In recent years, there have been increasing opportunities for dental clinics to examine medically compromised or/and very elderly patients, and the importance of systemic management is increasing in order to realise safe dental treatment. It may be misunderstood that advanced knowledge and skills are required to manage the general condition of patients, but in fact what is essential in the general management of patients undergoing dental treatment is the basic knowledge required to understand the condition of patients undergoing dental treatment, to recognise and respond to changes and abnormalities in their general condition, and to share this knowledge with all staff involved in dental care. Biological information such as vital signs (blood pressure, pulse, respiration, temperature) and arterial blood oxygen saturation (SpO₂) are essential for understanding the patient's general condition. The early detection and responding to abnormalities based on this biological information may lead to safe dental care. In addition, the incidence of systemic complications during dental treatment is expected to increase in a super-aged society. Appropriate responses to systemic contingencies such as the vasovagal reflex and hyperventilation syndrome, which may occur during dental treatment, are also essential for safe dental treatment. This article describes the normal values and correct measurement methods of vital signs and other biological information essential for understanding the patient's general condition, and also describes the typical systemic contingencies that occur during dental treatment and how to deal with them.

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The purpose of the present article is to report a case of a patient with chronic periodontitis who showed little interest in the oral health. The patient came back to the clinic after an interruption, and the hygienist in charge of the patient explained the current state of his oral health using the patient's documentation (medical interview, intraoral photographs, X-ray examination and periodontal tissue examination), and made efforts to raise the patient's awareness. As a result, the patient was able to continue coming to the clinic and undergo basic periodontal treatment and SPT. The patient, who had been cooperative in self-care for a while, gradually lost motivation due to paralysis of the lower half of his body caused by an accident, and his condition remained unstable. Although not a case of severe periodontal disease, the patient's periodontal tissues are still under control through continuous visits and regular documentation. Through this case, we would like to share the perpetual process of recognizing importance of managing periodontal disease while taking into account the changing patient's background and the issues that our clinic should support in order to maintain the oral health of this patient in the future.

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In our daily practice, we frequently encounter cemental tears, the details of which are still unknown. In the present article are reported two cases of cemental tears in the maxillary central and maxillary lateral incisors accompanied by a lot of bone resorption, for which removal of the cemental fragments and root surface debridement were insufficient and hence supportive periodontal therapy (SPT) was performed after periodontal regenerative therapy. Dental radiographs and CBCT were effective in diagnosing cemental tears. Good results have been obtained at present, albeit in a short period of time.

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The aim of this survey was to understand the trends over time of first-time patients at regularly managed dental clinics. The survey collected and analyzed the characteristics of first-time patients by collecting anonymized daily records from dental clinics that are members (mainly clinics that have been certified as “clinics that protect and nurture oral and general health”) of the Japan Health Care Dental Association (JHCDA). This 17th report is a compilation and analysis of the oral health records of first-time patients (total number of patient records with birth date and gender recorded: 16,045, 7,022 males, 9,023 females) from 70 clinics (across 27 prefectures) over one-year period (from January 1 to December 31, 2022). In principle, all the oral health records of new patients at member clinics were accepted as digitized data, and we requested cooperation from members who had records (it was not necessary for all items to be recorded) of the average number of decayed, missing and filled teeth (hereafter, DMFT index) per child aged 6 years or older, and the DMFT index, number of remaining teeth, degree of progression of periodontal disease and smoking history per adult, and we compiled the records. The results of the survey showed a decrease in the DMFT index by age (group) for those aged 12 and over, as in the previous survey, and an increase in the percentage of non-smoking young men. In addition, an increase in the number of remaining teeth was observed in both men and women in the older age groups.

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