The aim of this study was to examine a guideline of correspondence for extraction of the third molar on disabled patients. 63 patients (41 males and 22 females) attending the Pediatric Dental Clinic of Kagoshima University Dental Hospital participated in this study. The subject teeth were 169. The principal handicaps of these subjects were autistic developmental disorder and mentally retardation. Themes of the examination were details until extraction, status of oral health behavior until extraction, and considerations for their handicap associated with extraction. The results in this study indicated that the threshold for decision of extraction on the disabled patients is lower than healthy patients through a difficult situation of dental health care. If caregivers wish extraction of a third molar by reason of uneasiness of maintenance for satisfactory oral hygiene, a dentist should choose preventive extraction. We suggest the continuous periodic dental health care from infancy as the preventive measure to raise the threshold for decision of extraction. Because of this we thought that the continuous periodic dental health care is useful for the instruction of getting into the habit of plaque control on the disabled patients.

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From January to December 2003, the Showa University Pedodontics Department carried out checkups of 1065 cleft lip and palate patients; facts regarding the tooth extraction cases are as follows:
1. From the total number of patient visits (2320) during the one-year period, 110 cases involved tooth extraction.
2. Patients in this study ranged from 4 to 18 years of age. The greatest number of extractions was carried out on the 8-year-olds.
3. As for the reasons for tooth extraction, the largest number of cases were requests from orthodontists.
4. For those cases involving bone graftings, an average of 1.33ml anesthesia was used, and for the other cases involving persistence of deciduous teeth, an average of 0.73ml anesthesia.
5. Of the 133 teeth extracted from 110 patients, 5 teeth showed extreme tooth decay while 27 cases involved persistence of deciduous teeth most of which were of the upper jaw. From the bone grafting patients, there were 25 incisor deciduous teeth extractions located near the alveolar cleft. From the 76 extractions requested by orthodontists, most involved maxillary decidious teeth followed by permanent premolars.

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We described two cases of mandibular cyst related to apical periodontitis in mandibular second deciduous molar. In all cases, non-vital deciduous tooth and buccal cortical bone expansion were found. In a case of radicular cyst, based on clinical feature and CT-Xray finding, it was observed that succedaneus second premolar tooth displacement and no involvement of the crown of the permanent tooth in the cystic cavity after extraction of the second deciduous molar. On the other hand, in a case of dentigerous cyst, the second premolar was visible in the cystic cavity after maruspialization. These cases have had no recurrence after the surgical treatment.
These results indicate there are distinct differences between the clinical features of radicular cysts and dentigerous cysts. Radicular cysts have displacement of adjacent succedaneus tooth. Dentigerous cysts invaginated crown of succedaneus tooth in cystic cavity.

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Restrictive cardiomyopathy (RCM) is characterized by restrictive filling and reduced diastolic volume of either or both ventricles with normal or near-normal systolic function and wall thickness. In this report, we present a case of tooth extraction for decayed tooth with periapical lesion associated with RCM and severe heart failure.
A 7-year-old girl was admitted to the Department of Medicine Tokyo Women's Medical University Medical Center East because of treatment for severe heart failure following a decision to seek heart transplantation in America. Because dental examination was required during the pre-operative period for heart transplantation, the patient was referred to our department on Aug. 27, 2002.
Clinical and X-ray examination showed decayed left upper first deciduous molar with periapical lesion. After discussion with the Department of Medicine and Anesthesiology, we decided to perform tooth extraction under intravenous sedation. On Sep. 25, intravenous sedation was started with midazolam and pethidine hydrochloride after intravenous injection of ABPC. Thereafter, we observed adverse reaction to sedation and the systolic blood pressure decreased to 65mmHg. Therefore, we changed dosage of DOA from 1γ to 4γ that was continuously administered from the pre-operative period. We carried out tooth extraction under local anesthesia with 2% lidcaine when systolic blood pressure stabilized near 90mmHg. Heparin sodium was also administered continuously during surgery. Instability of blood pressure due to tooth extraction or local anesthesia was not observed.
Postoperatively, there were no symptoms of infection, including increasing of WBC or CRP, and bleeding. The patient went to America to receive heart transplantation on Feb. 24, 2003.

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A case of lymphangioma arising in the tongue is reported. The patient, a 4-year-old male, who was presented with a tumor of the middle of the tongue. MRI revealed a lesion extending from dorsal surface to the deep of the tongue. He received partial resection of the tumor based on the clinical diagnosis of tongue hemangioma.
Histopathologically, the tumor was diagnosed as lymphangioma. There is no clinical evidence of recurrence and the function of the tongue has improved 10 years after the operation.

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It is necessary for dentists to control the mandibular hypomobility in children even if it happens relatively rarely. In this case report, we present two different causes for limitation of mouth opening.
They have morphological abnormalities in their unilateral masticatory muscles on the CTs, but there is no abnormal finding around their temporomandibular joints. Case 1 is a 3 year-old boy who had a history of cranial operations several times due to multi-located brain vascular malformations. On his CTs, atrophic changes were detected in some masticatory muscles that were controlled under facial and trigeminal nerves. Case 2 is a one-year old boy who has a congenital wryneck. His temporal muscle reveals hypertrophy on his CTs. Dystonia of masticatory muscle was suspected from these findings as well as his sternocleid muscle of his wryneck. At the present time, it is very difficult to detect in detail such as electro-myographies about their pathology because of his younger age. Therefore, we will observe his oral conditions and follow up for a long time.

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A 14-year-old boy suffering severe aplastic anemia was referred from the Department of Pediatrics in Hiroshima University Hospital. He was treated with allogeneic peripheral blood stem cells transplantation from his younger brother. The chronic graft-versus-host-disease was developed in 170-days after transplantation. The manifestations in the oral region was quite unusual. The remarkable tumor from the tongue and oral mucosa were observed, and it aggravated oral hygiene. The histophathologic with diagnosis revealed the tumor consisted of hyper growth of granuloma with active vascularization.
GVHD in young patients must be increased in the near future. We should increase the quality of life of the patient with early dental intervention.

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We report a case of a congenital tooth (supernumerary tooth) in a female infant with cleft uvula. She was referred to our department by her pediatrician because of a small swelling with a tooth-like aggregate at the lower alveolar region. We found a congenital tooth and cleft uvula at the first inspection. A dental X ray showed that the congenital tooth was a supernumerary tooth, because four tooth girms of deciduous incisor were confirmed. At 5 months after her birth, we surgically removed this tooth and granulation mass under a general anesthesia. The removed specimen consisted of a juvenile tooth and a connective tissue with inflammatory cells infiltration. Because her relatives had cleft anomaly, we analyzed the gene of IRF-6, which was reported to be a causal gene of Van der Woude syndrome, in DNA extracted from the removed tissue. However, we found no mutation in all the exon of IRF-6 gene.

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Mucous cyst in the lip is a common disease. It arises usually single; multiple mucous cysts in the unilateral side rarely occur. We report a case of multiple mucous cysts in the unilateral side of the lower lip in a child.
A 9-year-old boy visited the Department of Dentistry and Oral Surgery of Toho Hospital because of a painless swelling in the lower lip. The clinical diagnosis was multiple mucous cysts and excision was performed. The tumors were pathologically diagnosed as mucous cysts and mucous glanuloma. Post operative finding has been good, with no evidence of recurrence as of 6 months after the operation.

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Tooth impaction is caused by systematic or local etiologic factors such as cysts, odontogenic tumors, supernumerary teeth, delayed tooth development and gingival fibrosis. There are few cases of impaction of deciduous teeth.
Recently, we encountered a case of impacted teeth of the mandibular right second primary molar in a 7-year-old boy. Radiographic examination revealed that the mandibular right second primary molar was impacted, and there were not any abnormal findings such as cysts or odontomas around the tooth.
Under regional anesthesia, the tooth was extracted. Histopathological examination of the soft tissue over the impacted tooth showed that the cause of impaction was suspected to be of hyperplasia of the collagen fiber at the submucosal layer.
After 2 years and 7 months of surgical treatment, the second premolar tooth tends to be erupting.

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We report a case of ameloblastoma in left second molar region of the mandible of a child. The ameloblastoma is relatively common benign odontogenic tumor most often located in the mandible. Many of the patients are young adults in the second decade of life. Radiographs usually show multilocular radiolucent lesion in most cases; however, sometimes demonstrate a unilocular radiolucency and a differential diagnosis from an eruption cyst and a dentigerous cyst becomes increasingly difficult. Thus, in certain factors, many cases may be the result in misdiagnosis of these other diseases and still be lurking. Therefore, the difficulty of diagnosis and the importance of the preoperative biopsy for ameloblastoma may be indicated.

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