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We aimed to assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study participants were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Blood test results, underlying diseases, surgical site, extraction method, and postoperative complication data were obtained from medical records. Potential risk factors of postoperative complications were analyzed using multivariate logistic regression. Patients were divided into two groups: 61 (26%) patients with a CD4 count < 200/μL, and 170 (74%) with a CD4 count ≥ 200/μL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n = 10; surgical site infection, n = 2). The rate of complications did not differ between the CD4 < 200/μL group (1.6%) and the CD4 ≥200/μL group (6.5%) (adjusted odds ratio [aOR]: 9.328, 95% confidence interval [CI]: 0.470, 185.229; P = 0.1431). Surgical extraction with bone excavation, but without CD4 count, was identified as a risk factor for post-extraction complications (aOR: 22.037, 95% CI: 1.519, 319.617; P = 0.0234). A low CD4 count is not a risk factor for post-extraction complications in patients with HIV infection. We conclude that tooth extraction should be performed based on dental/oral conditions, and not delayed until CD4 count improvement.

Source of fever in chemotherapy patients is often unknown. Fever can also be fatal. No observational studies have determined the incidence of dental focal infection (DFI)-associated fever, despite oral cavity being a potential source of infection. We report the incidence of fever after chemotherapy in patients with hematological malignancies and their association with DFIs in 441 patients visiting our institution during a 6-year period. Dental treatments, including tooth extraction, were performed, and their oral and hematological profiles were monitored after chemotherapy. Fever was evident in 87 (38.5%) of 226 patients (≥ 38˚C) after the first cycle of chemotherapy. Sepsis due to DFIs (n = 4; 4.6%) was evaluated. Chemotherapy was delayed due to DFI in one case. Fever after chemotherapy should be differentiated from oral infections. Our study emphasizes the significance of DFI in patients with fever after chemotherapy and can help in improving the prognosis of patients.

Aim We conducted a multicenter study to explore the risk factors of developing pneumonia and the effectiveness of perioperative oral management (POM) for the prevention of pneumonia in postsurgical patients. Methods and results A survey covering eight regional hospitals was conducted over 4 years, from April 2010 to March 2014. Using the Diagnosis Procedure Combination database, a target group of 25,554 patients with cancer who underwent surgery was selected and assessed from a population of 346,563 patients without pneumonia on admission (sample population). The study compared the incidence of pneumonia and attempted to identify the significant predictive factors for its occurrence in these patients using multiple logistic regression analysis. Comparative assessment for the occurrence of pneumonia before and after POM implementation showed a significant incidence decrease after POM introduction in the target group, with no such change observed in the sample population. Multiple logistic regression analysis showed that the odds ratio for pneumonia occurrence after POM introduction was 0.44, indicating a reduced risk of pneumonia. Conclusion POM in cancer patients was indeed effective in reducing the incidence of pneumonia in hospitals and thereby helped in preventing pneumonia during hospitalization.

A 42-year-old man diagnosed with acute myeloid leukemia complained of progressive swelling of the right side of his face with pain 11 days after the third cycle of consolidation therapy with high-dose arabinosylcytosine-cytarabine. Head and neck magnetic resonance imaging showed a mass lesion in his right maxillary sinus with parapharyngeal involvement, which included the right masseter muscle, intraorbital involvement, and an abscess in his brain. Chest computed tomography revealed peribronchial small nodules in his right upper lobe and a necrotic tumor in his right lower lobe. Molds identified as Cunninghamella bertholletiae were isolated from the necrotic ulcer. According to these results, chemotherapy for leukemia was discontinued. High-dose liposomal amphotericin (10 mg/kg/day) was initiated. Because renal dysfunction occurred, the dosage was decreased to 6 mg/kg and combined with 150 mg/day micafungin. Debridement of necrotic tissue in the right maxillary sinus and establishment of the fenestration between the sinus and oral cavity were performed. Subsequently, brain and lung lesions were surgically removed. Rhinocerebral mucormycosis was successfully treated without relapse over 3 years by a 112-day course of intravenous anti-fungal therapy and 223-day course of terbinafine and partial surgical removal, respectively, to maintain masticatory and ocular functions. To our knowledge, there has been no other report of a long-term survival case of rhinocerebral mucormycosis due to C. bertholletiae.

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder characterized by tumorigenesis and physical deformities. Although more than 50 clinical manifestations have been described, only two major criteria or one major and two minor criteria are necessary for diagnosis. The most frequently observed manifestation in the oral and the maxillofacial region is an odontogenic keratocyst. In this study, we describe a 14-year-old boy with a diagnosis of NBCCS who presented with a central odontogenic fibroma (COF) in the mandible. This report highlights the importance of precise diagnosis and the choice of surgical method for COF.

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.

A case of surgical ciliated cyst after Le Fort I osteotomy is described. A 32-year-old man who had undergone Le Fort I osteotomy in 1992 was referred to our hospital because of swelling in the left cheek. Radiographic and computed tomographic examinations showed a unilocular cystic lesion in the left side of the maxilla. The lesion was diagnosed as a maxillary cyst. We treated the lesion surgically. The lesion and thin bony wall between the cystic cavity and maxillary sinus were removed, so that the bony cavity commuted with the inferior nasal meatus. The postoperative course was uneventful, and there was no evidence of recurrence 12 months after surgery. On the basis of the clinical course and histopathological findings of the surgical specimen (i.e., the cyst had a thick fibrous wall lined by stratified ciliated columnar or cuboidal epithelium), the lesion was diagnosed as a surgical ciliated cyst.

Objectives We investigated distracted keratinized epithelium to elucidate any proliferative and degenerated changes and to estimate the stability of the gingival tissues in mandibular distraction osteogenesis in a rabbit model. Study design Twenty-two rabbits were subjected to unilateral vertical osteotomy. After a latency period of 4 days, devices were activated 3, 6, and 10 days at a rate of 1 mm/day. We additionally investigated the recovery of the distracted gingiva in consolidation periods for 3 weeks. The animals were examined by histologic and immunohistologic methods using proliferating cell nuclear antigen (PCNA), single-stranded DNA (ssDNA), and keratin. Results Atrophy of distracted gingiva was observed characterized by loss of rete ridges, acanthosis, vacuolation in the prickle cell layer, and cleavage of the keratin layer. Proliferating cell nuclear antigen–positive cells and ssDNA-positive cells were observed in the basal and prickle layers, respectively. During consolidation periods, slight recovery of rete ridges, thinning of the keratin layer, and immature epithelial layer was observed. Conclusions Proliferative and degenerated changes occurred to compensate for cell death and distracted space. Thickness of gingival tissues was maintained by high mitotic activity and delay in the rate of cell maturation. Immature epithelial layer was related to sensitive and weak resistance against various stimulating factors, such as cleavage of the keratin layer among distracted gingival tissues.

We report a rare case of Warthin tumor accompanied by bone formation. A 57-year-old woman with pus discharge in the right mandibular gingiva visited our hospital in August 1995. Several fistulas in the right mandibular gingiva and a rough-surfaced tumor 1.5 cm in diameter on the right side of the tongue were found. The clinical diagnosis was osteomyelitis of the mandible and tongue cancer. Sequestrotomy of the mandible and partial glossectomy were performed in October 1995. At that time, a computed tomographic (CT) scan showed 1-cm-diameter lesion in the right parotid gland; however, she hesitated to undergo surgery. In April 2001, a CT scan revealed a bilateral mass 1.2 cm in diameter near the parotid glands, and the mass in the right parotid gland increased to 2 cm in diameter and possessed a small calcified granule inside. 99mTc scintigraphy of the salivary glands showed a hot spot in the both parotid glands, consistent with the tumor. In March 2002, she underwent extirpation of the tumors arising in the both parotid glands. Histopathological examination showed a typical Warthin tumor appearance, with bone formation in the hyalinized structure of the tumor. At present, the patient has no evidence of disease.

Trichorhinophalangeal syndrome (TRPS) type I is characterized by slowly progressing systemic osseous dysplasia, exhibiting craniofacial and other skeletal deformities. However, there have been few reports describing this syndrome after undergoing orthognathic surgery. In this report, we present a patient with TRPS I who successfully underwent orthognathic surgery. In addition, we examined the skeletal stability of the patient for 2 years after the surgery.

Soft tissue changes in the chin were compared between patients undergoing sagittal split ramus osteotomy (SSRO) for mandibular setback with and without reduction genioplasty. Twenty patients with symmetrical skeletal Class III malocclusion were examined. Twelve underwent SSRO alone (group I), and 8 underwent SSRO combined with reduction genioplasty (group II). Reduction genioplasty was performed by two horizontal osteotomies, removing the bony wedge, and posterosuperior movement of the inferior segment of the chin. Lateral cephalograms were obtained preoperatively and 6 months postoperatively. Pre- to postoperative changes in the positions of hard-tissue points (B-point [B], pogonion [Ng], and menton [Me]) and soft-tissue B-point [sB], soft-tissue pogonion [sPog], and menton [sMe] were measured on the cephalograms. The ratio of the soft tis-sue movement to the hard tissue movement was also calculated. Though superior movement of Me was significantly larger in group II than in group I, there were no significant differences in the superior movement ratios of sMe to Me between the two groups. However, the posterior movement ratio of sPog to Pog was significantly larger in group I than in group H. These results suggest that the reduction genioplasty performed by two horizontal osteotomies, removing the bony wedge, and posterosuperior movement of the inferior segment of the chin had little effect on the posterior movement of the chin. Therefore, in patients with skeletal class III malocclusion, reduction genioplasty should be applied mainly to vertical shortening of the chin.

Gnathodiaphyseal dysplasia (GDD) is a syndrome characterized by bone fragility, sclerosis of tubular bones, and cemento-osseous lesions of jawbones. Although some cases of this syndrome exist in families with autosomal dominant inheritance, the underlying gene has never been identified. We analyzed a large four-generation family with GDD by linkage analysis using genomic DNA from nine affected and six nonaffected family members. A genome-wide search using a set of highly polymorphic microsatellite markers showed evidence for linkage to chromosome 11p14.3-15.1. Two-point linkage analysis of microsatellite markers spanning this locus resulted in a maximum logarithm of odds (LOD) score of 2.70 with a recombination fraction (theta) of 0 at D11S1755, D11S1759, and D11S915, and a maximum LOD score of 3.01 at D11S4114 was obtained in multipoint linkage analysis. Haplotype analysis detected no recombination between GDD and six closely linked markers (D11S928, D11S1755, D11S4114, D11S1759, D11S915, and D11S929) and established the candidate interval of 8.7 cM on chromosome 11p for GDD. Although GDD has been considered to be a variation of osteogenesis imperfecta (MIM 166260), our results indicate that this syndrome is a new and distinct disease entity from other systemic bone diseases. Furthermore, these genetic markers are useful for presymptomatic diagnosis of GDD in some families and for identification of the GDD gene.

We recently encountered a rare case of desmoplastic fibroma occurring in the right side of the maxilla with osseous lesions of the left shoulder, left forehand, and neck. A 47-year-old woman was referred to us for painless swelling of the right side of the maxilla. On intraoral examination, the swelling was firm, nontender, and had a sessile base and a smooth surface. Computed tomography revealed a soft tissue mass at the right side of the maxilla, measuring 28×35×40mm, which showed poorly defined radiolucency and a welldemarcated margin. The tumor had elevated the right sinus floor, and spread into the right pterygomaxillary fissure, with oppressive erosion to the right ramus of mandible. At the neck region, right shoulder, and right forearm, there was radiographic evidence of cottonlike and solid osteopetrosis. Wide resection of the maxilla, including the surrounding tissues, was performed under general anesthesia. At the present, the patient's progress is good.

Objectives: Mallampati classification s a standard preoperative airway examnation assessing mouth opening and tructures within the oral cavity. Hypothsis of this study was there is a positive orrelation between mallampati score and linician’s viewing and injection difficulies during the inferior alveolar nerve IAN) blockage. Materials and methods: 150 (86 emale/64 male) patients were included n this prospective, double blind study. atients who had restricted mouth opening rom any reason were excluded from the tudy. Mallampati airway class, age, sex, ody mass index (BMI), obstructive sleep pnea (OSA) and/or snoring history were ocumented by same chief resident for all atients at the beginning of the appointent. Injection and viewing difficulties uring the IAN anesthesia deposition and urgical procedure, latent duration for local nesthesia and total deposited anesthetic olution amount were recorded by same rst year resident. Visual Analogue Scale VAS) was used for evaluation of viewing nd injection difficulties during the IAN lockage and surgical procedure. Results ere statistically evaluated by regression nalysis. Results: There was a statistically ignificant relationship between BMI, SA, snoring and high mallampati score p< 0.05). Majority of the snoring probem was observed in male patients however leep apnea problem was approximately qual for male and female patients. There as also a statistically significant relationhip between the VAS score of viewing and njection difficulty during the IAN blockge and high mallampati score (p< 0.05). Conclusions: A clinician should be ware of possible relationship between a igh mallampati score and difficulty in iewing the injection location of an IAN lockage. Conflict of interest: None declared.

Background Oral care is important for oral and systemic health, especially for elderly institutionalized individuals and compromised patients. However, conventional mechanical plaque control is often difficult for these patients because of the pain or the risk of aspiration. Although antimicrobial photodynamic therapy (aPDT), which is considered an alternative or adjunct to mechanical approaches, has potential application as a less stressful method of daily plaque control, no clinical application of this technique has been reported. Methods We investigated the inhibitory effect of a combination of toluidine blue O (TBO), and a red light-emitting diode (LED) on dental plaque formation in healthy volunteers. The optimal concentration of TBO was determined in preliminary in vitro experiments to evaluate the bactericidal effect of aPDT on Streptococcus oralis and to clarify its safety in fibroblast cells. To survey the mechanism of TBO-mediated aPDT, the quality and quantity of reactive oxygen species (ROS) generated during aPDT were also examined using electron spin resonance (ESR) spectroscopy. Subsequently, the inhibitory effect of aPDT on dental plaque formation was investigated in eleven subjects as a clinical pilot study. The right or left mandibular premolars were randomly assigned to the treatment (with aPDT) or control (without aPDT) groups. In total, aPDT was applied six times (twice per day) to the teeth in the test group over a period of four days. On the fourth day, the study concluded and the analyses were performed. Results A combination of 500 or 1000 μg/ml TBO and LED irradiation for 20 s significantly decreased the number of colony forming units of Streptococcus oralis. The cytotoxicity of aPDT was comparable to that of standard antiseptics used in the oral cavity. Hydroxyl radicals were detected by ESR analysis, but singlet oxygen was not. A randomized controlled trial demonstrated that aPDT with 1000 μg/ml TBO and red LED irradiation significantly suppressed dental plaque formation without harming teeth or the surrounding tissues. Conclusions aPDT has the potential to be a promising novel technical modality for dental plaque control. Trial registration This trial was registered with University Hospital Medical Information Network Clinical Trials Registry (number UMIN000012504). Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-152) contains supplementary material, which is available to authorized users.