In Japan, consensus development of opinions on water fluoridation has confronted a very difficult hurdle to realize water fluoridation in spite of being an essential process. The opinions of leaders are very important. Regarding water fluoridation, dentists have to play a central role as public oral health professionals. However, the opinions and attitudes of Japanese dentists on water fluoridation are very ambiguous, and they have never exercised leadership in the promotion of water fluoridation.

 Water fluoridation is a very important public policy an viewing from various angles, such as medical and sociological viewpoints.

 Consequently, we suggest that all professionals and organizations concerned with public oral health should make efforts to promote consensus development on water fluoridation as a public policy.

　The present study aimed to clarify the relationship between speech mechanism impairment and articulation function using oral diadochokinesis (OD). Subjects comprised 29 patients (23 men, 6 women; mean age, 68.8±9.3 years) undergoing rehabilitation due to dysarthria who consented to participate. In addition to measuring the OD rate, speech mechanism assessment and three other tests were simultaneously conducted. Multiple linear regression analysis was used to investigate the relationship between the OD rate and results of speech and speech mechanism assessment and presence or absence of orofacial, eating, or deglutition disorders.

　The following items demonstrated a significant relationship with all of the the OD sounds /pa/ /ta/ /ka/. The speech assessment parameters of speech intelligibility and degree of speech naturalness revealed that the higher the OD rate, the more patients’ speech was ‘well understood’ and ‘completely natural’ (standard partial regression coefficient (β)=0.42-0.71; p<0.001-0.037). The longest exhalation and maximum phonation time of the speech mechanism parameters showed that the higher the OD rate, the longer the duration (β=0.46-0.62; p=0.002-0.021). Furthermore, higher scores for tongue protrusion and elevation were associated with a higher OD rate (β=0.46-0.52; p=0.007-0.020). Eating and deglutition disorders showed a significant correlation with /ta/ (β=0.49; p=0.012) and /ka/ (β=0.54; p=0.005).

　The present findings suggest a relationship between dysarthria and speech, respiration, phonation, and eating and deglutition disorders.

　Recently, jellies and commercial thickening agents have been widely utilized among elderly people with swallowing difficulties. The aim of this study was to clarify the effect the ingestion of supplementary food for swallowing disorders has on oral hygiene.

　Thirteen healthy adults without swallowing difficulties were subjects in this study. They were evaluated regarding their intraoral residues after taking test foods (cookie, jelly, thickened water) by measuring the optical density of liquid after mouth rinsing of water. The experimental conditions such as amount, duration, swallowing, and chewing were strictly limited to simulate patients with dysphagia.

　As a result, ingestion of jelly or thickened water after taking a cookie reduced the intraoral residue significantly. Among several conditions tested, chewing was very efficient to reduce the intraoral residue. In conclusion, it is suggested that the ingestion of jelly with chewing after a meal might improve oral hygiene in people with a decreased deglutition function, in addition to prevent aspiration of residual debris. Furthermore, we should consider not only the texture of food but also the way to eat it for the maximum effect of intraoral residue removal.

　“Behavioral objectives” have been adopted in the “Oral Health Examination, Assessment, and Health Instruction Program for Adults”, as an approach to increase self-efficacy. In our previous study, we reported changes in oral health behaviors during this program. The present study analyzed the status of behavioral objective setting and goal achievement, based on descriptive epidemiology.

　Subjects were 245 people, with a mean age of 40.4 years old (standard deviation: 11.0), who underwent examinations, as part of the program, at institutions in four prefectures (Tokyo, Aichi, Miyagi, and Kochi), which store a sufficient amount of data. A total of 485 behavioral objectives were set: one to three items per person. Based on their similarities, the 485 objectives were classified into nine categories: “tooth brushing and its methods”, “the use of auxiliary tools”, “dental plaque cleaning”, “meals/eating”, “physical health/exercise”, “smoking cessation”, “others”, and “not categorized”. Each of the nine categories was classified into one to nine sub-categories. The goal achievement rate for each category was calculated based on the examinees’ self-assessment.

　“The use of auxiliary tools” was set as a behavioral objective by the largest number of examinees (58%), and the achievement rate was also the highest (62%). While 32% of examinees set “dental consultation” as an objective, the achievement rate was relatively low (29%). On comparison of the achievement rate, there were significant differences in the total rate and that for “the use of auxiliary tools”, “tooth brushing and its methods”, and “dental consultation” between the four institutions. Examinees’ age composition and the health guidance method were characteristic in each institution. It was suggested that behavioral objectives set by examinees and the achievement rates were related to their characteristics, guidance methods, and procedures.

　Dental examination data (DFT) of students of a unified lower and upper secondary school in Hiroshima were analyzed to investigate factors influencing the DFT. They entered the school in 2000 and 2001 academic years, and the examination was carried out once a year a total of six times. The following results were obtained:

　1. Although students who entered the school in 2001 had 0.55 less DFT than those in 2000. The girls’ DFT was 0.42 more than that of the boys.

　2. Although the DFT of all students increased by 1.9 during their five student years, that of students who had over six DFT in the first examination did not increase.

　In order to confirm the obtained results, more examination data of students should be obtained, and the dental examination might need more precise standards, like the DMFS index and Dental Health Capacity of Clune.

Abstract in Japaneses

　Oral health care is an important and significant facet of nursing and welfare in Japan, but many facilities suffer from problems in delivering this care. The purpose of this study was to define those factors that limit the delivery of oral health care in nursing facilities for the elderly.

　A seminar with a workshop was offered for staff in nursing facilities for the elderly in Fukuoka, Japan on 14 December, 2009. The 67 participants were divided into 11 groups and asked to report the difficulties they experienced in caring for their patients’ oral health. We used the KJ method to identify problems in oral health care in these facilities, and the importance and urgency of these problems were then ranked using a two-dimensional expansion method. After analyzing 11 products, 69 codes were defined in decreasing order of relevance. The most relevant were “rejection of care”, “lack of experience (knowledge/skills) among staff”, “dentures”, “deterioration of oral function” and the most important and urgent was “no assessment and no basic manual”. Having identified the major barriers to delivering good oral health care to elderly patients, we encourage dentists and dental hygienists to collaborate with workers in the nursing and welfare fields to formulate strategies to overcome these pressing issues.

　Because the information given by nursing care staff might help dental professionals to understand the problems associated with delivering oral health care in nursing facilities, we consider that workshops for nursing care staff are of significant benefit in promoting the interactive exchange of information, creating an integrated and cooperative relationship between staff in the nursing and dental fields.