The caries judging criteria(Co ～ C4) currently in use by the Japanese Association of School Dentists has been established linearly on histological appearance and the degree of severity of caries without any regard of its changing risks. This traditional disease model ‘A caries does not heal spontaneously and develops if left untreated’ should be reconsidered and a new detection and assessment system has to be proposed. The formulating work of ICDAS II has begun on an internationally measurable caries judging criteria. ICDAS II is minutely designed to group findings and establish caries lesions, not by drilling treatment of teeth, but encouraging remineralization on the premise that findings include the teeth judged C1, however caries development ceases leaving many stained but otherwise healthy teeth. The wide use of ICDAS in Japan will help to reduce the trend of excessive drilling of patients’ teeth.

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It is recognized that regular maintenance has control over tooth loss. But, when patients are analyzed in detail, it is found that there are some cases of multiple tooth loss regardless of dental maintenance. 268 patients of the middlescence with reliable clinical records among the patients having visited for more than 15 years were analyzed revealing that 27 patients (about 10% of the total) lost about half of their teeth (218 teeth out of a total 414 lost teeth). The samples were divided in two groups, those who received more than three maintenance sessions as the ‘ maintenance group’ and those who received no maintenance as the ‘non-maintenance group’. These groups were examined from 20 years of-clinical records to reveal that: the maintenance group lost an average of 1.4 teeth while the non-maintenance group lost an average of 3.3 teeth. This is more than double the difference between them. It verified the importance of maintenance. Among the maintenance group, there were 18 samples who lost more than 5 teeth mainly due to severe periodontitis or restoration.

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Changing to a correct brushing method, I experienced an improvement of marked gingival configuration in patients. A male patient visited us feeling uncomfortable about gingival recession. At the first examination, he used a toothbrush with hard bristle as in Fones brushing method. He was instructed to use a toothbrush with soft bristle, stroking the brush laterally on the gingival recessed portion and brushing the interdenal space by holding the brush longitudinally. Instruction and observation continued for 3 weeks, then 4 months and so on. After 10 months, the plaque was not completely removed, causing gingival inflammation. He was asked to visit our dental office to acquire a knack in placing a brush on the cervical area. When 2 years had passed, recessed gingival was observed. Further improvement occurred and after 4 years and 8 months, the exposed root surface was mostly covered.

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Caries responsible for enamelogenesis imperfecta (MIH) is considered comparatively rare. But, when a higher rate of caries can be controlled through the early detection of congenital failure such as an enamelogenesis imperfecta, then correct treatment at the right time becomes important. 8 clinical cases are shown here. Jasulaityte, et all. Reviews an expression rate of enamelogenesis 5.9% ～ 25% are imperfect. Intraoral digital pictures of 108 patients at the age of 12 when they visited our dental office were examined on a computer. The teeth with white opacity, yellow opacity, yellow-brown demarcated opacity and enamel loss are defined as enamelogenesis imperfecta. Expression was recognized on front teeth, molars and also second molars with in 12 in 108 samples (11.1%). Healthy teeth increase with a decrease of caries, but enamelogenesis imperfecta, central tubercle and deeper fissures develop at a constant rate. Therefore, intraoral examination with knowledge of their expression rate is important.

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The Japan Health Care Dental Association has formulated data for new patients with a purpose to comprehending experiences of patients visiting dental offices which are less influenced by regularly controlled treatment. The outcome of the study will become the standard for patients who visit dental offices in Japan. This study utilizes data on 10,982 patients who visited 31 research-friendly dental offices nationwide from January 1 through December 31,2007, including factors such as age, sex, the age of first examination. It also includes data for patients aged 20 and above of the number of DMF teeth, the number of remaining teeth, specific degree of periodontal disease development (by the protocol of the Japan Health Care Dental Association), smoking experience, the age of first smoking, current smoker or not, and the total numbers of cigarettes ever smoked by the first examination. DMFT from the age of 5 to 20 shows the same tendency with last year, but that from 15 to 18 there was a decrease compared to last year. The numbers of people who gave up smoking increased in 40’s and 50’s.

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Although common oral diseases are not life threatening, oral health may influence the overall wellbeing of individuals. The purpose of this study was to compare the impact of oral health conditions on the general health-related quality of life (HR-QOL) and the oral health-related quality of life (OHR-QOL) between patients attending dental care regularly and drop-outs from the dental treatment. From August, 2006 to September, 2006, a consecutive 4,317 subjects older than 40 years of age from 26 private practices in Japan were enrolled in this study. The subjects were requested to complete a questionnaire that included life style, HR-QOL and OHR-QOL instruments. Patient's self-assessment of HR-QOL was measured by the 8-item short form health survey questionnaire (SF-8), encompassing eight summary scales and two summary dimensions. GOHAI (General Oral Health Assessment Index) was used for the measurement of OHR-QOL. Oral health parameters were collected from the treatment records. A total of 3,334 subjects completed the baseline survey. One-year follow-up survey was performed using the same questionnaire and survey protocol from September 2007 to December 2007. During the follow-up period, 65.0 % of individuals (2,168/3,334) attended the dental office and regarded as regular attendant. Among regular attendant, 94.1 % (2,041/2,168) responded to the questionnaire survey. Individuals who did not show-up during the follow-up period were 1,166 (35.0 %), and regarded sporadic attendant. Sporadic attendant were mailed same questionnaire, and responded 369 (31.6 %). The younger individuals tend to become sporadic attendants. Subjects with more present teeth also showed the tendency to discontinue the dental treatment. Sporadic attendant showed improvement of OHR-QOL comparing with regular attendant. Improvement of OHRQOL of sporadic attendants may partially be due to the younger age and more present teeth number comparing regular attendants. Oral health demonstrated a significant association with the wellbeing of individuals through our baseline survey. Further empirical study is necessary to reveal the implications of the dental care on the quality of life.

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