To study the reproducibility of salivary buffer capacity determined with Checkbuff^[○!R], we measured the flow rate, pH, and buffer capacity of saliva as well as its PO_4^<3-> and protein concentrations contributing to the buffer capacity. In addition, to clarify the relations among these factors in saliva, we not only studied the correlations among them but also examined whether there were differences in these factors related to the degree of caries risk estimated by Checkbuff^[○!R]. On the basis of the results of this study,the following conclusions were obtained. (1) Because the variance in the stimulated salivary flow rate was smaller than that of resting saliva,stimulated saliva showed a more adequate reproducibility. The values for pH and the buffer capacity measured with Checkbuff^[○!R] showed a high reproducibility with both resting and stimulated saliva. (2) Significant positive correlations were noted in the flow rate between resting and stimulated saliva,as well as between the flow rate and pH of both resting and stimulated saliva. Accordingly, those who had a large resting salivary flow rate showed a large stimulated salivary flow rate, and those who had a large salivary flow rate also showed a high salivary pH. (3) In relation to the risk of caries, significant differences were observed in the pH of saliva, the buffer capacity of resting saliva, and the protein concentration in stimulated saliva, between the high and mild buffer capacity groups. Thus, it became clear that the risk classification based on the buffer capacity obtained from stimulated saliva measured with Checkbuff^[○!R] reflected the differences not only in the pH but also in the protein concentration of saliva.

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This study examined the relationship between the concentration of salivary agglutinin that interacts with a Streptococcus mutans surface protein antigen (PAc) and other factors that have been used to assess the risk of dental caries. The subjects were 64 students aged 20 years. The salivary agglutinin concentration was determined using an enzyme-linked immunosorbent assay. In addition, the stimulated salivary flow rate, buffer capacity, number of mutans streptococci, DMFT, and DMFS were obtained. There were correlations between the salivary agglutinin level and % DMFT and % DMFS (Pearson product moment correlation coefficients : γ=0.29 and 0.25, respectively, p<0.05). These results suggest that determining the concentration of salivary agglutinin that interacts with S. mutans PAc is useful for assessing the risk of dental caries.

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The purpose of this study was to examine the life situation of 998 applicants for nursing care insurance in Kagoshima city. The results were as follows : 1. The age range of the subjects was from 41 to 102 (mean±SD, 80.7±8.2), and 97.1% of them were more than 65 years old. There were no significant differences in the distribution of levels of support or care needed between males and females. 2. The largest age group was 80-84 years old, and it comprised mainly two groups needing support (33.7%) and care level 1 (32.2%). 3. The majority of subjects (70.3%) were living at own home and the proportion of the subjects classified into the groups needing support and care level 1 was 69%. There were significant differences in the distribution of levels of support or care needed between home-living and institutionalized subjects. 4. The proportions of subjects who need watching or attendance during dental activities were 24.8% for swallowing, 26.1 % for eating, and 34.6% for oral prophylaxis. In each item, there was a significant correlation between the practice ability of the subjects and levels of support or care needed. 5. The ability to perform oral prophylaxis was significantly correlated with swallowing and eating ability. Ninety-five percent of the subjects who were able to perform oral prophylaxis by themselves were included in the groups of independent, needing support, and needing care levels 1 and 2. 6. Medical doctors had little understanding of the necessity for home-visit dental treatment (1.1 %) and home-visit dental hygiene instruction (0.8% ).

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Objective : A survey was undertaken to ascertain the factors related to the attitudes of general dental practitioners regarding the treatment of HIV carriers. Methods : Questionnaires on infection control and awareness/experience in the treatment of HIV + or hepatitis virus carriers were delivered in March, 2004 to 471 general dental practitioners selected from lists of graduates of two dental schools and of two dental study groups in Japan. Completed sheets were returned by post anonymously. Results : Completed sheets were collected from 431 respondents (91.5%). The percentage of those who reported to have treated a HIV+ patient was 2.5%. Whereas nearly 90% showed a willingness to treat HA+, HB+, and HC+ patients, only 31.9% showed a willingness to accept HIV+ patients. Of the respondents, 28.6% stated they would refuse to treat HIV positive patients, with 33.6% for AIDS patients. The main reasons they stated concerning the difficulty of dental treatment for HIV+ patients were as follows : (1) difficulty in disinfection, (2) dental staff's acceptance, (3) negative effects on other patients, and (4) the possibility of cross infection to health workers. Multiple logistic regression analysis showed four factors to be significantly correlated with the attitude concerning the treatment of HIV+ patients. The odds ratios of the factors were : 1.73 for 'practice or understanding of standard precautions', 0.57 for 'experience of needle injury', 3.50 for 'having been asked to treat an HIV+ patient', and 1.78 for 'advanced postgraduate experience of oral surgery or oral anesthesiology'. Discussion : These results suggest many dental practitioners still have a great misunderstanding concerning infection control : while most of them would accept a hepatitis virus carrier, which might represent a stronger possibility of infection, many of them would refuse an HIV carrier, which represents a lower possibility of infection. The reasons they cited were not based on scientific knowledge, but seemed to be affected by the possible negative effect on their other patients. The results also suggested that the more a dentist was aware of infection control, the more positively he/she may would accept an HIV carrier. Effective post graduate education on infection control based on current knowledge (CDC 2003, for example) to dental practitioners for practicing universal and/or standard precautions, and a change in the attitude of dental practitioners seems to be crucial for promoting the oral health care of people living with AIDS/HIV, with the proper consideration of their human rights as well as providing safer dentistry within the community.

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The use of fluoride toothpaste was surveyed by questionnaire in 213 nursery school children aged from 9 months to 6 years in Tobetsu-chou. The purpose of the study was to promote the use of fluoride toothpaste for infants. The survey was carried out from November to December, 2005 using a questionnaire prepared by the Committee for the Promotion of Fluoride Use of the Japanese Society for Dental Health, and the results were as follows: 1. The rate of fluoride toothpaste usage in all children was 72.2%. Significant differences in usage were observed with age (p<0.001). These results indicate that the rate of fluoride toothpaste usage was 20 points lower than the "Kenkou Nippon 21" target figure (more than 90%) proposed by the Ministry of Welfare and Health in 2000. 2. Eighty % of the subjects used a toothpaste amount 1/3 of the toothbrush head size. Also, 74.1% of the subjects rinsed their mouth more than 3 times following toothbrushing. Recommendations need to be made on how to use fluoride toothpaste, the appropriate amount to use, the frequency of use, and the frequency of mouth rinsing following toothbrushing. 3. Over 50% of fluoride toothpaste users selected it for its fluoride content. 4. Reasons given by parents for not using toothpaste were anxiety about the ingredients and concerns about its effectiveness for small children. We conclude that accurate and adequate information targeted to parents is necessary to promote the appropriate use of fluoride toothpaste for the prevention of dental caries in children.

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The present study was conducted in order to evaluate differences in the prevalence of dental caries using different criteria. In annual health check-ups for school children at two primary schools, a junior high school and a senior high school, dental examinations were provided using criteria of the British Association of the Study for Community Dentistry (BASCD criteria) as well as criteria of the Japanese Association of School Dentists (JASD criteria). At primary schools, the number of teeth rated as "Untreated" among the 7,606 teeth examined was 159 according to the JASD criteria and 17 according to the BASCD criteria. Thus, the number of teeth rated as "Untreated" by the JASD criteria was 9 times more than the number rated by the BASCD criteria. At the junior and senior high schools, the number of teeth rated as "Untreated" by the JASD criteria was approximately 3 times and twice more, respectively, than the number rated by the BASCD criteria. It could be assumed, in primary schools, that many of the teeth rated as dental caries by the JASD criteria were in the early stage of decay limited only within enamel, which would be rated as intact teeth by the BASCD criteria, or arrested dentin caries, also rated as intact teeth by the BASCD criteria. Among the teeth rated as 'Intact' by the BASCD criteria and 'Untreated' by the JASD criteria, 31.6% of the primary school children and 14.3% of the junior high school pupils were rated as 'Untreated' by BASCD in the examination performed the following year. This suggests that, compared to using the BASCD criteria, clinical caries examinations using the JASD criteria tended to result in a more frequent prevalence of decayed teeth rated as 'Treatment needed', leading to the early detection of more children with a high risk of dental caries. The results of this study, as a whole, show that assessments made during dental examinations of school children vary widely depending on the diagnostic criteria used, and suggest some challenges for oral health services as follows: (1) To establish continuing care to provide observation and guidance for children with a high risk of dental caries, especially in primary schools; (2) To strengthen the role of family practitioners to provide observation and preventive care; (3) To discuss the revision of diagnostic criteria for dental examination and improve the remuneration system for dental care.

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Inflammatory periodontal destruction diminishes the supportive function of teeth, and tooth loss is associated with QOL and general health. We examined the relationships between inflammatory substances in gingival crevicular retention fluid (GCRF) and the health status. Prior to the study, we developed standardized apparatus for the collection of GCRF in the workplace. Samples of GCRF were collected from 200 subjects at their workplace and were delivered to the laboratory in bulk for the determination of hemoglobin (Hb), α_1-antitrypsin (AT), lactoferrin (Lf), immunoglobulin A (IgA), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). The periodontal status was assessed using the CPI system and the health status was surveyed with questionnaires which included the three categories of lifestyle (35 items), subjective symptoms (37 items), and oral health status (20 items). Logistic regression analyses of the levels of inflammatory substances in GCRF as dependent variables exhibited relationships with health status. The number of items which exhibited significant relationships in each category of the questionnaires were: 3, 0, and 3 for Hb; 1, 1, and 1 for AT; 7, 0, and 2 for Lf; 4, 0, and 0 for IgA; 2, 0, and 2 for AST; and 2, 0, and 3 for ALP, respectively. Hb, Lf, AST, and ALP were associated with CPI. These results indicated that inflammatory substances in GCRF were associated with the health status. The GCRF tests, which reflect the periodontal inflammatory status, may have a potential as a tool for the motivation of behavioral changes in dental patients.

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It has been reported that xylosylfructoside (XF) effectively inhibited the synthesis of water-insoluble glucan (WIG) and adherence of mutans streptococci to smooth surfaces. The purposes of this study were to examine the cariogenicity of XF and assess the inhibitory effect of XF against the cariogenicity of sucrose using culture and artificial mouth systems. S. mutans MT8148 was cultured in heart infusion broth containing 1% sucrose with 0-5% XF in a glass test tube. The amounts of WIG and bacterial cells in the adherent fraction were significantly inhibited by XF in a dose-dependent manner. In the artificial mouth system, 1% XF did not inhibit the formation of artificial biofilm and enamel demineralization in the presence of 1% sucrose, but 2.5% XF significantly inhibited the formation of biofilm on enamel slabs, pH decrease underneath the biofilm, and enamel demineralization, suggesting that an appropriate concentration of XF could inhibit, in part, the cariogenicity of sucrose.

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In Higashihiroshima, a project named "dental health check-up for mothers and children" began at the 18-month-old health check-up in 1993. The project was aimed to carry out dental examination and tooth brushing instruction for mothers at the place of the dental check-up for their children. There was some possibility that mothers missed the 18-month-old health check-up itself to avoid their own dental examination. Therefore, this study aimed to investigate the compliance rate for the 18-month-old health check-up with the "dental health check-up for mothers and children" project in Higashihiroshima from 1993 to 2000, and to compare the obtained data with the previous compliance rate. As a result, the compliance rate for the 18-month-old check-up did not change and maintained a value of a little over 90%, even with the commencement of the "dental health check-up for mothers and children". In addition, the compliance rate for dental examination for mothers increased. It was considered that the main cause of the increase was the improvement of the examination process. Moreover, continuation of the project might reduce the resistance to undergo dental examination by mothers, and thereby increase the compliance rate. Therefore, "dental health check-up for mothers and children" might be one of the effective systems to promote the health of both mothers and children, since the compliance rate for the 18-month-old check-up was very high. On the other hand, the mothers' oral status was scored according to the criteria of ORI in "dental health check-up for mothers and children". Though the developer of ORI examined the mothers' status in 1993, all members of the Higashihiroshima Dental Association have been able to examine the status using ORI after some lecture classes and ORI training.

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It is one of the goals for "Healthy Japan 21" to increase the use of fluoride toothpaste to more than 90% of all school children. The purpose of this study was to investigate the usage of fluoride tooth-paste among Japanese students. In 2005, a questionnaire survey was conducted throughout Japan. Totally, 17,237 questionnaires, which were collected from 9,810 primary school and 7,427 junior high school students, were analyzed. The results showed that 88.1% (primary school children: 88.2%; junior high school students: 87.8%) of all subjects (including both those who do and those who do not use toothpaste) had the habit of using fluoride toothpaste. The rate of students who use fluoride toothpaste was 93.1% (primary school children: 95.0%; junior high school students: 90.7%) with the exclusion of those not using toothpaste. About 49% of primary school children who use fluoride toothpaste were conscious of the effects of fluoride. It was suggested by these results that this goal for oral health set by "Healthy Japan 21" has been achieved for children of school age. Various factors were considered to contribute to this result. It will be important to monitor the regular use of fluoride toothpaste by school children in the future.

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Although there are descriptions of dental caries and its preventive procedures in the health textbooks ('HOKEN', in Japanese, 2004 version) used nationally in elementary schools in Japan, we found that the global standard describing the results of research for dental decay and caries prevention in the latter half of the 20th century was not represented. Dental caries constitute a multifactorial disease. A favorable balance between demineralization and remineralization is necessary to maintain intact teeth throughout life. Therefore, it was thought that dental health could be improved by accurately describing dental decay and effective caries preventive strategies in textbooks such as 'HOKEN'. The following points should be emphasized: (1) The carious process, so-called demineralization, and the remineralization of demineralized teeth should be correctly described. (2) The description emphasizing that dental decay can be prevented through oral hygiene alone should be corrected. (3) Proper explanation of the insights into fluoride and salivary activities that promote remineralization should be given. National health promotion for the 21st century (Health Japan 21) is developing in Japan. This movement is based on the ideas of health promotion. As the incidence of caries is decreasing worldwide, we propose that textbooks reflecting evidence-based dentistry for the improvement of the quality of the life of schoolchildren should be produced. In particular, The Japanese Society for Dental Health should immediately establish a subcommittee to focus on the textbook to discuss and publish the results from the standpoint of oral health for all, and endeavor to communicate the global standard to schoolchildren and persons working in school dental health.

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As members of the Nutrition Support Team (NST) at Tokushima University Medical and Dental Hospital, we have worked on professional oral care (POC) with our inpatients. Also, we started bedside POC with inpatients after studying their health and nutrient intake. This led us to have a closer working relation with ward staff and improve the oral care provided by nurses during their routine work. The results of the first oral examination of 43 inpatients we have included so far showed that the percentage of oral problems such as tongue coating, debris, dental plaque, calculus, expectoration, dry mouth, and bad breath were considerably high. Many of these oral conditions were thought to be related to the patients' physical conditions. After POC, however, improvements in patients' oral conditions were noted in more than 50 percent of the cases. Consequently, it can be said that the POC provided by the NST has not only improved the oral hygiene condition of patients but also nurtured closer working relations among departmental staff in the hospital.

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With the introduction of the fluoride mouthrinsing program in elementary schools, correspondence and changes in the work of school-nurse teachers were investigated by semi-structured interview. Simultaneously, their freely-given opinions on the fluoride mouthrinsing program were obtained. Many school-nurse teachers could not understand the significance of the introduction of the fluoride mouthrinsing program. Therefore, they were apprehensive that the effective explanation and execution of this program could not be fulfilled. This shows that the level of understanding of this program was not sufficient among the promoters, school staff, and parents of schoolchildren as a whole. Also, some school-nurse teachers considered the work involved in the fluoride mouthrinsing program a burden for them. On the other hand, other school-nurse teachers were very positive concerning the effects of the program, and wanted to perform their part very enthusiastically. Despite the execution of the fluoride mouthrinsing program, there was little evidence that the level of cooperation between school staff and school dentists was improving. It is necessary to carry out further extended investigations. Thereby, we can obtain important information to be utilized in the development of any future fluoride mouthrinsing program.

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