What role should prevention- and maintenance-oriented dental clinics play in the maintenance care of the elderly? The decline in independence with aging varies greatly from person to person, but even in the absence of major illness or accident, the aging process makes it difficult for the elderly to live independently due to the decline in physical and cognitive functions. Therefore, in maintenance care for the elderly, we have to look out for the decline in activities of daily living. The case of sarcopenia dysphagia from frailty, which led to death in a short period of time, calls for attention to the fact that it is difficult to recover from repeated aspiration pneumonia that results from sarcopenia dysphagia. In dental clinics, it is important not only to pay attention to the signs of oral frailty, but also to take into account " physical frailty, " " psychological frailty, " and " social frailty " behind oral frailty, to encourage participation in local frailty check projects, and to collaborate with multiple professions in the community to partake in communitycontained care. As medical care for the elderly is shifting from hospital-based to community-based, it is paramount for dental clinics to be actively involved in preventing frailty and introducing the elderly to the community-based general care.

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In recent years, the importance of dental disease has been increasingly recognized and has attracted attention, including the approval of a resolution on oral health by the World Health Organization (WHO), which aims to promote oral health and integrated disease prevention. However, in Japan, dental disease is not always widely recognized and there is little media coverage. The importance of oral health has been recognized in recent years because the prevalence of dental disease, which has been emphasized as decreasing, is actually higher than that of other diseases, and oral health affects systemic health. Based on the data, it is necessary to disseminate a correct understanding of the importance of dental diseases to other health professionals.

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Family dentists have the opportunity to perform autotransplantation of tooth and dental trauma under ideal conditions. The most ideal donor tooth is that with an incomplete root, and the key to success is to perform the graft with appropriate root development stage. The patients often visit family dentists from their infancy, and through maintenance, they can monitor the presence or absence of congenital defects of permanent teeth and the availability of suitable donors, and wait for the appropriate time for transplantation. In addition, depending on the patient’s risk of tooth loss during maintenance, it is possible to estimate with higher degree of confidence whether or not the donor tooth can be preserved. With regard to traumatized teeth, the treatment of avulsed teeth and the treatment of patients immediately after injury are especially important. Family dentists can improve the outcome of treatment of avulsed teeth by providing patients who attend maintenance appointments with information on how to respond to the injury.

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Orthodontic treatment is not a restorative treatment, but a creative treatment that transforms the patient into a new state. Therefore, it is necessary to clarify the goal of treatment before the onset of treatment. Throughout the course of treatment, changes in 1) dentition and occlusion, 2) function, 3) soft tissue profile, and 4) stability after treatment should be closely monitored. All of these factors should work together and complement each other, resulting in a posttreatment state that is comfortable both biologically and mentally. Naturally, the improvement of the patient's main complaints must also be achieved. Among these goals, patients who show the open mouth at rest or tension in the upper and lower lips when the lips are closed often recommended tooth extraction. In addition, although it is difficult to maintain the results of orthodontic treatment for the rest of the patient's life because the teeth continue to move over time, extraction is often selected to avoid unnecessary expansion of dental arch and to maintain the mandibular inter-canine width for the best possible post-treatment stability. With the recent emergence of implant anchors, orthodontic treatment is often discussed from the viewpoint that teeth can be moved freely as if it were a prosthetic design, and the specialty of orthodontics is greatly compromised with the emergence of aligner orthodontics. Orthodontic treatment is a medical treatment built around the body's response to orthodontic forces, so it is not appropriate to talk about orthodontic treatment in the same breath as prosthetic mechanics. As an orthodontist, I hope that the members of the Japan Health Care Dental Association will take this opportunity to revisit their views on orthodontic treatment.

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Although drug eruptions are rarely chief complaints in dental practice, there are cases in which oral mucosal lesions such as stomatitis present suspicions of drug eruptions. Drug eruptions are often caused by drugs frequently prescribed in dentistry, such as antibacterial agents, antipyretic analgesics, and anti-inflammatory drugs, so they are also encountered in dentistry. The most common types of drug eruptions include fixed drug eruptions that develop on the same area of the skin and erythema multiforme with edematous erythema on the skin. Severe drug eruptions that require special attention, such as the potentially fatal Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell syndrome), may be diagnosed from symptoms of the oral mucosa during a dental visit. Therefore, careful observation by a dental health care professional and a drug history during a medical interview are particularly important when drug eruptions are suspected. These severe drug eruptions require prompt and smooth treatment, which requires collaboration with other departments such as dermatology. Therefore, it is necessary to deepen understanding of basic information on drug eruptions that may be encountered in dentistry, initial responses through medical interviews, and procedures that can be performed in dentistry. In addition, it is desirable to have knowledge on standard proceedings of providing medical information when drug eruptions are suspected in dental care because sharing medical information in cooperation with other departments leads to early detection and early treatment.

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We focus on the plaque control status of a child male, 2 years and 11 months old at the time of initial examination, for about 15 years until the age of 18 years, and report on his mental growth process and changes in plaque control. At the initial visit, plaque control was poor, with total number of decayed and filled teeth: 8 and multiple ICDAS code 3-4 fossae. He had sweets within reach at all times and ate them when he wanted, and he regularly drank cola during meals. One month after tooth brushing instruction to the mother, there was a marked improvement in his oral hygiene. The mother requested remineralization therapy. After explaining the harmful effects of pacifier use, the patient reported that he was able to stop using the pacifier 3 months later. 7 months later, his plaque control record (PCR) decreased to 10%, and the open bite observed at the initial visit also improved. Therefore, the patient was transitioned to maintenances with regular PMTC. After puberty, the patient stopped talking to his mother but continued to listen to the dental hygienist, but a permeation image (XR3) extending into dentin was observed on the proximal adjacent surface of #46. We recommended that he refrain from cutting intervention and instead focus on lifestyle improvement, with PMTC visits every 4 months, fluoride rinsing, and flossing. This lifestyle continued, and even when he temporarily stopped attending school in his second year of junior high school, he continued to take fluoride rinses and floss before bedtime. When we told him that he would have to have his teeth shaved at the observation site if he did not change his lifestyle, the PCR value decreased at the end of him first year of high school. We suggested that the patient be followed up with less cutting intervention, beginning with poor plaque control in early childhood, and he continued to visit the dentist for PMTC throughout adolescence. This is a report on an observed case of plaque control condition that experienced several ups and downs during the process of mental growth.

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The patient was a 53-year-old female at the time of the first visit. She came to our clinic with a complaint, " Many of my teeth are beat-up ". A treatment plan was formulated respecting the patient’s preference and intention. The actual treatment consisted of basic periodontal therapy to improve the periodontal tissues, extraction of teeth that could not be saved, and restorative treatment of teeth with substantial defects. The patient requested a fixed prosthetic treatment for the missing mandibular bilateral molars, so we performed implant treatment. The patient was enthusiastic about self-care during the treatment, and visited the clinic regularly for maintenance, and her oral health has been stable for 15 years since the placement of the superstructure. We report on the evolution of our postimplant maintenance practice through this case study.

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A survey by questionnaire method was conducted to investigate the current status of frailty (including oral frailty) among elderly patients (aged 75 to 85 years) visiting our clinic. The survey took a form of either individual interview or handed-out questionnaires, and the questionnaires included information on means of transportation, number of remaining teeth, understanding of the progress of periodontal disease, oral cognition, weight, walking speed, difficulty opening a can, eating, conversation, oral function, social activities, desire for oral function tests and oral function training, and future concerns. The subjects were divided into two groups according to the number of remaining teeth; A group of patients with 20 teeth or more and another group with fewer than 20 teeth were compared with one another. The number of remaining teeth and the progression of periodontal disease were understood by 16% and 21% of the respondents, respectively. In terms of physical fitness, 60% of the subjects felt that their walking speed was slow. In the oral cavity, 55% of the subjects had dry mouths, 38% bit their lips, tongue, and cheeks, and 35% swallowed or aspirated, suggesting the presence of frailty. Comparing the group with 20 or more teeth and that with fewer than 20 teeth, the former had higher percentages in the following items: driving by themselves, oral cognition, no weight change, can eat anything, no dry mouth, no aspiration, and doing some social activities. On the other hand, the group with fewer than 20 teeth were more likely to bite their tongues, cheeks, and lips, and to desire an oral function test and to be interested in training. There was little difference in walking speed, difficulty in opening the lid, time required for eating, ability to speak as desired, and spilling food. The most important concern was how to secure transportation to the clinic.

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We conducted a questionnaire survey on the treatment of elderly patients among the member dentists of the Japan Health Care Dental Association who actively provide longterm periodic maintenance-oriented dental practice. The results showed that although routine practice was linked to understanding and recording changes due to aging of patients, it was difficult to say that the practice was able to respond properly to changes in patients. Furthermore, a comparison of the two groups of dentists, those who made routine home visits and those who did not, revealed that home-care dentists were more likely to be able to detect changes associated with the aging of their patients at the level of daily living, and were also more likely to respond promptly when support was needed in the lives of elderly patients. The results of the questionnaire suggest that it is important to establish a streamlined care system in the clinic in collaboration with the local community so that patients can receive support when needed.

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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 17th survey included 13,908 new patients (6,061 male and 7,847 female patients) who visited the 63 member clinics (across 24 prefectures) during the period between January 1st and December 31st, 2021. 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.

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