This paper is to investigate the effect of maintenance by surveying both patients who visit the clinic for maintenance at least once a year and those who visit the clinic only when they have problems, complaints or pain, and need to have them treated. The criteria for subjects are as follows; the dentulous patients at Tamashima Dental Clinic in their sixties and seventies as of September 2013; and came to the clinic for maintenance for 10 years consecutively after the initial treatment (Maintenance Group: N=64) or did not come to the clinic for maintenance at all for 10 years after the initial treatment (Non-maintenance Group: N=82). For those subjects the number of lost teeth during the 10 year period and the causes were reviewed. In the Maintenance Group, the average number of lost teeth was 1.2±2.3 (±1SD, the same shall apply hereinafter) in the sixties and 1.1±2.0 in the seventies, and in the Non-maintenance Group 2.0±3.3 in the sixties and 4.4±4.0 in the seventies. The difference in the numbers of lost teeth between those two groups was 0.8 in sixties and 3.3 in seventies. The trend in the number of lost teeth shows smaller change over 10 years from fifties to sixties compared to that from sixties to seventies. Further site-by-site comparison suggests the effect of the regular maintenance, particularly, in the lower anterior area, the Maintenance Group showing the better record in the preservation of the natural teeth. In general terms, further progression of periodontal disease and the higher rate of smoking and obesity in the Non-maintenance Group suggest the correlation between overall health consciousness and maintenance visits.

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The 3 year-old patient with many cavities was at first uncooperative with treatment and home care instructions. We first tried to change and rethink our clinic’s mindset and appointed a hygienist as to better communicate and build a consensus with the patient and his mother. Together with his mother’s effort, we gradually built a consensus on preventive care with the patient; he continued to come to the clinic for regular check-ups and maintenance care, and his consistent awareness for oral health has rewarded him (now a young adult) a permanent dentition free of caries.

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The 55 year-old female patient first came to our clinic with a chief complaint of repeated swelling and pain in the upper and lower left molar regions. The intra-oral examination revealed significant alveolar bone resorption around the upper and lower left second molars, which were diagnosed as hopeless and then extracted. After discussing possible restorative options with the patient, in order to ensure occlusal support, implants were selected. After the initial periodontal therapy the implant surgery was carried out, and occlusal support was successfully restored. In 6 years post treatment and provision of occlusal support, the case has not seen any major problem. This report is to discuss the details of regular check-ups and maintenance of the 6 year follow-up.

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A 15 year-old female patient first came to our clinic with a chief complaint of tooth decay and request for cleaning. In the initial therapy the cavity was temporarily filled with glass ionomer cement. In order to assess and control the caries activity in longer terms, the case was shifted to a regular checkup and maintenance phase (without what is often called“final restoration”). After decrease of caries activity—which is highly susceptible to dietary and lifestyle habits—and hardening of enamel and dentin lesion were confirmed, the temporary filling was replaced with composite resin. Prognoses of cavity treatment may vary depending on the timing of restoration; in the long run restorative treatment after (re)mineralisation of enamel and dentin may lead to a better result than treatment involving removal of active carious lesions or cavities. The result showed positive signs in the present case, but limitation of the present clinical system at our clinic became apparent in the process of incorporating detection of caries activities at the same time.

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An instance of dental enamel hypoplasia was first observed in the first molar of a 5 year-old female patient. Toothbrushing instructions were given, and the relevant area was closely monitored, but pit-and-fissure caries was developing. Hence, infected tooth substance was cut off and a filling was applied. The shape of shadows in the images taken with DIAGNOcam in this process assimilates the cavity preparation form, which implies further applicability of DIAGNOcam in caries treatments in the similar context.

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A 51 year-old male patient first came to the clinic with a request for recementation of the inlay. After resolving the patient’s chief complaint, we communicated the oral condition of the patient and provided initial periodontal therapy. The patient holding an important position at work and generally being quite busy we were afraid might disrupt regular check-ups and maintenance care at the clinic. Contrary to our concern, the patient has continued to come to our clinic for maintenance care over 3 years and counting. The hygienist in charge has established a good trusting relationship with the patient and in turn has found it rewarding to take part in maintaining the patient’s good oral health.

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This paper is to present the result of the survey conducted at the time of dental examinations in 2012 and 2013 at a public preschool in a rural area with a population of 18,000 people; a possible link between the responses to the questionnaires on “toothbrushing and diet” and the dental health status was investigated. Of 124 preschool children (0-5 years old) examined, many had 1-2 siblings and about 25% lived with their grand parent. The degree of interest in oral health was generally high; almost all parents or caregivers brush their children’s teeth (after the children brush their teeth on their own if they can) either sometimes or every time. As for usage of fluoride, some use multiple means of fluoride, e.g., fluoride gel and fluoride toothpaste, and application of fluoride tends to start rather late—as from 2-3 years old. Among 0-3 year olds there are more carious teeth in the group of preschool children living with their grandparents on average than those living without their grandparents, but there was no significant difference among 4-5 yearolds.

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This study aims to find out risks of dental caries related to orthodontic treatment and different types of malocclusion, and develop effective ways of caries prevention; clinical data of 100 patients—who came to our clinic at 18 years old and younger with a permanent dentition at the onset of orthodontic treatment—were inspected on the dental caries occurrence and frequent sites. As for criteria of caries, ICDAS was employed, i.e., white spot lesions, etc, visible signs of demineralization were counted as caries. According to intraoral photographies taken at patients’ initial visit, there was no correlation between site specificity and the types of map occlusion. 38 patients had caries lesions at the initial visit; 21 patients underwent orthodontic treatment without development of new caries lesions while 17 patients developed new carious lesions. Of 62 patients without carious lesions at the initial visit, 39 underwent orthodontic treatment without developing new carious lesions while 17 with new carious lesions. Of new lesions found in 40 patients, 13 lesions in 4 patients progressed into cavities. The rest were incipient caries. Frequent sites and symptoms include discolored enamel lesions on the occlusal surface of upper and lower second molar and white spots on labial surfaces of anterior teeth and the buccal surface of lower first molar. On the one hand there was no correlation between frequency of caries during orthodontic treatment and eruption state of the upper second molar at the onset of orthodontic treatment; on the other hand, lower second molars erupted during orthodontic treatment were more prone to develop carious lesions than those erupted before orthodontic treatment. Multiple white spots tend to develop in the same patient; especially, in all six patients with white spots at the initial visit new spots were detected during the orthodontic treatment. Based on these findings, our clinic’s caries management system was reformed, and ICDAS is now integrated into the preventive management system. I would like to investigate and communicate impact of environment and acquired behavior based on statistics of long-term clinical results.

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The purpose of this survey is to investigate oral health status of new patients at dental clinics. Subjects were collected in anonymised digital format from JHCDA member clinics. For children and minors, DMFT scores were kept, and for adults DMFT scores, the number of remaining teeth, the condition of periodontia and smoking status were recorded. This 7th report is based on the relevant clinical raw data of 10,708 new patients during the period of January 1st and December 31st 2012, collected from 37 clinics (in 18 prefectures). Not all clinics share the same content of clinical examination, so depending on the survey items, the population size varies. The valid population, i.e., inclusion of age, sex, the date of birth and initial visit is 9,778; with additional criteria, for instance, 20 years-old and over, smoking experience, and progression of periodontal disease, the parent population is down to 4,249. The average DMFT score of 12 year-old boys is 2.24 (2.3 in 2005) while that of girls is 1.94(2.32 in 2005). As for the number of remaining teeth, in the age group of 60-64 year-olds, the average of the male patients was 22.8 (21.7 in 2005) while that of the female patients 23.1 (22.7 in 2005). On a more general note, the result of statistical analysis suggests the link between wealth levels and oral health status (at the initial visit); the group of elderly patients in the region with significantly low local tax per capita exhibits comparatively poorer dental health status, and the more aged the group, the more distinct this trend becomes.

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