This article aims to clarify the definition of dental caries as an infectious, communicable, multifactorial disease and to discuss the ways of secondary prevention for a high-risk practice. Concerning the clinic biological features of mutans streptococci, a preliminary preventive method against dental caries for a large group does not seem effective in preventing dental caries for a high-risk practice. Thus, it requires certain techniques to remove the biofilm formed by mutans streptococci. This article features the background of neglected public health in Japan, the historical survey of dental caries, infections of dental caries, understanding of indigenous oral bacteria (S. mitis, S. oralis, S. salivarius) and oral bacterial ecology, and the mutans streptococci removal theory established by the author and colleagues with the results of its practice.

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According to the report of the survey conducted by the Ministry of Health and Welfare into dental diseases DMFT index (1999), and data from 4,396 new patients’ (ages 10 years and above) dentitions at Hiyoshi Dental Office in Sakata-city, the following hypothesis can be suggested: many people undergo restorative treatments in their teens and early twenties, which will be repeated until they finally end up with extraction, typically in their 50’s. To test the hypothesis, the reasons for each treatment (i.e. CR restorations, mental inlays, crowns,) were researched on a tooth-by-tooth basis. Research subjects were 88 new patients (28 male and 60 female patients) at the Hiyoshi Dental Office ages 30, 40, 50 and 60, whose collective teeth amounted to 2,446 (1,050 front teeth, 1,396 molars and premolars). For further investigations, 348 patients who were new to the Hiyoshi Dental Office before the year 2000 are also counted as research subjects, on the same basis. On average, the following features were found in the results; teeth maintained healthy until maturity showed less tendency to need treatment thereafter; the number of treated teeth with dental pulp declined as the patient’s age increased, the number of treated teeth without dental pulp increased till the age of 50 and then decreased after the age of 60; treatments occurred considerably more often on treated teeth than healthy teeth; teeth with severe loss of the root (loss of half or more the root of a tooth) are rare (1.9% at 50 years old); most reasons for the extraction are derived from caries. This information corroborates with the hypothesis. Hereafter, prospective studies based on patients’ individual dentition information will help clarify problems in restorative treatments at earlier ages, and lead to a more preventative approach resulting in lifetime health benefits.

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This mainly summarizes the article, as Key Review, “Clinical significance of nonsurgical periodontal therapy; An evidence-based perspective of scaling and root planning (SRP)” with an additional explanation on key contents. Also a part of the general report and other related articles are introduced. Other helpful references for understanding SRP are found in Worksites, parts of which are on the structured abstract, to enable citations. Figures are modified from original work in order to be helpful for a better understanding of the material and for further explanatory purposes, e.g. to assistants and patients. The “Q & A” section is designed to bring acquired knowledge into the actual clinics. By using Key Review and Q & A, the concept of today's non-surgical periodontal therapy, based on scientific evidence, can be gained. In the future, progress in clinics and laboratories or a change in society's needs may necessitate additional contents and modifications.

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