appetite, weight loss, and loss of energy. We immediately referred her to a psychiatrist, and she was diagnosed with major depressive disorder.

In order to address her primary complaint of severe pain, dental treatment was administered by a dentist, and she was given instructions regarding maintenance of oral hygiene by a dental hygienist at our hospital. The dental hygienist also provided her with dietary advice to promote the secretion of saliva to counteract dry mouth, a side effect of the medication prescribed by the psychiatrist. The long-term oral health guidance provided by the dental hygienist was equally important to the dental treatment in relieving the symptoms of this patient with major depressive disorder. In spite of her frequent depressive moods, the instruction provided by the hygienist enabled her to maintain satisfactory intraoral health.

Trisomy 13 is an autosomal chromosomal abnormality caused by an extra chromosome 13. The frequency is considered to be one out of 5,000-12,000 births. Trisomy 13 presents with serious congenital heart disease, respiratory disease and brain malformation, and most with this condition die early. We report the dental treatment for a very rare case of an adult patient with partial trisomy 13.

The patient was a 22-year-old woman, 118 cm tall and 12 kg in weight, with severe mental retardation, agenesis of the corpus callosum, and epilepsy. The patient was non-cooperative due to her mental retardation and it was necessary to treat many of her teeth, so we decided to treat her under general anesthesia. Composite restorations were placed in eight carious molars and three primary teeth were extracted. The treatment time was 1 hour 50 minutes, and anesthesia time was 2 hours 59 minutes. She was in good condition just after dental treatment.

However, one month later she was hospitalized with a lung abscess that was thought to be due to an infection after teeth extraction. Afterwards, she was hospitalized several times with an infectious disease, and was considered to be at high risk for infection.

We intend to continue planning her oral health maintenance in cooperation with pediatrics and other departments.

The research aim：To improve the quality of life （QOL） for disabled persons, health care centers in Hyogo Prefecture offer systematic personal assistance for their dental health supported by the local dental association （the Program for Dental Health Service：PDHS）. In this study, we examined the dental health conditions for those who had received the PDHS and their attitude in daily dental care to evaluate how PDHS affected the QOL of disabled persons.

Methods：We extensively reviewed the data on the dental conditions of all persons in the PDHS. We compared the persons who have a family dentist with those who have no family dentist. The χ² test and logistic regression analysis of the data were used for the analyses.

Results：The results of 88 persons revealed significant improvements in dental health in recipients of the PDHS. In comparison with non-recipients, recipients were less vulnerable to dental caries （p＜0.01, odds ratio 0.72, 95％CI 0.58－0.90）.

Conclusion：It is an urgent issue to promote the PDHS for further improvement of the QOL of disabled persons. We encourage disabled persons to actively participate in the PDHS or similar available programs.

Aims：To establish a simple method of evaluating the dental treatment adaptability of patients with PDD.

Methods：We created a dental treatment adaptability evaluation table consisting of 26 items in 8 categories and asked patients’ parents to answer the questionnaire. Sixteen patients （12 males and 4 females, 6-19 years old） participated in this study and were divided into two groups depending on the state of their dental treatment adaptability. The first group consisted of patients who were emotionally compromised and the second group consisted of patients requiring special treatment. Then, we compared the two groups on the evaluation items. Statistical analyses were conducted using Mann-Whitney’s U test.

Results：1. Regarding age, there was no significant difference between the two groups. 2. For the two categories of cognitive ability and sensitivity, there was a significant difference between the two groups at p＜0.01. 3. For the two items of taste and hearing, there was a significant difference between the two groups at p＜0.05.

Conclusions：The patients requiring special treatment were strongly correlated with the categories of “low cognitive ability” and “high sensitivity” in this questionnaire, suggesting that these categories are important for the dental treatment of patients with PDD. Our questionnaire could be a useful and simple method of evaluating the dental treatment adaptability of patients with PDD.