Recently, a direct oral anticoagulants (DOACs) has been developed and prescribed widely to replaces warfarin. The aim of this survey was to investigate the outcome of invasive treatment administered in accordance with existing guidelines in our department in patients receiving DOACs

From April 2015 to December 2016, we examined 15 patients who were receiving DOACs and underwent oral surgery at Suidoubashi Hospital of Tokyo Dental College and invasive treatment as outpatients. The survey items, including gender, age, original disease, DOAC type, CHADs2 score, presence or absence of past history of cerebral infarction, treatment modalities, reasons for treatment, treatment content, presence or absence of drug withdrawal and post-bleeding treatment, the treatment duration, and local hemostasis method, were investigated retrospectively from reviewing patient’s medical records.

The study included 10 men and 5 women, with a mean age of 72.0 years. The type of DOAC was dabigatran in 3 cases, riveroxaban in 10 cases, and apixaban in 2 cases. The treatment content was tooth extraction (simple and surgical tooth extractions), tooth extraction and cystectomy, and tumor resection. Thirteen patients continued to receive DOACs, and two patients chose drug withdrawal before treatment. Three cases required additional treatment due to bleeding. In one case, a combination of topical hemostatic agent and surgical plate was used for local hemostasis.

No serious complications, such as embolic disease, occurred in 15 patients. This survey results suggest that invasive treatment in patients who receiving DOACs in accordance with guidelines could lead to adequate local hemostasis.

Mecobalamin tablets, a vitamin B12 formulation, are often given to patients with postoperative neurosensory disturbance of the lip after orthognathic surgery, especially those who underwent sagittal split ramus osteotomy. Intermaxillary fixation or elastic traction is required in these patients until the jaw bone fragments are stabilized. Due to restricted mouth opening, these patients have difficulty taking medication in the form of tablets. The simple suspension method is one means by which drugs can be delivered to such patients. In this study, we developed a new delivery method for a simple suspension of mecobalamin, which is light-unstable, by light shielding with mouthwash cups used in dental practice. Under daylight conditions, suspensions of mecobalamin tablets were prepared by the simple suspension method in three groups： unshielded preparation (unshielded group) , covered with a paper cup (paper cup group) , and covered with a stainless steel cup (stainless steel cup group) . The remaining amounts of mecobalamin were measured over time in these groups. The amount of mecobalamin remaining was 102.7％ at 5 min, 69.5％ at 10 min, 38.2％ at 15 min, and 7.7％ at 30 min in the unshielded group； 101.1％ at 5 min, 92.5％ at 10 min, 82.5％ at 15 min, and 59.8％ at 30 min in the paper cup group；and 100 ％ after 30 min in the stainless steel cup group. This study revealed that light-induced decomposition of mecobalamin suspensions can be prevented for 30 min by covering them with a stainless steel cup that can completely block light. Covering with a stainless steel cup is a simple light-shielding method that can be used when preparing the suspension at the time of administration. A medical care team with healthcare professionals such as oral surgeons, pharmacists, and nurses should provide effective methods of drug delivery to patients following orthognathic surgery, as they have difficulty taking drugs orally. Also, it is necessary to verify the efficacy of treatments provided by the medical care team for postoperative adverse events such as neurosensory disturbance.

Objective The purpose of the present study was to examine the association between depression and hyposalivation.

Methods Data were obtained from 911 patients seen at the Dry Mouth Clinic at Tsurumi University Dental Hospital with complaints of dryness in the oral cavity. To determine the independent and combined effects of depression or antidepressant medications on salivary flow rates, differences among the groups with respect to depression and medication were first evaluated by two-way analysis of variance (ANOVA). Based on the hospital anxiety and depression scale (HADS), patients were divided into 3 groups according to depression and anxiety scores (0-7, 8-10, and 11-21). Each of the 3 groups were further divided into 2 groups based on whether or not they were taking antidepressants. Furthermore, logistic regression analysis was used to evaluate the relationship between independent variables (gender, age, medication and HADS) to the saliva flow rate.

Results Two-way ANOVA revealed that depression scores had a significant correlation with saliva flow rates. However, there was no significant difference in saliva flow between groups on antidepressant medication and not on anti-depressants. Logistic regression analysis showed a significant correlation between saliva flow rates and depression score, gender, and age. Patients who were categorized as depressed with HADS scale scores of 11-21 revealed a multivariate adjusted odds ratio of 2.552 for decreased unstimulated saliva flow rate and 1.660 for decreased stimulated saliva flow when adjusted for age, gender, and medications.

Conclusions The results of this study suggest that depression more closely correlates with decreased saliva flow rate than antidepressant medication.

Purpose：The purpose of this study was to investigate the efficacy of a candy containing citral, cinnamaldehyde, oligonol, and capric acid for oral candidiasis.

Methods：The effectiveness of the candy was evaluated in a double-blind placebo-controlled trial in 20 patients with hyposalivation and erythematous candidiasis. A definitive diagnosis of oral candidiasis was made on the basis of clinical features of the lesion, microscopic detection of filamentous fungal elements in smear specimens, and fungal culture. Twenty subjects were divided into two groups, test candy group and placebo group, and administered the test or placebo candies twice a day for 7days. Lesions were clinically evaluated. Candida albicans （viable CFU/ml） in oral rinse samples were measured on days 0 and 8.

Results：Atrophy of the dorsum of the tongue （p＝0.015）, redness of the dorsum of the tongue （p＝0.046）, and redness of the oral mucosa （p＝0.015） were significantly improved in the test-candy group （Wilcoxon t-test）. No statistically significant differences were observed in viable C. albicans CFU/ml and moisture content in the oral mucosa between test-candy group and placebo group.

Conclusion：The test-candy significantly improved signs of erythematous candidiasis, suggesting that the test candy can be useful in prevention of oral candidiasis in patients with hyposalivation.

Objective：The purpose of this study was to examine the effect of chronic stress on the secretion of salivary epidermal growth factor (EGF).

Material and methods：A mouse receiving long-term phenylephrine (PHE), an α₁-adrenergic receptor agonist, was used as a model to simulate chronic stress. Male ICR mice, at 12 weeks of age, were divided into 2 groups：a PHE group and a control (CTL) group. For the PHE group, PHE (5mg/kg) was injected intramuscularly twice a day for 5 days. Control mice received equivalent volume injections of saline alone. The pilocarpine-stimulated whole saliva was collected for 20 min, and then the submandibular gland (SMG) was removed. The salivary EGF concentration, and levels of EGF and EGF mRNA in the SMG extracts were determined. Immunohistochemical staining against EGF and pro-EGF in the SMG were observed. In the dispersed SMG cells, the EGF concentration stimulated by phorbol 12-myristate 13-acetate (PMA), an activator of PKC, was determined.

Results：The salivary EGF concentration was significantly lower in the PHE group than in the CTL group (p < 0.05). Concomitantly, the levels of EGF in the SMG extract were significantly lower in the PHE group than in the CTL group (p < 0.05), although there was no significant difference between the groups in the EGF mRNA levels. Immunohistochemistry revealed a reduction in the size of the EGF-immuno-reactive granular convoluted tubule (GCT) in the PHE group compared with the CTL group, suggesting that the GCT became atrophic or that depletion of cellular stores of mature EGF-containing secretory granules occurred. Similarly, the pro-EGF-immunereactive GCT was also reduced in the PHE group compared with the CTL group. Additionally, in the PHE group, EGF-immunereactive was weak in the secretory granule compare with that in the basolateral cytoplasm, suggesting that posttranslational processing from a precursor to active EGF via pro-EGF was impeded. In the dispersed SMG cells, although the EGF concentration was increased upon stimulation with PMA in the PHE group, there was no significant difference between the PHE and CTL.

Conclusion：The present results suggest that the salivary EGF was decreased by chronic stress due to the impairment of posttranslational processing and inhibition of intracellular signal transduction.

In patients receiving long-term administration of pilocarpine hydrochloride for the treatment of xerostomia associated with Sjögren’s syndrome, changes in the volume of salivary secretion, subjective symptom score, and incidence of adverse drug reactions were investigated. The subjects were 64 patients who received pilocarpine hydrochloride for 104 weeks or longer. We assessed changes in the volume of salivary secretion, subjective symptom score, incidence of adverse drug reactions, etc. during the treatment. The assessment revealed that the mean volume of salivary secretion significantly increased after 12 weeks of treatment, compared with that before the treatment. Then, the volume remained unchanged until week 104 of treatment. The mean subjective symptom score significantly decreased after 12 weeks of the treatment. Then, the mean score remained unchanged until week 104 of the treatment. In most patients, adverse drug reactions occurred soon after the treatment initiation, and there were a few patients who subsequently developed new adverse drug reactions. Moreover, hyperhidrosis and pollakisuria persisted for a long period in many patients. These findings suggested that pilocarpine hydrochloride remains effective for enhancing salivary secretion and relieving subjecting symptoms for at least 104 weeks after the treatment initiation. Additionally, long-term administration of the drug did not raise the incidence of adverse drug reactions.

Lamotrigine, as a new generation anticonvulsant and mood stabilizer, has been widely used in treating epilepsy and bipolar disorder. However, the Japanese Ministry of Health, Labour and Welfare has warned of the adverse reaction of lamotrigine. We here report a case of severe stomatitis associated with lamotrigine. A 64-year-old man presented with severe stomatitis without skin rash. He had been taking lamotrigine for bipolar disorder for at least 18 months. We suspected this adverse reaction to be due to lamotrigine. Soon after lamotrigine was stopped by the attending psychiatrist, the symptoms of stomatitis completely resolved. We finally diagnosed severe stomatitis induced by lamotrigine based on his past and recent experience. Oral surgeons should be aware of the possibility of severe stomatitis caused by lamotrigine.