This article discusses the provision of sedation for uncooperative special need dental patients. Most of dental treatments have been performed in these patients with the techniques of behavioral control. However, if this behavioral control fails during treatment, it is nearly impossible to treat them without either sedation or general anesthesia. Sedation is also beneficial for patients because it circumvent the aggravation of negative behaviors related to their stress during the treatment. Also, the morbidity and mortality related to dental sedation is relatively low. In this regard, the provision of sedation for people with special needs can be considered as a safe and necessary techniques for their treatment.

This paper classified the articles of special needs dentistry(SND) published in Korean medical database according to thematic distribution and chronological change to assess recent academic trends and indicate the direction of study in the future. We selected articles in 17 dental journals registered with the Korea Research Foundation This study found that the total number of articles of SND was 292 in 17 journals from 1973 to 2012. The biggest number of articles of SND was published in the journal of the Korean Academy of Pediatric Dentistry, which means pediatric dentists contribute to dental treatment of people who need special care. According to growing number of people with disabilities, the number of articles related in SND has been increased since 2000. Also, the aged and children as well as people with disabilities fit into the category of SND and the scope of SND has been enlarged. So dentists should concern and study more about SND in the future.

Objectives: The goal of this study is to establish data baseline to ameliorate oral health policies for patient. The research was conducted in dental clinic at Seoul Metropolitan Children's Hospital - the major municipal hospital for the disabled. The outpatients' visiting patterns to the dental clinic were analyzed, compared to other medical departments. For further research related to TMD, the questionnaires were given to the subjects. Material and methods: Data for visiting patterns/frequencies was collected from patient records of 1419 outpatients who visited the dental clinic at Seoul Municipal Children's Hospital in 2011. Then TMD-related questionnaires were given to 127 outpatients who were over 13 years old. Results: 1. 219 out of 1419 patients (15.4%) who visited the dental clinic at Seoul Municipal Children's Hospital in 2011 were the disabled. 2. Compared to normal patients, disabled patients visited the dental clinic and rehabilitation medicine department more frequently.(p<0.05) However, there was no apparent difference in visiting frequencies between the disabled and the normal patients in the psychiatric department.(p=0.3237) 3. 44% of the TMD-related questionnaire subjects responded that they often consumed relatively hard or tough food, 53% answered they had unilateral chewing habit, 3% had bruxism, and 12% had clenching habit. Conclusion: In the dental clinic at Seoul Municipal Children's Hospital, 19% of outpatients over 13 years old had TMD such as clicking and pain. Also, the disabled patients' visits to the dental clinic were considerably more frequent, compared to the normal patients and to other medical departments. Accordingly, the result may suggest that the proper systematic supports from the government are essential to the dental clinic at municipal hospital for the disabled.

Most of disabled people face hardness in caring their general oral hygiene by themselves. So that, they are once involved in dental caries or periodontal disease, they have much bigger chance of aggressive progress. Therefore preventive dentistry is more important to disabled one than non-disabled. They need to be checked with routine periodic dental examination and by that, oral disease must be found at initial stage. We selected 37 patients from newly visited 237 patients who had dental treatment at the free dental clinic, Gangnam district, Seoul, between 2000 and 2001. This study is a comparative evaluation of first 2 years' treatment records of selected 37 patients (male 28, female 9) with that of their last 2 years. 24 of 37 have mental retardation, 9 have autistic disorder, 2 have auditory disorder, 1 has brain disorder and 1 has crippled disorder. Their dental treatment records categorized by 4 level; score 4 stands for endodontic treatment, score 3 stands for general conservative treatment, score 2 stands for preventive treatment, such as sealant and score 1 stands for routine check. In first 2 years of treatment, average score was 2.85 which score means approximately general conservative treatment. And that of last 2 years was 1.44, which means routine check. In early time of their visit, they will receive the treatment due to their chief complaint. And after that early time, they can have a routine check so that they can be treated before the disease get worse. The patient's oral health can remain decent only by a simple treatment.

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.

Takayasu's arteritis 환자의 치과 치료 시 침습적인 치과 술식 전 심내막염 가능성을 고려하여 예방적 항생제를 투여한다. 복용 약물에 의해 치은증식이 발생할 수 있으므로 약물의 적용에 관한 의과적 자문이 필요하다.

이와 같은 정신질환에 따른 자해성 구강손상의 경우 원인 질환에 따라 다양한 정도와 양상의 구강손상을 발견할 수 있으며 그에 따른 치료방법 또한 그에 맞게 적용되야 한다. 이러한 치료방법의 선택은 임상증상과 세심한 평가 후 선택되어야 하며, 이들 중 행동조절법이나 구강 내 장치의 사용과 같은 보존적 치료를 시도해 본 이후, 보다 침습적인 신체 속박술이나 약물치료 그리고 외과적 수술이나 발치 등을 적용하는 것이 효과적일 것이다.

저자는 de Grouchy 증후군을 가진 4세 여자 환아에 대한 임상적 및 방사선학적 관찰을 통해 다음과 같은 지견을 얻었다. 1. 환아는 de Grouchy 증후군의 증상인 심장 및 발가락의 기형, 근긴장의 저하, 뇌량의 부분적인 무형성, 시각 장애와 청각 장애, 지적 능력의 저하, 성장 발달의 지연 등을 나타낸다. 2. 환아의 구강 및 두개악안면 소견으로 상악골 열성장과 전치부 반대교합을 보이며, 불량한 구강 위생으로 인한 다발성 치아우식증이 관찰된다. 3. 환아의 구강 위생 관리 및 치료 부위의 유지를 위하여 주기적인 치과 검진이 필요하며, 상악골 열성장과 전치부 반대교합을 개선하기 위해 추후 교정 치료가 필요할 수 있다.

저자는 본 증례를 통하여 발달장애 환자의 치과치료 시 다음과 같은 지견을 얻었다. 1. 발달장애 환자의 경우 불량한 구강위생 등으로 인하여 치과적 치료가 필요한 경우가 많다. 2. 발달장애 환자의 경우 비약물적 행동조절만으로 치과적 치료를 위한 충분한 협조도를 얻기가 어렵다. 3. 발달장애 환자에 있어서 midazolam 구강 전투약을 이용한 전신마취 하 치과치료가 매우 유용하게 적용될 수 있다. 4. 숙련된 의료진의 철저한 감시하에 정맥주사용 midazolam 제재를 설탕시럽에 혼합하여 투약한다면 전투약을 통해 기대하는 효과를 얻을 수 있다.

레녹스-가스토 증후군은 소아 난치성 간질 중의 하나로서, 여러 형태의 간질 발작과 정신지체, 뇌파상 각성시 1.5-2 Hz의 극서파복합이 나타는 것을 특징으로 한다. 간질발작은 대개 1-8세경에 나타나며, 대부분의 환아들은 인지기능의 심각한 장애와 정신지체를 일으킨다. 발작과 정신지체를 동반하여 치과치료 시 양호한 협조도를 얻을 수 없고, 본 증례와 같이 다발성 우식증이 있는 경우, 안정적인 생징후를 유지, 감독하며 내원 횟수를 줄일 수 있는 전신마취 하 치과치료가 유리할 것이다. 본 증례에서는 레녹스-가스토 증후군을 가진 14세 3개월 여아를 전신마취 하에 안정적이고 효과적으로 치과 치료할 수 있었다. 레녹스-가스토 환자의 전신 상태에 대한 충분한 술전 평가가 선행되고, 간질발작 증상에 대한 적절한 조절이 선행된다면, 전신마취 하에 치과 치료를 매우 효과적으로 진행할 수 있을 것을 사료된다.

I participated in Academic Exchange Program(Action plan II) between KADH(Korean Association for Disability and Oral Health) and JSDH(Japanses Society for Disability and Oral Health) for 2 months from 3rd July 2012 to 2nd september 2012 in the Department of Hygiene and Oral Health, School of Dentistry, Showa University at Tokyo, Japan. I have observed their operation process and learned what dysphagia is and how it is consulted and taken care of as a therapy for patients with eating and swallowing disorders for two months in The department of special needs dentistry at Showa University Dental Hospital, Jonan Branch of Tokyo Metropolitan Kita Medical Rehabilitation Center for the Disabled, Smile Nakano Center, Tokyo metropolitan center for persons with disabilities in Lidabashi for one week, Eating and swallowing functional therapy workshop for disabled children, Tokyo metropolitan Tobu medical center for Persons with Developmental/Multiple Disabilities located in Minamisunamitchi for one week and on The 17-18th JSDR(Japanese Society of Dysphagia rehabilitation) in Sapporo. Through Action Plan II program, I learned how precious eating, drinking and swallowing with ease are and observed how they do and what they do as a dentist or a dental hygienist in Japan for dysphagia patients. Therefore, I want to present the dental approaches of children with dysphagia in Japan, based on my experience for two months.