A serious problem has recently arisen in the pediatric emergency medical care system of Japan. The needs for pediatric emergency medical care are increasing, mainly due to birthrate decrease and joining of women to social works. The man-power of medical service, however, is insfficient. Shortage of pediatrician and closure of pediatric clinic in hospital makes the pediatric medical care systems confused, and it would say that the pediatric emergency medical care systems are now confronted with a crisis of brake down.
True emergency cases are very few in fact among children who visit emergency units. It is so difficult to differentiate them from other children, and true severe patients have been mixed up with common patients. In different from adult, it is impossible to divide pediatric emergency systems in the first, the second and the third systems clearly, because all child patients need check with pediatricians. The check of all children makes them so tired and exhausted.
In order to improve this situation, the Japan Pediatric Society proposed “the goal and work-plan for reform of pediatric medical care system”, which is, to integrate many pediatricians into some regional pediatric centers. Along this proposal, we have to do our best, taking specific characteristics of areas into consideration.

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Forty-five jaw cysts from 40 child inpatients were analyzed in our department.
The following is the results:
1. Dentigerous cyst was the most common type of jaw cysts. Most cysts were located in the mandibular premolar region.
2. Most operations were performed under the general anesthesia. For over 10-year-old patients, operations can be performed under local anesthesia.
3. 95.6% of the treatment was surgical enucleation. Recurrence was in only one case that was marsupialized among the dentigerous cysts.
4. Recently, associated teeth except wisdom and supernumerary teeth tend to be preserved.

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We investigated the oral function in mentally handicapped children using questionnaires, and compared the results with those obtained from healthy children.
The subjects were 49 healthy kindergarten children and 26 mentally handicapped children. Ingestion function, swallowing function, and voluntary motor function of the tongue were investigated. Abnormal ingestion function was significantly higher in handicapped children (88%) than in healthy children (67%) (p<0.05). Swallowing function was abnormal in 12% of the healthy children, and 23% of the handicapped children. The mean voluntary motor function value of the tongue was significantly higher in healthy children (12.8) than in handicapped children (6.4) (p<0.05). Furthermore, “Dislike hard food” and “Dislike food which is tough and difficult to chew” were significantly more frequent in handicapped children than in healthy children (p<0.05).
Although ingestion and swallowing functions were lower in handicapped children than in healthy children, abnormalities in ingestion function and dislike of hard food were also noted in healthy children, suggesting that there are many children who “do not chew” or “can not chew”. From our results, we considered that it is important to obtain masticatory adaptation behavior by making meals pleasant and providing guidance in ways of eating.

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In this paper four cases of oral malignant tumor occurred in children were reported, at the Department of Dentistry and Oral Surgery, Keio University Hospital from 1984 to 2004. They were malignant lymphoma of the lower lip, squamous cell carcinoma of the lower gum, neuroblastoma of the mandible, and osteosarcoma of the mandible.
[Case 1] A 12 year old-girl came to our hospital with a chief complaint of a painless tumor of lower lip. The tumor was surgically removed under general anesthesia, and a pathological diagnosis of malignant lymphoma was made. After the operation, radiation therapy (40Gy) was given. There is no evidence of recurrence about 17 years and 1 month after the operation.
[Case 2] A 12 year old-boy was referred to our hospital because he was pointed out to have an ulcer of lower gum at the dental check-up of his school. The pathological diagnosis by the biopsy was squamous cell carcinoma.
[Case 3] The patient was a 14 year old-boy with a chief complaint of gingival swelling in the left molar region of the mandible. The pathological diagnosis of the mandibular lesion by biopsy was neuroblastoma, and the primary tumor was found in the left adrenal gland. Chemotherapy, surgical resection and radiation were given. Twelve years and 4 months after the mandiblectomy, the patient is alive with no evidence of local recurrence or metastasis.
[Case 4] A 9 year old-girl complained of a painless swelling in the chin. Pre-and post-operative chemotherapy (MTX+VCR) was administered, mandiblectomy combined with neck dissection was performed. However 10 months later, there was a metastasis of the lung. She died 2 years and 4 months after the first medical examination.

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The disabled children are more susceptible to dental trauma in comparison with the healthy children. Maxillary incisors have a tendency for more dental trauma. The aims of this case study are to examine for related problems with disability on the treatment by the therapeutic experience of the traumatized maxillary incisors of disabled patients based on two cases. One of cases (case 1) is luxation and impacted injuries teeth of the patient with slight ly mentally handicapped and emotionally disturbed children, another case (case 2) is subluxation teeth of the patient with Down's syndrome. In the case 1, the related problems were hyperactivity on the treatment and insufficient oral hygiene at post operative care, and in the case 2, the problems are the short root of a tooth and an increased susceptibility to infection.

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We describe a case of congenital epulis observed in an 8 day-old female neonate. Clinical examination of the lesion showed a spherical, pedunculated mass on the right posterior maxillary gingiva, about 10×7mm in diameter. Excision of the tumor tissue was performed as an outpatient. The tumor was diagnosed histopathologically as an epulis fibrosa. As of 7 months after the operation, no sign of recurrence has been observed.

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Pleomorphic adenoma rarely arises in childhood. We report a case of pleomorphic adenoma of the palate. A 12-year-old boy was referred to our department for evaluation and treatment of palatal swelling. The lesion was diagnosed as a pleomorphic adenoma on examination of a biopsy specimen. The lesion was excised under general anesthesia. The pathological daiagnosis was pleomorphic adenoma. At present, the post-operative course is uneventful with no evidence of recurrence.

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We encountered two cases of penetrating wounds due to toothbrush piercing into the oral mucosa. A 10-year-old boy patient was stuck into the medial region of right mandibular ramus, and a 7-year-old girl patient was stuck into the left cheek. In both cases, the toothbrushes were easily removed under local anesthesia without severe postoperative complication. CT was useful to confirm the location of toothbrush in the first case. The cause of these cases was an accidental hitting when they were brushing their teeth after lunch at school. To prevent such accidents, we should call attention to parents, teachers, and pupils.

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Dentigerous cysts are developmental cysts. The pathogenesis of dentigerous cysts remains unknown; however some literature attribute the origin to degenerative changes in the reduced enamel epithelium following completion of the crown. Dentigerous cysts commonly occur unilaterally associated with the crown of permanent teeth. We report a case of dentigerous cysts occurring in mandible bilaterally in a 10-year-old-girl. A panoramic radiograph showed a well-defined radiolucent lesion that includes the crowns of unerupted bilateral mandibular second premolars under deciduos second molars. Computed tomography (CT) showed buccal cortical thinning and displacement of intra alveolar canal. Under general anesthesia, the cysts enucleated considering the preservation of involved permanent teeth. One year follow-up visit showed correct eruption of the teeth and stable occlusion.

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We presented a case of thyroglossal duct cyst performed reoperation. A four-year-old boy visited our clinic with the complaint of an unhealing mass of his anterior neck. He was given an incision to discharge the fluid some-times under the diagnosis of abscess of the neck. The clinical appearance and imaging features settled the diagnosis of thyroglossal dust cyst. He received a simple extirpation of the cyst at first, but it recurred six months after the operation. Secondary Sistrunk method was done with hyoid bone resection. Postoperative course of the second operation was uneventful for one year observation period.

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We report a case of huge hemangioma of the gingiva and cheek in an infant. A 8-month-old-boy was reffered to our department with a chief complaint of swelling of his maxillar gingiva. MRI revealed a mass thought to be a hemangioma in the right posterior maxillar gingiva and cheek. Angiography did not demonstrate the feeding vessels of the tumor. Only the tumor of the gingiva was surgically resected under general anesthesia. The postoperative course was uneventful, 9 months after surgery no evidence of reccurrence had been observed. MRA finding was very useful for the hemangioma of the infant.

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Odontoma is a tumor arising from the dental enamel, dentin and dental cementum where the majority is of the harmartoma type. At times, the components of the enamel epithelia may be identified at the marginal regions. We herein report a case of infantile odontoma with concomitant ameloblastoma that was histopathologically identified.
A 9-year-old boy sought dental consultation at the Department of Dentistry and Oral Surgery, Toho Hospital with the chief complaint of abnormal tooth eruption of the anterior maxillary tooth. Clinical diagnosis for odotoma was established with radiographic examination. The lesion was enucleated under local anesthesia. Histopathological examination identified cellular foci of ameloblastoma in both the ondontogenic solid and soft tissues and was diagnosed as compound odontoma. The post-operative course has been uneventful.

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