The importance of multidisciplinary collaboration in the field of health care has been pointed out at the macro level, including the micro level, which pursues the effectiveness and efficiency of patient care; the cost effect in hospitals; the mezzo level, which pursues improving the quality of medical care; and promoting the construction of a community-based integrated care system. Currently,
there are more than 7,890 nursing homes for the elderly in Japan, with more than 540,000 elderly residents （2017）. The purpose of this paper is to examine the role of dentists in the practice of eating support by multidisciplinary collaboration especially in nursing homes where elderly people with weakness and disabilities are admitted.
The team-based medicine curriculum at Showa University has been thoughtfully arranged to spread out the learning locations and contents and to enable students to steadily acquire the necessary skills for team-based medicine in a structured, graduated fashion over six years in the Schools of Medicine, Dentistry and Pharmacy and four years in the School of Nursing and Rehabilitation Sciences（Departments of Nursing, Physical Therapy and Occupational Therapy）. To ensure consistent interprofessional collaborative education across year levels and schools up to graduation as well as to support academic staff to collaborate across schools, we constructed an electronic portfolio system using Xoops （Extensible Object Oriented Portal System）, the software for constructing community websites, to provide online support for communication between students and academic staff. The learning outcomes of this curriculum are broadly consistent with the interprofessional collaborative competencies of the Canadian Interprofessional Health Collaborative established in Canada and have led to the acquisition of an array of skills for the practice of interprofessional collaboration.
In order for elderly people requiring long-term care to live in a familiar environment while maintaining vibrant lives and dignity, eating until the final moment with their mouth is a key factor. To eat with their mouth indefinitely, not only improvement of masticatory and deglutition function based on its appropriate estimation, but also adjustment of food size and texture to their limited ability is necessary for safety and to prevent a state of low nutrition. We have received a grant-in-aid for lifelong practitioner education from Okayama Prefecture and have started an educational workshop to experience small group discussion mimicking multidisciplinary cooperation based on meal rounds regarding the nutritional management of elderly people requiring long-term care. Since the workshop is connecting medicine, dentistry and nutrition science, it is supported by the regional medical, dental and dietetic associations and is stimulating multidisciplinary cooperation in nursing care facilities and home care sites.
Giant cell granuloma （GCG） is widely considered as being non-neoplastic. Recently, non-surgical mandibular approaches such as intralesional corticosteroid have yielded favorable outcomes. Here we describe a patient with a GCG that worsened under intralesional corticosteroid injection, and review the literature. A 60-year-old female patient was referred to us with a large painful mass in the left mandible. Panoramic radiography and computed tomography （CT） revealed a 3×4-cm multilocular radiolucent area within the mandible that was pathologically diagnosed as a GCG from a biopsy. The patient was treated thirteen times with intralesional injections of triamcinolone acetonide （Kenacort-A 20mg） once per week aiming to reduce and eliminate the lesion. Nevertheless, the GCG increased to 4×6cm, so the tumor was surgically resected under general anesthesia. The patient has remained free of relapse for 33 months and has a good prognosis. Almost all reports describe that local steroid injections reduce or eliminate mandibular GCG, and a tendency to increase in size is rare. It is suggested that surgery should be done promptly when GCG does not respond to local steroid injection.
Hemangioma is often found in the head and neck region, but it occasionally occurs in salivary glands, especially in the submandibular gland. A 40-year-old male was referred to our division with a painless swelling in the left submandible. A hen's egg-sized mass with an elastic, soft and flexible feeling was observed in the left submandibular region. Abnormal change in the oral cavity was not found. The clinical diagnosis was a suspected salivary gland tumor. The tumor was surgically removed under general anesthesia. The dark red tumor was partially adhered to the submandibular gland, however, the border between the lesion and the surrounding tissues was clear. The mass, which consisted of the tumor and submandibular gland, was easily removed in a group. Since malignancy was not ruled out due to its rapid growth, an instant pathologic examination was performed during the surgery. Since no signs of malignancy were found in the examination, additional procedures such as extensive excision were not necessary during surgery. The final pathological examination revealed that the lesion was mainly composed of arteries, veins and capillaries of various sizes, and there was no malignant change in the lesion. Thus, considering the clinical and pathological findings, the tumor was diagnosed as a cavernous hemangioma in the submandibular gland. Two years have passed since the surgery, and both his general and local conditions are good with no sign of recurrence of symptoms.
Stickler syndrome is an autosomal-dominant disorder caused by mutation of pro-collagen genes and characterized by bone malformation, eye disease, mandibular micrognathia, and cleft palate in the oral and maxillofacial region. Palatoplasty is associated with the risk of difficulty of intubation because of the small jaw and airway obstruction caused by postoperative edema during the peri-surgical period. Here, we describe the case of a 4-month-old girl with Stickler syndrome with a past history of being intubated and sedated because of an airway obstruction caused by glossoptosis and laryngomalacia who was intubated and sedated after palatoplasty. To prevent complications, in consensus with pediatricians and anesthesiologists, the patient was managed postoperatively with intubation and sedation in the pediatric intensive care unit. Evaluation of the level of swelling and extubation was performed in 2 days. She was discharged from the hospital with no complications 7 days post-surgery as is done in usual cases of palatoplasty. We consider that the combined use of intubation and sedation is effective in preventing peri-operative complications after palatoplasty in a patient with Stickler syndrome.
Syphilis is a common sexually transmitted disease which is caused by Treponema Pallidum. Although its incidence has dramatically decreased with the use of penicillin since World War Ⅱ, a significant resurgence of syphilis has been reported in Japan. It is rare to encounter late syphilis due to the spread of antimicrobial agents. We report a case of tertiary oral syphilis in the upper jaw with anti-resorptive agents-related osteonecrosis of the jaw （ARONJ）. An 82-year-old woman presented in our hospital because of gingival pain. She was treated with alendronic acid sodium hydrate and denosumab for osteoporosis. Based on a biopsy of the left maxillary palate and blood test, syphilis gumma was diagnosed. The symptoms of syphilis infection were not seen until 82 years old, and there was no history of clear lesions equivalent to syphilis stage Ⅰ, or Ⅱ. In this case, we performed the sequester exclusion method after treating the syphilis with Amoxicillin （AMPC） medication. No evidence of disease recurrence has occurred 25 months after treatment.
Eosinophilic granulomatosis with polyangiitis （EGPA） is classified as anti-neutrophil cytoplasmic antibody associated vasculitis, which is a necrotizing vasculitis with mainly lesions in small blood vessels such as capillaries and venules. It is a rare systemic vasculitis disease. The number of people affected in Japan is currently around 2000, and it is estimated that there are 100 new patients each year. The disease had been conventionally called Churg-Strauss syndrome or allergic granulomatous vasculitis, but in 2012 it was renamed EGPA. In the head and neck region, bilaterally symmetrical salivary gland swelling has been shown. Treatment is mainly based on steroid therapy and has a good prognosis, but occasionally there are reports of severe complications such as intestinal perforation and heart failure. We report a case of EGPA showing IgG4-related disease. The symptoms such as salivary gland swelling disappeared with steroid therapy after we consulted the department of rheumatology and connective tissue disease, but four months after the initial treatment, systemic symptoms such as fatigue, facial edema, skin redness in the upper and lower limbs and re-elevation of peripheral blood IgE, IgG4 and eosinophil were observed. Accordingly, we consulted the department again and diagnosed EGPA.