The purpose of this study was to identify the factors which affected the onset and the accumulation of primary and secondary caries in adults undergoing regular preventive program, and to identify those patients with high or lowrisk of caries by using Classification and Regression Trees (CART). A clinical data set of 732 patients aged between 20 to 64 in nine general practices was analyzed using the following parameters: age, DMFT, levels of mutans streptococci (SM) and lactobacilli (LB), the saliva flow rate and buffer capacity, compliance to a preventive program. CART analysis identified patients at high risk for primary caries with an odds ratio of 3.08 according to SM levels and compliance; and those for secondary caries with an odds ratio of 3.69 according to LB and SM levels. Poisson regression analyses showed that accumulation of primary caries was affected by compliance, SM and LB. And that of secondary caries was affected by DMFT, SM and LB. Conclusions are that cariogenic bacteria were important factors for both the onset and accumulation of primary and secondary caries, and that participation in a regular preventive program limits the onset and the accumulation of primary caries in adults.

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The purpose of this retrospective study is to investigate and elucidate the relationship between previous dental caries experience of young adults (20~39years old) at the first visit and the number of treatment in the following 10 years.【Methods】Subjects were selected from the clinical database at Sugiyama Dental Clinic (SDC) as of Sept. 2013 and the number of treatments they received was investigated. As a result, excluding two patients who received aesthetic treatments during the maintenance period, 26 patients were selected based on the following criteria at the time of the first visit: aged between 20~39 years old, with 28 remaining teeth or more, with sound periodontia or initial periodontitis, and maintenance period at SDC 10 years or longer. Further, subjects were divided into 3 groups rested on the DMFT score at the first visit; A (DMFT = 0~5), B (DMFT =6~10), and C (DMFT≥11).【Results】The number of treatments subjects received averaging 3.8±3.90 for A (n=5), 5.0±5.01 for B (n=8), and 9.0±3.89 (n=13). As such, the numbers of the treatment incidents were significantly different (p=0.04). The breakdowns of the treatments also showed different trends: in the group A were seen relatively minor treatments such as fillings while in the group B and C more complex root canal treatment and major restorations and replacement for missing teeth were involved. The average treatment cost (based on NHI points) of group C amounted to more than 4 times as much, compared to that of group A. The result indicates a correlation between caries experience and frequency of invasive treatments during the maintenance period for young adult patients.

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A 55 year-old male patient, whose wife was a maintenance patient at our clinic, presented with complaints of many cavities and pain in the anterior gingiva, partially moderate, initial periodontal inflammation and overbite. As part of risk assessment, a saliva test and a dietary survey were conducted; the score of streptococcus mutans and lactobacilli indicated high risks and a habit of frequent soft drink intake was confirmed. First, periodontal treatment and dietary instruction and lifestyle recommendations were made, and then caries treatment was conducted. As for the overbite, the patient refused orthodontic treatment, and instead the bite was raised through restorative treatments. During two years of caries and prosthetic treatment, the patient complained “jaws feeling tired”, so the prosthetic treatment was finished with the occlusal vertical dimension reversed to the original. In the following 7 year maintenance period soft drink restriction has been kept and though the pain in the anterior gingiva comes back when the patient is busy and tired, oral health has been maintained without any newly developing caries or periodontal disease.

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In the present case of a pediatric maintenance patient, the refusal of an x-ray by the mother hampered a concise diagnosis. This made the maintenance care challenging, but in order to promote behavior change, information sharing was prioritized with the utmost attention. The continuous effort fruited in change of the mother's attitude towards x-ray taking; she requested an x-ray after some time. The take-home message of this case is not only the value of visual information for the concise diagnosis, but also the importance of understanding and respecting the patient's concern, finding alternatives—in this instance, intra-oral photography of the region at risk frequently taken—and providing the best possible maintenance care under the given circumstances.

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This clinical report presents three cases of autogenous tooth plantation of wisdom tooth to replace missing premolar. In the first case, the lower wisdom tooth was transplanted to replace the upper premolar; in the second case the upper wisdom tooth to replace the upper premolar; and in the third case the upper wisdom tooth to replace the lower premolar. During the 3～7 year follow-up, all three cases have seen no trouble such as root resorption. Though wisdom teeth suitable for the replacement of premolars are rarely available, these cases suggested possibilities of autogenous tooth plantation to replace a missing premolar. As presented in the forth complementary case, at my clinic, if a wisdom tooth suitable for such autogenous transplantation is found in the patient's mouth, the patient would be communicated about the possibility of the future possibility of transplantation though maintenance of sound dentition and prevention of periodontal disease are of the utmost priority. This clinical policy is in line with the philosophy of the Japan Health Care Dental Association, namely, always taking into consideration the possibilities of trouble in the future and preparing for life-long oral health.

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A 5year old female patient and her 1year old brother first came to our clinic, both with many caries lesions; they underwent necessary restorative treatments and then continued to make periodical visit to the clinic for maintenance care. This paper is to report the case of these two patients where the caries management failed and many new caries lesions developed during the maintenance period. Risk assessment revealed obvious caries risks: poor plaque control in spite of the toothbrushing instruction, poor sugar control and snacks before bed time were quite frequent due to their late bedtime. As a result the caries activity was high, and it was hard to predict and prevent further development of initial caries lesions. Looking back at this case, I overestimated the effect of maintenance care at the clinic and underestimated the importance of home care such as dietary control and plaque control. Through this case I recognized the need to reform our practice as to better communicate with patients about the home care and be better tuned to ever changing caries risk of patients so that prompt address to increased risks would be possible.

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March 2004, a two year old patient visited for a check-up Chigusa dental clinic, a Japan Health Care Dental association member clinic. Though overbite and crowding in the anterior region were seen in the deciduous dentition, at this point no corrective intervention was made and six-monthly maintenance was started. Immediately prior to completion of permanent dentition, the patient was introduced to Arimatsu orthodontic office. Due to upper and lower anterior crowding and Angle Class II malocclusion seen in the permanent dention, upper first premolars and lower second premolars were extracted. Orthodontic treatment was carried out according to the plan the patient agreed to at the first visit, aiming for betterment of alignment of teeth, occlusion and the lip morphology. The treatment period was 21months, and following the treatment an orthodontic retainer is used and the patient has been receiving maintenance care at two dental clinics. For two white spot lesions were seen prior to orthodontic treatment, increase of caries lesions was a major concern. As of 14years old, there has been developed only one additional white spot. This is a successful case of collaborative effort by two clinics, resulting in sound teeth and occlusion.

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The purpose of this survey is to investigate yearly change in oral conditions of new patients at JHCDA member dental clinics (mostly JHCDA certified) where regular checkups are systematized and clinical data is regularly recorded and readily available in digital format. For children and minors, the caries experience of permanent teeth was collected and analyzed while for adults, in addition to caries experience, the number of remaining teeth, periodontal conditions, and smoking background were aggregated and analyzed. This 10th survey on new patients is based on the clinical data of 13,344 new patients (male 5,582, female 7,762) collected at 44 clinics across the country (21 prefectures) from January 1st - December 31st 2014. Those 44 clinics were divided into 3 groups according to the amount of local tax per capita in municipalities where they were located and relevant parameters were compared. Compared by age brackets, those groups showed different tendencies in DMFT in middle school students and older. In the adult population, the lower income population exhibited greater age-related increase of DMFT. Other finding include expansion of the DMFT disparity in the population aged 50years or older - when remaining teeth start to decrease; for remaining teeth of the population aged between 60 and 65years, the lower income group showed greater variability within the group while the juvenile population of the lower income group (aged between 11 and 13years) exhibited smaller variability in DMFT compared to its counterparts in the other two groups.

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