This study describes the characteristics of patient receiving comprehensive dental treatment under general anesthesia at the pediatric dentistry of Chosun University dental hospital in Gwangju, between August 2004 and March 2008. The conclusion runs as follows : 1. Most patients(64.8%) were young (under 10 years of age) and mean age was 8.6 years. 2. The primary reason(31.1%) why they chose general anesthesia was lack of child's cooperation (normal but unmanageable). Following in order are mental retardation, Autism and cerebral palsy etc. 3. Resin restorations were performed most frequently(87.8%) followed by pulp treatment, preformed crown, extraction and sealant. 4. It takes 3 hours 10 minutes for general anesthesia on the average. The mean treatment time under general anesthesia was 2 hours 52 minutes. 5. 29 children(39.7%) visited again after general anesthesia for recall check.

치과의사는 혈우병 환자의 치료 시 주의사항에 대해 잘 알고 있어야 한다. 혈우병 환자의 내원 시 소아과 의사 및 혈우재단 등 전문가에게 의뢰하여 환자의 상태에 대한 자문을 얻어야 하고, 치과 치료 시 적절한 계획 하에 최소의 침습적인 치료가 행해지도록 노력해야 하며, 응급 상황을 대비하여 지혈방법을 습득해야 한다. 또 환자와 보호자에게 평소 구강 관리의 중요성을 일깨워 침습적 치과 치료의 빈도를 줄일 수 있도록 해야 한다.

Williams syndrome is a rare genetic disorder with a frequency of one per 20,000~50,000 live births. It is caused by a deletion of one elastin allele located within chromosome subunit 7q11.23(long arm). This syndrome is frequently accompanied by disorders such as congenital heart disease, facial anomalies, mental retardation, and so on. The characteristic facial appearance includes full lips, rounded cheeks, broad forehead, periorbital fullness, flattened bridge of nose, small nose with anteverted nostril, long filtrum and low-set ears. In oral features, hypodontia, high prevalence of dental caries, microdontia, enamel hypoplasia, delayed eruption, and malocclusions have been found. Most adult patients with Williams syndrome lack social adaptability and lead seclusive lives, however, young patients are rather very friendly and talkative, and seem smarter than their actual intellectual quotients. They also tend to favor staying with grown-ups rather than mixing with their peers, and tend to present problematic temper tantrum during dental treatment.

비정상적인 교상을 예방하기 위한 정확한 protocol은 존재하지 않는다. 하지만 전치부를 발치하는 등의 침습적인 방법을 사용하기 이전에 soft mouth guard를 사용하는 등의 보존적인 방법을 먼저 고려하는 것도 좋은 방법이라 생각되며, 보다 양호한 결과를 얻기 위해서는 관계되는 전문가들과의 협진이 필요 할 것으로 사료된다.

A 33-years-old female pateint with cerebral palsy showing spastic quardriplegia and severe mental retardation was scheduled for dental implant restorations. Before implant surgery we had to take implant CT. But, because of her involuntary motion and communication difficulty, sedation was needed in order to take CT. After 8 hour NPO, propofol infusion sedation with TCI (target controlled infusion) system was administered. The propofol blood concentration of the patient was maintained 2-3 ${\mu}$/ml to keep deep sedation to prevent uncontolled movement. During sedation, we monitored ECG, pulse oximetry, blood pressure, capnometry for patient safety. Oxygen was administered via nasal prong for preventing hypoxemia and to keep airway during sedation some bands were applied to lift mandible. Total duration was 20 minutes for taking CT, and she was discharged from hospital after 30 minute rest without complication.

Cerebrovascular Accident(stroke) is that a sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial vascular event. If stroke happens at the portion of trigeminal motor nucleus or its control part of cerebral cortex, masticatory muscles will be atrophy or paralyzed. So it is possible that dental occlusion changes after stroke. A 74-aged woman recurred mild stroke 2 month ago, who had experienced severe stroke 2 years ago. After recurrence, suddenly her upper full denture was dropped when lower denture contacted upper one. According to the her occlusion exam, her lower jaw moved back slightly compared with the occlusion of old denture. And her face had asymmetry and lower jaw dislocated to paralyzed side. A 50-aged man was treated because many cervical caries, which would occur because of an aftereffect of stroke, long-herm hospitalization and limits of self oral-care. 6 years ago he had cerebral hemorrhage and he claimed that he cannot bite exactly. Just two pairs of teeth was contact on biting, his lower jaw was located back, too. This two case suggests that dental occlusion can change after stroke.

본 증례에서 나타난 Kostmann 증후군 및 MDS의 치과적 소견을 정리해 보면, 전반적인 치주염(GPP), 고도의 치조골 소실 및 치아동요도, 협점막의 궤양, 편도염, 구강내 동통, 하순의 점상 출혈 등을 들 수 있다. 적극적인 항생제 투여와 G-CSF 피하 주사가 환자의 전신적 상태 향상에 도움을 줄 수 있으나 완치가 어렵기에 치과 치료시 주의가 필요하며, 구강위생관리를 철저히 잘 할 수 있도록 환자 및 보호자에게 지속적인 관심을 가지고 교육해야 할 것이다.