We conducted an investigation for 4 years from January 2008 to December 2011 to evaluate the oral psychosomatic patients who visited the Osaka Dental University Hospital.
The number of patients diagnosed during the 4-year period was 245. We examined the gender, age, address, date of consultation, clinical department, diagnosis, and dosage of the patients.
As a result, we found the following.
1. The male-female ratio was 1 : 3.4.
2. It took 2.5 months on average before the diagnosis.
3. The number of new patients tended to be small in May and large in December.
4. There were regional differences in the distribution of patients. The population density was also higher in two areas where there were many patients.

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Introduction: Intracystic injection of OK-432 is reportedly effective in the treatment of cystic diseases such as ranula; however, only a few facilities perform this treatment modality. We herein report our experience of performing intracystic injection of OK-432 for cystic diseases in the head and neck area with favorable outcomes.
Subjects: The subjects were 50 patients treated with intracystic injection of OK-432 in the Department of Oral Surgery, Nishiarai Hospital, between January 2005 and March 2014.
Methods: (1) Diluent replacement: The contents of the cyst are aspirated as much as possible, and OK-432 solution diluted to the same volume as that of the aspirate is injected. (2) High-concentration injection: A solution containing OK-432 is injected at a high concentration without aspiration of the contents of the cyst. (3) Aspiration-injection procedure: The contents of the cyst are aspirated as much as possible, and OK-432 dissolved in 2-4 mL of physiological saline is injected.
Results: The treatment was effective in 47 (94%) of the 50 patients. No serious adverse reaction was observed.
Conclusion: Intracystic injection of OK-432 is a treatment modality that can be performed safely on an outpatient basis.

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As keratocystic odontogenic tumors (KCOT) have a high level of proliferative activity in epithelial cells and tend to grow aggressively in the jaw, careful attention is required. The purpose of this study was to report experiences of KCOT and analyze information regarding recurrence.
A retrospective review was performed in 66 patients and 75 tumors with KCOT who underwent surgery and were followed up for at least 6 months at Nagasaki University Hospital from 1992 to 2014.
KCOT occurred more frequently in men (57.6%) than in women (42.4%), and occurred most commonly in the second decade (24.2%), followed by the first decade (19.7%); the mean age of patients was 36 years old. The most frequent clinical complaint at first admission was asymptomatic, followed by painless swelling and painful swelling. The mandibular molar and ramus were the most common sites of involvement. Surgical procedures included enucleation (84.0%) and marsupialization before enucleation (16.0%). The patients were followed for 6 to 252 months. Recurrences were found in 15 out of 75 tumors (20.0%). Univariate and multivariate analysis showed that treatment of the tooth root in contact with the primary lesion is a significant independent factor for recurrence (P<0.05).
It is suggested that the tooth root in contact with the primary lesion should be extracted to reduce the incidence of recurrence. The period between primary operation and recurrence ranged from 10 to 137 months. For these reasons, careful long-term follow-up is required.

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Methotrexate (MTX) is a drug therapy for rheumatoid arthritis. Here we report two cases in which MTX caused severe stomatitis. Case 1 was an 83-year-old woman who presented in our department with stomatitis and eating disorder. Blood tests revealed pancytopenia. Treatment with granulocyte colony stimulating factor (G-CSF) was started and a blood transfusion of platelet concentrate was administered. She was also examined in the Department of Nephrology for renal dysfunction and started on hemodialysis. Our department provided pain relief for stomatitis and infection prevention. Case 2 was a 77-year-old woman who presented in our department with stomatitis and eating disorder. Blood tests revealed pancytopenia, severe renal dysfunction. Treatment with G-CSF, intravenous antibiotics infusion, and oral antifungals was started. By day 7, the pancytopenia and stomatitis was improving. MTX is believed to cause stomatitis as a precursor to the development of pancytopenia, and if risk factors for the appearance of MTX side effects are present, it is important for clinicians to be particularly careful of this possibility.

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We report a case of phlegmon of the cheek due to pericoronitis of partially impacted fused teeth. The patient was a 57-year-old woman who was referred to our institution with complaints of a right cheek swelling. Panoramic radiographs revealed a tooth-like opacity in the lower right molar region. The patient was diagnosed with phlegmon of the cheek due to pericoronitis of tooth-like hard tissue in the molar region.After anti-inflammatory drug treatment, she underwent excision of the tooth-like hard tissue under general anesthesia. The excised mass was a fusion of a supernumerary tooth and the lower third molar. At the last follow-up, the patient was healthy with an uneventful postoperative course.

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Recently, calcium hydroxide has become the main flow root canal disinfectant. During a root canal treatment, we mistakenly press-fitted Calcipex II^® (Nippon Shika Yakuhin Co., Ltd.) resulting in a case of extravasated submucosal mandibular alveolar. An outline of the experience is reported here. The patient was a 61-year-old female. She was treated for an infected root canal caused by apical periodontitis of the first molar in the left mandible. CT scan performed due to non-cessation of symptoms revealed bone permeation of the distal root of the first molar in the left mandible, and continuous heterogeneous calcification in various internal areas from the extracortical side of the left mandible. Distal root cyst, distal root perforation, apical periodontitis and foreign body in the first molar of the left mandible were diagnosed and thus, hemisection of the distal root was performed. Furthermore, the distal root tip of the first molar of the left mandible was extracted and the foreign body was removed under general anesthesia.
She presently has a bridge in place, occlusion has been established, and progress is good.

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We report a case of tongue necrosis caused by compression from an intubated tube and disseminated intravascular coagulation. The patient, a 59-year-old female, underwent surgery followed by tracheal intubation due to perforation of the sigmoid colon and acute generalized peritonitis. Disseminated intravascular coagulation later occurred and necrosis spreading from the tip to the body of her tongue appeared. After the tube was removed, she received thorough treatment including mucosal cleaning, oral care and application of ointment at this department, resulting in improvement. This case confirmed the need for oral care from the time of intubation after the general condition of a patient worsens.

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We report a rare case of a huge anterior maxillary cyst in combination with a dentigerous cyst extending into the maxillary sinus in a 46-year-old man. The patient was referred to our hospital from an otolaryngology department. X-ray and CT examinations revealed a large cyst in the anterior maxillary region and a radiopaque lesion in the left maxillary sinus. The cysts were removed surgically and causal tooth roots in the anterior maxillary region were resected under general anesthesia. The histopathological diagnosis was radicular cyst in the anterior maxillary region and dentigerous cyst in the maxillary sinus.

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IgG4-related disease is a recently proposed pathological entity characterized by tumor-like enlargement of one or more organs, IgG4 positive plasma cell accumulation and raised serum IgG4 levels. We present a case of submandibular lymphadenopathy with IgG4-related disease. The patient was a 49-year-old man, who had been receiving periodontal treatment in our department. We investigated swelling of the right submandibular region that had been identified previously. An excisional biopsy revealed enlarged lymph nodes. IgG4 positive plasma cells were found in interfollicular areas (IgG4/IgG ratio: 89.5%). Thus, IgG4-related disease was suspected. The serum IgG4 level was high on blood testing, and so we consulted the department of rheumatology. At present, he is asymptomatic except for the head and neck lesions without medication. The patient is on regular follow-up with hematological and radiological examination.

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For patients undergoing treatment for bone metastases by the administration of drugs such as bisphosphonates (BP), osteonecrosis of the jaw is a serious side effect. In recent years, it has been reported that some drugs other than BP also cause osteonecrosis of the jaw. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has designated such osteonecrosis as MRONJ (medication-related osteonecrosis of the jaw), and has published its position paper. We herein report a case of osteonecrosis of the jaw in a patient being treated with three drugs (denosumab, bevacizumab, and zoledronate).
A 68-year-old patient who was being treated with the administration of the three drugs for lung cancer and bone metastases was referred to our department with pain and exposed bone in the posterior mandible. Under a clinical diagnosis of osteonecrosis of the jaw, routine observation with antibiotic administration and irrigation of the exposed bone were performed after stopping administration of the drugs. However, the patient's general symptoms worsened, and six months after the first visit he died of multiple organ failure.
The present case indicates that the use of denosumab may be associated with osteonecrosis of the jaw because denosumab was used more frequently than BP. Reports on necrosis of the jaw caused by denosumab or angiogenesis inhibitors may increase in the future, therefore it is necessary to understand the condition of underlying diseases and to diagnose the adaptation of invasive dental treatment for patients treated with those drugs as well as BP.

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Actinomycosis is an inflammatory bacterial disease caused by Actinomyces species. It often occurs around the mandible and rarely in the maxilla. Early detection and subsequent treatment reduce its severity. Recently, there has been a significant reduction in the incidence of actinomycosis in Japan because of early antibiotic administration. Because an intractable oral ulcer is an early symptom, it is important for oral surgeons to detect actinomycosis, if present, and to be able to differentiate between oral cancer and actinomycosis during the initial patient consultation. Here we report a case of maxillary resorption caused by actinomycosis. An 86-year-old female was referred to our hospital because of swelling of the right maxilla. Physical examination revealed diffuse swelling with induration in the maxillary right premolar region. An X-ray and computed tomography examination revealed bone destruction of the right maxilla. We performed surgical curettage and biopsy, and the result of histopathological diagnosis was maxillary actinomycotic infection. There has been no sign of recurrence since the treatment.

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The human anti-RANKL monoclonal antibody, denosumab, inhibits bone resorption. It is used to prevent bone metastasis in various solid carcinomas, including those affecting the lung and breast. It is also used for the treatment of other conditions such as hypercalcemia, osteoporosis, and multiple myeloma. However, although osteonecrosis of the jaw is a common side effect in patients receiving denosumab, due to the small number of reported cases in recent years, denosumab has been approved for use in this country. A case of necrosis of the jaw bone that was thought to be caused by denosumab is presented. A 67-year-old man, treated for the progression of lung cancer, was administered denosumab for a period of 11 months. Following extraction of the right maxillary first molar, in view of the long-term jawbone exposure, osteosclerosis of the upper jaw was noted during radiographic evaluation.

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Central odontogenic fibroma (COF) is a rare odontogenic tumor, the primary treatment of which is tumor ablation with extraction of related teeth. We report a case of COF that developed in the left maxilla in a 24-year-old woman. There were no subjective symptoms, however, she had noticed malposition of the second premolar to the palatal side and slight swelling of the buccal gingiva around the tooth since nine years old. The swelling had recently become larger, and she was referred to our clinic. A biopsy of the lesion showed a histological diagnosis of COF. CT images revealed resorption of the alveolar bone around the tumor, and expansion to the roots of the premolars and first molar. Reconstruction of the alveolar ridge using iliac particulate cancellous bone and marrow was carried out immediately after tumor ablation with extraction of the premolars and first molar. Five months later, there was no evidence suggesting tumor recurrence, and alveolar ridge augmentation was clearly apparent on CT images. The serial dental implant treatment was thus completed. The occlusion was restored by an implant prosthesis, and no evidence of tumor recurrence was found during four years of follow-up.

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A case involving difficulty with manual reduction of anterior dislocation of the temporomandibular joint (TMJ) in a patient with Parkinson’s disease is presented. The dislocation was reduced using continuous reduction provided by leverage obtained using bite blocks and elastic traction.
The patient was an 81-year-old male with Parkinson’s disease. In the past, the patient had repeatedly experienced bilateral habitual dislocation of the TMJ. In February 2008, the patient developed severe aspiration pneumonia requiring a tracheostomy under general anesthesia, whereupon dislocation of the TMJ was noted.
Upon initial examination in our department, dislocation of the TMJ was treated by manual reduction. Despite dislocation being noted again the following day, the patient was receiving respiratory care in the intensive care unit, so the TMJ remained dislocated until the patient could be seen again 5 days later. Reduction failed despite repeated attempts at manual reduction. Open reduction under general anesthesia would have been difficult given the patient’s general condition, so continuous reduction was performed using intermaxillary traction. After 4 days, the heads of the condyles had been repositioned, and occlusion had been restored. To prevent additional dislocations, intermaxillary fixation was performed. The patient’s course was satisfactory, and additional dislocations were not noted.

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歯内療法においてX線画像から得られる情報は，診断や治療計画の決定において重要である。しかしながら通常の口内法X線写真だけでは根管形態，根尖部の状態，解剖学的構造物の関係を詳細に検討することは困難なことがあり的確に歯内治療が行われないこともある。近年ではCone-Beam-CT (以下CBCTとする。) により高解像度な3次元画像が得ることにより，歯内療法を行うための重要な情報をわれわれに届けることができるようになった。
今回，下顎右側第二小臼歯の根管形態が口内法X線写真では把握出来なかったもののCBCTでは正確に描画でき，的確な歯内療法が行われた症例を経験したので報告する。

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今回われわれは，含歯性囊胞の感染に起因した小児のGarré骨髄炎と診断された1例について報告した。患者は4歳，男児で右側下顎臼歯部の腫脹部の精査を主訴として来院した。受診時，左側頰部から顎下部に圧痛と開口障害を伴う腫脹を認め，顔貌は左右非対称であり，左側下顎大臼歯部の頰側歯槽粘膜部に圧痛を伴う瀰漫性腫脹を認めた。画像所見では第二乳臼歯は歯根吸収を認め，病変内部に一部包含され，頰側皮質骨外側には層状の骨膜反応を認めた。全身麻下にて口腔内から左側下顎第二乳臼歯を抜去し腫瘍摘出術を行った。病理学的所見では非角化性重層扁平上皮に裏装されて囊胞様構造を認め，上皮下結合組織は浮腫性の炎症細胞浸潤を伴っていた。臨床症状，画像所見および病理組織学的所見からの総合的診断により，含歯性囊胞の感染に起因したGarré骨髄炎と診断した。小児期における顎骨骨髄炎に対しては，消炎処置後に原因歯の抜去と囊胞摘出を行うことにより良好な治癒経過が得ら，早期の診断と治療が重要であることが示唆された。

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