Clinical Statistics for Dysphagia Patients ≦ 18 Years of Age in the Center of Special Needs Dentistry, April 2012-March 2013

In April 2012, the Center of Special Needs Dentistry (SND) was established at Showa University Dental Hospital to provide function training for children with eating and swallowing disorders. A statistical clinical assessment was performed on new patients ≤18 years of age who visited the Center over a 1-year period (April 2012–March 2013) to assess the conditions present at the initial visit. In all, 60 patients (29 boys, 31 girls, mean (± SD) age 4.2±4.1 years, range 0-18 years of age) were included in the study. Most patients were <1 year of age (32%) and most came from one of four cities in the Johnan area (Shinagawa City, Meguro City, Ota City and Setagaya City). The most common primary diseases at the initial visit were cerebral palsy and cleft lip and palate. The third largest patient group was of healthy children with oral function problem. Over 60% of patients attended the Center of SND because of an eating-related complaint. More than 50% of patients were obtaining nutrients via oral intake; the remaining patients were obtaining nutrients via non-oral or a combination of oral and non-oral intake. Because of the young age of the patients and the fact that most were from neighboring areas, it can be inferred that effective community health care is being provided. It is necessary for the Center of SND to continue to provide professional treatment for dysphagia and to contribute to community medicine

Changes in Oral Dryness of the Elderly in Need of Care: The Effect of Dentifrice with Oral Moisturizing Agents

The aim of this study was to find a method for the elderly to cope with xerostomia and oral dryness. In particular, we investigated whether daily oral health care with a dentifrice that included a moisturizing agent could affect oral dryness. The subjects were 10 elderly women (mean age was 80.1 years old) who resided in a nursing home and were using a dentifrice that contained a moisturizing agent for daily oral health care. After three months of the beginning of using a dentifrice, the participants were classified into 2 groups, 5 women who continued to use the dentifrice and the others who stopped using the dentifrice for two months. An oral dryness evaluation was carried out with an oral mucosal moisture measurement and a saliva wetness test at the beginning of use of the dentifrice, three months and five months later. The oral mucosal moisture measurement of buccal and tongue mucosa indicated a significant improvement after 3 months of continued use of the dentifrice. However, all participants who had stopped using the dentifrice reverted to their prior oral dryness condition after five months. In the dentifrice group there was almost no variation for two months. These results show that application of a dentifrice with an oral moisturizing agent could improve the oral dryness of the elderly. When the elderly stop using the dentifrice, multidirectional intervention could be needed for fundamental improvement of oral dryness and xerostomia

Three-dimensional Motion Analysis of Lip and Mandibular Movements during Mastication

Many aspects of the coordination of lip and mandibular movements in the process of eating have not yet been clarified. This time, aiming to objectively evaluate lip and mandibular movements when chewing, the movements of the corners of the mouth and the mandible during mastication were measured three-dimensionally and analyzed. The subjects were 20 healthy women with individual normal occlusion. The test food was a commercially-available biscuit with a weight of 1 g. With six measuring points set for the lips and pogonion, the movements at those measuring points were captured with two CCD cameras during mastication, and the resulting images were analyzed with a three-dimensional motion analysis system. The analysis result showed that X- and Z-axis movements occurred on the working-side corner of the mouth, with Z-axis movements preceding X-axis movements, while on the balancing-side corner of the mouth, X- and Z-axis movements occurred simultaneously. Data on the amount, time taken, and speed of movements measured at each anatomical landmark showed that the working-side corner of the mouth moved a greater distance at a faster pace and, therefore, in less time than that of the balancing-side corner of the mouth. This is conceivably due to the aforementioned differences in X- and Z-axis movements of the working-side and balancing-side corners of the mouth. Further comparisons and studies with expansion of the subjects to include children will be necessary

Activities and Actual Achievements of Respiratory Support Team at Showa University Hospital: Report of Activities in the Year 2012

In this study, the contents of the Respiratory Support Team (RST)\u27s activities, present status of the activities, and oral health problems were evaluated to standardize the management of patients using ventilators at Showa University Hospital. The RST consisted of medical doctors, nurses, medical engineers, physiotherapists, dentists, and dental hygienists. The aim of the team was to standardize the management methods of ventilators and promote early weaning from ventilators. Between April 2011 and March 2012, the RST performed interventions for a total of 184 inpatients. The number of interventions was highest for respiratory medicine, followed in order by gastrointestinal medicine, hematology, cranial nerve surgery, and cardiovascular surgery. During rounds and in training sessions, the members of the RST explained and demonstrated the management of ventilators and facemasks to the staffs of wards where ventilators were used. The results indicated that the management methods of ventilators at Showa University were partially standardized through knowledge transmission from the members of the RST to the staffs of the wards. Moreover, since the dental professionals participated in the RST, the ward staff had opportunities to improve methods of oral hygiene management. However, some future recommendations were provided on indication sheets that varied according to the type of ventilator, and there was no standardization in terms of ventilator settings and facemask selection

Survey on the Issues and the Changes of Oral Health Condition of Inpatients in the Intensive Care Unit

The aim of this study was to consolidate oral health management systems in the acute stages. The practical status of oral health in perioperative patients and improvements achieved through coordinated oral health care were investigated. Subjects of the present study were 87 patients who underwent oral intubation in the intensive care unit (ICU). These patients attended an oral health care center from October 2010 to March 2011. Dentists rated the oral status of subjects within 24 h of admission to the ICU on a three-point scale by assessing the lips, teeth, mucous membrane, gingiva, tongue, and saliva. In addition, the number of Candida colonies detected on the tongue was noted at initial assessment. At initial assessment, 70% of participants with respiratory diseases were classified as having oral problems. However, few subjects showed presence of dental plaque or reported problems involving the mucous membrane. The proportion of Candida-positive participants was higher in those with respiratory diseases than those with cardiovascular diseases. When comparing the Candida-positive and -negative subjects, a greater proportion of the former had problems with the lips, saliva, mucous membrane, and tongue. With regard to the time-dependent changes recorded on these problems, improvement in the condition of the lips tended to occur earlier than the conditions of the tongue. As it has been suggested that maintaining a clean tongue can be critical in patients undergoing oral intubation, it is important to continue appropriate oral health care in the acute stage

Incidentally found abdominal para-aortic and inferior mesenteric root lymph node metastases of prostatic adenocarcinoma in a surgical case with sigmoid colon cancer

We report a rare case of incidentally found metastatic adenocarcinoma in the abdominal para-aortic and inferior mesenteric root lymph nodes originating from the prostate, at the time of surgery in a patient with sigmoid colon cancer. A man in his mid-seventies was scheduled to undergo laparoscopic-assisted sigmoidectomy and regional lymph node dissection. At the beginning of laparoscopic surgery, a caterpillar-like swelling of abdominal para-aortic lymph nodes was found; the diagnosis using frozen sections was a metastatic adenocarcinoma showing cribriform and solid growth patterns different from typical colorectal cancer. The surgical procedure was changed to an abdominal sigmoidectomy with widely extended lymph node dissection, including inferior mesenteric root lymph nodes and sampling of abdominal para-aortic lymph nodes. The resected sigmoid colon cancer was a papillary/tubular adenocarcinoma invading the muscularis with no lymph node metastasis (pT2N0M0/pStage IIA). Additionally, the presence of a metastatic adenocarcinoma showing cribriform and solid growth patterns different from the primary sigmoid colon cancer was confirmed in the abdominal para-aortic and inferior mesenteric root lymph nodes. The metastatic adenocarcinoma cells were positive for prostate-specific antigen (PSA) and negative for CDX2, indicating that the tumor was from the prostate. A total of ten prostatic core needle biopsy specimens also contained a usual (acinar) adenocarcinoma, with a Gleason score of 4 + 5 = 9. Androgen blockade was performed; the serum PSA level was reduced to 0.06 nanograms per microliter in the subsequent five months. Regardless of radiologic images, examination of serum PSA level is recommended before surgery in male surgical colorectal cancer patients more than 60 years old