Autistic spectrum patients who could not smoothly accept the oral examination at the first visit were given behavior modification, and the factors that influence the effect of behavior modification were investigated. The subjects were 41 out of 81 patients with autism spectrum disorder who visited our clinic for the first time from April 2019 to December 2022 and could not accept the oral examination smoothly. Parents were interviewed about chronological age, gender, developmental age, severe behavioral disorders, disability characteristics, past dental treatment experience, and medical treatment experience. The relationships among the acquisition/non-acquisition of adaptive behaviors in the 13 steps and survey items were analyzed and examined by Fisher’s direct probability calculation and decision tree analysis. As a result of the analysis, the effects of behavior modification were associated with：six developmental ages；the total score of severe behavior disorder；“strange voice”；“stereotypic behavior”；“hypersensitivity”；and “experience of medical restraint”. All subjects with a developmental age of 2 years 7.5 months or older in language comprehension and no “stereotypic behavior” showed an effect of behavior modification on the 13 steps. It is suggested that people with ASD whose language comprehension development age is 2 years 7.5 months or older and who do not have “stereotypic behavior” may be able to undergo oral examination and tooth surface cleaning with a polishing brush. This shows that people with ASD can understand dental instruments and overcome the fear of past experiences of medical restraint.

The effects of behavior modification on ASD patients were considered to be dependent on developmental age, and the characteristics of ASD hindered the effects of behavior modification. If people with ASD can accept oral examination and polishing, they can receive regular checkups at their local dental office without restraint. These results could serve as a guideline for receiving regular checkups in the community.

We experienced a case of general anesthesia for a very elderly patient with moderate aortic stenosis.

The patient was a 100-year-old female (height：132.5cm, weight：44.3kg) with hypertension. She had no history of syncope, chest pain, or shortness of breath while walking. A tumor was found on her right palate and a palate tumorectomy under general anesthesia was scheduled. Echocardiography revealed moderate aortic stenosis (aortic valve area：1.01cm²), mild mitral regurgitation, mild left ventricular wall hypokinesis, and mildly reduced left ventricular ejection fraction (50％). A chest radiograph showed mild cardiomegaly, and a blood test showed high brain natriuretic peptide (63.2pg/ml).

General anesthesia was induced with 1mg of midazolam, 0.25µg/kg/min of remifentanil hydrochloride, 5.9µg/kg/min of dopamine hydrochloride, and 1％ desflurane. After continuous administration of 5.0µg/kg/min of dobutamine hydrochloride for hypotension was started, tachycardia was observed. Therefore, continuous administration of 0.08µg/kg/min of noradrenaline was started instead of dopamine hydrochloride and dobutamine hydrochloride. In addition, the drug for maintenance of anesthesia was changed from desflurane to propofol. Thereafter, a stable hemodynamic state was maintained during the operation. The outcome was good and she was discharged 3 days after the operation without any major complications.

As life expectancy continues to rise, the number of surgeries for elderly patients is increasing rapidly. Indications for surgery in the elderly patients are determined by factors such as age, general condition, complications, and surgical procedure. The quality of life of patients can be improved by treating the disease under general anesthesia with proper management through the perioperative pathway, if the patient is highly motivated for treatment and activities of daily living are good.

We report a case in which an elderly patient with dementia who had a history of late-onset epileptic seizures was treated with intravenous sedation several times and had difficulty coping with postoperative epileptic seizures. This patient did not cooperate with dental treatment due to dementia, and so intravenous sedation was used in combination. Three of a total of nine intravenous sedation dental procedures resulted in epileptiform seizures. The first epileptiform seizure was noted upon emergence from anesthesia after the fourth dental treatment. Flumazenil-related withdrawal symptoms were suspected, so flumazenil was not used in the fifth dental treatment, and epileptiform seizures occurred while recovering from anesthesia. We suspected that the nerve excitatory effects of propofol might have induced epileptic seizures, and therefore anesthesia was managed without propofol from the sixth time onwards. The eighth dental treatment required 7mg of midazolam. Due to insufficient recovery from anesthesia, flumazenil was administered, resulting in epileptic seizures. The use of propofol and flumazenil in patients with epileptic seizures may trigger epileptic seizures.

The MUH Shield is a functional orthodontic appliance which can be used immediately because it is sold as a ready-made product, and requires no time for impression acquisition or fabrication, thus avoiding rejection, and so may be suitable for children with disabilities. In this study, we report three cases of children with autism spectrum disorder and anterior crossbite in whom the MUH Shield was used to improve the tegmental relationship.

The developmental age of the three patients was 3-4 years old. They accepted oral examination, and there was no extreme perioral sensitivity or bad oral habits. First, the device was shown by the TSD method, touching was performed, and then the device was inserted into the oral cavity. After training on taking the device on and off several times, the patients could close the lips and breathe nasally while holding it in the mouth for 1 minute.

In two cases, the device was difficult to use at bedtime and could only be used for about 1 to 2 hours during the day, but with the cooperation of the mother, one of the two cases improved after about 1 year of continuous daily use. In the other case, the relationship improved after 2 months because it became possible to use it at bedtime 1 week after the start of use.

In patients with autism spectrum disorder, it is considered worth trying this device as the first choice when anterior crossbite is observed.

The prevalence of drooling and dysphagia in cerebral palsy (CP) is estimated to be about half. Pharyngeal dysphagia is common even in children with mild CP, but there is limited evidence of intervention for dysphagia in CP. Interferential current stimulation (IFC) to induce the swallowing reflex by stimulating the superior laryngeal nerve has been reported to improve the swallowing reflex in adults, but there are few reports in children, and even fewer in medically complex children with severe dysphagia requiring continuous pharyngeal suction.

This case report describes a CP child with severe dysphagia who had difficulty in processing saliva even with continuous pharyngeal suction due to poor swallowing reflex. We conducted weekly taste stimulation therapy or direct swallowing therapy in combination with IFC from the second month of intervention (age 0 years 8 months).

After the intervention, SpO₂ decreased due to coughing and drooling improved, and the duration without the continuous pharyngeal suction device gradually increased, achieving a level of swallowing function that allowed partial oral intake at the 22nd month of intervention (2 years and 4 months).

This case report suggests that feeding therapy with IFC, which stimulates the superior laryngeal nerve, may be useful for children with severe dysphagia who require continuous pharyngeal suction.

The Special Olympics (SO) is an international sports organization that provides opportunities for people with intellectual disabilities to play sports and connect with their communities through sports. The SO also conducts activities aimed at maintaining their health, such as providing health checkups at the time of athletic events. It has been reported that opportunities to receive medical examinations decrease after school graduation for people with intellectual and developmental disabilities. Even if they are aware of pain or discomfort, it is difficult for them to communicate their symptoms by themselves. To mitigate this problem, the SO includes dental checkups as one of the categories of health examinations. We surveyed the impact of volunteer activities on psychological barriers to persons with intellectual disabilities among dental professionals who volunteered to perform dental checkups at the SO Japan Summer National Games held in Hiroshima in November 2022.

The volunteer participants included 29 dentists (48.1±9.3 years) and 18 paradentals (39.4±10.9 years). The results of the questionnaire showed that the participants’ image of people with intellectual disabilities was more favorable after volunteering, especially in the categories of “friendly,” “cheerful,” “excellent,” “unique,” “familiar,” “poor,” “scary,” “don’t want to get involved with,” and “annoying” (all p＜0.05). In addition, a total of 76.6％ of the respondents answered that their “mental barriers” had “not changed,” “disappeared,” or “decreased.” Additionally, 78.7％ of the respondents answered “strongly agree” or “somewhat agree” in response to the question “Would you be willing to participate again in an event involving people with intellectual disabilities?”. On the other hand, no respondents answered “strongly disagree” or “somewhat disagree.”

There are still many situations where people with intellectual disabilities cannot receive adequate dental care. Therefore, there is an urgent need to modify the environment for them to be able to easily receive dental care. The present study suggests that being involved in activities with the disabled may effectively reduce psychological barriers between people with and without intellectual disabilities. Thus, providing many dental professionals with such opportunities can contribute to normalization of attitudes in dentistry.

It is well known that oral health care for children and patients in residential hospitals for persons with severe motor and intellectual disabilities (SMID) is important for their general health management. In many cases, daily oral health care of patients with SMID is performed by facility staff who are not dental professionals. Therefore, in this study, we investigated the awareness of facility staff regarding oral care, and examined the issues of oral hygiene instruction and oral health care.

The target of this questionnaire survey was 104 facility staff working at a rehabilitation center. The response rate to the questionnaire was 97.1％ (101 facility staff：45 nurses and 56 Ryouiku staff).

The proportion of nurses and Ryouiku staff with oral health care experience prior to employment was 82.2％ and 37.5％, respectively, showing that Ryouiku staff had significantly less experience. The Ryouiku staff spent significantly shorter time on oral health care than nurses；a significant number of nurses had problems with oral health care.

The nurses replied “lack of manpower” or “other work takes priority,” and other items related to the work environment. More than 90％ of the facility staff responded that they were aware of issues and difficulties in oral health care. Items of concern were “bad breath” and “general condition,” which the Ryouiku staff were significantly less concerned about. More than 95％ of the facility staff received oral health care instruction, and “mucous membrane exclusion” was significantly more common among nurses as a change after the instruction.

This questionnaire survey suggested that the oral hygiene instruction workshop at the time of employment contributes to changes in staff awareness, and that it is necessary to conduct oral hygiene instruction workshops on a regular basis to reduce differences in oral health care skills among staff.