We investigated the relationship between oral care and candida species in 16 patients (14 men and 2 women) undergoing radiotherapy for head and neck cancer. They also received oral care by specialized dental staff. Candida species were detected in 12 patients (75% of all patients): C. albicance was detected in 8 cases (50%) and non-C. albicance was detected in 4 cases (25%). Advanced oral mucositis of more than grade 3 was seen in 13 patients, and candida species were detected in 11 cases.
Oral care in consideration of candida species is important because C. albicance and non-C. albicance were frequently detected in patients undergoing radiotherapy for head and neck cancer even though their oral condition was well maintained.

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This study was carried out to collect and analyze the data obtained from patients to establish the ideal education system for clinical training at university dental hospitals.
For this purpose, we obtained the information from the outpatients who visited the Tohoku University Dental Hospital using a questionnaire for our education and clinical training system.
The following results were obtained.
(1) “Referral from general practitioner” was the most common reason for visiting our hospital for new patients and patients aged younger than 40, while “reliable treatment” was the most common reason for revisiting patients and patients aged over 40.
(2) Most patients accepted the treatment and observation by interns and undergraduate students regardless of generation. Revisiting patients refused to see them less than new patients.
(3) The permissible time for clinical training purposes was longer in revisiting patients and patients aged over 50 compared with new patients and patients aged younger than 50, respectively.
These results suggested that elderly and revisiting patients were more cooperative with our clinical training program than younger and newer patients through the assurance of extensive safety and conscientiousness regarding treatment.

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Objective: To identify the effects of temporomandibular joint clicking on condylar movement in the morning.
Subjects and Methods: The study group consisted of 14 subjects: seven individuals with normal temporomandibular functions and seven individuals with unilateral temporomandibular joint clicking. As a maximum jaw opening and closing test, the subjects were instructed to open their mouth as wide as possible for one second and then to close their mouth for one second. The movements of the left and right condylar points during these actions were recorded. The test was administered twice: once in the morning and once in the evening of the same day, after which the results were compared and analyzed.
Results: We found that condylar movements were limited in the morning and the rate of movement was less stable in the clicking group of subjects.
Conclusion: The results suggest temporomandibular joint clicking not only limits condylar movement but also affects stability.

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Syphilis is a common sexually transmitted disease which is caused by Treponema pallidum. Although its incidence dramatically decreased with the use of penicillin after World War II, a significant resurgence of syphilis has been reported in Europe, the United Kingdom, the United States, Russia and China in the past decade.
On the other hand, syphilis has gradually decreased, and its incidence was the lowest among sexually transmitted diseases in Japan. However, it has been reported that recent cases of syphilis did not present typical symptoms, and extragenital sites, especially the oral cavity and the pharynx, have increased as the site of the primary lesion. In general, it has been reported that the clinical manifestations of secondary syphilis include skin disorders, constitutional symptoms, and genital lesions. Oral lesions arise in at least 30% of patients with secondary syphilis, however, oral lesions as a single site without other organ involvement are extremely rare.
We report a case of secondary syphilis arising in the hard palate alone of a 53-year-old male. The patient received treatment using sawacillin^® and viccillin^®. Serological test levels for syphilis including RPR, TPHA and FTA-ABS gradually decreased.
We report the details of this rare type of secondary syphilis and discuss recent syphilitic features.

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We report the case of a 35-year-old adult with hereditary angioedema (HAE) who underwent oral surgery under local anesthesia. Hereditary angioedemas are rare but significant events in simple oral surgery because they can cause acute life-threatening laryngeal edema. The patient was diagnosed as left mandibular radicular cyst involving the third molar based on the findings of CT and panoramic radiography. In accordance with the HAE guidelines, C1-INH was injected before surgery and tranexamic acid was administered long-term to avoid angioedema attacks. He underwent tooth extraction and cystectomy under local anesthesia. Although edema was recognized at the proximal phalanx of the middle finger, no other complication occurred during or after surgery.

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We report a case of fibrous dysplasia of the mandible with histopathological evaluation after long-term observation. A 2-year-old boy was referred to our clinic in 1988 because of a swelling of the left mandible. Radiographic examination revealed calcifying tissue-like radiopacities within a lesion. Histopathological examination showed fibrous tissue and woven bone. We diagnosed this case as fibrous dysplasia. We carried out curettage under general anesthesia. Six months after the operation, the patient had a bone swelling that grew rapidly in the same region. However, the bone swelling stopped growing after one year and we followed up the subsequent history until the end of the growth stage. After 16 years of surgical treatment, resection of the mandible inferior border was carried out for esthetic improvement of asymmetric mandible. Histopathological examination showed loose bone and fibrous tissue.

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This paper reports a rare case of Fordyce's spot with a cyst formation in the buccal mucosa. The patient was a 71-year-old Japanese male who noticed a painless swelling surrounded by Fordyce's spot in the right buccal mucosa. The swelling was elliptical in shape, 2mm in diameter, and had a yellowish surface. We excised the swelling with Fordyce's spot over the buccinators muscle. The excised specimen was examined histopathologically and was diagnosed as Fordyce's spot with a cyst formation. No recurrence has been observed.

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Granular cell tumor is a relatively uncommon benign tumor that occurs at sites such as the skin, oral cavity, breasts, and bronchus.
We report a case of multiple granular cell tumor on the lateral border of the tongue.
In November 200X, a 50-year-old woman presented to us with a nodule on the left lateral border of the tongue. It was approximately 8 mm in diameter, had distinct margins, and was hard elastic on palpation. The nodule was painful only when it came in contact with the teeth. The right lateral border of the tongue had normal mucosa. The nodule was resected under local anesthesia. The pathological diagnosis was a granular cell tumor.
Three years later, a nodule of 5 mm in diameter appeared on the right lateral border of the tongue. This lesion was also resected and the pathological diagnosis was again a granular cell tumor. No recurrence was observed at either of the surgical sites.
Granular cell tumor is usually a benign tumor. However, it shows the potential for local invasion, recurrence, and malignant transformation. Thus, such tumors should be strictly observed for malignancy and recurrence.

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Oral metastasis of renal cell carcinoma is rare. We report a case of renal cell carcinoma with multiple metastases that initially presented as a tumor of the upper gingiva. The patient was a 66-year-old man who visited our department because of a swelling of the upper anterior gingiva. Biopsy was performed, and gingival metastasis from renal cell carcinoma was strongly suspected on histopathological examination. Computed tomography (CT) demonstrated a large mass of the right kidney and multiple metastases of the lungs. Renal cell carcinoma with metastases to the lungs and upper gingiva was diagnosed. Resection of the gingival tumor was performed because of its rapid growth and difficulties in eating. Nephrectomy was performed at the same time. The patient then underwent administration of sunitinib. Finally, he died of pulmonary metastasis at 7 months after the surgery. However, surgical resection of gingival metastasis and dentures for the resected part are useful for improving patients' quality of life. We reviewed the literature on oral-region metastasis of renal cell carcinoma, and found 29 cases reported in Japan.

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We report a case of hemorrhage after extraction of the upper third molar which required an emergency operation to achieve hemostasis. A 50-year-old woman was referred to our hospital because of hemorrhage after extraction of the upper third molar. After tooth extraction at a dental clinic, continuous bleeding from the socket of the extracted tooth and swelling in the cheek occurred. We tried hemostasis under local anesthesia but it was unsuccessful, so we immediately performed an emergency operation to achieve hemostasis under general anesthesia. A continuous hemorrhage from the posterior of the maxillary tuberosity was found. We stopped the bleeding by pressure hemostasis using hemostatic material. The patient's postoperative course has been good with no recurrence of bleeding.

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During the growth and development phase, an infant's jawbone and face has a different structure to that of an adult, and treatment policies need to take into consideration how to avoid inhibiting subsequent growth and development.
This article reports on the treatment of a boy aged one year and five months with a fractured mandible, achieving positive therapeutic progress in reduction and fixation by using a splint and circumferential wiring.

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Hepatitis B virus (HBV) reactivation induced by cytotoxic chemotherapy or immunosuppressive therapy is an important issue in carcinoma patients. We report a case of drug hepatopathy in a patient with oral carcinoma which was suspected of HBV reactivation during oral cancer therapy. The patient was a 63-year-old man. He was given a diagnosis of lower gingiva squamous cell carcinoma. He received preoperative chemotherapy with docetaxel and underwent an operation. To prevent postoperative swelling, he was administered steroids. Six days after the operation, blood testing revealed a high AST and ALT. Although we suspected HBV reactivation at first, the quantitative HBV-DNA level was low and the diagnosis was eliminated. With intravenous fluid therapy, AST and ALT gradually decreased and returned to within normal limits. As a result, he was given a diagnosis of drug hepatopathy through the treatment progress. Our findings suggest that attention should be paid to HBV reactivation in an HBV carrier who receives cytotoxic chemotherapy or immunosuppressive therapy.

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Cryptococcosis is a deep mycosis caused by yeast-like fungi such as candidiasis, and cryptococcal granulomatous lesions are rare in the oral region. We recently experienced a suspected case of granulomatous cryptococcosis in the left buccal region.
A 73-year-old man was referred to our department by his primary care dental office complaining of a tumor in the left buccal region. An elastic hard painless mass with a size of 10 × 13 mm was palpable in the left buccal region. The mass was enucleated under local anesthesia. The histopathological diagnosis was granulation tissue formation by fungal infection of Cryptococcus, etc.

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The surgical reduction and plate fixation of a condylar fracture can lead to early recovery, but the extraoral approach might induce complications, such as facial nerve injury and the creation of visible scars. Recently, an endoscopically-assisted intraoral approach has been introduced to avoid these complications, and we performed this procedure in two cases with subcondylar fractures. Case 1: A 33-year-old female had subcondylar and mandibular body fractures due to a traffic-related injury. She had hearing loss and visual impairment. Case 2: An 84-year-old female had subcondylar and mandibular body fractures due to a traffic-related injury. She had dementia and delirium. Both patients had difficulty communicating, and surgical treatments were performed to enable early recovery. An endoscope with a 30-degree angle was used to visualize the condylar fracture through an intraoral incision. Titanium miniplates and screws were used to stabilize the fracture site with the help of a contra-angle drill and screwdriver. The intermaxillary fixation was released on the seventh and fifth postoperative days, respectively. This surgical procedure is minimally invasive and can lead to an early recovery, and so can be a useful method for treating condylar fractures, if the patients and indications are properly selected.

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We report a case of purulent meningitis and subdural abscess secondary to odontogenic maxillary sinusitis. A man in his forties was referred to our hospital because of a frontal headache and fever. He was given a diagnosis of acute pan-sinusitis caused by odontogenic maxillary sinusitis. Maxillary teeth as an origin of infection were extracted. However, he became drowsy, and paralysis on the left side of the body arose. MRI examination revealed multiple subdural abscesses extending from the right frontal lobe to the parietal lobe. Broad-spectrum antibiotics were administered, and drainage by craniotomy was carried out. The pathogens were shown to be Streptococcus constellatus and Fusobacterium nucleatum. Subsequently, he was relieved and left our hospital without any sequelae.

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