In this study, we sought to determine factors that influence the ability to masticate in children with a cleft lip and/or palate (CLP). The subjects were 131 patients aged 4-12 years, and their guardians. A questionnaire survey was conducted targeting guardians regarding their awareness of diet and mastication, and about the dietary and living behavior of their children. Additionally, an oral examination was performed and the mastication ability of children was determined using a chewing gum method. In the mixed dentition stage, mastication ability was significantly lower in children suffering from CLP than in children with no such condition. Guardians of children with CLP had greater concerns about the present and future dental arch of their children than guardians of children without CLP. In children without CLP, a shorter nursing period in the suckling stage corresponded to stronger mastication ability in the chewing gum test Regarding the preparation of meals, about 80% of guardians answered that they tried to include hard foods for mastication training for their children. Diet analysis, however, revealed that soft foods accounted for a large part of meals. These results suggest that the mastication ability of infants with CLP is low, and their guardians have great concern about the oral conditions of the children. Providing guardians with specific information about effective foods is important for developing the mastication ability of their children, especially in infants who have CLP.

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As part of Japan's Health Care Reform 2008, health check-ups to detect symptoms of metabolic syndrome were made mandatory; however, they do not include a dental health program. Limited information is available on the association between metabolic syndrome and periodontal disease. In the present study, we determined the association between the components of metabolic syndrome and periodontal status in a rural community in Japan. A total of 246 residents (30-64 years old) participated in a comprehensive health screening. The medical examination included anthropometric and manometric measurements and blood chemistry tests. Periodontal status was assessed using the Community Periodontal Index scoring method and subjects with the score of 3 or 4 were considered to have periodontitis. Participants taking medication for diabetes mellitus, hyperlipidemia or hypertension were counted as positive for high fasting blood glucose, dyslipidemia or high blood pressure, respectively. Chi-square tests and stepwise logistic regression analysis were used to estimate the association between each component of metabolic syndrome and periodontal status. A total of 41.0% of subjects were considered to have periodontitis. Significant differences between subjects with and without periodontitis were observed in age, gender, blood pressure and fasting blood glucose level (p<0.001, p=0.001, p=0.008 and p<0.001, respectively). A stepwise logistic regression model showed that subjects with a fasting blood glucose level ≥110mg/dl were at increased risk of having periodontitis (adjusted odds ratio=2.118, p=0.049). The results indicate that a high fasting blood glucose level might be a potential indicator for the presence of periodontal disease in this rural Japanese population with a low prevalence of metabolic syndrome. Residents with high levels of fasting blood glucose are recommended to be informed of the correlation between periodontal disease and diabetes mellitus in health check-ups for metabolic syndrome.

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Health promotion for not only patients but also healthy people in the local community is important for dentists. Students at Hiroshima University Dental School therefore visited a local junior high school for oral health promotion. The students gave a lecture on oral health, and demonstrated plaque disclosure and brushing instructions for junior high school students. In this study, we analyzed a questionnaire survey and determined the factors related to the increase of awareness in the junior high school students. Questionnaire surveys from all 254 junior high school students after the presentation were summarized, aggregated, and analyzed with Fisher's exact test. The surveillance revealed that plaque disclosure had a striking effect on the students and the presentation increased the number of students with high awareness of oral health. Analysis with Fisher's exact test revealed that increasing the awareness of oral health was correlated with the number of students who realized their poor brushing skills after plaque disclosure (p<0.01). This is necessary to increase their awareness, although plaque disclosure had a striking effect on the students; however, no relationship was observed with the other factors. These findings indicate that the plaque-disclosing demonstration has advantages for oral health promotion in junior high schools and more advanced instruction based on plaque disclosure is considered of value to increase their awareness, contributing to oral health promotion.

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There is limited evidence of the influence of physical or intellectual disabilities (PID) on dental caries and periodontal diseases. This study investigated the prevalence of dental caries and periodontal conditions in subjects with PID. A total of 227 subjects at 24 small-scale working institutions for adults with PID in Niigata City were surveyed. The mean age of subjects was 34.7±2.3 years. After subjects were divided into four groups according to age, we evaluated mean DMFT and periodontal conditions using CPI. Furthermore, the occurrence of dental caries and periodontal conditions was compared between subjects aged 20-29 years with and without intellectual disabilities (ID). Mean DMFT was similar to averages from subjects in Niigata Prefecture, except for the mean number of decayed teeth and the percentage of persons with the highest CPI code. In addition, mean DMFT and decayed teeth were 6.31±6.13 and 1.23±2.89 for subjects with ID, and 3.05±3.81 and 0.09±0.29 for subjects without ID. All differences between ID and non-ID subjects were statistically significant (p=0.01 for mean DMFT; p=0.01 for decayed teeth). In addition, the mean number of decayed teeth between subjects who required assistance with daily oral care and subjects who did not was 0.23±0.75 and 1.20±2.88, respectively (p=0.02). There was no significant difference in the percentage of persons with the highest CPI code between subjects with and without PID. Our results indicate that the mean DMFT and the number of decayed teeth might decrease if assistance in daily oral care were provided for subjects with PID. Experts, such as dentists and dental hygienists, should provide support for daily oral care among these subjects because the family or institution staff often do not have enough time to help.

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It is well known that a risk perception affects the decision of whether to adopt new substances, activities, and technologies. We conducted a survey on the risk perception of fluoride therapies with a questionnaire developed by Slovic. The subjects were 1,030 women in their thirties who were registered as monitors by a web research company and had children living in 10 prefectures selected based on the number of children participating in fluoride mouth-rinsing programs. Sixty-one percent of their children experienced a fluoride application, and 69%, 18%, 0.6% experienced fluoride toothpaste, fluoride mouth-rinsing, and fluoridation, respectively. Most had obtained knowledge about fluoride from dental personnel and administrative health officers. The knowledge level of the effectiveness and risks of fluoride application was the highest, followed by fluoride toothpaste, fluoride mouth-rinsing and fluoridation. The level of fear of fluoridation was significantly higher than that of other fluoride therapies. The desire for fluoride application and toothpaste to increase in the near future was strong; however, that for fluoride mouth-rinsing and fluoridation was weak. It was found that there was an association between the number of fluoride therapies their children had experienced and the desire to increase them, except for fluoridation. Factor analysis showed that the first factor was "Sense of fear", the second was "Amount of information", and the third was "Sense of risk control". The first and second factors were similar to "Dread" and "Unknown" identified by Slovic et al. There was little difference among "Sense of fear" of various fluoride therapies; however, "Amount of information" on fluoridation and fluoride mouth-rinsing was significantly less than that of fluoride application and fluoride toothpaste. The subjects had little information on fluoridation in every prefecture and there was no difference in the "Amount of information" on fluoridation among prefectures with widespread fluoride therapies or not, but the "Amount of information" on other fluoride therapies was greater in prefectures where fluoride therapies are widespread. It was suggested that little information on fluoridation was provided even in prefectures where topical fluoride therapies are widely used.

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The purpose of the present study was to investigate the relationship between the number of masticatory cycles and estimated food and nutrient intake in elderly Japanese. The subjects were 349 patients (182 males and 167 females) aged 75 years in Niigata prefecture who participated in a dental examination, measurement of masticatory cycles, and a brief-type self-administered diet history questionnaire (BDHQ) in 2003. In the measurement of masticatory cycles, patients were instructed to chew 2 pieces of rice cracker (a rice cracker 4cm in diameter was broken into 2 pieces). The number of masticatory cycles was counted by observing the movement of the mental region. The patients were asked to raise their hands upon initial swallowing, and the number of masticatory cycles before the first swallowing was used as the masticatory cycles. Food and nutrient intake was calculated using the program for BDHQ. The relationship between the masticatory cycles and estimated food and nutrient intake was evaluated using multiple linear regression analysis, after simultaneously adjusting for sex, body mass index (BMI), smoking status, the number of teeth present, the usage of dentures, and masticatory function. The results of multiple linear regression analysis showed that patients with a greater number of masticatory cycles had a significantly higher intake of seafood (p=0.041), and milk (p=0.029) and significantly smaller intake of snacks (p=0.007) as food, and significantly higher intake of total protein (p=0.001), animal protein (p=0.001), calcium (p=0.008), phosphorus (p=0.001), zinc (p=0.009), vitamin D (p=0.001), vitamin B_2 (p=0.010), vitamin B_6 (p=0.031), vitamin B_<12> (p=0.004), pantothenic acid (p=0.001), and cholesterol (p=0.034). The results of the present study suggested that the elderly with more masticatory cycles have higher seafood and milk intake, and lower snack intake as food, and higher intake of protein, mineral, vitamins and cholesterol as nutrients.

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The regional clustering of cross-sectional and time-series data on draft of 3-year-old Japanese children in all 47 prefectures of Japan over a 25-year period from 1981-2006 (25y-dmft-trend) were evaluated using autocorrelation statistics employing Moran's I test (MIT) and Geary's C test (GCT). The dmft distributions every five years were not random, and regional clustering every year was significant Patterns of time-series changes in dmft were evaluated using seven indicators: 1. maximum, 2. minimum, 3. range, 4. r² (contribution rate), 5. slope of simple regression line (SRL) between years and dmft, 6. intercept of SRL, and 7. number of inflection points of the optimum regression curve determined by the Akaike information criterion (AIC), and classified by principal component analysis. As a result, two Pas (COMP1 and COMP2) were extracted. COMP1 was highly correlated with indicators 1, 3, 5, and 6, whereas COMP2 was related to indicators 4 and 7. The cumulative contribution rate by COMP1 and COMP2 was 80.3%. Regional clustering of COMP1 was highly significant employing both MIT and GCT, while COMP2 was not significant using either MIT or GCT. Stepwise multiple regression analysis was performed with COMP1 as a dependent variable (Y), and ten mutual non-correlative factors (X) extracted by Varimax factor analysis with 48 prefectural socioeconomic indicators such as population movement, industry structure, and healthcare status, in order to clarify the relationship between regional clustering and various socioeconomic indicators. Consequently, seven factors were significant (p<0.05-0.001) and the multiple regression coefficient R was 0.85 (p<0.001). It was indicated that the leading indicators contributing to the regional clustering of the 25y-dmft-trend were the prefectural increase in dentists, decrease in the percentage of workers engaged in primary industries, and a reduction of the mortality rate caused by lifestyle-related diseases.

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In Sri Lanka, the civil war has come to an end, and so the economy is expected to improve. These economic advances may bring about an increase in lifestyle-related diseases, including dental caries. Socioeconomic studies related to dental health behaviors are needed in order to detect the signs of impending threats to dental health. The purpose of this study was to identify simple indicators of the socioeconomic status and community development which are likely to influence the dental health behaviors of schoolchildren. The participants were 949 children aged 12, selected randomly in Sri Lanka. The ethnic group, parents' educational background and occupation, and monthly household income were analyzed as indicators of the socioeconomic status. The ownership of 24 household economic indicators, mainly consisting of household appliances, was also analyzed as an indicator of community development. The relationships between these indicators and four dental health behaviors (consumption of sugared foods/drinks, daily tooth brushing, fluoride toothpaste use, and regular dental checkups) were analyzed. The results of this study showed that the socioeconomic status and household economic indicators influence dental health behaviors. Household economic indicators were mainly divided into three factors by factor analysis: luxury appliances/facilities, household appliances, and driver or domestic worker. These categories of household economic indicators had different effects on the socioeconomic status and on the four dental health behaviors. Simple sums of binary responses of factor loadings of these three factors can be used as a substitute for other factors. These three substitute indicators will be useful when response refusal rates are high for items such as the monthly household income and educational background.

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To improve dentel health throughout life, it is extremely important to promote oral care and regularly monitor oral health in both individuals and the community as a whole. The objective of this study was to perform covariance structure analyses to examine the correlations between oral hygiene, self-care, and preventative visits in patients whose regular dentist is in private practice. The data collected during the study was also used to clarify the relationship between subjective health and satisfaction with life. The subjects included 2,900 patients of 42 regular dentists of dental clinics who belonged to the Tokyo Metropolitan Ward Dental Association. During March and October 2008, anonymous self-administered questionnaires were completed by the subjects and their oral health was ascertained by their regular dentists. The number of responses was 2,745 (94.7%), with the mean age of the participants being 52.6 years. The results showed that patients whose main reason for the consultation was prevention and who were subjectively healthy and used interdental cleaning devices showed favorable oral hygiene and a normal gingival state. Significant correlations between these parameters were observed in both men and women. The goodness of fit indices in our model were NFI=0.997 and RMSEA=0.008. The findings of the present study emphasize the significance of undergoing regular checkups with regular dentists providing continuous primary oral care, in order to maintain favorable oral health and prevent dental disorders.

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We conducted a semi-structured interview survey involving five dentists who had experience of home visits. All subjects were specifically selected and a questionnaire was mailed to each of them in advance. The interview was conducted based on the aforementioned questionnaire and an additional interview guide comprising interview items. The interview items discussed included positive and negative experiences that each interviewee had during home visits, and problems they had faced. Matters related to tooth extraction were carefully singled out from the original interview transcript and then they were interpreted employing the KJ method. Tooth extraction during home visits was divided into two major categories. The first category involved no extraction being carried out, with the dentists providing alternative methods of treatment. These cases involved a wait-and-see approach, occlusal correction, filling, and designing overlay dentures. The second category involved extraction being carried out only when it was absolutely necessary. When the dentists chose extraction as the first-choice treatment, two different sets of criteria were used. The first set of criteria for extraction during home visits was exactly the same as that for extraction in dental clinics. The second set was completely different from the criteria in dental clinics. Four criteria were clearly defined in home visits. First, caregivers gave the final approval for extraction, and courses of treatment after extraction were performed. Second, supervisors of care homes made the final decision. Third, cooperation and linkage with other medical service personnel and medical supervision (including controlling anticoagulants) were key to decision-making. Finally, there were some cases where the dentists were forced to follow other dentists' decisions. With the interview results presented herein, we demonstrated that, for home visits, it is more essential for dentists to develop practical communication skills rather than to brush up on advanced techniques or proficiency. Trusting relationships with physicians, nurses, care home personnel and caregivers, and mutual understanding among all medical professions are required. Furthermore, information sharing regarding control medication (including anticoagulants) among dentists and physicians should be promoted. It is also suggested that dentists should be encouraged to become more positively involved in home visits, and opportunities for home visits should be offered equally with clinical training.

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