This report is to present a case of a 63 years old－at the initial visit－female patient with heart disease, who later suffered from cerebral infarction and resultant paralysis on the right side of the body. For 11 years she has continued to come to the clinic for maintenance care, accompanied by her husband or care person albeit interruptions by repeated hospital admission due to fracture by fall, etc. In 2004 when she started to come to our clinic, our clinic had a vague idea about preventive and maintenance care; hygienists were not assigned to the individual patients for long term and periodontal examinations were not accurate. In short, it was nothing more than the owner dentist’s ambition to change the clinical practice from the conventional one to the more prevention oriented practice, focusing on preservation of teeth and patients’ oral health. Over the course of the following years we studied “Health Care” clinical practice, and such clinical consensus has been shared among the staff members. Present report discusses the case of elderly patient, through which we came to rethink our engagement with elderly patients, along with our clinic’s transition from the predawn of Health Care clinical practice to current practice.

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A reliable prognosis of oral care naturally assumes periodontal and cariological considerations, but occlusal (mechanical) considerations are equally important. In treating for a 59-year-old female patient with a chief complaint of chewing difficulties due to severe periodontitis, 7 dental implants were placed, and occlusal support was restored in order to improve occlusal relationship from Eichner class B3 to class A. Along with this 4-year follow-up case, discussed here are considerations for dental caries, periodontitis, maintenance care for natural and implant dentition, clinical examination items, and the design and materials of implant superstructures. As a result, manifested are challenges differing from those in maintenance care for natural dentition.

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In 1999 a 30-year-old woman visited the clinic with a chief complaint of detached inlay in #36. For many caries lesions in the maxillary anterior region and moderate calculus deposition in the mandibular anterior region were seen, caries treatment and initial periodontal therapy were conducted. The patient was severely disabled. She walked slowly but independently, but given difficulties with a routine visit to the clinic and with brushing due to disabilities in extremities, maintenance care was not recommended. For 8 years from the initial visit, the patient came to the clinic with some complaints, and each caries or periodontal treatment was completed with one or two visits. About 8 years from the initial visit when the patient started to suffer frequent pericoronitis of mandibular wisdom teeth, and the hygienist in charge suggested “Let’s make your mouth less susceptible”, and she started to come to the clinic for maintenance care every three months. Caries development became infrequent during the maintenance period, and 16 years after the initial visit the patient’s oral condition is stable with BOP index drifting below 2%. The patient is maintaining her oral health despite some misgivings about tooth hypersensitivity due to tooth contacting habit and suspected erosion.

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This report is to present a case of patient with approximal dentin caries where invasive treatment has been avoided. The patient has been visiting the clinic for maintenance care on a regular basis and x-ray images have been taken once a year and examined with reference to the x-ray chart recommended by Japan Health Care Dental Association. The female patient was 7 years old at the initial visit and came to the clinic with a chief complaint of pain in the upper right region. The patient’s dental caries experience score was 7 in the deciduous dentition and 0 in the permanent dentition. As for the patient chief complaint, the dental cavity in the upper right D showed pulp involvement, so pulp extirpation was unavoidable and followed by resin filling repeated a few times. After the restorative treatment, the patient has been visiting the clinic for maintenance care a couple of times a year and have been receiving PTC, PMTC, fluoride application, TBI, and dietary instructions for 15 years. 8 years after the initial visit, A radiolucent spot in the molar region appeared on the bitewing x-ray. The radiolucent spot has been monitored with bitewing x-rays taken on a regular basis, and an invasive treatment has been avoided for 6 years.

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A 41-year-old—at the initial visit—female patient continued to visit the clinic after the chief complaints were resolved. During maintenance period, periodontitis and caries lesions were kept under control to a reasonable extent, and no major problem had been seen. In the 14th year, however, extraction of the right mandibular second molar was unavoidable due to root fracture. It is assumed that in case a patient receiving professional maintenance and dental caries and periodontitis being controlled, root fracture becomes more frequent. This was supported by our clinical data; common reasons for extraction at the initial visit were caries and periodontitis, and during the maintenance period root fracture was the most common reason for extraction. Causes of root fracture were miscellaneous, and prevention of root fracture for devitalized teeth is not straightforward. In order to support patient’s health and prosperity, understanding the causes of root fracture and conducting preventive measures are necessary.

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This paper is to discuss merits and limitations of International Caries Detection and Assessment System (ICDAS) at a public dental center for the disabled. This dental center was founded for patients with disabilities who have difficulty receiving treatment at private dental clinics. The staff of the center includes full-time and part-time dentists and hygienists and works on rotating shifts. ICDAS was first introduced at the center in April 2010 and has been employed since for incipient caries detection and as reference in monitoring progression of caries mainly for patients from 6 to 12 years old. Whether to employ ICDAS is left to the discretion of dentists or hygienists in charge; ICDAS was used for 92 of 1078 (8.5%) patients who visited the center between April 2012 and October 2012, and 42 out of 206 (20.4%) patients from 6 to 12 years old. The merits of ICDAS raised by the users include: “objective”, “useful and suitable as index for long-term follow-up”, “inductive to careful observation and improvement in teeth cleaning”, and “effective in decreasing drill-and-fill treatment, general anesthesia, and sedation”. Meanwhile, difficulties in air-blow and in keeping the mouth open due to the disabilities were raised as challenges and limitations of ICDAS application particular to patients with disabilities.

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The purpose of this survey is to investigate general trends and oral conditions of new patients at dental clinics. Patient data was collected in anonymized format from JHCDA member clinics (mainly JHCDA certified clinics). For children and minors, the DMFT score was collected, and for adults, in addition to the DMFT score, the number of remaining teeth, periodontal conditions, and smoking background were also collected. This 9th reports based on the data of 11,765 new patients (male 5,048, female 6,717) collected at 41 clinics across the country (21 prefectures) from January 1st − December 31st 2013. As a result, found were five trends in the age composition of the patient and that of population in the municipalities where the participant clinics were located. Findings from the DMFT index by age group show general improvement; e.g., for 12 year-old boys (n=30) the DMFT index was 1.23 (2.30 at the first survey conducted in 2005) while 1.93 for girls (2.32 at the first survey). Significant improvement is also seen in the groups of minors older than 12 years old and over 60-year-old male patients. Slight improvement was seen in the number of remaining teeth in adults. Other findings include marked disparities in DMFT and the number of remaining teeth in relation to wealth levels.

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