Month 20162 arrival at the dental outpatient clinic to intravenous sedation until completion of the dental surgery. With consideration of cost-effectiveness, absence of adverse physical effects, immediate effect, safety in terms of not using drugs, and lack of concerns about recovery, this information could lead to more appropriate decisions regarding anxiety management in dentistry.

In the Wnt/β-catenin signaling pathway, Wnt signal is transmitted to glycogen synthase kinase-3β (GSK-3β) through Dishevelled (Dvl), GSK-3β activity is inhibited, β-catenin phosphorylation is inhibited by the inactive-type GSK-3β, and β-catenin is transferred to the nucleus where it interacts with lymphoid enhancing factor (LEF)/T-cell factor (TCF), a transcription factor, which is considered to induce and regulate gene expression. In tooth development, it has been reported that Wnt and LEF are expressed at the earliest stage and are related to tooth development, but there are few reports on the situation at a later stage, and there have been no reports on Dvl and GSK-3β. In this study, we immunohistochemically examined the distribution of factors related to the Wnt/β-catenin signaling pathway, Wnt10, Dvl, GSK-3β, p-GSK-3β (inactive GSK-3β), and β-catenin, using serial sections of rat first molar germ to investigate the role of the Wnt signaling pathway in tooth germ development and tooth morphogenesis. Immunostaining for anti-Wnt10, anti-Dvl, anti-GSK-3β, anti-p-GSK-3β, and anti-β-catenin showed positive reactions at the inner enamel epithelium of tooth germ and weakly positive reactions at the dental papilla cells in contact with the inner enamel epithelium at embryonic day 19. At 8 days after birth, immunostaining for every antibody showed positive reactions for preameloblasts and preodontoblasts and more clearly positive reactions for secretory ameloblasts and odontoblasts. These results suggest that Wnt10, Dvl, GSK-3β, p-GSK-3β, and β-catenin are distributed in inner enamel epithelium, secretory ameloblasts, and odontoblasts, and that the Wnt/β-catenin signaling pathway via Dvl and p-GSK-3β is involved in these cells. In addition, for each of the factors, differentiated secretory cells showed more clearly positive reactions than undifferentiated cells; therefore, we conclude that the Wnt10 signaling pathway may be involved in differentiation to ameloblasts and odontoblasts, as well as secretory functions of ameloblasts and odontoblasts.

Acute angle-closure glaucoma (AACG) is a rare complication of general anesthesia. The coexistence of individual risk factors for postoperative AACG and factors associated with intraocular hypertension are considered to be required for postoperative AACG to develop. We present a case of AACG after general anesthesia for oral bone grafting in a patient with no preoperative eye symptoms. In this case, several factors such as postoperative care in a darkened room, psychological stress, and postoperative hypertension may have precipitated the event in this patient, who may have had preexisting undiagnosed elevated intraocular pressure. The interval between the earliest appearance of symptoms at 9 hours and the ultimate diagnosis was 36 hours. In the postoperative period following general anesthesia, any patient is at risk for AACG. It is important that a postoperative diagnosis of AACG should be considered and a timely consultation with an ophthalmologist be considered if a postoperative patient complains of red eyes, visual disorder, eye pain, headache, and nausea.

We report the successful management of general anesthesia for a patient with Pelizaeus-Merzbacher disease (PMD). PMD is one of a group of progressive, degenerative disorders of the cerebral white matter. The typical clinical manifestations of PMD include psychomotor retardation, nystagmus, abnormal muscle tone, seizures, and cognitive impairment. General anesthesia for a patient with PMD may be difficult mainly because of seizures and airway complications related to poor pharyngeal muscle control. In addition, the possibility of exacerbation of spasticity should be considered. A 20-year-old man with PMD required removal of impacted wisdom teeth under general anesthesia. General anesthesia was induced with thiamylal, fentanyl, and desflurane. Anesthesia was maintained with desflurane and continuous intravenous remifentanil under bispectral index and train-of-4 monitoring. Anesthesia lasted 1 hour 20 minutes and was completed uneventfully. Airway complications, seizures, and exacerbation of spasticity did not occur postoperatively. Preoperatively, our patient had no history of epilepsy attacks or aspiration pneumonia, and no clinical symptoms of gastroesophageal reflux disease. Therefore, exacerbation of spasticity was one of the most likely potential complications. Identification of these associated conditions and evaluation of risk factors during preoperative examination is important for performing safe anesthesia in these patients.

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