It has passed nearly 5 years since the examination method for saliva and cariogenic bacteria was introduced into Japan, which is helpful for handy evaluation of caries risks at the chair side. During October, 1980 to October, 1998, 4,110 individuals who visited Hiyoshi Dental Clinic (Sakata City) were examined and the data were collected. Among the obtained data, the collectable value in relation to caries-risks are reported here. Regional deviation has to be considered. Therefore, the mean profile of dental patients' in the whole country can not be defined immediately from this data. However, it can be useful reference materials when the similar tests are performed at the clinic. When making risk evaluation or self-evaluation of a clinic it based on their examination results, it can be valuable to refer to the examination results which contains great number of cases. Among advanced industrial nations, the intraoral conditions of Japanese people are unique reflecting the differences of medical and health system, the ratio of treated tooth, frequency in use of fluoride agents, and sugar intake. In Japan, from this view points, it is also important to make people's caries-risk profile clear. By the examination of mutans streptococci level (Dentcult® SM) in the saliva, the residence of mutans streptococci (occupying more than 80% of tooth surface) was shown in 39% in men and 46% in women. In salivary buffering capacity test (Dentobuff® Strip), very low-level value was indicated in 25% of men and 32% of women, respectively. Additionally salivary secretion speed, lactobacilli level in saliva, the frequency of eat and drink, taking medicine for the adverse effect against sialoschesis, the conditions of use of fluoride agents, and plaque control level were examined and data were collected. The results are reported here.

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An investigation of smoking habits was conducted among the patients in the periodontal maintenance period and the new patients. The 1616 individuals of 10 - 84 years old who made the first visit at Hiyoshi Dental Clinic (Sakata City) during the period of 10, 1980 to 10, 1998 and 973 patients of 10 - 84 years old who visited the clinic for maintenance (periodontal maintenance therapy) during the same period were examined. As for smoking habits, there is a report that the amount of smoking accumulation affects health greatly. Therefore, the number of cumulative cigarettes was calculated by [ (number of cigarettes per day) x (years of smoking)] and the obtained figures were classified in 4 levels. Also depending upon the bone absorption degree observed radiographically, the progress level of periodontal disease of each tooth was divided into 4 classes, respectively. The patient's clinical stage of periodontal disease was determined by the average degree of his/her whole teeth. The other factors including clinical probing depth, the number of lost teeth, and effectiveness of maintenance were examined in relation with smoking habits. Consequently, the ratio of smoker in men reached 60% in almost all age groups, while in women more smokers were found in younger age group. Also especially in patients over 30 years old, there were significant differences on the progress level of periodontal disease between smokers and non-smokers. In this research the ratio of smoker in men was very high, and it was clearly indicated that smoking was one of the risk factors of periodontal disease, particularly in men. Recently a number of studies proved that smoking could become a risk factor of periodontal disease. However, it has not become popular yet that a dental clinic tackles on smoking issue in part of its clinical practices through risk diagnosis or prevention and treatment of periodontal disease. For the preventive treatment of periodontal disease in dental clinic, it is an urgent matter to make clear clinical effectiveness by improving smoking habits in periodontal supportive therapy. Therefore, knowing patient's actual smoking habits and utilizing that information into risk diagnosis of periodontal disease have become more important than ever.

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Management of patient's clinical data is important for the patient's well being as well as for the objective evaluation in the clinic. But the effective management becomes more difficult as more information is obtained. So, the information management system should also have to be considered in the light of cost effectiveness. Authors have ever proposed data management system for obtaining clinical epidemiological data, in addition to the recordings of conventional diagnostic chart or intraoral photography. While some portions of the system are introduced in this magazine, the significance and the system for patient's data management, which authors adopt in the daily practice are mentioned first of all.

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I opened a dental clinic at a town of 7,500 population where there was only one dental clinical facility available. The patients' oral health conditions were far worse beyond my expectation. I was given chances to examine oral health conditions of the most children in the town as a school dentist. I adopted possible measures in turn in my school health activities; 1) not using explorer at the examination, 2) the diagnosis of “regard the questionable tooth as a healthy tooth”, 3) instruction of the fluorine application for treatment of primary caries, 4) mouth washing with 0.2% NaF once a week. Consequently, the DMFT index of 12 year-old children at the elementary school declined to 1.2 in 1998 from 3.0 in 1994, and the caries-free ratio of permanent tooth in the same age group was improved to 50.6% from 31.4%. Having focused on local dental health activity at first, contributed greatly to the preparation of the establishment of preventive dental practice in my clinic.

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Through the health activities as a school dentist, I had an opportunity to reconsider school dentist's role, the purpose of health examination, the goal of a school dentist, and the aim and meaning of CO (Questionable Caries for Observation). In the school oral health examination, I stopped using explorer and took intraoral photos. These photos were utilized for providing information to the family as well as observing prognosis. As the results, the DMFT index of 12 year-old children (the 6th grade) improved to 1.6 in 1998 from 4.3 in 1993. I realized the importance of establishing social circumstances that protect and nurture health. This will be obtained by working in closer cooperation with home-school-home doctor.

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In order to prevent developing caries during orthodontic treatment, sugar control and tooth brushing were thoroughly instructed. Evaluation of DMFT indicated that DMFT index increased 2.8 during 2 years of orthodontic treatment. This was almost same rate as the one of general age-group children. After this, knowing the theory of cariology, my preventive measure against caries developments was altered. Based on the results of risk evaluation, professional care was concentrated in the high-risk sites, which included sealing and fluorine application to the necessary site. 38 patients of orthodontic treatment with multi-bracket apparatus were evaluated, and found that DMFT index increased 0.1 in 2 years during their orthodontic treatment of 12 - 14 year-old.

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I am in the 7th year as a school dentist at an elementary school. Between the first 3 years and the following years of this period, my thought for diseases, measures for health examination, standard of diagnosis, and measures for coping with diseases changed greatly. With these alteration, DMFT index showed remarkable change. I had understood that the public health activity was just a principle and therefore the real activity existed in the site of the clinical practices. In the first 3 years, backed with this understanding, I concentrated only on accurate handling of school dental health examination. This can be related to current Japanese health insurance practices, which advocates the theme of 8020, keeping 20 natural teeth at the age of 80 years old, in principle, while the priority is placed on the treatment. I had managed people focusing on the dental practice, but the dental health activity at a school provided me a best chance of social study, where I was able to learn variety of different thoughts or values of people. It also taught me the importance of taking a consistent attitude towards “protecting and nursing health and enhancing the health value”.

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Conventional medical treatments of chronic diseases inclined toward symptomatic therapy are being criticized. However, the management system in hospitals and clinics which forms, so to speak, medical basement structure cannot be changed from the conventional management system of income and expenditure in a day. The reformation of medical treatment system appears to being fettered by management. Management data over the past 14 years have been provided from 10 members' clinics where the focus on medical treatment were shifted from restorative and prosthetic therapy into preventive treatment. Then, the potentials and problems of such change have been analyzed. The change of patients number suggests that there are mainly two types of clinics; one is that the insurance number has consistently increased, and another one is that the number was declined or otherwise leveled off. We have studied these two contrastive groups to find the cause of the difference occurred. Consequently, it was apparently indicated that the change of capacity at a clinic could become one of the major conditions in the management of a clinic focussed on preventive treatment.

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