Ronen Shika Igaku

In elderly patients who are treated with neuroleptics, antidepressants or other antipsychotic drugs, the occurrence of Parkinsonism has been observed as the sideeffect. The Parkinsonism occurrence mechanism has been clarified by mean of researches based on the study of the dopamine receptor (subtype) and the dopaminergic function. However, until now it is unclear why long-term damage of the dopamine neurotransmitter induces tardive dyskinesia.
Oral dyskinesia (OD), an oral motor disorder mainly characterized by involuntary movements of the lips, tongue and jaws, which seem like masticatory movements, has a great importance for dental practicioners. Sore dentures, impairment of the masticatory function, speech disorders and difficulty in making new dentures are some of the consequences related to oral dyskinesia. Gradual or complete interruption of medication or changes in the prescription have been made in order to partially improve the symptoms. Furthermore, adjustments to maladapted dentures and making new dentures have been reported to help in the reduction or elimination of symptoms. Thus, the purpose of the present study was to make clear the relation that exits between the occurrence of OD and the examination findings including the occlusal condition. To achieve this, 151 elderly patients were investigated. From the total population of 151 patients, 38 were drug treatment patients. Moreover, 15 out of these 38 patients presented oral dyskinesia. The results of the present study suggested that in the 38 drug treatment patients investigated, there were no relations between the oral dyskinesia occurrence and age, gender and ADL. However, a relation between OD occurrence and the occlusal condition was observed (p<0.0005).

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A clinico-statistical analysis was performed as to the appearance of EGG (Electrocardiogram) changes during the perioperative period for dental practice in 440 cases (160 male and 280 female) over 65 years whose mean age was 75.3 years under hospitalization in our hospital for six years (March 1994-February 1999) in Hinode Dental Office Makomanai.
We investigated changes in the ECG pattern, blood pressure and heart rate retrospectively from clinical records and ECG records under hospitalization and during the perioperative period. The perioperative period was defined as the period since getting up on the day of the dental visit day to getting up the next morning. ECG changes were defined as the difference or aggravation from ECG on admission.
Out of the 440 cases, 296 showed abnormal ECG on admission, and 417 had some basic diseases. Out of these 417, 63 cases showed ECG changes during the perioperative period, and drugs for basic diseases were administered in 43 cases (73.0%). On the other hand, 354 cases did not show ECG changes, and nothing was administered in 310 cases (87.5%). 59 cases (13.4%) showed ECG changes during the dental visit. As to the type of ECG changes, abnormal impulse formation was most often seen in 54 cases, ST depression in 4, and the conduction disturbance in 1. As for the dental treatment at the appearance of ECG changes, oral surgery was most frequent: 35 (59.3%) cases, tooth preparation and impression taking: 22 cases (37.3%), root canal treatment: 19 cases (13.6%), and denture adjustment: 8 cases (13.6%). We gave emergency care in 11 cases during dental practice. On the other hand, before or after dental practice 12 cases showed ECG changes. The ECG changes were abnormal impulse formation in 12 cases, and ST depression in 2 cases. It seemed that ECG changes in 6 cases were caused by stress due to dental treatment. We gave emergency care in 6 cases, including 2 cases transferred to medical hospitals. It was suggested that some ECG changes during the perioperative period were caused by physical or mental stress due to dental treatment. From these experiments we suggest that elderly patients should be managed systemically not only during dental tretment but also before and after.
In conclusion, it is important to manage elderly dental patients during the perioperative period.

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