When we step into diagnosis and treatment of a patient who has not presented symptoms yet, we face problems of totally different dimension from merely treating a patient according to his chief complaint. In which degree is our diagnos is certain? In which degree is the prevention program efficient? Can we assure patients to provide with the satisfactory results? Even though the caries risks have been examined, unless a practical prevention program aimed for the risk is drawn, the determination of the caries risks becomes, so to speak, only a tool for motivation. Furthermore, we would always be driven into carrying out excessive prevention measures for the purpose of obtaining a sure result. If so, the cost-effectiveness of prevention control would remain low, in spite of the fact that the risk has been determined. In the light of this situation, the caries risks of successful caries-free patients have been analyzed, keeping eyes on the total risk, for stopping excessive prevention and getting adequate standard of prevention control in a clinic. The total risk is a simple aggregate of each index, from 0 to 3, of the following 7 factors; 1) the determination of salivary buffering capacity (Dentobuff Strip), 2) the measurement of the quantity of mutans streptococci in saliva (Strip mutans), 3) the measurement of the quantity of lactobacilli in saliva (Dentocult-LB), 4) the secretion speed of stimulating saliva, 5) the frequency of food intake, 6) plaque accumulation degree, and 7) the condition of fluoride use. 308 subjects of investigation, those who are over 10 year-old and being caries-free of permanent tooth, were all under continuous maintenance at Hiyoshi Dental Clinic. The mean value of total-risk score of these 308 subjects during maintenance period was 11.4 and the mean during maintenance period when they reached at caries-free status of permanent tooth was 7.8, and those who were less than 11 was 282 (91.6%). Also with a study about a controlled group of 300 new patients who visited clinic at almost same period with the investigation subjects, it was found that the total risk of these controlled group was 11.3, very close with the one of initial visit of those who achieved caries-free status. From these facts, a greater possibility for achieving caries-free condition can be expected, if diagnosis and treatment preceding carious cavity formation are sufficiently made based on the cariology, the risk of high-risk patients are well controlled, and the total risk is sustained less than 11.

抄録全体を表示

The incidence of dental caries is thought to be greatly influenced by the respective risk factors in individuals. We have been trying to establish an individual program for the prevention of dental caries based on the risk prediction in the long-term occlusal enhancement. The procedures of our individual program are as follows: At first, all caries risk factors were examined. After the risk profile is predicted for diagnosis of caries pathogenesis, the preventive menu is selected and the program is provided for a patient before orthodontic treatment. Then, the changes of the patient's risk of caries are monitored throughout the long- term occlusal enhancement. This study was designed to evaluate the efficacy of our individualized program. The subjects consisted of 64 patients who were cared by our individualized program during the first phase treatment of the long-term occlusal enhancement. The results of this study were as follows: (1) Significant correlation was observed between the LB-score and DMFT. (2) Several preventive prescriptions were supplied to the group of high LB-score . (3) The LB-score was useful for understanding the respective caries risk in individuals. (4) Although the LB-score tended to inclease during the 1st phase treatment period, 30% of the patients could maintain low LB-score. Accordingly, attention should be paid to the other risk factors as well. (5) The incidence of new caries was significantly prevented during the period of this study. Therefore, the efficacy of this individual program was confirmed. In conclusion, a systematic management for the prevention of dental caries can be performed without aggravation of the caries risk in individuals throughout the long-term occlusal enhancement.

抄録全体を表示

We have conducted an examination on caries risk of primary- and secondary school children (275 children) of Izena village, a remote island village in Okinawa prefecture, using a saliva test (product of Orion Diagnostica Inc.) every year starting from 1997. Oral health instruction and dental treatment is carried on based on the results of this examination. In this report we will show the caries risk-profile of primary- and secondary school children, which was obtained from the examination in 1997. The number of children showed SM score zero, which was an evidence that mutans streptococci in saliva was below the detectable limit, occupied approximately 50%. It showed no relation between plaque score and SM score, and corelation between dietary frequency and LB score was indicated. By conducting this examination on caries risk of school children, we could share the knowledge of caries risk with school staffs and parents. We have realized educational effects on this point.

抄録全体を表示

With the results of an investigation conducted in November in 1999, it was shown that the DMFT index of the 6th grade of primary schools in Sakata city was 1.1 and cariesfree (DMFT=0) rate was 55.6%. At the neighboring Akumi county (Hirata-cho, Matsuyama-cho, Hachiman-cho, and Yusa-cho) similar results were demonstrated: DMFT; 1.2 and caries-free rate; 49.5%. This region located north of the Shonai plains, which stretches from the foothills of Mt. Chokai to Mogami liver, is a distinguished agricultural area, and the caries prevalence rate of the 3 year-old in Yamagata prefecture, where this region belongs, has always been counted in the nation's worst 3. The improvement of caries prevalence rate in Sakata and Akumi district is considered attributable primarily to the comprehensive effects of the energetic efforts of school nurses and dentists through their school health activities, changes of the examination standard, and activities of home dentists who shifted their practices to preventive control. Notably, a significant result was led owing to the revision of the examination standard being actively proceeded through the district dental association. The cooperation among school, home and home dentists is considered to bring a good result, since the children's caries risk presently holds a wide range.

抄録全体を表示

In Japan discussing about usefulness and spreading applications of fluorides aimed for caries prevention is still dealt as if it were a kind of taboo. This has been resulted from the disputes over fluorides that have been taken place as if a confrontation of ideology. As a matter of fact, there is a confrontation between a few activists who advocate water fluoridation and the opponent groups that strongly oppose fluoridation. This dispute has become an obstacle to the application of fluorides itself. It can be said that one of the causes of such an unproductive argument has been brought from the absence of a consensus among dental and medical professionals for this issue. In the light of this situation, we conducted “a survey of professionals' awareness for the application of fluorides” on the specialists of professors, assistant professors and lecturers in the university. These professionals belong to the clinical chairs, including preventive dentistry and oral hygiene, of all Japanese dental colleges and dental faculties (total 29 schools) and the chairs of pathology, biochemistry and pharmacology. The number of the effective addresses was 827 persons and the effective replies 256 persons (31.0%). The same survey has been carried out to our members as well. We will report the results of the survey and review it in this paper. This survey has indicated that most dentists in Japan, who have high awareness to the issue, consider “preventing caries from occurring is one of the most significant concerns for those who related to dental practices.” The survey has also shown that these dentists recognize that the fact that the application of fluorides brings great effects on caries prevention and checking disease progression has been proved by the extensive epidemiological studies. As for the application measures of fluorides, dentifrice, professional care and fluoride mouth-rinsing have been supported, in particular, dentifrice obtained supports about 80% among replies. On the other hand, water fluoridation remained 27% of support.

抄録全体を表示