The solution of 2 % lidocaine hydrochloride containing a vasoconstrictor with a 1.8 ml cartridge is now generally used as a local anesthetic in odontotherapy. The purpose of this study was to investigate the amount of anesthetic employed for conventional dental treatment.
Thirty-two patients (40 teeth), who underwent conventional dental care such as cavity preparation, pulpectomy, dental prophylactis, periodontal curratage and tooth extraction, underwent infiltration anesthesia using 1.0ml ORA^® inj, cartridge (Showa Medical Co.)
The surgeon was asked the dosage in each case, and the effect of anesthesia after injection was judged by the patient's response whether the treatment was completed without any pain.
Each surgeon was asked their opinion about the 1.0ml cartridge used in this study.
The results were as follows
1. The mean amount of the injected anesthtics was 0.59±0.29m1 in 40 cases, and the manifestation of the effects of infiltration anesthesia was 97.5% at the time of 5 min. after each injection.
2. It was pointed out by operators that the size of the 1.0ml cartridge employed was easy to hold, however, the syring must be improved.
3. The side effects as unpleasant things were not reported.
From above findings, 1.0ml ORA^® inj, cartridge contained sufficient amount of anesthtics for the infiltration anesthesia on the conventional dental treatment but not for the blocked anesthesia.

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Recently, treatment for MRSA (methicillin resistant Staphylococcus aureus) infection has been discussed because of resistance to many kinds of antibiotics. In the maxillofacial region, especially nasal, oral cavity and pharyngeal space, MRSA reduced indigenous bacteria in anatomical bases. It is well known that the cancer patient easily becomes immunocompromised due to chemotherapy, radiation therapy and surgical treatments. An active treatment using vancomycine and other treatments are often required for the postoperative patients with MRSA following reconstructive surgery. In this report, a clinical study on MRSA infection for oral cancer patients treated in our department is presented. The subject were 17 cases with oral cancers, (11 males and 6 females), 7 tongue cancers, 4 oral floors, 3 buccal mucosas, 2 lower gingivas and 1 lower lip in each primary sites, mean age of 63.9 years, ranged 44 to 78 years, from 1995 to 1998. During this period, MRSA infection ratio was 1 to 2% among all hospitalized patients, but 6% of all oral cancer patients were cultured. About 70% of these oral cancer patients were more than 60 years old. Most cancers were advanced tumor over T3 in size, and reconsouction by pedicled or vasuclarized major flaps was done after cancer ablation. Many kind and long period antibiotics were needed in order to care for operated wounds when surgical treatment was employed for the cancer radicality, and most MRSA infections were complicated in these patients. For two patients, MRSA eliminated by isodin and GM cream placed directly on the wound might couse percutaneous infection. Only one of 5 patients responded to administration of vancomycine but others did not respond to MRSA.

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When administering medication, the oral cavity presents specific problems in comparison with other organs. In other words, there are diverse factors such as the palate, the proximity to olfaction, the existence of sensitive tactus and the tongue, sputum and teeth.
Carboxymethyl Cellulose Sodium (CMC) and Sodium Polyacrylate have been used as adhesive agents for the mucous membrane of the oral cavity in manufactured oral ointments and hospital preparations. However, even with the use of these agents, the adhesion time of oral ointments has not increased satisfactorily and the problem of the taste of the ingredients remains. This situation requires improvements for comfortable use of such ointments for all occasions.
HPC Film consisting of Hydroxypropyl Cellulose (HPC), a water-soluble high-polymer was used as a covering material without active ingredients. After applying 10% Tetracycline CMC ointment to the buccal mucosa, lower buccal gingiva, soft palate and margin of tongue, they were covered by HPC Film. Changes over time in the presence of the ointment were compared between cases with and without HPC Film. It was found that by using a covering of HPC Film, adhesion time was markedly increased. Even in the tongue which was difficult to attach, the adhesionmaintenace time of oral ointment with HPC film indicated six-fold that without the film.

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Oral ointment contains adhesive agents with high molecular weight soluble in water as one of the base materials, providing a special property of adhesion to oral mucosa. On application, a strange suction-like sensation may be felt on the mucosa, inhibiting tongue movement and opening of the mouth and causing discomfort and anxiety. Questionnaires asking patients their opinions about oral ointment revealed a small number of patients with anxiety. A survey on the method of application of oral ointment, timing of application and degree of cleanliness of the oral cavity indicated inadequacy in the method of application in some patients.“Instructions for Application”and“Precautions”printed on the packing insert for oral ointment were found to be rather vague and unsatisfactory in many aspects.

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Hemodynamic and renal responses were studied under acute hemodilution alone and combined with sodium nitroprusside controlled hypotension. Fifteen mongrel dogs were divided into 2 groups : a hemodilution alone (HD) group and a hemodilution combined with hypotension (HP) group. Hemodilution was performed by withdrawing 20ml/kg blood and replacing it with 6 % Hydroxyethyl starch in saline (Salin-HES^®, MW : 70, 000) at 1.5-fold the volume of blood. Hypotension was produced during 90 minutes by intravenous infusion of sodium nitroprusside at the mean arterial pressure of 70 mmHg, group HP only. The results were as follows:
1) CI increased significantly after hemodilution in both groups. However, CI increased significantly compared with control value during hypotensive period in group HP.
2) PaO₂ and PaCO₂ did not change all experimental period in comparison with those of control value in both groups.
3) Renal blood flow increased significantly compared with control value in two groups after hemodilution, and renal blood flow did not differ significantly in all experimental periods between the two groups.
4) Renal tissue oxygen tension was not significant between before and after hemodilution, and renal tissue oxygen tension did not differ significantly in all experimental periods between the two groups.
The findings in the present study suggested that when combined with hemodilution, sodium nitroprusside is a preferable hypotensive agent, in regarding to the renal variables.

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The tissue concentration of an ester-type oral cephem antibiotic, cefcapene pivoxil hydrochloride (CFPN-PI, Flomox^®), was investigated in patients with temporomandibular joint disorder (TMD) . The results were as follows :
1. The peak concentration of CFPN in serum was 17.2μg/ml after oral administration of CFPN-PI 200mg. The peak concentration in synovial fluid of temporomandibular joint (TMJ) was 0.45μg/ml. The peak level in serum was 3.8-fold that of the peak level in synovial fluid.
2. The rate of transfer of CFPN from serum to synovial fluid of TMJ after oral administration was 12.1-74.0%.
3. Adverse reaction was slight diarrhea in one case.
Based on the above, CFPN-PI is considered to be useful for TMD patients with surgical infection.

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Death due to gas gangrene following tooth extraction of mandibular third molar was reported. The patient was a 53-year-old female. Her mandibular left third molar was extracted 8 days before she was referred to our clinic. She did not receive any prophylactic antibiotics. After tooth extraction she developed swelling and pain of the left oral floor and the neck with severe sore throat and trismus. She had been treated with intravenous antibiotics and surgical drainage at a local hospital, however, the symptoms did not improve. The CT findings of the neck were abundant gas in the soft tissue of the neck. The diagnosis was cervical gas gangrene. The hematological tests revealed increase of white blood cells (13600/mm³), CRP (25.9mg/dl), blood sugar (332mg/dl), hypoalbuminemia (Alb ; 2.5g/dl), and liver dysfunction (GOT ; 42IU/l, GPT ; 63IU/l) .
She seemed to be getting better due to drainage on Day 4 after admission, however, the neck skin became necrotic widely. On Day 8, rapid swelling and severe pain from the neck to chest were observed. The general conditions began to worsen, and she died of multi-organ failure on Day 12 (19 days after tooth extraction) . Enterococcus faecalis, Streptococcus milleri, Gemella haemolysan and Peptostreptococcus micros were isolated from the pus.
It was considered that the necrotic tissues of the neck, which might cause residual infection, should have been removed completely, and the management for hyperglycemia and hypoalbuminemia was also very important to treat severe infectious gas gangrene.

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The frequencies of severe oral and neck phlegmon due to tooth extraction and infection after third molar extraction were studied to examine background factors of infection.
1) Phlegmon occurred after tooth extraction in 20 of 142 patients (14.1%) treated in our hospital. Gas gangrene occurred in 14 of 70 patients (20.0%) reported in Japan. These infections frequently occurred after lower third molar extractions. Even severe gas gangrene did not always occur in patients with easily infective underlying diseases.
2) Although prophylactic antibiotics was administered to all 825 cases of lower third molar extraction, 6 patients (0.7%) had phlegmon and 68 (8.2%) had infection of the alveolar region. There was no relationship between the presence of underlying diseases and incidence of infection.
3) The results showed that lower third molar extraction frequently causes phlegmon or infection of the alveolar region. The incidence of infections could not be compared between the presence and absence of prophylactic antibiotics because it was adminis-tered to all patients. In the future, it will be necessary to conduct comparative clinical studies on third molar extraction with and without prophylactic administration and on different administration periods.

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Because of the unique clinical features of the complicated pathological conditions, multifactorial onset and spontaneous healing in the natural course of temporomandibular disorder (TMD), it is not very easy to determine the necessity of full-scale treatment. Therfore, the importance of incipient treatment of TMD was suggested. Furthermore, since most of the patients with TMD have pain as the chief complaint, there has been a tendency to select drug therapy as a choice of incipient treatment.
This study was designed to elucidate the usefulness and safety of ampiroxicam for incipient treatment of patients with TMD.
Fifty patients with TMD pain were administered 27mg of ampiroxicam once a day. The results were as follows:
1. The efficacy rate (more than moderately) was 72% in the scoring evaluation. Concomitant symptoms were observed in 3 patients, representing 6 % in incidence, but none were serious.
2. The results indicated that to use ampiroxicam as the incipient treatment was useful for relieving pain of TMD patients.

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