With the increase in the number of elderly people requiring nursing care, there are more and more opportunities to provide home-visit care. During home visits, patients in various systemic conditions are treated, and oral care is an essential basic procedure that must be performed on all patients. However, even though the term “ oral care ” is now widely used and recognized, the interpretation and content of what it means and how it should be performed differ from person to person. In this paper, we will first examine the origins of the term “ oral care ” and the various definitions currently available, and then we will discuss how oral care should be understood and interpreted. We will then discuss how oral care should be performed, how we should interact with patients, their families, caregivers, and other professionals through oral care, and what we should do to become dental professionals who contribute to improving the quality of life of patients, which society expects of us.
The oral cavity plays a role as a feeding organ for food and water intake, an articulatory organ for speech, and a respiratory tract for emergency breathing. In addition, the morphology of the oral cavity, including the alignment of teeth and jaw shape, is an esthetic component of the face, and its problems are linked to functional problems such as mastication and speech, and the psychological impact of such disharmony is significant. Childhood is a period of dynamic change in oral morphology, as represented by the replacement of deciduous teeth with permanent teeth, and a period in which these functions are acquired in parallel. The development of morphology and function is always linked, and children's internal psychological factors also have a great impact on them. In particular, the psychological aspect of children is greatly influenced by their nurturing environment.
For the healthy development of the oral cavity, it is extremely important to achieve a good balance between morphology, function, and psychology, and we need to provide support from multiple perspectives, not just one. On the other hand, systemic factors also play a major role in the development of oral morphology and function.
This article is to summarize general oral development and the systemic factors that influence the development, and concludes with an overview of support for the development of oral function.
The ACFF Japan chapter, an international charity whose goal is to combat dental cavities, has developed the Japanese version of ICCMSTM e-learning as a key part of its activities. FDI recommends the use of ICCMSTM to disseminate Minimal Intervention Dentistry. The basic structure of ICCMSTM can be summarized by the 4Ds; Determine: the individual’s caries risk assessment; Detect: detect and evaluate carious lesions; Decide: on the personalization of treatment strategy; and Do: implement appropriate treatments. Following the caries risk assessment, ICDAS is used to evaluate how the carious lesions develop and progress. After that, options for professional and self-care are drawn up and appropriate intervals for clinical visits are set, so as to assess the effectiveness of caries management. Currently, the Japanese version of e-learning focuses on clinical practice. We are planning to promote and extend its use to dental education of clinical cariology in Japan.
With the increasing number of patients with dementia is increasing, appropriate measures are wanted in dental practice. Dementia is defined as a condition that interferes with daily life due to cognitive impairment. In the clinic settings, where outpatients with early dementia are more often seen than those with late dementia, it is necessary to recognize and appropriately respond to each and every initial symptom. If the dementia is mild, dental treatment is possible to a certain extent, taking the patient's condition into consideration. Since deterioration of the oral environment is predicted to occur as cognitive function declines with dementia, predictive management of oral function and oral hygiene is important. The causes of deterioration of the oral environment include difficulty in self-care due to higher brain dysfunction and refusal of oral hygiene management by others. Since patients with dementia are relatively more likely to accept “familiar ” actions and events performed by “familiar ” people, we believe that building such relationship through early oral hygiene management, such as regular visits, is one way to help manage the oral environment of patients with dementia. In addition, dental clinics and dental professionals can support patients with dementia and their families by collaborating with social resources, such as community comprehensive support centers, as a member of the community comprehensive care system. It is important for dentistry to provide comprehensive support for patients with dementia, not only in terms of their oral health, but also in terms of their general condition and living environment.
In the dental clinical setting, some patients present with chronic pain despite the absence of mechanical or organic impairment. In the past, it has been called variously “idiopathic pain”, “psychogenic pain”, and “nonorganic pain,” but in 2017, the International Association for the Study of Pain (IASP) propose the concept of “nociplastic pain” as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage. It is positioned as a “third mechanistic descriptor of pain” following “nociceptive pain” and “neuropathic pain,” which are pain mechanisms. In response to this, in the International Classification of Orofacial Pain, 1st edition (ICOP-1), published in 2020, a chapter on “Idiopathic orofacial pain” was incorporated, in which three diseases that may occur by the mechanism of nociplastic pain in dentistry were classified: “Burning Mouth Syndrome”, “Persistent Idiopathic Facial Pain,” and “Persistent Idiopathic Dentoalveolar Pain”. On the other hand, mental disorders such as Somatic Symptom Disorder, depression, personality disorders, and schizophrenia may cause patients to complain of pain. Although the mechanism is not clear, it is possible that patients experience cenesthopthie or nociplastic pain.
This article describes these disorders with case examples.
Dental caries and periodontitis are two of the most important biofilm-associated infectious diseases in dentistry. Effective removal of dental biofilm is necessary for prevention of dental caries and periodontitis as dental biofilm is the main cause of these diseases. The most effective way of biofilm removal has been considered to be mechanical approach, such as daily toothbrushing. Some studies reported that electric toothbrushes can remove more effectively than manual toothbrushes. However, electric toothbrushes have to be moved along a row of teeth by hands as well as manual toothbrushes. It is often difficult to move a toothbrush for elder and/or handicapped people. Therefore, a full automatic electric toothbrush, named g. eN, was newly developed by Genics Co., Ltd., a venture company associated with Waseda University. The efficacy of this full automatic toothbrush was investigated by modified O’Leary’s Plaque Control Record (PCR), which evaluates six sections instead of conventional four surfaces, for a simple semi-quantitative evaluation. The results showed a significant decrease in PCR scores after brushing compared to before brushing both full-mouth and in each of the six blocks of dentition. The mean PCR score after 220 seconds of brushing using the g.eN prototype automatic toothbrush used in this study was 22.4%. This score is considered to be enough to maintain oral hygiene. This study suggests that the full automatic electric toothbrush is useful to remove dental biofilm and maintain oral health.
To understand the impact of the spread of COVID-19 (novel coronavirus infection) on dental visit behavior in Japan, we investigated monthly changes in the number of first-visit patients during the year 2020 with the cooperation of 58 dental clinics in 27 prefectures nationwide, compared to the average monthly number of first-visit patients in 2018 and 2019. The following characteristics were observed in the number of first-visit patients in 2020, when the COVID-19 pandemic began: (1) the number of minors decreased from April to July, and increased in October for males and in September for females; (2) the number of adult first-visit patients remained at a low level of 60-90% of that of the previous years throughout the year; (3) the number of adult male and female patients decreased by half in April and May respectively, and recovered to a certain extent in September and October. This drastic fluctuation in the number of first-visit patients was largely influenced by the fact that dental checkups for minors were conducted avoiding the COVID-19 epidemic period and widening the target age window, and that the school dental checkups were rescheduled, if any, to any time in the school year. The number of first-visit adult patients exhibited a roller coaster-like decline and increase, with a sharp drop in April and May and a return to the previous year's level in September and October. It is assumed that this was due to the fact that many patients refrained from seeing physicians following the declaration of the state of emergency, and some clinics were closed, resulting in a decrease in the number of first-visit patients, which was then reversed in early autumn when COVID-19 had settled down, causing an increase in the number of patients.
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 15th survey included 12,919 new patients (5,725 male and 7,194 female patients) who visited the 59 member clinics (across 26 prefectures) during the period between January 1st and December 31st, 2020. 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. As a result, the DMFT index continues to decrease in all age groups above 12 years, the marked decrease in male smokers continues in younger age groups, and the number of remaining teeth continues to increase in both men and women above 65 years of age.