The numbers of dental clinics that can be nominated as “Healthcare type clinic” are still remaining at lower level at the moment even four years have passed since the Japan Health Care Dental Association has been established. One of such reasons is estimated that many dental clinics are not in a position to figure out how to apply the information to give solution to the current problems and how to transform themselves to health care type clinic, even though abundant volume of information is supplied. Our association invented the TMR (Total Management Risk) and the THR (Total Health Care Risk) that are extracted from the information obtained as a result of dental clinic basic questionnaires given at the management course (Held on the evening before the international symposium) in March 2002 and that are used as referencing index for the analyzing evaluation of clinics. Using this newly established referencing index, we have executed dental clinic risk analyzing over participants of management course, councilors and the Forum DEWA members. As a result of this analyze, it was figured out that the achievement level of health care dentistry of the members are varicolored and there exist great differences of their abilities among the members. Among the participants of management course the average figure of TMR indicated 20.0 and the average TMR figure of such clinic where the director is answering “Having confident in treatment” was extremely low which proves the fact that the confident of clinic director is the “Keyword” of the successful management. Furthermore the TMR average figure of the councilors of the association marked 13.9 while the average THR indicated 43.8. Although the record of TMR of the councilors was shown “Lower risk” than that of the participants of management course, it was clarified that there are many problems remained even if they are councilors. On the other hand the analyzing result of Forum DEWA members who are actually the founders of the Japan Health Care Dental Association marked 12.9 on average TMR and the average THR indicated 40.8. As a whole it might be concluded that the achievement degrees of health care type clinic is rather high from the fact that there found many low risked clinics. However, it has to be recognized that the distribution of the data management was polarized. Moreover, it was found that the problems and defects of our own clinic were clearly figured out when this evaluation method is projected on to the historic changes of our Chigasaki Dental clinic. Originally, this evaluation method was invented for the purpose to carry out personal analyzing, however, it was verified that further more effort might be necessary to achieve more effective risk analyzing that has more objective view, because this evaluation method is successfully carried out only when it is evaluated based on the certain successful patterns as health care type clinic.

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It is widely mentioned that rubber dam protects teeth under treatment from moisture such as saliva, and is the very effective method of defending that from the invasion of bacillus. Especially, it is assumed as an indispensable method of endodontic treatment. Moreover, this method indicates higher effectiveness in the resin restoration. However, in the revision of the medical treatment fee under the health insurance system, which is executed in April, 2000, the environment of applying this rubber dam method in clinical stage becomes more severe than ever viewing from the fact that the calculation of rubber dam on the resin restoration becomes not accepted as the calculation base of insurance applicability. One of such reasons is considered that the number of such dental clinics that are extend this rubber dam method constantly is considerably little. However, the investigation to clarify the actual status of applying this rubber dam method which has an appropriate object and proper collection rate was not yet implemented so far. In this connection the reality of this method applying is not clarified by now. With regard to this situation, we have executed our investigation to clarify the actual status of applying the method and the reason why this method is not used on the base of questionnaires given to the members of the Japan Health Care Dental Association. The investigation was carried out by the method to give questionnaires mailed to 1124 member dentists and researchers. (Sending questionnaires on March 18th 2001 and the answer collection time limit was set on May 18th May). The answers were collected from 448 members, and the successful collection rate was indicated as 39.9%. As a result of this investigation, it was clarified that the one who answered, “rubber dam is applied currently” was 51.1% and one who answered “Applied on almost every day” was answered in the percentage of 22.5%. While the answer “Several-times in a week” was 13.8% and “several-time in a month” was answered in 6.2%. Regarding the time of use, the answer “during endodontic treatment” occupied the largest share of 66.1%. The next position was occupied by “Accidental mis-deglutition prevention on the treatment for infants”. Between the relations of cases of using the application and non-using, there are no difference observed among the differences of sex, age, clinical experience years, and number of patients daily treated and the chair time per patient. Furthermore there were no differences observed between the types of clinical education received at the university either. However, some relative relation was observed between the ratio of rubber dam execution and diagnosis that are not applied insurance. On the other hand, regarding the reason of not using rubber dam, the highest share was marked with the reason “Because of annoyingness” (34.3%) and the next position was occupied with the reason of “Because patients dislike it” (18.8%). Regarding the expectation on the effect achieved when rubber dam was applied, a big difference was admitted between the members of “rubber dam was applied” and “rubber dam is not applied”. Among the members who answered “rubber dam is applied”, 67.2% of them answered to indicate their expectation that “Result of treatment in teeth is expected to be improved” by applying rubber dam, while only 40.7% of the one who answered “rubber dam is not applied”, made the same answer “Result of endodontic treatment is expected to be improved” The difference of both was statistically significant.

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Dental caries have been suggested to be multi-factorial disease. In this respect, the clinicians have been used the caries risk tests that evaluate the etiological factors for the dental caries. Clinicians’ empirical evidences have been shown that some of factors might contribute greatly compared with other factors. Then, it is necessary to evaluate the weight of the risk factors for the incidence of new dental caries. The determination of the weight of each factor may lead to establishment of effective method for the prevention of dental caries. In this study, data was obtained from the clinical examination of the 1664 outpatients of Hiyoshi Dental Office who satisfied the three inclusion criteria that the age was under twenty years old, caries treatment was completed with oral hygiene instructions and that risk factor evaluation was received at first visit and on the final clinical treatment. The number of patients who developed dental new caries during the maintenance period was 296 (17.8%) and the mean observation period was 2.84 ± 2.11 years. (year range: 1 to 15 years) By the Logistic regression analysis, the scores of Dentocult SM and Dentocult LB, O’Lettys plaque control record and caries on deciduous teeth on the initial examination could be the prognostic factors for developing new dental caries. Especially, scores of Dentocult SM and Dentocult LB were statistically significant when adjusted by the age of the first visit and maintenance periods. And the analysis from the data of treatment completion, the same tendency was observed. Among the factors in the risk tests, the factors of the oral bacteria were especially important. The cut-off point of the each risk factor was also examined. As the result from this data, the cut-off points were set as 2 on the Dentocult LB, 3 on the Dentocult SM, 2 on the Dentobuff and 2 on the amount of dental plaque, 6 ml on the volume of 5-min stimulated saliva, 5 times per day on the frequency of meal taking, and 7 on caries on deciduous teeth. The effect of the regular check-ups were evaluated by NNT (Number Needed to Treat) The results indicated that the NNT of the regular check-ups was 6. This result suggested that the regular check-ups are very effective for the prevention of the dental caries.

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Precavitated carious lesions control through the intervention in the process to the carious lesions brings up healthy tooth row. We shall explore the critical path that can effectively bring the benefit to patients. Caries risk is different between individuals with site specificity. The total risk (simple addition value of caries risk indices), which helps us recognize the difference of risk between individuals and consider the difference of risk between sites, shall be used in the examination and diagnosis of each tooth and its surface. We shall take a statistical approach to analyze the interaction between respective factors of the caries risk, for at more effective risk control.

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Many patients who visit dental clinic for consulting answer they do not know whether their using contain fluoride or not when it is questioned. In this connection, we decided to check the package indications of commercially available dentifrices and a fact was found that many of them do not clearly indicate the contents of fluoride. The examination of this package indication was carried out by purchasing all types of dentifrices available from vicinal seven stores such as drugstores and others. Among 91 types of dentifrices purchased, 77 types were considered to be distributed popularly in the market and we counted 45 types (52%) among them are indicating the contents of fluoride on their ingredients labels. Furthermore, there were 27 types of fluoride containing dentifrices that carried the indication of fluoride contents besides the ingredients labels. Moreover, it was observed a tendency that the higher priced commodities by gram unit price do not have fluoride contents. The images of the commodity packages and the section of ingredients labels are shown here as information material.

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