Root caries is often seen on the exposed root surface due to advanced periodontal disease in adulthood, periodontal treatment or improper brushing, or at the margins of restorations. As both the prevalence of dental caries in young population and tooth loss in the elderly population decrease, coronal caries as the modern disease decreases, while rearising root caries as the ancient disease will be seen. Hence the focus of caries management is shifting from crowns to roots. Non-surgical, preventive or arresting approach should be prioritized in treatment of root caries. As such, primary and secondary prevention and root caries management with silver diamine fluoride (SDF) are spelled out in the present paper.

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To evaluate the influence of maintenance care on tooth loss, a survey was conducted from July to Dec 2015 with 1764 patients at 31 member clinics of the Japan Health Care Dental Association. Those who visited the clinic for at least 9 years between 2003 and 2015 are referred to as "maintenance" (mean period 10.9 years) patients and the others are defined as "non-maintenance" (10.6 years) patients. Among patients who presented with alveolar bone resorption in at least half of existing teeth at the initial visit, those in the maintenance group were significantly less likely to lose 3 teeth or more compared to the non-maintenance group (p < 0.05), in the aggregate of all age groups as well as age groups of 50-59 years old, 60-69 years old, and 70 years old or over. This suggests that maintenance care is effective as a preventive measure of tooth loss. In addition, among patients undergoing diabetes treatment, those in the maintenance group were significantly less likely to lose 3 or more teeth compared to the non-maintenance group (p < 0.05). For both patients at higher risk of tooth loss and patients undergoing diabetes treatment, maintenance care was indicated to be effective in preventing tooth loss.

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The female patient was 65 years old at the initial visit and had lived a life far from dental clinics. She presented with root caries seemingly triggered by subclinical generalized severe chronic periodontitis. Pain caused by root caries led her to the initial visit and then to subsequent periodontal therapy. Over the course of treatment, the patient learned and faced the condition of periodontal disease, which in turn incited behavioral change. The patient has been undergoing supportive periodontal therapy (SPT) for 4 years and counting. Plaque control is still unstable due to patient’s living environment. Keeping in mind the risk of developing new root caries, at every SPT for this case I have been renewing my recognition on the difficulty of maintaining intraoral environment.

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Despite the long-reported decrease of dental caries in children, many patients present with dental caries in multiple teeth. As for the pedodontic patients with caries, their guardians’ cooperation as well as the patient’s effort is a vital component of treatment and maintenance care since living environment and knowledge and understanding of the dental caries by their guardians have a great impact on the patients’ disease progression and its management. Information on dental caries being abundant, it is important to provide accurate information to their guardians as well as the patients at a right time in a fitting manner. In this report presented is a 9-year follow-up case of caries risk management for a high-risk patient aged 3 years and 7 months at the initial visit. The guardian’s understanding and collaboration throughout the course of treatment and maintenance care played a major role in an attempt for healthy permanent teeth .

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糖尿病と診断された，重度の慢性歯周炎患者の症例．歯科衛生士がデータ（問診・エックス線診査・口腔内写真・歯周組織検査などの検査資料）を用いて現状，治療の必要性を説明することで患者は口腔内に関心をもつようになり，セルフケアと来院継続の協力を得ることができた．そして歯周基本治療を行った結果，顕著に歯周組織が回復した．糖尿病の治療中断や歯科来院が長らくなかったという影響も大きいといえる．現在では日常生活に支障がないほどに改善がみられ，患者が食事の楽しみを再び取り戻すことができている．本症例から歯科医院のチーム医療による歯周基本治療とメインテナンス継続の重要性を再確認し，患者のQOL向上に携わることができた．

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A case of caries management with near-infrared caries detection device (DIAGNOcam) and resin infiltrant (Icon) Approximal caries is commonly found in clinical practice, but has been considered difficult to manage due to multiple reasons, such as not detectable under direct vision, difficult to maintain plaque control, and lack of effective drill-free approach. The present paper is to report a case of ①caries management with the caries detection device for approximal carious lesions (DIAGNOcam) for the purpose of monitoring of the lesions in conjunction with ②application of resin infiltration to the approximal enamel carious lesions (Icon®; DMG, Germany), from the mixed dentition period to completion of permanent teeth. Numerous studies have been conducted overseas reporting their effectiveness in clinical practice; this introductory report is to present their clinical applicability since caries detection by DIAGNOcam and caries treatment with infiltrant (Icon) are still considered unconventional in Japan.

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A new caries risk assessment method was developed for patients across all ages, based on the checklist of oral hygiene habits and oral health, incorporating the lessons from the caries risk assessment the Japan Health Care Dental Association used to recommend—namely, imposing on patients the saliva test not covered by public health insurance. The results of medical interviews were directly recorded on the digital device at the chairside. As for the bacteria test, caries activity test (CAT21 test; Morita) was employed. The execution rate of this new assessment method was 67.4 ％: 1106 out of 1640 patients who either visited Sugiyama Dental Clinic for maintenance care or shifted from treatment to maintenance care received the new caries risk assessment. Analyses by different age groups showed the tendency that the older they get, the less likely the patients rinse their mouth properly (tend to rinse too much) and us proper amount of tooth paste (tend to use too little). The new caries risk assessment method is faster and cheaper than the previous method and may allow patients to receive the assessments multiple times—which in turn may capacitates us to oversee the change in patient’s caries risk.

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This survey was conducted to investigate oral health status of new patients at dental clinics practicing routine maintenance. Subjects were collected in anonymised digital format from Japan Health Care Dental Association (JHCDA) member clinics. The subjects of this 11th survey included 12,261 new patients (5,173 male and 7,088 female patients) who visited the 47 member clinics (across 22 prefectures) during the period between January 1st and December 31st, 2016. For children and minors, the DMFT scores were recorded, and for adults the DMFT scores, the number of remaining teeth, the condition of periodontal tissues and smoking status were recorded, but subjects with incomplete information were also included in the analysis. As a result, the DMFT index continued to decrease across all age groups above 12 years old; decrease of male smokingpopulation across all age groups was observed; and the number of remaining teeth continued to increase across age groups above 65 years old in both male and female population. Also, the subjects were divided into 4 groups based on the amount of municipal or ward tax according to the location of the participating clinics. The findings include; ① in the population 10 years old and over, higher DMFT scores were observed in lower income groups; ② in the adult population, the DMFT index naturally increases along with the age, and this trend was more prominent in low income groups; and ③ in the population 50 years old and over, tax-amount-per-capita and the average remaining teeth are directly proportional among 4 groups—the higher the local tax the more remaining teeth, as seen in the last year’s result.

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