The purpose of this survey was to elucidate the patient satisfaction and behaviors towards the regular dental check-ups with focus on preventive care in 39 private dental clinics. The sample of 9,024 patients was surveyed using questionnaire sheets distributed at private dental clinics. The number of sheets collected was 5,129 and the response rate was 56.8%. The results were summarized as follows: 1) The dental clinics participated in this survey were characterized as higher number of dental hygienists and higher number of patients visits in a day compared with the national average. 2) The typical patients, who participated in our survey, were women, with age below 14 years old and 40-49 years old, whose occupation were students or civil servants. 3) The factor, which showed the strongest correlation with the patients' adherence to the regular visit, was the technical competence of hygienists. And the strength of the correlation of it was twice as much as technical competence of the dentist. 4) Treatment fee, appointment system, stuff members' attitude, however, are patients' priority to be improved towards enhanced the satisfaction.

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With the cooperation of 39 dental clinics of the board members of The Japan Health Care Dental Association, a Survey on Dental Practice was conducted utilizing questionnaire sheets targeted visiting patients. The object of this survey was to research how dental practice of each clinic being evaluated by patients, the purchaser of the service. The questionnaire sheet filled by individual patient was directly mailed to the third-party institution for analysis. Total 9,024 questionnaire sheets were distributed to all patients for a set period. The response rate was 56.87%. It should be noted, however, that the samples surveyed comprises visiting patients of dental clinics where adopt regular check-up systems unpopular in Japan. The results were as the followings: 1) The rate of visiting patients due to health management was 35.2%. 2) Over 40% replied “home doctor” as the reason of their choice of the dental clinics. 3) The most highly rated item as the information patients wish to get about dental clinics was “reputation”; 34.2%. 4) 46.5% had an experience of visiting clinics for health maintenance not for treatment, among them, those who showed willingness of continuing “regular check-up” occupied 94.9%. Apart from the above summarized results, a great difference among dental clinics was observed about evaluation of several items including quality of provided services and the amount of “willingness to pay” for dental services. This is an interesting facts also disclosed from this survey.

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This report reviews morbidity rate of periodontal disease, tendency of DMFT and the number of present teeth, and efficacy of caries prevention, periodontal disease prevention, periodontal disease treatment, and periodic management. The following data have been used for making evaluation; the Survey of Dental Diseases in 1999 (6,903 samples; Ministry of Health, Labour and Welfare), Suita-city (Osaka Pref.) Adult Dental Examination (12,955 samples), and author's patients data (4,674 samples; the patient's data including severity of periodontal disease were rated by the protocol incorporated in “Wistaria”, a template of a database-software that facilitates clinics managing patientsdata, which the Japan Health Care Dental Association offered exclusively for the member). No great discrepancy was observed among these three data as for present-teeth number and DMFT for each age, when compared with the data of author’s patients data of initialvisit. From the data of Research of Dental Diseases Actual Condition, it is recognized that teeth loss is rapidly accelerated at the age over 50, since tooth strength is almost suddenly lost and becomes vulnerable at this age due to repetitive treatment aimed at early-stage caries detection and treatment. Therefore, this data also shows the evidence that appropriate periodontal treatment and/or periodic care-management have not been provided. The data of “Health and Welfare Trend Research” (Ministry of Health, Labour and Welfare) also underwrites this fact. From the data of 1,176 patients (the mean age at the first visit; 45.6 years old) visiting author's clinic for periodic care-management, it has been obsereved that mean number of teeth loss per patient is 0.3 in the period of average 6.4 treatment years and 80.3% of the patients among them experienced no teeth loss during the same period. In analysis of 396 patients who had deciduous teeth and mixed dentition at the first visit, DMFT changed from 0.9 to 1.3 and caries-free rate became from 66.1% to 61.9% after average 5.9 years periodic care-management. The lower the first-visit age DMFT increase can be well controlled and caries-free rate can be maintained at higher level. It has been well observed that periodic care-management contributes to adult teeth loss incredibly and to lessen DMFT increase greatly.

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The goal in clinical decision-making is to obtain tangible patient benefits. The word tangible indicates that the end result of an intervention should be an outcome that patients can perceive. Such outcomes are referred to as clinically relevant outcomes or true endpoints. The clinically relevant outcomes in dentistry are saving teeth and improving dental related quality of life by improving esthetics, minimizing pain, or improving chewing function. In dentistry, there is almost no clinical research to assist clinicians in determining which clinical decisions are associated with tangible patients benefits. Dental clinical research has focused mostly on the study of intangible outcomes; outcomes that patients cannot perceive. Intangible outcomes measures are referred to as surrogate endpoints or measures of disease process. Examples of surrogate endpoints are changes in probing pocket depths, changes in Streptococcus mutans levels, or changes in cephalographic anatomical landmarks. It has been a common and pervasive assumption in dental research that the study of factors that influence clinically relevant outcomes was unnecessary. In the USA and Europe, billions of dollars have been spent on the study of intangible outcomes, and yet almost none of these resources were focused on the study of clinically relevant outcomes. Such a one-sided approach to clinical research can be dangerous; clinical interventions that influence intangible outcome measures do not necessary influence tangible outcome measures. Improvements in intangible outcome measures may result in real harm, or vice-versa. For instance, once widely used interventions that successfully lowered lipid levels, increased immune function, or normalized heart rhythms, have now been shown to increase mortality. In such instances, use of intangible outcome measures led to falsepositive results; conclusions that interventions had positive effects, while in fact the interventions were harmful. Similarly, interventions have been identified that had no impact on 'important' intangible outcomes measures, and yet provided real benefits. In such instances, intangible outcome measures led to false-negative results; conclusions that interventions were ineffective, while in fact the interventions were beneficial. If we want to stay true to our goal of providing tangible patient benefits, clinical epidemiology will have to start playing an increasingly important role in dental research. Clinical epidemiology is defined as the study of the factors that influence tangible patient outcomes. Clinical epidemiology can assist clinicians in providing reliable answers to important and controversial clinical questions related to etiology, diagnosis and treatment.

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The United States is the only developed country in the world that does not have a national health program, resulting in an expensive and fragmented health care delivery system. In spite of spending more money than any other country in the world, the United States is ranked 24th in life expectancy, at 70 years of age, and Japan is ranked number one in life expectancy, at 74.5 years. In terms of health systems, the United States has been ranked 37th, and Japan 10th in the world, by the World Health Organization for quality, access and cost. Total dental expenditures in the United States were about $53 billion in 1998, or 4.6% of all health expenditures, as compared to 8.7% in Japan. About 92% of U.S. dentists are in private practice and there are 53.1 dentists per 100,000 people in the U.S. as compared to 66.3 in Japan. About 108 million Americans do not have dental insurance. Most dentists are prevention oriented, and preventive services are taught in all 55 dental schools. The scope of dental practice for dentists, dental hygienists and assistants is determined by different laws in each of the fifty states. There are about 100,000 hygienists in the United States trained in 230 schools. Dental hygienists have 2-4 years of education and training after high school and work under the supervision of a dentist. Most of their work is prevention oriented: charting, x-rays, prophylaxis, fluoride treatment, dental sealants, sports mouth guards and oral health education. The average net income of private practice dentists has increased 41% from 1990 to 1996, from $94,200 to $132,810. This is in the highest 8% of U.S. family incomes. The productivity of a dental practice is determined by the number of chairs, dental hygienists and dental assistants in the practice. Practices which effectively utilize hygienists and assistants can spend more time on prevention and with each patient as well as be more productive. The role of the government in oral health in the U.S. is minimal. Government is primarily involved in needs assessment, policy development, and assurance, in addition to licensure and regulation. Most states have a dental director, as do some of the major cities, like Boston, New York and Los Angeles. The federal government plays a leadership role in developing national goals for prevention which are promoted to all health professionals and the public. The goals for the year 2010 are called Healthy People 2010. Oral health goals include improving access and promoting prevention such as dental sealants, community fluoridation, and oral cancer detection. Over 145 million Americans, or 62% of people on a public water supply, are receiving the health and economic benefits of fluoridation and about 23% of 8-year-olds have sealants. The first ever U.S. Surgeon General's Report on Oral Health was released last year, documenting the importance of oral health. Although there has been a dramatic decrease in the prevalence of tooth decay in the last 20-30 years due to fluoridation, fluorides, improved technology and access, many Americans are still not able to obtain dental services. Primary prevention is more beneficial to patients and the public than secondary or tertiary prevention and it should be the foundation of better patient care. The dentists of today and the future must be continuously involved in learning new procedures, techniques and concepts to best serve their patients.

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The Japan Health Care Dental Association has celebrated fullthree years since its launch. Taking this opportunity I would like to review our activities and their outcomes based upon our “Mission” we adopted at the time of establishment. Our Association does not merely seek for member's profit, but we are aiming; to assess and adjust our daily practice primarily and to consider “what the medicine should be” in order to serve people maintain and enjoy “comfortable chewing”, “conversation free from functional restraint” and “smiles that are filled with youthfulness and dignity”. The Association's establishment itself and activities have influenced medicine and dental medical research in great deal, however, we can not deny that there are still tasks we could not complete satisfactory nevertheless adopting as objectives.

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