A retrospective clinical study of emergency treatment in Douhoku Oral Health Center was performed. The total number of patients was 6,277 from April 1, 2007 to March 31, 2017, of whom 3,539 （56％） were male and 2,738 （44％） were female. The largest group of patients were in their thirties. Hokkaido is divided into 14 Promotion Bureaus, and patients from all Promotion Bureaus were treated. Most of the patients live in Kamikawa Promotion Bureau. The most frequent reasons for patient visits were periodontitis. Ten years ago, the main disease affected the molars in the lower jaw, followed by endodontic treatment. Recently, medication measures have increased. We must establish a fundamental system with maximum effort for the benefit of the patient. We will be required to play an important role as a primary medical institution and must consider how to deal with patients who come to the emergency and critical care center.

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This study compared the difference in information processing of “character” and “tooth” by comparing 20 beginners（novices）who had acquired textbook knowledge about tooth forms and 20 intermediate students（advanced）who had also acquired empirical knowledge, using event-related potentials（ERP）. 　The subjects were presented with a schematic diagram of “character” and “tooth” at a ratio of 2：8 according to the oddball task, and were instructed to press the button only when the target stimulus was presented. In the analysis, the ERP waveforms were averaged to obtain the averaged waveform, and principal component analysis was performed. As a result, in the information processing process of “character”, the ratio of the components of “N2b”, “P3a”, and “P3b＋SW composite” was the same for both advanced and novice subjects. In the information processing process of “tooth”, the ratio of “P3a” and “P3b” was large for both, and the same tendency was observed. However, the advanced subjects were divided into “N2b＋MMN composite”, “P3a” and “P3b”, and the difference in information processing process from the novices became clear. From the above, the “character” task was processed in the same way, but in the “tooth” task, advanced subjects who had acquired empirical knowledge seemed to recognize patterns earlier and to perform efficient processing.

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Focal osteoporotic bone marrow defect （FOBMD） is a rare benign jaw lesion consisting of hematopoietic bone marrow, which results in a focal bone defect. The present report describes a case of FOBMD in the mandibular molar region of a male in his 70s. A panoramic radiograph showed the presence of an undefined round, thumb-sized radiolucent lesion in the left mandible. CT and MR images suggested a clinical diagnosis of primary intraosseous lipoma. The surgical specimen was a yellow soft-elastic fat tissue, and it was difficult to histopathologically distinguish focal osteoporotic bone marrow defects from primary intraosseous lipoma. However, the definitive diagnosis of FOBMD was established on the basis of the histopathological findings of remaining hematopoietic marrow and no capsule formation. The postoperative clinical course has been uneventful for 2 years.

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Tetanus often leads to death without early diagnosis and treatment. We report a case of tetanus. A 78-year-old woman consulted the department of surgery at our hospital for trismus. Physical examination revealed severe trismus and stiffness of the masseter muscles. The patient had no history of trauma, but had undergone emergency surgery for obturator hernia 5 days prior to presentation. We diagnosed tetanus based on her clinical symptoms and condition. The next day, she was transferred to the intensive care unit. She received respiratory care with sedation and tracheal intubation. She recovered from tetanus and was discharged on the 98th day. Tetanus is usually diagnosed based on typical symptoms and a history of trauma, but when there is no notable history of trauma, tetanus must be diagnosed based on the clinical course and symptoms.

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Reports of allergies related to dental treatment are increasing and the dental materials used are often limited. Herein, we present the case of a patient who had drug eruptions after receiving treatment using multiple dental materials. We performed a patch test on the dental materials, identified the cause of the condition, and provided effective treatment. Blister formation on the buccal mucosa and skin eruption with keratinization of the dorsum of the hand were observed. Based on the biopsy and clinical findings, the symptom noted on the dorsum of the hand was diagnosed as a fixed drug eruption. However, the cause was unknown. As the patient reported that the symptoms worsened after dental treatment, we decided to perform a patch test using dental materials; based on the results, the oral symptom was diagnosed as contact dermatitis, and the patient’s condition was caused by dental cement including eugenol or methacrylate. Thus, the material was replaced with one whose safety was confirmed by a patch test. The symptoms in the oral cavity were relieved and the symptoms noted on the back of the hand were resolved.

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Ameloblastoma is the most frequent among odontogenic tumors, and mainly occurs in the jawbone, whereas peripheral ameloblastoma （PA） occurs in soft tissue surrounding the jaw bone. Here, we report a case of PA of the buccal mucosa. The patient was a female in her seventies with the chief complaint of a submucous mass of the right buccal mucosa. In October 201X, she became aware of swelling of the retromolar pad of the right-side mandible, and was referred to a dental surgery hospital in April 201X＋1. In the hospital, excisional biopsy was performed under local anesthesia and the pathological diagnosis was ameloblastoma. As part of the tumor may have remained after the biopsy, follow-up was continued but there was no malignancy. In May 201X＋2, because the tumor increased in the same region, she visited our hospital. We diagnosed ameloblastoma by re-biopsy and resected the tumor of the right-side buccal mucosa under general anesthesia. As a result, a definitive diagnosis of peripheral ameloblastoma was made. She remains in good condition without recurrence at six years after the operation.

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Parotid gland swelling is a symptom encountered in the clinical field. However, only a few cases of swelling from emphysema of the parotid gland have been reported. Here, we report a case of emphysema of the parotid gland caused by dental treatment. 　A 37-year-old female was referred by her home dentist because of left lower buccal swelling. She felt pain during dental examination with home dentistry, and swelling of the left lower buccal was observed after using an air syringe. At the initial visit, clinical findings of swelling and tenderness of the left lower jaw were observed and there was no torsion sound. An image of air in the parotid gland was observed by CT examination. From the clinical findings and CT examination, we diagnosed emphysema of the parotid gland. As a treatment, antibiotics were prescribed to prevent secondary infection, and she underwent a follow-up examination. The symptoms disappeared after 2 weeks from the first visit and no recurrence of pain or swelling has been observed to date. 　Emphysema of the parotid gland is a rare disease, but must be prevented by considering the anatomical characteristics of the parotid gland during dental treatment.

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Ceftriaxone is a widely-used cephalosporin with advantageous pharmacokinetic properties and a broad antimicrobial spectrum. We report a case of ceftriaxone-induced neurotoxicity in a 61-year-old woman on hemodialysis. After normal-dose ceftriaxone was administered daily for 5 days to treat phlegmon of the cheek, the patient developed impaired consciousness, systemic myoclonus, and disorientation. Brain MRI and examinations for blood and cerebrospinal fluid were conducted with neurologists, but the cause was not detected. The symptoms disappeared shortly after withdrawal of CTRX. Finally, the patient was diagnosed as Ceftriaxone-associated epilepticus. Ceftriaxone is a safe antibiotic for patients with renal insufficiency, as it is excreted through hepatic pathways. Dentists should consider that antibiotic-associated encephalopathy may develop with ceftriaxone administration in patients, especially those complicated with renal dysfunction.

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Most schwannomas originate from the sensory nerves. Hypoglossal schwannomas arise extremely rarely and are usually associated with hypoglossal dysfunction. We herein report a case of intracranial hypoglossal schwannoma associated with the initial symptoms of tongue hemiatrophy. 　A 35-year-old woman was referred to our hospital with a chief complaint of swelling on the right side of the tongue. Because we could not locate the swelling, we asked a referred dentist for follow-up. After 6 months, she noticed the swelling again and was referred back to our hospital, whereupon we identified tongue hemiatrophy. An intracranial lesion was suspected, and MRI was performed. A 48-mm-long well-circumscribed lesion was found on the right side of the hypoglossal nerve canal. 　The patient was referred to the neurosurgery department of a local hospital, and a brain tumor was diagnosed. The tumor was resected with the patient under general anesthesia, and histopathological examination confirmed a schwannoma. 　Postoperatively, right hypoglossal nerve palsy was observed as a sequela. Neither tumor recurrence nor neurological symptoms of another cranial nerve have been found as of one year postoperatively.

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As medical technology has advanced and patients’ interest in medical treatment has increased in recent years, the chance of encountering a huge ameloblastoma has decreased. When choosing the most appropriate treatment, we should consider the patient’s age, sex, general condition, social background, wishes, and postoperative quality of life while considering the radicality of the procedure. We treated a giant ameloblastoma of the mandible in a patient with schizophrenia. First, we consulted our hospital’s psychiatric department regarding perioperative mental management. We then performed tumor resection and jawbone reinforcement using a titanium plate with the patient under general anesthesia. Intravenous sedation with dexmedetomidine hydrochloride was performed for 5 days postoperatively until the patient’s general condition stabilized. The patient’s postoperative clinical course was good, and no signs of recurrence were observed 5 years after surgery.

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The infratemporal fossa is a space surrounded by bones, and is a difficult place for clinical diagnosis of lesions and surgical approach. Infratemporal fossa abscess is a relatively rare disease, and despite the fact that its cause is often a dental infection, there are few reports in the field of oral surgery. We report a case of infratemporal abscess due to inflammation of the upper right second molar. Deep infections in the head and neck region sometimes suddenly deteriorate, and in addition to antimicrobial treatment, it was considered necessary to perform surgical drainage at an early stage.

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Glandular odontogenic cyst （GOC） is a rare odontogenic cyst derived from odontogenic epithelium; GOC shows aggressive behavior, unpredictable recurrence and rarely, malignant transformation. We describe our experience with a case of GOC arising in the mandible. A 49-year-old woman was referred to our hospital because of tenderness of the right mandibular canine region. Imaging findings revealed bone absorption with partially multilocular cortical bone absorption and buccal cortical bone loss in a well-defined area, 45mm in diameter, including from the right mandibular second premolar to the left mandibular canine. The clinical diagnosis was mandibular cyst. Under general anesthesia, cystectomy and apicoectomy in contact with the lesion were performed. Immunohistochemically, positive mucous cells for periodic acid Schiff （PAS） staining and mucicarmine staining in the epithelium were observed; the histological diagnosis was GOC. The postoperative course was satisfactory, and there has been no sign of recurrence for 2 years and 7 months.

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これまで，歯槽部に限局して生じた歯原性角化囊胞（OKC）の報告はない。今回，歯槽部に限局して生じたOKCを2例経験したのでその概要を報告する。症例1；画像検査で第一・第二小臼歯の歯根間に類円形の透過像を認めた。症例2；画像検査で犬歯と第一小臼歯の歯根間に類円形の透過像を認めた。いずれも病理組織学的にOKCの診断であった。このようなOKCは報告がなく，術前の臨床診断では周辺性歯原性角化囊胞や側方歯周囊胞との鑑別は困難であった。

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