Many convincing merit of perioperative oral management（POM）for the patients scheduled various medical operation had been shown. However, POM has not been widely spread in medical setting so far. We learned the actual conditions of medical doctors from preparation for major surgeries to perioperative period. We considered effective cooperation for POM between medical hospital and dental clinics.

View full abstract

Gastric cancer is the second leading cause of cancer-related death in Japan. The stage of gastric cancer is dicided on depth of tumor invation, degree of lymph nodes metastases, and existence or non- existence of distant metastasis. A therapeutic strategy of gastric cancer patient is decided according to his clinical stage. Very early gastric cancer is treated by endoscopic resection, such as endoscopic mucosal resection or endoscopic submucosal dissection. On the other hand, far advanced gastric cancer with distant metastasis is treated with chemotherapy or best supportive care. Surgical resection with regional lymphadenectomy remains only curative treatment for most of gastric cancer. Laparoscopic gastrectomy offers significant advantages on short-term outcomes compared with open surgery for patients with gastric cancer. Approximately 90 % of patients with gastric cancer, including both early and advanced cancers, have underwent radical laparoscopic gastrectomy in our hospital. The clinical pathway of laparoscopic distal gastrectomy provides discharge from the hospital post operative 10th days due to advantages on short-term outcomes of laparoscopic surgery. Though surgical procedures in gastrointestinal cancer became less invasive by laparoscopic surgery, there remains several high invasive surgical procedures such as esophagectomy and pancreatico- duodenectomy. Further, elderly patients, especially over 80 years old, and patients who were treated with chemotherapy pre- or post-operatively have been increasing. Perioperative oral care is expected to have a pivotal role in these patients to avoid postoperative complications, including aspiration pneumonia. Cooperation between medical and dental doctors would provide safe surgery and medication for patients with gastrointestinal cancer.

View full abstract

Primary lung cancer is the leading cause of cancer death in most industrialized countries including Japan, and the most effective therapy for the cure is surgery. Traditionally, lobectomy through open thoracotomy had been performed as a standard surgery for lung cancer, but less invasive surgery such as video thoracic surgery has been increasingly performed. On the other hand, in specialized hospitals, more complex surgery such as bronchoplasty as well as extended surgery and extrapleural pneumonectomy for malignant pleural mesothelioma, are performed, which may be associated with increased morbidity and mobility. To prevent postoperative complication including pneumonia, oral care prior to thoracic surgery is essential. In the present article, thoracic surgical techniques for primary lung cancer and malignant pleural mesothelioma are described.

View full abstract

It was revealed that oral hygiene influenced the onset of perioperative complications. The need of perioperative oral management aiming at the outbreak decrease in treatment complications and an early discharge was recognized. As a result, perioperative oral management fee was founded at revision of medical service fees in Fiscal year 2012. It was admitted that dentistry was important to the medical postoperative complications prevention. This enforces oral management until a discharge before hospitalization by medical department dentistry cooperation, and it is thought that it was recommended that complications are prevented. It is thought that the health care services provided by health insurance introduction of the item which established an important point for the prevention was timely for dentistry to do preventable illness such as periodontal disease or the caries if targeted for treatment very much. We discussed 222 patients who calculated perioperative oral management fee a year of from April, 2012 to March, 2013 for observation and the characteristic and problems in department of Dentistry and Oral Surgery, University Hospital of Occupational and Environmental Health. We relate it to position improvement of dentistry for increase in number of patients by appealing to the society for importance of perioperative oral management. It is necessary for the dentist to deepen the understanding for the disease from head to foot because we let you recognize the importance to the medical department side enough concretely, and the medical department medical attendant introduces a patient to the dentistry side smoothly. It is necessary to build the patient introduction method that it is simple and easy as possible, and there are few burdens for the medical department medical attendant of the origin of introduction. We will evaluate validity and the effect of the oral management method of our course in future. I want to appeal for the need of the oral management team foundation in connection with in-hospital Respiratory Support Team and Nutrition Support Team.

View full abstract