Purpose：Dental caries and periodontal disease are infectious diseases caused by oral bacteria. Plaque control is essential for preventing these diseases since dental plaque is where these pathogens exist. In this study, we examined the effects of using catechin-gel to control dental plaque among the disabled using an electric toothbrush, and its effects on the number of oral bacteria in saliva.

Methods：Fifteen disabled individuals undergoing treatment in a dental clinic for the disabled were perticipated in this study. Brushing instructions under supervision by a dental hygienist were given. Catechin-gel was applied once a day for four weeks in the oral cavity after using an electric toothbrush to remove dental plaque, and then the plaque control records between pre- and post-application were compared. Furthermore, DNA was extracted from saliva and the number of oral bacteria was calculated using real-time PCR.

Results：The plaque control records pre- and post-application of catechin-gel were 62.8 （±22.7） and 63.7 （±20.1）％, respectively. Catechin-gel had no effect on the total number of oral bacteria and total number of streptococcus groups during oral cavity normalization calculated using real-time PCR. However, there was some influence on the bacteria causing dental caries and periodontitis. In particular, the number of Treponema denticola decreased significantly.

Conclusion：Catechin-gel did not quantitatively affect dental plaque in the disabled. We suggest that catechin-gel might have an effect on oral pathogens and, more importantly, could be useful for oral care among the disabled.

The purpose of this study was to investigate the relationships between developmental age and characteristics of autistic spectrum disorder （ASD） in infancy with the current physical behavior management in ASD persons who had experienced compulsory dental treatment in infancy. The subjects were 31 ASD persons aged 9 years who had experienced compulsory dental treatment at 4 to 5 years of age. The subjects were classified into three groups according to the method of behavior management used at the age of 9 years as follows：persons who were treated by normal methods （NOR group）, persons who underwent dental treatment quietly under physical restraint （PH group）, and persons who could not behave well during their treatment （N-PH group）. Several items, such as developmental age, characteristics of ASD, and adaptability to everyday life, were investigated from interview records at the age of 4 to 5 years, and the results were compared among the groups. As a result, the developmental age of language understanding at 4 to 5 years of age of the NOR group was higher than that of the other two groups （p＜0.05）. There were fewer hyperactive patients in the NOR group than in the N-PH group （p＜0.05）. Furthermore, the N-PH group was more sensitive to touch at 4 to 5 years of age than the other two groups （p＜0.05）. Moreover, there were more patients who exhibited self-injuring behavior in the N-PH group than in the other two groups （p＜0.05）. Thus, it was demonstrated that ASD persons who were somewhat high in developmental age of language understanding and were not hyperactive in infancy may be able to adapt to treatment by normal methods in the future, even if they experienced compulsory treatment in infancy. On the other hand, persons who were sensitive to touch stimulation and had self-injuring behavior in infancy are unlikely to improve adaptability to dental treatment in the future.

Spina bifida is an aplasia of the spinal column, and three types are recognized：spina bifida occulta, meningocele, and myelomeningocele. Myelomeningocele is characterized by a sac filled with nerve tissue and meninges. Because of the protrusion of this sac, people with myelomeningocele spend their daily life in a sitting or prone position. Intravenous sedation is indicated for patients with dental phobia, and requires patients to stay in the supine position. Care in positioning a patient with myelomeningocele during intravenous sedation is very important to avoid sac injury. Therefore, during operation, the use of soft rolls and a donut-shaped cushion is recommended in order to disperse body pressure. We report a case of intravenous sedation in a 33-year-old man with myelomeningocele who required perioperative positioning. Sedation was induced with midazolam and propofol, and the sedation time was 65 minutes. During dental surgery, soft rolls and donut-shaped cushions were used, and treatment was completed in a short time. There were no injuries to the myelomeningocele during or after surgery.

Severe hemophilia A is a hereditary-related bleeding disorder due to the lack of factor Ⅷ （FⅧ）, causing frequent life-threatening bleeding. Regular replacement of FⅧ is the standard treatment to prevent bleeding. Existing FⅧ products, however, have short half-lives, requiring frequent intravenous injections which burden patients with developmental disabilities and reduce compliance with prophylaxis. Recently, recombinant FⅧ Fc fusion protein （rFⅧFc） has been developed to prolong the half-life of FⅧ and thus lessen the burden of regular replacement therapy. However, there is no information on the effects of perioperative infusion of rFⅧFc on bleeding after tooth extraction. We report a case of teeth extraction under intravenous sedation in a 9-year-old boy with severe hemophilia A and autism spectrum disorder by using perioperative rFⅧFc infusion therapy. Since his FⅧ activity was less than 1％, he was regularly infused with FⅧ products （3 times/week）. But, after the development of rFⅧFc, the previous FⅧ products were replaced by rFⅧFc for his regular infusion therapy with no side-effects. After confirming that FⅧ activity increased to levels ＞80％ without inhibitor development, we extracted his teeth with dosing rFⅧFc just before and 24-h after the operation. There was no abnormal hemorrhage during and after the extraction, and wound healing proceeded normally. In this case, perioperative infusion of rFⅧFc was effective for hemostasis after tooth extraction. Thus, rFⅧFc reduced the number of times of intravenous infusion and lessened the burden, thus improving compliance, enabling safe extraction in this patient with severe hemophilia A and autism spectrum disorder.

Introduction：Complete atrioventricular block is a disorder of the cardiac conduction system without conduction through the atrioventricular node, causing complete dissociation of the atrial and ventricular activities. Since patients with complete atrioventricular block are at high risk of ventricular standstill and sudden cardiac death, many of them require the insertion of an artificial heart pacemaker. We report the case of an 86-year-old female with Alzheimer’s dementia, in whom complete atrioventricular block was found by ECG monitoring at our dental clinic on her first visit.

Case report：She came to our clinic to have a new denture fitted because she had lost her old one. After an X-ray was taken, she sat on a dental chair and her vital signs were checked. ECG revealed complete atrioventricular block. As a result of consultation with cardiovascular specialists, installation of an artificial heart pacemaker was indicated, but this was not done due to her impaired cognitive function. After her first visit to our clinic, her denture was found and was adjusted. It was recommended that her dental treatment be done in a hospital dental clinic where emergency facilities were available.

Discussion：Geriatric patients with dementia are associated with underlying disease. Moreover, it is reported that donepezil, which is widely used to treat mild to moderate Alzheimer’s dementia, carries the risk of life-threatening arrhythmia. Since patients with dementia cannot complain of an abrupt feeling of unwellness, it is imperative to monitor vital signs and general condition during dental treatment. In 2015, a new strategy for dementia （New Orange Plan） was established by the Japanese government. It recruits dentists who are engaged in local health care to improve the quality of care for patients with dementia. To achieve the goal, local governments need to build a system to support dentists.

In order to prevent chemotherapy-induced febrile neutropenia, radical and complete dental treatment is highly recommended before initiating cancer chemotherapy. Here, we present the case of a 4-year-old girl with severe dental caries who was treated on the second day of initiating cancer chemotherapy. She was diagnosed with acute myeloid leukemia on her first visit to the Department of Pediatric Oncology in our hospital. The next day, initial cytotoxic chemotherapy was initiated, and the patient was referred to our department for evaluation of oral infectious disease. We found severe dental caries and pulpitis on an intraoral examination. Because the patient was at high risk of tumor lysis syndrome, rasburicase was used to prevent acute kidney injury；no clinical manifestations were observed. We chose urgent treatment before the onset of myelosuppression from chemotherapy, and on the following day, comprehensive dental treatment was performed under general anesthesia. After tracheal extubation, she developed acute respiratory distress syndrome as a clinical manifestation of tumor lysis syndrome. Chemotherapy was discontinued for 20 days to allow the improvement of respiratory function. After her recovery from acute respiratory distress syndrome, chemotherapy was reinitiated and the patient showed complete remission without experiencing any critical oncologic emergencies. Dental procedures should be minimally invasive after initiating chemotherapy to prevent life-threatening complications associated with chemotherapy.

Diaphragmatic hernia （DH） is caused by abnormal development of the diaphragm while the fetus is forming, and is often associated with severe respiratory and circulatory failure. A defect in the diaphragm allows abdominal contents to move into the chest cavity. DH is extremely rare in adults.

A 20-year-old female with intellectual disability and limbs-trunk function disorder was referred to a dental health center for oral care and dental treatment. She had received regular dental evaluation at a dental clinic in a general hospital since she was 17 years old. Dental treatment under general anesthesia was planned at 18 years old. An abnormal position of the left diaphragm was discovered in the preoperative examination by chest X-ray. DH was suspected, and so the dentist of the general hospital consulted the department of internal medicine and the department of surgery. Although DH was diagnosed, general anesthesia was performed because of the years that had passed since birth with no evidence of DH. No complication associated with general anesthesia occurred. When she was 19 years old, wisdom teeth extraction under general anesthesia was planned. However, general anesthesia was not acceptable because of her DH. Thereafter, as her dentist had retired, she was referred to the dental health center.

Removal of both left- and right-side upper wisdom teeth under intravenous sedation （IV） was scheduled at the center. As her DH was asymptomatic, the extraction was performed under IV. Midazolam and propofol with quick metabolic sedatives were administered intravenously, and her spontaneous respiration was maintained. The total doses of sedatives were 3mg and 200mg, respectively. The length of the procedure was 34minutes and that of IV was 70minutes. There was no remarkable complication during the perioperative period.

In conclusion, it is considered that IV use of midazolam and propofol may be effective for behavior control for the dental treatment of patients with intellectual disability with asymptomatic DH.

Coffin-Lowry syndrome （CLS） is an X-linked recessive disease, causing malformations characterized by typical facial features, short stature, frame deformity and severe intellectual disability. Findings in the oral cavity associated with CLS include premature exfoliation of primary teeth without root resorption, early tooth loss due to short root, and periodontal disease. There appear to be no reports about periodontal treatment for such cases.

We report the periodontal treatment of two cases：a 28-year-old and a 46-year-old. At the first visit, we found a lot of dental plaque and calculus, poor oral hygiene state, reddening and swelling of the gingiva, and deep periodontal pockets. We also found tooth mobility and alveolar resorption in both cases.

Because of severe intellectual disability, we performed oral hygiene through mouth cleaning with assistance care and professional care. We provided non-surgical periodontal therapy while applying behavior management. After a re-evaluation, we performed a combination of antibacterial therapy, scaling and root planing for the deep periodontal pockets. When necessary, we used intravenous sedation for periodontal treatment of the patients.

After these treatments, the state of the periodontal tissue was improved so we carried out supportive periodontal therapy.

Coffin-Lowry syndrome related to periodontitis due to genetic disorder accompanied the clinical findings of these two cases. In addition, we think that it is important to perform oral management from an early stage, as well as after periodontal treatment.

It is difficult to evaluate the success of implementing a minor oral surgery （MOS） protocol in facilities lacking equipment for general anesthesia or intravenous sedation for special needs patients for whom MOS is indicated. We adapted and implemented an MOS protocol for such patients using the following four criteria：parental consent was provided；the patient could maintain a posture for a specified period of time；this posture could be maintained through behavior management；and the MOS procedure could be completed within 30 min.

We used the adapted MOS protocol for 62 patients with an indication for MOS. The procedure was completed in 61, but was discontinued in the remaining patient. The most frequent indication for MOS was surgical extraction, of which 39 procedures were performed. Apicoectomy, intraoral inflammation surgery, and benign tumor removal were among the other procedures performed. The most frequent postoperative complication was swelling of the cheek. Restraining by assistants and use of a restrainer were adopted as methods of behavior management. The extracted impacted lower third molars were categorized asⅠA,ⅠB,ⅡA, andⅡB, according to the classification proposed by Pell and Gregory. Neither ClassⅢnor Position C molars were extracted. One MOS case was discontinued due to difficulty in securing an operative field due to cheek puckering.

Our results suggest that an MOS protocol can be adapted to and implemented in special needs patients in whom an operative field can be successfully secured. Furthermore, extraction of Pell and Gregory classⅠA,ⅠB,ⅡA, andⅡB impacted lower third molars can be performed successfully using this protocol.