Wound healing in the oral mucosa is clinically distinguished from skin healing in terms of both its rapidity and relatively minimal to no scar formation. However, wound healing failure induces oral function decline. The condition of chronic non-healing wounds induces eating disorders, communication obstacles, and breathing difficulties. These symptoms can be life-threatening as well as reduce patients’ quality of life, and tend to occur in individuals with disabilities and the elderly because of their malformation, dysfunction and immunodeficiency. According to a previous study, GGsTop^®, a γ-glutamyl transpeptidase (GGT) inhibitor, suppressed reactive oxygen species and induced the production of collagen and elastin in dermal fibroblasts. In addition, Shimamura et al. reported that GGsTop^® was valuable for the treatment of oral mucositis. We conjectured that GGsTop^® would be useful for oral wound healing, and so studied its effect with/without TGF-β1 in gingival fibroblasts HGF-1. In addition, we demonstrated the efficacy of GGsTop^® on wound healing of palatal mucosa in mice. The cell migration of HGF-1 was enhanced with GGsTop^® by scratch assay. GGsTop^® with TGF-β1 strongly promoted wound healing. The production of TGF-β1 in HGF-1 was enhanced by GGsTop^®, which induced the gene expressions of type I collagen and matrix metalloproteinase 13. However, αSMA gene expression was not enhanced. The wound healing process of palatal mucosa was faster in wild-type mice than in the control. Scarring was not seen. GGsTop^® is considered to be useful for treating oral wound healing.

Nasotracheal intubation is commonly performed during dental treatment, as it has advantages of providing easy accessibility. However, complications occur more frequently with this type of intubation than with an orotracheal route. We report here a case in which the tracheal tube was blocked by nasal mucus during tracheal intubation, which resulted in an unexpected airway emergency.

The patient was a 16-year-old boy with autism spectrum disorder (ASD) and intellectual disability. He visited our clinic for dental treatment with the chief request of tartar removal. Treatment was planned, including ambulatory general anesthesia because of poor cognitive ability. Nasal anatomy abnormalities could not be excluded during the preoperative history. Furthermore, we were unable to confirm potential difficulties with managing the upper airway, because an adequate examination could not be performed.

The patient was transported to the operating room and routine monitors were placed, followed by inhalation induction with an increasing concentration of sevoflurane in 100% oxygen. A peripheral intravenous line was placed, and intravenous neuromuscular blocking and anesthetic agents were administered. Mask ventilation was started without trouble. There was no problem with starting nasotracheal intubation, though ventilation thereafter was difficult and finally became impossible because of a high level of airway resistance. End tidal CO₂ (ETCO₂) tracing was absent with no chest movements on ventilation. Chest auscultation revealed complete absence of air entry bilaterally with no sound in the abdominal area. We determined the existence of ETT blockage and immediately extubated the tube, which led to the discovery of nasal mucus that had completely obstructed its tip. A new ETT was then used for nasal intubation and the planned dental treatment under general anesthesia was performed thereafter without further complications.

For many patients with ASD anesthesia procedures can be performed, though the preoperative evaluation is often difficult. In the present case, we did not realize prior to surgery that the patient was affected by severe rhino-stenosis. Should ventilation difficulty be encountered, the possibility of a blood clot or foreign body occluding the lumen of the ETT should be kept in mind and forceful ventilation avoided. When in doubt, it is best to remove the ETT. The most important point in the present case was that a blockage was immediately noticed when the patient began to have breathing difficulties. After replacing the ETT, no further complications occurred and unnecessary additional administration of medication was avoided.

Marfan syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in the Fibrillin-1 gene (FBN1) that affects the cardiovascular, skeletal and ocular system. Orofacial characteristics are used in the diagnosis of this syndrome, consisting of retrognathic mandible, temporomandibular joint alterations, high arched palate, dental crowding, and posterior crossbite, which have a higher prevalence and severity in patients with MFS. Severe periodontitis is deeply involved in deterioration of aortic condition. For patients with MFS it is important to elucidate the onset mechanisms of periodontitis. Fibrillin-1 encoded by the FBN1 gene consists of periodontal ligament (PDL) and contributes to the formation and maintenance of PDL. Thus, previous studies have focused on PDL in cases of severe periodontitis. There is no report on using gingival fibroblasts, which are a component of periodontal tissue. In addition, few studies have focused on tissue inflammation. Therefore, we examined the use of gingival fibroblasts from monozygotic twins with MFS to clarify the onset of chronic inflammation such as periodontitis in MFS. There were significant differences between twins in the pattern of gene expressions, transforming growth factor-β type I receptor, Interleukin-6, and matrix metalloproteinases. Furthermore, gene expressions in gingival fibroblasts from Marfan syndrome with more serious cardiovascular conditions were higher compared with the other.

Dental treatment under the standard, psychological approach may be difficult in patients with special needs. Therefore, we have selected a pharmacologic approach for these patients by performing dental treatment under general anesthesia. The Special Needs Dentistry Center was established in 2012 to better serve this group of patients. We investigated patients who received dental treatment under general anesthesia at the Special Needs Dentistry Center in Showa University from 2012 to 2017.

Dental treatment under general anesthesia was performed on 474 cases (318 male, 156 female). The average age was 20 years, 1 month old. The youngest age was 3 years, 1 month old and the oldest age was 74 years, 1 month old.

The most common disability was autism spectrum disorder (196 cases), followed by intellectual disability (113 cases), then chromosomal abnormalities and syndromes (46 cases). The most common dental treatment was composite resin restoration (416 cases), followed by root canal treatment (116 cases). 275 cases had teeth extracted.

In the Special Needs Dentistry Center, we actively utilize day-to-day general anesthesia treatment to ensure the safety of our treatment and to reduce the mental burden on the patients. There are restrictions on treatment time, and the treatment may require multiple times to be completed in some cases. We think that this approach is a suitable method for people with disabilities who often find it difficult to adapt to changes in the environment, and we intend to actively utilize it in the future.

In order to promote regional collaboration in special needs dentistry, we conducted a questionnaire survey to clarify the cause of not having a regular examination after dental treatment under general anesthesia.

The subjects of the survey were 691 patients who had finished dental treatment at our clinic and had been referred back to their primary dental clinic. Among them, questionnaires were mailed to 250 patients for whom it was not possible to confirm regular examination at their primary dental clinic. The contents of the survey included the status of dental visits after dental treatment at our clinic, the reasons for not having a regular examination, and the evaluation of satisfaction with dental treatment under general anesthesia at our clinic. The questionnaire collection rate was 36.4％ （91/250 people）. Among them, 42 patients did not go to their primary dental clinic. The unexamined rate was high for preschool children, elementary school children, and home patients. By referral, secondary special care dental clinics were the highest. Regarding the reason for not having a regular examination, 16 patients described “busy and no suitable time,” followed by “it is difficult to adapt to dentistry” （11 patients）, “there is no problem in the mouth” （6 patients）, and “had a school check-up” （2 patients）.

In the satisfaction survey of unexamined patients, over 90％ were satisfied with informed consent regarding general anesthesia and dental treatment. However, not all patients who showed high satisfaction had regular examinations. These findings suggest it is necessary to raise awareness of the importance of regular examinations after dental treatment and to further strengthen regional collaboration.

Introduction：Third molar extraction is sometimes performed under general anesthesia for patients with intellectual disability, with multiple teeth extracted in some cases to decrease the number of hospital visits required. Although a multiple tooth extraction procedure is generally convenient for the patient and family members, it may cause a reduced amount of eating after the operation, because of pain and incompatibility. In this study, we investigated the relationship of post-operative food consumption with various factors related to third molar extraction performed under general anesthesia in order to consider recovery conditions, including amount of nutrition.

Materials and methods：We enrolled 25 patients with intellectual disabilities aged older than 18 years who had been hospitalized for a third molar tooth extraction procedure under general anesthesia. Those for whom the amounts of both staple and supplementary foods were reduced comprised the Decreased group, while the others were the Non-decreased group. The study protocol was approved by the ethical committee of Hiroshima University （Epidemiology-No. E-1529）.

Results：Postoperative amounts of both staple and supplementary foods consumed by all patients were significantly decreased compared with the preoperative amounts. Notably, the operation time was significantly longer in the Decreased compared with the Non-decreased group.

Discussion：There was no correlation between operation time and number of teeth extracted. Our findings indicate that operation time may be more affected by difficulty with extraction compared with total number of extracted teeth.

Conclusion：In our clinic, it is suggested that the length of surgery time may have an effect on the decrease in postoperative food consumption after extraction of the third molar under general anesthesia. On the other hand, effects of other items such as, number of extractions, extraction sites, difficulty of extraction or general anesthetic drugs were not observed.