Child abuse is attributable to the debilitating relation of parents and child, and its risk factors are that there are characters of parents and child, viable history of parents, problems of family, relation of family and its region. Protection of child abuse is needed social supports due to intervention of risky family. Cases of child abuse come across medical fields. So, medical servers should be acquired characteristics of child abuse, purposed to making an early diagnosis and its treatments. Medical facilities are requested guard and care of children, its therapy from regional society.

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The problems with cleft lip/cleft palate, especially those associated with complete cleft lip, alveolus and palate are complex and multifaceted. Residual esthetic stigmata and/or speech disturbances after surgery adversely influence patient's appearance and function. Accordingly, multidisciplinary treatment should be performed so that the patient can realize optimal functioned, esthetic and social conditions. This paper will present problems about the sequential treatment and multidisciplinary approach for the cleft lip and palate patients whom we perform in our clinic.
Cleft lip and palate treatment should be systematic, sequential and it should be directed by consistent policy. We emphasize that the dental knowledge and experiences in multidisciplinary management are indispensable in order to obtain good results. The usefulness of Hotz's plate is recognized in worldwide. Presently, we are satisfied with our results of two-stage palatoplasty by Perko's technique, based on the clinical and research activities. These include investigation of maxillary dental arch form, incidence of reversed occlusion, esthetic problem of facial balance, velopharyngeal function, speech, incidence of oronasal fistula, and palatal sensation.

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In this review, the latest thinking on pediatric dental treatment and oral care is discussed in the relation to child growth and development from the perspective of Pediatric Dentistry in Japan.
Topics related to the treatment of traumatic primary tooth injury are as follows.
(1) Treatment of an intruded primary tooth or immature young permanent tooth is usually delayed for several months until the tooth re-erupts.
(2) Pulp treatment in immature permanent tooth must be attempted to keep the root pulp alive.
(3) Though replantation of an exfoliated primary tooth is not recommended in either AAPD or IATD guidelines, in Japan replantation is usually positively selected.
Next, other topics about incision of the frenum and midline diasthema in denture guidance are discussed.
Moreover, recall system is most important in Pediatric Dentistry and the Institution of Pediatric Dental Specialists was started in July 2005.

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Heart transplantation is recognized as the standard therapy for end-stage heart failure in Europe and America. The 1-year survival rate for recipients is 80%, and the 5-years survival rate was 70%. In particular, heart transplantation is necessary for the survival of a severe pediatric cardiomyopathy patient. Since there are many children with severe cardiomyopathy in Japan, the prevalence of heart transplantation will increase in the near future.
We studied 10 pediatric patients after heart transplantation aged 3 to 15 years for whom dental examination and treatment were requested by the Department of Internal Medicine at our center. Sixteen decayed teeth were found in 6 patients, 2 teeth with apical periodontitis in 2, 30 teeth with gingival enlargement in 2, 3 teeth with hypodontia in 2, 1 fused tooth in 1, 2 microdonts in 1, 1 impacted tooth in 1, and mobility of a deciduous tooth in 1. All patients received an explanation of tooth brushing technique. Eight teeth were extracted in 2 patients before heart transplantation, and 2 teeth were extracted in 2 patients after heart transplantation. Dental calculi were removed from 6 teeth in one patient.
We report the details of these oral lesions and appropriate dental procedures for children with heart transplants and describe ontimal antibiotic treatment.

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The purpose of this study is to report an evaluation of speech therapy for patients with a brief discussion. The patients were seen in the 2nd Division of Oral and Maxillofacial Surgery, Meikai University Hospital, between September 1, 2000 and August 31, 2005. During the period of this study, 107 (nonage) patients under 20 years of age were evaluated and/or managed with speech therapy. The results were as follows:
(1) Ninety-eight of the patients had some form of congenital disorder. Seventy-seven of them with cleft palate had severe articulation disorders, and needed more speech therapy than the other 21 of them without cleft palate.
(2) Only 9 of the patients had functional articulation disorders. Since their families expressed high motivation to get a good intelligibility, speech therapy for the patients was done more frequently than that for the others.

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Morphological change of the submucous cleft palate (SMCP) is generally mild and does not exhibit a marked cleft, therefore, the disorder often fails to be noticed in the earlier stage, and by the time the patients visit a hospital, they have already developed hyper nasality and articulation disorder, which makes the treatment more difficult and there are also many problems in initiating treatment. There is a great deal of variety in speech disorders. In addition, the symptoms vary considerably according to the degree of disorder, so much remains unknown about the treatment. However, the patients of SMCP vary from a patient needing surgical therapy to a normal patient able to speak without surgical treatment. In this study, we investigated the present state of patients with submucous cleft palate who visited our department with the purpose of aiding future treatment.
The results are as follows:
1. There were 24 males and 26 females, with a male to female ratio of 1: 1.08.
2. Chief complaints were speech problems (60.0%), 15 patients (30.0%) desired to undergo a detailed oral examination, 3 (6.0%) desired surgery, and 2 (4.0%) desired prosthesis surgery.
3. In the treatment of speech disorder, sixteen patients (36.4%) underwent speech rehabilitation only, and 28 patients (63.6%) underwent surgery combined with speech rehabilitation.
4. During the course of observation, 93.8 % of the cases with speech disorder were improved after speech therapy only, and 96.4% of the cases with disorder were improved after surgical operation and speech therapy
The difficulty in diagnosis of submucous cleft palate was due to the lack of suitable clinical systems. Therefore it is necessary for clinics to cooperate in the treatment of submucous cleft plate.

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The purpose of this study was the comparison of maxillary growth after treatment of cleft palate by a supraperiosteal or mucoperiosteal flap. The subjects selected for this study were the patients under Hellman's dental stage IIC or IIIA. The upper and lower plaster models were obtained from 53 cases of the children with cleft lip and palate who were treated by mucoperiosteal flap at one year and six months old in our clinic (13 cases of bilateral cleft lip and palate [BCLP], 20 cases of unilateral cleft lip and palate [UCLP], 20 cases of cleft palate [CP]) and 45 cases of the children with cleft lip and palate who were treated by supraperiosteal flap (12 cases of BCLP, 18 cases of UCLP, 15 cases of CP). For the control, 30 upper and lower plaster models were obtained from normal children. The following results were obtained.
1. Occlusal patterns: In dental stage IIC period, classified by the terminal plane, a ratio of the mesial step type was 75.0% of the mucoperiosteal flap groups, while it was 56.8% of the supraperiosteal flap groups. In dental stage IIIA period, classified by the Angle's classification, a ratio of Class III was 7.8% of the mucoperiosteal flap groups, and it was 6.0% of the supraperiosteal flap groups.
2. Arch length: Upper arch length of the supraperiosteal flap groups were near to those of the normal groups, and for the comparison, different arch lengths of the mucoperiosteal flap groups in UCLP cases and CP cases were smaller than those of the normal groups.
3. Arch width: Widths between the first molars of the supraperiosteal flap groups were near to those of the normal groups.
4. Tongue space capacity: Tongue space capacity of the supraperiosteal flap groups was bigger than that of the mucoperiosteal flap groups, but it was smaller than those of the normal groups.
Therefore, the obstacle to maxillary growth of the supraperiosteal flap groups is less than that of the mucoperiosteal flap groups. It was suggested that it was one of the final targets of consistent treatment to greatly contribute to the acquisition of the neutral articulation as far as possible.

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Cystic lesions in children treated and carried out histopathological examination in our department between 1978 and 2004 were studied from clinical viewpoints. The 286 subjects in this study included 84 cases with cysts of the jaw and 202 cases with cysts of the soft tissue. Among cysts of the jaw, the most common cyst was the dentigerous cyst (37 cases). 32 cases were radicular cysts, and others with odotogenic keratocysts, calcifying odontogenic cysts. Among cysts of the soft tissue, the most common cyst was the mucous cyst (171 cases). These cases comprised the majority of the cysts of the soft tissue.

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We report a case of bilateral globulomaxillary cysts. A 15-year old girl with Charcot Marie Tooth disease was referred to us because of pain and swelling of the left anterior part of the maxilla. A panoramic X-ray film and CT scan revealed bilateral globulomaxillary cysts with characteristic findings to enlarge of distance between root of lateral incisor and canine. Bilateral lateral incisor and canine were vital teeth. Both cysts were removed under general anesthesia. Cyst wall was not seen any epithelium, therefore there was no evidence of the facial fissured cyst. Then we thought of odontogenic cysts in this case, but precise cause was unknown.

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Congenital teeth which are present at birth are referred to as natal teeth, while those that erupt during the first month of life are referred to as neonatal teeth. There have been many reports on the frequency, classification, causes and treatments of early eruption. We encountered two cases of congenital teeth which required extraction right after birth.
Congenital teeth are rare, and almost always involve milk teeth, which was the case in the present two cases as well.
The congenital teeth in the present cases showed marked mobility, and because spontaneous loss was expected, it was decided to extract the teeth to prevent aspiration.
After adequately explaining the risks of misalignment and malocclusion associated with extraction of the congenital teeth to the patients' mothers, we plan to continue long-term follow-up.

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The ameloblastoma is the most common epithelial odontgenic tumor. and it is often difficult to make a differential diagnosis from a dentigerous cyst. We report a case of ameloblastoma revealed prior to orthodontic therapy. On February 18, 2004, an 11-year-old girl was referred to the Division of Orthodontics with a chief complaint of an unerupted second molar. Panoramic radiography showed a unilocular radiolucent lesion that included the crown of the unerupted second molar. A tentative diagnosis of dentigerous cyst was made, and the lesion was marsupialized.
Histopathological examination resulted in a diagnosis of ameloblastoma (follicular type).
Therefore excision of the tumor was performed carefully, and the related impacted tooth was managed conservatively by a tooth traction technique. The postoperative course was uneventful. There was no evidence of recurrence 2 years after the operation.
In conclusion, we emphasize that it is important to examine the lesion histopathologically even when marsupialization for a cystic lesion has been done.

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The treatment of mandibular fracture in infants has normally been carried out with conservative methods to consider the mandibular growth and existence of the permanent tooth germ before. We have encountered a case of a 1-year-3-months old girl with a fracture of the right mandibular body and the left condylar head region. After the occlusion was stabilized, intermaxillary retraction with an elastic band continued for 20 days.
After this therapy, no abnormality of mandibular function has been observed in this 2 years. Careful observation should be continued for a long duration in our department.

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Mucoepidermoid carcinoma is the common malignant salivary gland neoplasm observed in adults, however, in a relatively low incidence in children. This report described a case of mucoepidermoid carcinoma of the hard palate in a 10-year-old boy. He was referred to our hospital with a chief complaint of swelling on the hard palate on April 28, 1999. He had had a 6-month history of swelling on the left side of the hard palate. This lesion had been biopsied in another institution 2 weeks previously, and diagnosed as “mucoepidermoid carcinoma”. Clinical examination disclosed a smooth and round mass 25×15mm in size involving the left hard palate. There was no regional lymphadenopathy and general physical examination was unremarkable. Computed tomography showed an enhancing region corresponding to the tumor. The patient underwent excision of the mass with partial maxillectomy under general anesthesia. Microscopic examination showed a cystic lesion that was partly filled with proliferation of the tumor cells, and a pathological diagnosis of mucoepidermoid carcinoma was made. The clinical course after surgery was satisfactory for over 7 years, while he received administration of UFT 600mg per day orally for the postoperative 12 months.

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