The information obtained from caries risk assessment is very important and useful. However, the methods to predict at the chair side what a level of importance each parameter has or how much degree of risk individual patient risk means have not been established yet. The caries risk assessment close to the first medical examination is thought to have the significance as a guideline of risk improvement, but the information obtained in the maintenance phase is required to have a role of “the predictive factor of caries lesion occurrence” Then, we analyzed the medical care data of his patients with the expectation that the cavity occurrence in the patients under maintenance could be predicted. 63 study subjects were chosen from his patients who were aged from 5 to 12-year-old at the time of examination and received his maintenance over 3 years. 9 subjects of them were found to show the increase of DMFT score within 3 years after the first examination. We assessed the caries predictability of each examination value by comparing the pretest probability with positive and negative values. This assessment shows that the parameter whose positive predictive value goes up higher than pretest probability and comes down lower when a parameter value is negative works effectively as caries risk prediction. It also shows that a single parameter has increased its risk predictability when it was combined with other single risk predictable parameter.

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We think that it might require close to 20 years to assess how the periodic preventive management works to control dental disease, if it was performed in our dental office. Then, 89 study subjects, aged from 11 to 19-yea-old, from his patients who visited him periodically over 5 years for maintenance and were under 19-year-old. 89 subjects were divided into three age groups: 11-13, 14-16, and 17-19. With the data of the change in DMF value from each group, we planned to conjecture the effect of caries preventive management when it is performed in the subjects to the age of 18. Another evaluation was made on the two groups divided by the number of maintenance received. From the data obtained, we conjecture that the periodic preventive management may work to control the increase of DMF score to the average of 2 at the age of 20, if patients visit us periodically from 6 to 20-year-old and receive our maintenance.

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In Japan, antibiotics are frequently administered post-operatively for routine oral surgery and periodontal procedures to prevent infection. Recent studies support a growing concept, based upon evidence-based medicine (EBM), that the non-discriminant use of antibiotics is warranted and has no scientific basis. The emergence of antibiotic-resistant bacteria and their nosocomial transmission have become a major issue affecting public health. Europe and the United States have dealt with the practice of over-prescribing antibiotics by recommending that health care provides consider the appropriateness, efficacy, and need for the antibiotics prior to administration. These guidelines have seemed to stem the emergence and transmission of antibiotic-resistant strains. This review will describe the mechanisms by which antibiotic-resistance is developed and show the frequency at which these bacteria are propagated and transmitted. A brief historical perspective of antibiotic administration will be followed by a proposal protocol for the prescription of antibiotics that is currently in use at Boston University Goldman School of Dental Medicine. Finally a comparative analysis of the clinical use of antibiotics in the United States and Japan will be presented. We hope that this literature review will set the stage for the establishment of a consensus regarding the administration of antibiotics that will be based upon EBM.

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Periodontitis is different from other infectious diseases, because it is an inflammatory disease with a unique feature of periodontopathic bacteria colonizing in the exterior portion of the soft tissues in many cases. The local host resistance and reaction to the bacteria triggers the expression of the disease. We evaluated mRNA levels of the cytokines, and our study indicates that with the increase in the severity of clinical findings the levels of the cytokines (IL-1 β、IL-6, and TNF α), potent stimulator of bone resorption, maintain high in the local sites. In order to understand periodontitis, we need to have a better understanding of commonly called “Constitution” as well as bacteria. The interindividual difference of 1 codogenic (1 base) (more than 1% frequency of the population) is called as “polymorphism”, and this codogenic difference prescribes “the constitution”. Kornman et al demonstrated in their study that there is a correlation between IL-1 genotype and severity of periodontitis. About 30 % of the Caucasians and about 7-10% of the Japanese are IL-1 genotype positive group. Thus, there are controllable risk factors of periodontitis, such as plaque accumulation, and ncontrollable risk factors. We think that it will become more important to offer a patient a preventive program of periodontitis by objectively evaluating his/her risk factors. The purpose of this review is to describe the significance of the classification of periodontitis developed by AAP and a workflow of diagnosis and treatment of periodontitis within its scope, subject to the understanding of periodontitis.

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Gingivitis is a very common finding in most populations and in all age groups. On the other hand, chronic periodontitis is common in adults and older age groups, but is infrequent in the young segment of the population. Severe chronic periodontitis affects a subset of the population, and its prevalence is relatively low in most populations. In the United States, a recent survey that used a partial examination showed that severe chronic periodontitis affected approximately 3% of the 30 years and older, and 20% of the 65 years and older groups. A similar trend is found in other countries in the world. Earlyonset (juvenile) periodontitis is more prevalent in certain populations and racial groups, particularly in Asia, South America and Africa. We studied data from recent surveys and found marked differences in the periodontal status between the populations of Japan, U.S., and south Brazil. There also seems to be different levels of exposures and periodontal risk factors in these populations. Risk assessment could play an important role in the prevention and control of periodontal diseases, and clinicians should be proficient in detecting periodontal risk factors in order to more efficiently prevent and treat these diseases.

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Non-destructive and destructive forms of periodontal diseases may occur in young subjects. Gingivitis may be caused by dental plaque or other factors. Early-onset periodontitis is preceded by gingival inflammation, and local and systemic factors play important, though different roles in the pathogenesis of these diseases. The elimination of local factors is imperative for the successful treatment of aggressive forms of periodontal diseases. However, successful treatment often involves a thorough assessment and control of various etiological and risk factors, including behavioral and systemic factors.

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