A type of ectodermal dysplasia, hypohidrotic ectodermal dysplasia is a congenital disease accompanied by sparse hair, insufficient number of teeth, hypodontia, and hypoplasia of sweat glands. There is congenital edentulism of baby or permanent teeth or complete anodontia in the oral cavity appearance. This case report describes a patient with complete edentulism due to hypohidrotic ectodermal dysplasia who acquired esthetic and masticatory functions by a complete denture prosthetic, and 14 years of follow-up.

The first visit of the patient was in June 2010. He was a 3.2-year-old boy, with the main complaint of “We want a complete denture because of congenital edentulism, then dysphagia rehabilitation.” His oral cavity appearance was an edentulous jaw and the form of the alveolar ridge was low and string-like. His face had a senile appearance due to a short face caused by mandibular advancement. We took his physical growth into consideration when making his complete denture because the length and width of the alveolar ridge would grow. The denture was installed in the deciduous dentition period, mixed dentition period, and permanent dentition period. The first denture was made during his primary and mixed dentition period in November 2010 （3.7 years old）, the second one in October 2013 （6.7 years old）, and the third one in September 2017 （8.5 years old）. Currently, he is using the fourth one made in August 2019 （12.5 years old）. This denture acquired esthetic and masticatory functions.

In the present case it was necessary to make a complete denture to acquire pronunciation, esthetic and masticatory functions. We were able to improve the acquired esthetic and masticatory functions by making the complete denture while taking into consideration the growth and development of his maxillofacial and alveolar ridge.

We report our experience of general anesthesia for dental treatment and perioperative management of patients with intellectual disabilities （ID） and chronic heart failure （CHF）, and discuss the indications and management of these patients in dental facilities.

Case 1：A 45-year-old male with severe ID was scheduled for general anesthesia. The patient had a history of being transported to a general hospital due to general edema. Based on his clinical symptoms, he was diagnosed as acute heart failure. However, no examinations could be performed and the pathology was unknown because he refused medical intervention. Two diuretics （furosemide and spironolactone） were prescribed as symptomatic treatments, and some improvement was observed.

In the preoperative examination, the cardiothoracic ratio （CTR） was 53.6％, and the brain natriuretic peptide （BNP） was 50.3pg/ml. Although CHF was suspected, we could not receive any detailed information on cardiovascular disease from the medical department. Therefore, we planned an anesthesia induced by midazolam and fentanyl, which have minimal myocardial depression, and evaluated whether the cardiac reserve was maintained. After conscious sedation, tachycardia （102beats/min）, ST depression （3mm）, and multiple premature ventricular contractions （PVCs） were observed on the electrocardiogram （ECG）. After deep sedation, blood pressure was maintained, ST depression improved and PVCs decreased on the ECG. The cardiac function was maintained and it was assumed that the patient had a certain degree of cardiac reserve, and anesthesia was performed uneventfully with sevoflurane.

Case 2：A 63-year-old male with mild ID and cerebral palsy was scheduled for general anesthesia. Although there was no information on cardiovascular disease before anesthesia, heart rhythm irregularity and heart failure were suspected in the preoperative examination. Detailed examination revealed moderate heart failure （left ventricular ejection fraction （LVEF）） of 47％ with atrial fibrillation （Af）. The BNP was 106.2pg/ml and the CTR was 60％. Anesthesia was slowly induced with midazolam and fentanyl and maintained uneventfully with sevoflurane.

For patients with ID who cannot be examined for CHF preoperatively, anesthetics that have little myocardial depression （midazolam and fentanyl） can be used for general anesthesia, the patient’s remaining cardiac reserve should be evaluated from the circulatory response, and then anesthesia can be designed and managed appropriately. General anesthesia and perioperative management for ID patients with CHF during dental treatment can be safely performed in dental clinics by using these methods.