In order to detect the degree of caries development, the detection code, C1 to C4, has been used in Japan and D1 to D4, etc outside of Japan. However, these detection codes are not used for incipient caries that do not exhibit any carious cavity. Therefore, atients without a carious cavity are diagnosed as “Caries Free” patients. However, among the periodic cared patients, caries develop slowly. Furthermore, incipient caries on a smoothsurface may re-calcify to a healthy condition. Accordingly, the assessment of caries control needs the criteria to detect incipient caries. Thus, 36 patients were selected from the Sugiyama Dental Office: ① patients between 11 and 15-years-old and visit once or more a year for a dental care ② patients who visited for dental care at the 15-years-old between Aug.1, 2004 and July 31, 2005. Their tooth surface conditions were compared with their past intraoral pictures by ICDAS II Code and with their radiographies by six step code(XR). The results show that the total number of the filled tooth surfaces dropped to 3 surfaces from 10 surfaces and that the DMFS increased slightly from 0.56 to 0.81, 0.97, 1.03 and 1.14. They also show that the numbers of sealant filled teeth increased from 2.17 to 2.47, 3.00, 3.81 and to 4.11. Among the 20 patients with “No Filling”, only 9 patients did not show any lesion. 11 patients with lesions were given dental treatment and home-care to re-calcify the lesion. Our goal “Caries Free” must be reconsidered.

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A survey on the number and causes of tooth loss from periodontal disease development within a time frame of the first visit to the present time was conducted with patients who have been cared for continuously over 10 years or longer at the small private dental office, Ohnishi Denal Office, Kobe, Japan. The Japan Health Care Dental Association recommends that their members retain computerized clinical records regarding the time of maintenance care as routine procedure of daily practice using the database “Wisteria” (template of Filemaker Pro). The retrieved data shows that the group of first time atients in their 40’s (70 cases including 24 male and 46 female) lost an average 0.5 teeth over 12.9 years, from an average age of 44.7 years old to 67.0 years old. Furthermore, a second group of the initial patients in their 50’s lost 1.2 teeth over 12 years from an average age of 54.4 years old to 67 years old. When comparing the number of remaining teeth between the groups of the first time patients at the same ages, the former shows onehalf of tooth loss, and the latter shows one-third of tooth loss. Both groups show that tooth loss comes from caries-related dental extraction.

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The periodic dental care of patients provides us with an opportunity to observe, during the follow-up, the way in which incipient caries re-calcifies and, how they develop. As they are progressive changes, the decision to introduce intervention can be very difficult. “Thetime-base diagnosis” - to diagnose the risks which vary over a long time - has importance. The first step of “time-base diagnosis” is to describe the lesion with accuracy. In understanding the importance of this, we studied the possibilities of how to bring ICDAS, International Caries Detection System, and the recording technique of radiographies to the clinical level. The five panelists delivered their views on the importance of new criteria to detect the incipient caries from their point of view. Yoshihiro Tokushima, DDS (The First Life Hibiya Dental Clinic ) expressed his view on the importance to introduce ICDAS into Japan using four keywords: ① Endemic, ② 5-second air-blow, ③ Regional risk diagnosis and ④ Dental disease definition (Is white spot healthy?) Youichi Iijima (Associate Professor, Nagasaki University) expressed his opinion on how to manage the incipient caries having no carious cavity, the principle of re-calcification and its clinical application. Siichi Sugiyama, DDS, the moderator of the Symposium, introduced the ICDAS code with clinical cases using ICDAS and explained the importance of employing ICDAS for the periodic care of the patients in private dental offices by presenting long-term care cases. Yasuko Momoi (Professor, Faculty of Dentistry, Tsurumi University) spoke on guidelines that The Japanese Society of Conservative Dentistry has recently formulated. These guidelines are accepted under the terms that they include minimal intervention as a basic concept. However, the content relating to limitations of the restorative target to caries needs to be discussed from the view of the present concept of the caries. Finally, Shinpei Tsuge (Vice Deputy Chairman, Japanese Association of School Dentists) spoke, addressing dental checkups in schools, the difference in roles of school dental healthcare and private dental clinics. He highlighted the importance of cooperation between school and family dentists. The panelists exchanged opinions on how to resolve differences in understanding in the re-calcification solution of incipient caries among the dental college education, school dental healthcare and public administration.

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33 member’s dental offices around Japan offer periodic dental care, maintaining computerized clinical records of all their patients. They compiled the actual health of 11,588 first time patients (4,853 male and 6,735 female) for one year from Jan.1 to Dec.31, 2008. DMFT of a 12-year-old child shows a consistent reduction from 2.35 in the first survey to 2.35, 1.08 and 1.55. But DMFT of junior and senior high school students shows a significant increase, especially in females. DMFT of the adult age group show a steady improvement year on year in adults between 20 and 24 years old, from 9.83 at the first survey to 26.8% to 40% and more. The Japan Health Care Dental Association have compiled clinical records from member’s dental offices since 2006 and provided feed back from the results of the survey to dental professionals, society and clinical sites. This survey is one of them.

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