Application of Kampo Medicine to the Surgical Treatment of Generally Compromised Patients: A Case Series Report

<p> Purpose: When performing dental treatment, we need to consider the general conditions of patients who are allergic to antibiotics, who have a history of asthma, and who suffer from Type 2 diabetes, especially when performing surgical treatment for these patients. We applied Kampo medicine (Hainosankyuto, Rikkosan) to these patients and performed surgical dental treatment. Here, we report the cases and treatment procedure.</p><p> Case 1: A 48-year-old woman who complained about repeated gingival swelling in the left maxillary second incisor region. Radiographic examination showed bone resorption in the periapical region. Informed consent regarding the treatment plan was obtained before starting treatment. As she was allergic to antibiotics, Hainosankyuto was administered before the operation to prevent surgical site infection. After root canal treatment of the left maxillary second incisor, apical surgery was performed according to the Wassmund method. No surgical site infection occurred after the operation. At the 6-month recall point, radiographic examination revealed osseous healing of the peri-apical radio-opacity.</p><p> Case 2: A 28-year-old woman who complained about repeated gingival swelling in the right maxillary first incisor region. Radiographic examination revealed peri-apical radiolucency. Informed consent regarding the treatment plan was obtained before treatment. As she was a lactating patient and wished to avoid antibiotics, Hainosankyuto was administered before the operation to prevent surgical site infection. After root canal treatment of the right maxillary first incision, abscess incision was performed to remove granulation tissue and debris. No surgical site infection occurred after the operation. At the 3-month recall point, radiographic examination showed osseous healing of the peri-apical radio-opacity.</p><p> Case 3: A 52-year-old man who complained about gingival swelling and bleeding after brushing. At the first visit, the percentage of teeth with PD≥4 mm was 97%. The rate of teeth with BOP was 100% and O’Leary’s PCR was 100%. Inflammation was observed in the gingiva. Radiographic examination showed moderate horizontal bone resorption of teeth. Informed consent regarding the treatment plan was obtained before treatment. As he suffered from type 2 diabetes (HbA1c=6.5%), Hainosankyuto was administered before a flap operation to prevent surgical site infection. An initial periodontal treatment, including tooth brushing instruction, dental scaling and root planing was performed. Surgical periodontal therapy was performed to the sites with PD≥5 mm at the re-examination. No surgical site infection occurred after the operation. The patient’s clinical parameters are currently stable.</p><p> Conclusion: Application of Kampo medicine, such as Hainosankyuto and Rikkosan, in oral surgery is gentle for idiosyncratic patients, including patients allergic to antibiotics, lactating patients and diabetic patients.</p>