Bisphosphonate-associated osteonecrosis (BRONJ) is an adverse event associated with bisphosphonate drug treatment. An 81-year-old female has been taking bisphosphonates orally once a month for three years complained of pain in the left mandibular molar area after implant placement. Tenderness and fistula were formed. Extensive osteosclerosis in posterior area of the left mandible and bone resorption around distal side of #37i were shown on radiographs. She was given oral antibiotics for 6 weeks and bone resorption was improved. A 70-year-old male had a history of intravenous injection of bisphosphonates for blood cancer complained of #46i implant mobility. There was buccal fistula on #45 site. Radiographically, severe bone resorption and extensive osteosclerosis were shown. He was treated with removal of implant and inflammatory tissue. Patients who have taken bisphosphonates may develop BRONJ after tooth extraction or implant placement and are needed to meticulous plaque control for preventing BRONJ.

The rise of medical knowledge and awareness of the importance of dental and stomatognathic system increase the patients who visit dental emergency room. The chief complaints of patients who visited the emergency room varies from a pain, trauma, hemorrhag. The purpose of this study was to classify dental emergency patients by chief complaint and to analyze in indiviual group and to provide more effective emergency dental care. This study was carried out with 1129 patients visiting emergency room of the dankook university dental hospital from 7/2011 to 6/2012. Dental emergency patients was classified trauma, pain, hemorrhage group by chief complaint and studied mothly, the day of the week, time, age distribution and cause of the individual group. The chief complaint of visiting emergency room were trauma 660 people (58.5%), pain 347 people (30.7%), hemorrhage 96 (8.5%), other 26 patients (2.3%). The monthly distribution was observed in May (12.8%), March (10.5%), September (10.2%). The trauma patients were frequent in the spring and early summer but painful patients visited in September (12.7%) and May (11.8%) in March (11.2%). The peak age group was 20 to 29 years(20.9%), followed by 0 to 9 years(19.4%), 40 to 49years (15.2%,). In trauma group the peak age was under the age of 10 (31.7%), followed by 10 to 19 years (18.8%), 20 to 29 years (17.1%) . However, in pain group, peak age was 20 to 29 years (26.8%) followed by 40 to 49 years(21.3%), 30 to 39 years (19.6 %). The most common cause of trauma were subluxation(16.5%), laceration13.7%), uncomplicated crown fracture(12.05%) and in pain group was pulpal origin(46.1%), followed by periodontal origin( 20.7%), post op pain(8.9%). Undefined pain or neuralgia were 7.9%. The most common cause of hemorrhage was post extraction( 66.7%), post operation(16.7%), spontaneous bleeding due to periodontitis(12.5%). In conclusion, the trauma, pain were different in monthly distribution and the peak age of patients. Dental emergeny doctor should understand pattern of indiviual emergency group and perform proper diagnosis and treatment for more effective emergency care.

The population of patients with antiplatelet treatment is expanding globally with the rising prevalence of cardiovascular disease and increasing use of percutaneous coronoary interventions. While antiplatelet agents have revolutionized the management of atherosclerotic disease and its thromotic complications, the potential of bleeding remains an inherent risk. Dentists are more likely to stop antiplatelet therapy before dental extraction because they think that the patient is at high risk for bleeding. However stopping or altering antiplatelet therapy may expose such patients to the risk of a thromboembolic event such as thromboembolism, myocardial infarction, or cerebrovascular accidents particulary in patients wirh drug-eluting stent. In this study, we report 3cases that were perfomed dental extraction in patients receiving single or dual antiplatelet therapy without immediate and late postextraction bleeding and reviewed the literature on dental extraction in patients receiving antiplatelet therapy. We concluded that dental extractions may be safely performed in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken, thus averting thrombotic risk of temporary antiplatelet discontinuation