Pycnogeno®, a phytochemical extract from bark of the French maritime pine tree (Pinus pinaster Aiton), consists of standardized proportions of monomeric and oligomeric procyanidins and phenolic acids, which are categorized as polyphenols. Since various polyphenols have been reported to exhibit antibacterial effects, we examined the antibacterial activity of Pycnogenol® against eight oral bacteria, including Streptococcus mutans and Porphyromonas gingivalis, the causative pathogenic microorganisms of dental caries and adult periodontitis, respectively. Gram positive bacteria except Actinomyces viscosus tested in this study were susceptible to a 0.1% (w/v) concentration of Pycnogenol®, and efficacy against S. mutans was observed at a minimal 0.05% concentration (P<0.01). Longer treatment with 0.01% Pycnogenol® led to enhanced antibacterial effects against S. mutans and Streptococcus gordonii. Furthermore, Pycnogenol® apparently inhibited the growth of S. mutans from 6 through 24 h. Pycnogenol® also showed a significant antibacterial activity against Gram negative rods at a 0.1% concentration, whereas it had no effect on Veillonella parvula at the highest concentration tested in this study. Especially, black-pigmented P. gingivalis and Prevotella nigrescens were highly susceptible to Pycnogenol® at the lowest concentration, 0.001% (P<0.05). These results suggest that Pycnogenol® has antibacterial activity against various types of oral microorganisms which cause dental caries and periodontitis, and treatment with Pycnogenol® may be effective to prevent oral infections.

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The purpose of this study was to examine the relationship of noncarious cervical lesions (NCCLs) with the toothbrushing habit, bruxing habit, occlusal force, occlusal contact area, and average pressure. One hundred and thirty male (average : 36.2 years old) self-defense officials at Okadama Base of the Ground Self-Defence Force participated in this study. All existing teeth were examined for the presence and type of NCCL using the tooth wear index. Then, they were interviewed regarding bruxing and toothbrushing habits. Finally, occlusal force, occlusal contact area, and average pressure were measured using a pressure-detecting sheet. Seventy-eight subjects (60.0%) had at least one NCCL-tooth. A total of 3, 708 were examined, and 298 teeth (8.0%) were diagnosed as having NCCLs. The number of teeth with NCCL Grade 2 (defect less than 1 mm deep) was 208, followed by Grade 3 (41 teeth, defect 1-2 mm deep) and Grade 1 (40 teeth, minimal loss of contour). The prevalence of teeth with NCCLs was greater in the maxilla than mandible. Most NCCL-teeth were premolars. There was no significant difference in teeth with NCCLs between left and right sides. Logistic regression analysis revealed that the age (36 years or older, OR=2.43), toothbrushing pressure (400 g, OR=4.88), and occlusal contact area (>23.1 mm^2, OR=5.11) were associated with the presence of NCCL-teeth. It was concluded that aging, toothbrushing pressure, and occlusal factors were associated with the presence of NCCLs.

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The disease concept of "Metabolic syndrome" has been added to the health check-up system and health-supporting programs in Japan. The present study investigated the relationship between inflammatory substances in gingival crevicular retention fluid (GCF) and indicators of metabolic syndrome in workers. GCF samples were collected during health check-ups in a standardized manner. Samples were delivered in bulk to a laboratory for analyses of lactoferrin (Lf), hemoglobin (Hb), α_1-antitrypsin (AT), immunoglobulin A (IgA), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH). Workers were grouped as "positive" and "negative" according to the amount of each substance in GCF. Workers were also grouped according to metabolic syndrome and its indicators, such as waist circumference, blood levels of glucose, lipids including triglycerides and cholesterol, and blood pressure or medication to control diabetes, hyperlipemia, and hypertension. Records of 536 subjects (353 males and 183 females), aged more than 35 years, were analyzed. The percentage of subjects with positive GCF tests comprised 10.3% for Hb, 4.9% for AT, 10.4% for Lf, 49.1% for IgA, 11.9% for AST, 21.8% for ALP, and 6.3% for LDH, and 14.2% of subjects were diagnosed as having metabolic syndrome. Levels of inflammatory substances in GCF were significantly higher in subjects with than in those without metabolic syndrome for AT (P=0.037), Lf (0.002), IgA (0.001), and AST (0.016). Significant differences in the GCF levels were also apparent by indicators of metabolic syndrome : Lf, Hb, and IgA for waist, Lf, IgA, AST, and DH for blood levels of lipids, and IgA for blood levels of glucose. There was also a relationship between metabolic syndrome and GCF status of Lf (OR adjusted forage group, sex, and smoking=2.6, 95% CI=1.3-5.3) and IgA (2.0, 1.2-3.5) and between indicators of metabolic syndrome and GCF status : waist circumference and Lf (3.4, 1.6-7.0) and blood glucose level and both Hb (2.2, 1.0-4.7) and IgA (2.0, 1.1-3.5). These findings indicate an association between GCF levels of inflammatory substances and metabolic syndrome, suggesting a relationship between periodontal inflammation and metabolic syndrome.

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Periodontal disease and dental caries are major causes of tooth loss. To preserve functional and natural teeth, a preventive and maintenance program for the diseases has been conducted in Okayama University Hospital. The program has been shown to preserve more than half of the teeth receiving conventional treatment for periodontal disease and dental caries after 6 years of treatment : however, a small number of teeth are still lost during the maintenance period. This retrospective study was aimed at determining reasons for the tooth loss and factors associated with tooth loss during the maintenance program for 8-10 years in the University Hospital. One hundred and six consecutive patients (33 males, 73 females) who received maintenance care and attended for 8-10 years were studied. General health status, smoking, and reasons for tooth loss after 2 years from the initial visit were investigated. The following variables were recorded at the first visit, 2 years after the first visit, and at the re-examination after 8-10 years : number of teeth, probing pocket depth, probing attachment level, bleeding on probing, tooth mobility, and plaque index. Fifty out of 106 patients experienced tooth loss, and 103 out of 2, 508 teeth had been lost after 2 years of the first visit. Maxillary second molars were the most prone to loss. After 2 years of the first visit, 38 were lost due to periodontal disease and 25 were exfoliated. Patients with experience of tooth loss were higher in age, showed a higher prevalence of severe periodontitis and hypertension, and a lower number of present teeth at the start of the maintenance phase compared to those without. These results emphasize the importance of risk management of periodontal disease in maintenance programs to prevent tooth loss.

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The balance of dentistry between crown restoration and regular check-ups was compared. Four types of treatment were highlighted : inlay restoration, composite resin filling, pulpectomy-cast crown restoration, and regular check-ups for adults. As for the comparison method, medical profession incomes were calculated from the quick reference table for social insurance dental fee points, and then medical costs were subtracted to find management balances. Medical costs were divided into material costs, the costs of outsourcing dental technicians, and personnel expenses. Management balances per unit time were calculated based on management balances and chair time. As a result, the amount of management balance per unit time was ascertained to be in the following order : composite resin filling, regular checkups for adults, pulpectomy-cast crown restoration, and inlay restoration. This suggested that if dental hygienists and the dental chair can be secured for regular check-ups, the management balance of the dental office can be improved by increasing the number of adult patients who visit dentists for regular check-ups.

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The status of oral health in adult men in business establishments which have introduced a dental health service program for the first time would differ depending on the presence or absence of family dentists and their dental health behavior. With this in mind, we investigated the influence of family dentists on the oral health of company employees. A total of 985 men aged 30 to 59 were enrolled in this study. The subjects were the insured of a certain health insurance association. First, their oral health status was examined, and then they were divided into the following three groups : Group A consisted of those men who had family dentists, and had their oral health checked and their teeth scaled within the last 12 months ; Group B, those who had family dentists but who had not received any treatment over the past 12 months ; and Group C, those who did not have family dentists nor had visited any dental clinic within the past 12 months. The results showed that, between Groups A and B, there were notable differences in the method of tooth brushing and the use of instruments for proximal cleaning. The number of those interested in oral cleanliness was significantly larger in Group A than in Group B. Upon logistic regression analysis, it was brought to light that among the subjects in Group A, who saw their dentists on a regular basis, those in their 30s showed very good oral health behavior, while those in their 40s and 50s seemed to be keenly aware of, and take an active interest in, oral health. There have been no published reports on the differences in the state of oral health and oral health behavior between people with and without family dentists. Therefore, it can be said that the present study may act as catalyst for research into the role of family dentists and their influence on the oral health behavior and improvement of people's dental health administration.

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We examined the relationship between tongue coating, lifestyle, and subjective symptoms. Digital images of the tongues of 92 college students were reproduced in a computer. Subsequently, the thickness, color, and quantity of tongue coatings were evaluated by one examiner. The R, G, and B values of tongue coatings were calculated with computer software. Tongue coating was identified in all subjects. The highest scores of thickness and color were observed most frequently in the middle, rear section of the tongue. Average, standardized R, G, and B values in this section were 108.4±6.3, 75.5±3.9, and 71.1±4.3, respectively. Thickness showed a significant correlation with sex, tooth-brushing, and three kinds of symptoms of the digestive system (p<0.01-0.05) ; color was associated with one symptom (p<0.05). Quantity was significantly correlated with sex, tooth-brushing, and tongue-scraper use (p<0.01-0.05). Smoking and seven digestive system symptoms exhibited a significant association with at least one of the R, G, and B values (p<0.001-0.05). These results indicate that tongue coating may be related to lifestyle and subjective symptoms in college students. Tongue coating may be suitable as an indicator used by dental professionals regarding their patients health-related behavior.

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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. In recent years, there have been many dental projects for mothers and their children like this one. The purpose of this study was to investigate the influence of mothers' age and the birth order of their children on their dental health behavior. The subjects comprised 8896 mothers who participated in the check-up from 1993 to 2000, and their mean age was 29.9 years. They answered the HU-DBI questionnaire (maximum score : 12 points), an instrument for assessing dental health behavior before the check-up. The mothers' age and birth order of their children were considered to be a general female-based factor and a child-rearing factor influencing their dental behavior, rescpectively. As a result, both of the factors were related to the mothers' dental health behavior. Mothers from thirty-two to thirty-six years of age or accompanied by their third child showed the highest level of dental health behavior. Therefore, it was supposed that females had some age brackets within which they showed good or bad dental health behavior. Mothers might become more educated in dental health behavior as a result of child-rearing, even though mothers with many children would be under some disadvantage.

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This project is a logical continuation of our dental health program initiated in 1993 at a junior high school in Tokushima. In this current program, we evaluated the gingival condition using the PMA index performed during dental examinations from 1996. Because the score of the PMA index might be inconsistent between examiners, only one dentist performed the examinations from 1996 to 2004. In 2005, we modified this method to obtain a more objective estimation of gingivitis. More specifically, 5 dentists assigned the score of the PMA index and estimated GO (gingivitis under observation)/G (gingivitis) in 39 students using oral photographs obtained during dental examinations. A year later, 5 dentists re-evaluated the status after calibration of the PMA index based on the visual material from these results. Based on the results, we confirmed that this calibration was useful to reduce the discrepancy between examiners, even if some problems still remained regarding evaluations using oral photographs. Furthermore, the data obtained from oral photographs and the PMA index were found to be an efficient tool in dental health guidance by school teachers.

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