It has been recommended recently that patients receiving anticoagulant therapy should undergo dental extraction without discontinuation of anticoagulant drugs in consideration of the risk of thromboembolism, but the frequency of hemorrhagic complications has not been well documented. A retrospective study of 282 patients who underwent dental extraction under continuous warfarin therapy was performed. Twenty-two of the 282 patients (8.9%) showed postoperative hemorrhages: 14 of 168 (8.3%) in those receiving administration of warfarin alone, and 11 of 114 (9.6%) in those receiving administration of both warfarin and antiplatelet drugs. Most of the hemorrhages occurred within 2 days after the extraction. The rate of postoperative hemorrhage was 5.7% in those with prothrombin time International Normalized Ratio (PT-INR) of 1.49 or lower, 12.5% in those with PT-INR of 1.5-1.99, 12.8% in those with PT-INR of 2.0-2.99, and 16.7% in those with PT-INR of 3.0 or higher, although there was no significant difference between PT-INR and frequency of postoperative hemorrhage. All patients showing postoperative hemorrhage were treated successfully by local procedures such as suturing or application of cellulose oxide gauze. These findings suggest that dental extraction can be safely done without discontinuation of warfarin therapy.
The purpose of this study was to evaluate the efficacy of concurrent chemoradiation with intra-arterial docetaxel-nedaplatin infusion to metastatic cervical lymph nodes in oral cancers. Sixteen patients with advanced oral cancer accompanied by cervical lymph node metastasis were treated between 2003 and 2009 at Hirosaki University Hospital. A total of 66 Gy of external beam irradiation concurrent with 2 to 3 courses of intra-arterial chemotherapy infusion via the femoral artery with a combination of docetaxel (40 mg/m2) and nedaplatin (80 mg/m2) was conducted. Amongst the 16 patients, 6 received a total anticancer drug delivery to the primary tumor and 10 received a partial delivery to the nodal disease. The feeding artery to the nodal disease was the facial artery in 3 patients and the occipital artery in 3 patients. The remaining 4 patients received anticancer drug infusion to the external carotid artery with arterial redistribution technique where embolization was applied in order to achieve an antitumor effect due to a high local concentration. Treatment effect was evaluated by computed tomography (CT), magnetic resonance imaging and positron emission tomography-CT (PET-CT). Metastatic cervical lymph nodes disappeared in 15 out of the 16 patients (93.8%) post-treatment. Neck dissection was performed for the patient with residual nodal disease. One patient had neck recurrence at level V in ipsilateral neck. The three-year overall survival rate was 74.6% with a median follow-up duration of 27 months. Conclusion: Intra-arterial docetaxel-nedaplatin infusion concurrent with radiotherapy is an effective treatment not only for primary disease but also for metastatic cervical lymph nodes.
The main methods currently used to sterilize dental materials employ high-pressure steam, ethylene oxide gas, or hydrogen peroxide plasma. While these methods offer outstanding sterilization capabilities, each is not without its drawbacks. Because dental materials have extensive material properties, the sterilization temperature, humidity, and other parameters must be taken into consideration. Furthermore, a strong sterilization capability is required, but the method used should preferably have no environment impact. We have developed a low-temperature plasma sterilization device that uses oxygen radicals, and have been attempting to bring it into practical use. We recently evaluated the sterilization performance of our prototype device and examined its sterilization effect for dental burrs. When evaluating sterilization performance using biological and chemical indicator strips, we found that adequate sterilization was achieved in all cases after approximately 2 to 6 hours. When evaluating dental materials, we found that sterilization was adequate when the material composition of the burr was relatively simple. However, adequate sterilization was not achieved when burrs made of silicon, carborundum and other non-metallic materials were used. Further investigation of materials having tiny pores, and investigations using different sterilization processes, will be necessary to determine how to get the plasma to penetrate the deepest layers of the materials being sterilized.
Decreased signal intensity on T1 or proton-density weighted images and increased signal intensity on T2 weighted magnetic resonance images (MRI) in the bone marrow space are considered to represent bone marrow edema (BME). The purpose of this study was to determine whether condyle BME is associated with condyle bone changes. The study group consisted of 65 temporomandibular joints (TMJs) of 57 patients with TMJ disorders showing condyle BME on initial MRI. Condyle bone changes were compared between TMJs that showed a persistent BME pattern (BME-persistent group; 43 TMJs of 40 patients) and TMJs that showed a normal bone marrow signal (BME-disappeared group; 21 TMJs of 22 patients) on follow-up MRI. (1) In the TMJs which were normal shaped condyle on initial MRI, follow-up MRI showed that condyle bone changes had occurred in 53.9% of the BME-persistent group, whereas normal shaped condyle had continued in all of the BME-disappeared group. (2) In the TMJs which showed condyle erosion on initial MRI, follow-up MRI showed that condyle erosion had continued in 35.7% of the BME-persistent group, whereas condyle erosion had disappeared in all of the BME-disappeared group. (3) In the TMJs which were condyle osteophyte on initial MRI, follow-up MRI showed that condyle erosion had occurred in 22.2% of the BME-persistent group, whereas condyle osteophyte had continued in all of the BME-disappeared group. The longitudinal study showed that condyle BME was associated with condyle bone changes. Furthermore, it was suggested that condyle BME could cause condyle erosion.
The purpose of this study was to investigate the quantitative relationship between Candida detected in microscopic and culture examinations. A total of 82 samples obtained from patients at the Dry Mouth Clinic, Tsurumi University Dental Hospital were enrolled in this study. The patients were either clinically diagnosed to have erythematous candidiasis (EC) or suspected to have Candida glossitis (CG) and underwent both microscopy of a smear specimen stained with fluorescent dye, Fungiflora Y, and fungal culture examination. The specimens were obtained from the surface of the dorsum of the tongue by swabbing. The number of Candida was expressed as the number of fungi/field of vision(FOV)by microscopy, and colony-forming units (CFU) in the culture. The results of microscopic and culture examination demonstrated that there were 0 to 3.7 fungi/FVO and 0 to 1992 CFU/dish, respectively. The correlation coefficient of the examinations was 0.569 (p < 0.001) in the EG group and 0.645 (p < 0.001) in the CG group; the regression equation was [CFU/dish] = 330.4 × [number of fungi/FOV] + 124.6, and [CFU/dish] = 304.2 × [number of fungi/FOV] + 54.5, respectively. The study suggested that the direct examination of a smear was useful, even for quantitative evaluations, because a positive correlation was observed between the number of Candida detected by microscopic and culture examinations.
In this study, we examined 41 cases of accidental insertion during tooth extraction between October 1983 and March 2010, at the Department of Oral and Maxillofacial Surgery, Nagano Red Cross Hospital. We reported migrations into the maxillary sinus in 23 cases, under the periosteum in 10 cases, into a cyst in 6 cases, and into the oral floor in 2 cases. In addition, we considered the occurrence factor, treatment method, and prevention, and compared those with cases reported before in Japan.
Unilateral condylar hyperplasia is a pathological condition creating significant functional and esthetic jaw and facial deformities. We report here a case of successful treatment with a combination of condylectomy and orthognathic surgery for correction of facial asymmetry caused by unilateral condylar hyperplasia, although this combined approach has been considered controversial by oral and maxillofacial surgeons. A 36-year-old female presented with a 14-year history of a gradual growing facial asymmetry and painful temporomandibular joint on the left side. At the first visit, she presented with mandibular asymmetry to the right side as well as elongation of the left molar of both jaws, accompanied with temporomandibular joint pain on opening the mouth. Radiographic examination showed deformed and hypertrophic condyle of the left side. Subsequent to completing the preoperative orthodontic tooth arrangement, concomitant condylectomy and bilateral sagittal splitting ramus osteotomy were performed under general anesthesia. To prevent post-surgical adhesion, an artificial non-absorbable membrane was temporarily inserted into the excised space. Histological study confirmed the diagnosis of condylar hyperplasia without any tumor cells. The clinical course was satisfactory after receiving a 2-week course of intermaxillary fixation and subsequent active postsurgical functional rehabilitation.
Beckwith-Wiedemann syndrome, also called EMG syndrome, is characterized by exomphalos, macroglossia, and gigantism. Here we report a case of Beckwith-Wiedemann syndrome accompanied with macroglossia in a 14-year-old male. The patient was referred to our hospital for macroglossia and malocclusion in March 2008. The patient was diagnosed with Beckwith-Wiedemann syndrome by the clinical features: exomphalos, inguinal hernia, cryptorchism, macroglossia, and ear creases. The patient underwent Egyedi-Obwegeser glossectomy under general anesthesia in February 2009, and was discharged from our hospital without any subjective complaints. At the time of this report, the patient had been followed up for 22 months. There has been no evidence of recurrence and the occlusion has been improving.
We report a case of Paget's disease of bone with bisphosphonate-related osteonecrosis of the jaws (BRONJ) that was could have been observed for a long term after sequestrectomy. A 60-year-old woman was referred to our hospital in November 2004 with because she the had complaints ed of both the spontaneous pain of the left maxilla and the malodor of the mouth. Intraoral findings at the initial visit revealed a the defect of the alveolar gum from the left upper second premolar to the left maxillotuberosity and the sequestrum at the same site.Her face showed a typical features of the characteristic of Paget's disease of bone. Her midfacial unit was appeared forward and her chin was retreated. Radiographic views of the skull remarkably revealed a remarkable cotton-wool appearance, and the left maxilla in the orthopantomography was occupied with by many radiopaque images mixed with some radiolucent lesions that might have been sequestrum. CT scans showed that the maxilla was totally gross and the left side of the cortical bone had been abnormally absorbed. We performed the sequestrectomy of the left maxilla under general anesthesia in February 2005. This patient took had taken various some kinds of bisphosphonates for the Paget's disease of bone from November 2000 to September 2010. We finally diagnosed of the present case as Paget's disease of bone with BRONJ. This case received could have been performed a long- term follow- up after the surgical treatment for BRONJ. No signs of recurrence and or appearance of new lesions have been noted for six years since after the surgical treatment.