The aged population and the number of disabled people in Taiwan continue to increase. Dental treatment for patients with severe disabilities or more complicated oral conditions is usually handled in a specialized medical facility with special equipment. Home Dental Care is a dental service that reaches out to patients who cannot reach a dentist by themselves. It has been well established in Japan for more than 20 years. In Taiwan, however, it is not widespread. In this article, I will introduce the current status of Home Dental Care in Taiwan as well as how it is carried out.

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In this study, we examined the pneumonia depression effect of the facilities residents by encouraging the problem solving skills for oral health care offacilitiesʼ staff member, and by implementing an oral health care management method to improve daily practices.　The subjects are residents of an intensive-care old peopleʼs home located in Kyotango, Kyoto, Japan, and a twice-yearly inspection was done 7 times from 2010 to 2013. Our oral health care management had two activities. One is oral hygiene and the other is training of the ingesting/swallowing-function. On the management of oral hygiene, we proposed the oral health care methods to the staff according to individual subject condition using the oral hygiene classification developed by Takei et al. This followed the screening process implemented with mouth wetness and the number of Candida for the high risk pneumonia subjects. On the management of trainings of the ingesting/swallowing-function, we proposed the addition of indirect functional training to the direct functional training for lunch after the screening process implemented with the result of food testing for needy subjects. We supported once in one or two months for the initial year and provided the test results every half year for three years. Also, the data on hospitalization for pneumonia was obtained from the community hospital used by all subjects. In this research, oral health care management was done to improve the quality of daily oral health care for all the residents of the facilities. Also, the incidence of pneumonia was evaluated including the factor of dynamic change of subjects for three years.　The results showed that, the pneumonia depression effect was not clear, but candida counts and ammonia concentration decreased, and swallow-function improvements are recognized. Also, comparing the percentages of subjects hospitalized once or more in a year, before three years and after three years of the management, the number has declined. We will continue to consider further management methods to keep this pneumonia depression effect.

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　Opportunities for the treatment of elderly patients with oral cancer have increased with the advent of the super-aged society. A clinical study was conducted of the treatment of 5 super-aged oral cancer patients of 90 years or older.　Five patients were referred to our hospital；they were over 90 years old between April 2011 and June 2014. We researched their operations and QOL retrospectively.　Four patients underwent surgery, and four patients underwent tumor resection and neck dissection including late metastasis.　Surgery tends to be the first choice for elderly patients. In this study, 4 cases underwent surgery and the patients could keep their QOL. We are struggling to decide the treatment for elderly patients. One of the evaluations, frailty evaluation, has attracted attention recently, and we use such methods when making treatment plans.　We suggest that radical therapy including surgery should be considered for super-aged oral cancer patients over 90 year old.

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We performed anesthetic management for a 90-year-old patient with severe chronic obstructive pulmonary disease（COPD）. At initial evaluation, the results of lung function tests were as follows：forced expiratory volume in 1.0 s（FEV1.0）, 1.09 L；FEV1.0/forced vital capacity, 33.6％. After preoperative pulmonary management with an anticholinergic drug, FEV1.0 increased by nearly 30％ compared to initial evaluation. General anesthesia was induced with propofol（50 mg）and rocuronium（40 mg）. Anesthesia was maintained with air-oxygen-sevoflurane and remifentanil. Although PaCO₂ levels were high（55-58 mmHg）, we followed the theory of permissive hypercapnia, while maintaining low airway pressure and adequate expiratory time. We aimed to minimize the risks of postoperative respiratory depression and delayed ambulation. Although no problems were encountered at emergence and he was able to drink clear water uneventfully until noon on postoperative day 1, he choked on water and vomited in the afternoon while taking his medications. He choked on water again at night while gargling. Aspiration pneumonia developed on postoperative day 2. Recovery was achieved after 1 week and he remained free of aspiration after recovering from pneumonia. We were able to successfully complete the intended surgery under general anesthesia. The main factor underlying the pathogenesis of the development of aspiration pneumonia seemed to be oral intake of water under conditions of dysphagia due to resection of a right tongue cancer. Background factors to this situation were thought to be aging and a comorbidity of COPD.

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[in Japanese]

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[in Japanese]

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