In Japan, the intervention in the dental caries is excessive, but that in the periodontal disease is all too inadequate. In other words, there are no firmly established examination and intervention in the early and moderate stage of periodontal disease. It infers from this situation that most periodontal treatments may result in the unbalanced cost effectiveness. The aim of this article is to have a view of the directions; what will be obtained from any current examination of periodontal disease, and what diagnosis will be feasible in the near future. Since the author have focused his study on the bounds of the treatment nonsurgical procedures can reach, it is important to find out every possible risk factors relevant to the study. In order to summarize the significance of clinical examination and the interpretation of examination outcomes, this article will discuss the following subjects: 1) Current examination of periodontal disease, 2) Classification of periodontal disease in 1999 workshop, 3) Significance of pocket probing and bleeding on probing, 4) Tooth migration by inflammation, 5) Relation between the influence of tooth migration on the occlusion and the influence of mobility on the inflammation and progression of periodontal disease, 6) Cementum micro fracture from colossal stress, and 7) Personal differences in the responses to the periodontal treatment.

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Before undertaking the community oral health project, it is essential to collect information about the present situation of the community and to diagnose the community we live. Especially as the prevalence rate of dental caries decreases, the mean values in the community may not help us to have a true picture of the community, but also lead to misunderstand an actual condition of the community. Health care administration in Japan is by the age of children in the control of Ministry of Education, Culture, Sports, Science and Technology or Ministry of Health, Labor and Welfare, and in the control of municipal borough or prefecture, resulting in no consistent data available. Therefore, as a board member of Yachiyo Dental Association in charge of sanitary affairs. I have arranged a database of the oral health in our community and used it for “Healthy-town Building Program of Yachiyo City ” Information collected in the survey reveals an expanding gap between the regions, for example, over half of 12 year age group have DMFT 1 and less, but a quarter of children have DMFT 4 and more, and the region with high DMFT value and high percentage of untreated caries at the 12 year age group has tendency to have low rate of having a dental check at the age of 3.

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The survey for the medication, oral conditions including tooth conditions, and a dry mouth was conducted with 2,269 adult patients who attended at the private dental clinics. The aim of this survey is to invstigate the following items: a) if the medication has a relationship with the salivaly secretion and a dry mouth, b) if the lowered amount of salivaly secretion and a dry mouth have a relationship with dental caries and periodontitis, c) what medicines may cause a dry mouth and lower saliva secretion, and d) what the analysis of saliva reveals. Dr. Mochizuki M will give a report of c) and Dr. Nomura Y and Dr. Saito I will give a report of a part of the findings from, d) which is an ongoing issue. Among the subjects participated in this study, 2,269 subjects take some kind of medicine, and only 786 do not take any medicine. For the subjective symptom of a dry mouth, most of them responded “No experience” and only 84 subjects responded to experiencing a dry mouth “Frequently” or every day. Together with those who experience a dry mouth “In a while” accounts for about 10% of the research people. Among the general diseases in this study, hypertension is the most frequent and 463 cases out of 2,269. The relationship of subjective symptom for a dry mouth with the presence of dysfunction of masticatory, the presence of emotional stress, medication, underlying disease, age, smoking and oral diseases was investigated. The results reveals that masticatory function is related with a dry mouth. Emotional stress was examined using the selected contents from the interview sheet CMI that is applied in the clinical psychiatric service and most contents showed significant difference. The relationship of 5-minitue stimulated saliva volume with emotional stress was also analyzed however, no significant difference was observed. Accordingly, it can be presumed that emotional stress is related with a dry mouth, but not related with the wstimulated saliva volume. Mediation is one of the etiology of a dry mouth, but relationship is not identified that a presence of a dry mouth due to medication has with the stimulated saliva volume. –Age is related both with a dry mouth and the stimulated saliva volume. Smoking is substantially attributable with the stimulated saliva volume. Subjective symptom of a dry mouth and the stimulate saliva volume are both associated with dental caries, neither of them are associated with of periodontitis.

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With the cooperation of 2,269 adult dental patients from 35 dental offices, survey was conducted on: what medicines the dental patients take, and what medicines may cause dry mouth. Over sixty percent of elderly patients took medicines and about half of those medicines were reported dry mouth in their package insert. Our data could not show that antipsychotics, antidepressants, and antimuscarinic drugs well known as causative drugs of dry mouth produced dry mouth, because the number of cases treated with these drugs were very small in our data. On the other hand, since cardiovascular drugs and H2 blockers were administered to many patients, patients treated with these drugs showed many cases having dry mouth. However, it should be kept in mind that most of medicines were co-adminstered with other 1 to 3 medicines, therefore we could not identify which medicine cause dry mouth. As many different medicines were found in this survey, it was quite difficult to analyse the relation between dry mouth by medicines and the amount of stimulative saliva.

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Cortisol and Chromogranin A(CgA) in saliva are regarded as biochemical markers of emotional stress. 741 saliva samples collected from the patients who visited the dental offices were measured the amount of the substance to specify the normal range of them in salvia of healthy individuals. Assuming that the normal range includes 95% of the measured distribution, the normal range of Chromogranin A is 0-46pmol/ml. Subsequently, other study was conducted in Tsurumi University Dental Hospital to examine if such measured can be of value as a maker of clinical diagnosis. The saliva samples collected from the outpatients who presented the symptom of the dry mouth but were not identified the etiology of dry mouth (presumably associated with emotional stress) were measured the amount of Cortisol and Chromogranin A. And, with matching the age and gender, both measurand of Cortisol and Chromogranin A in the two studies were compared. In consequence, the patients with dry mouth have substantially higher values especially for Chromogranin A.

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If healthy gingiva and balanced dentition are maintained well from infancy to the age of 20 with fewest possible filling and restoration in the tooth caries, dental hygiene in the adulthood will be comparatively easy. However, in reality, many teeth are treated with restoration after the adolescent. Therefore, health education in the schools plays the import role for maintaining the dental health of children. Then, the author made survey on the involvement of dental health education in all textbooks currently used in Japanese elementary schools, junior and high schools, and also in the teacher’s manuals in the elementary schools. The data were organized into the materials. The survey reveals that only the textbooks in the elementary schools have description on dental hygiene, but most contents are not in depth.

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