Up until now, both caries and periodontal disease have been thought of as irreversible and incurable diseases. However, delayed diagnosis of advanced stages of the diseases and belated intervention are major reasons as to why the diseases have become irreversible. To diagnose and treat diseases at the reversible stage and to return the patient to their former condition is generally known as “secondary preventive care”. Recently, preventive care has been used to intervene at the curable stage of caries and periodontal diseases, accumulating good results. In order to make secondary preventive care available to the insurance system, an objective standard value must be established. Dental disease is an infectious, life style related disease. It is classified as a chronic infection. Therefore, I suggest that Dentistry should consider separately, “medical care of disease” and “medical care for positive health and a medical care for QOL (Quality Of Life)”. The health of the tooth is of special importance because there is a common risk factor associated with both positive health and disease prevention. This article argues that expanding secondary preventive care will contribute to the well being of the whole body as well as the enhancement of people’s QOL.

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This article describes the trends and the current status of dental diseases in Japan, mainly based on the results of the National Survey of Dental Diseases. This survey has been conducted every six years since 1957, which can demonstrate nearly half century’s history of dental diseases of Japanease people. The latest survey in 2005 indicated that tooth retention has improved and dental caries have declined. For instance, the survey in 1975 showed one in 5 (20%) among 55-64 year-old people were edentulous, which has been improved to one in 50 (2%) in the 2005 survey. Additionally, the majority of people over 75 years old were traditionally edentulous, but currently this has been reduced as low as one-third. The improvement of tooth retention might be due to by the increase of dentists. The major factor caries reduction might be recent widespread use of fluoride toothpaste in Japan. The response rate of National Survey of Dental Diseases has declined markedly. For this reason, the importance of other national statistics about dental health has become greater recently.

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The concept of “risk control” such as caries risk control has come to be widely known not only to people involved in dental treatment but also to the general public. However, the practice of risk control care to prevent dental diseases from occurring at the job site has various obstacles to overcome. The greatest obstacle is health insurance, which operates by a free-for-service system. This slants treatment towards restoration. Furthermore, the medical evaluation is not evaluated by dental outcome, but by nominal amount claimed. An online receipt system will definitely encourage this tendency. As an alternative to such a nominal evaluation of amount claimed, I decided to positively address the activity of evaluating health index and clinical index as dental outcomes. In order to ensure the goal, I will undertake “The Japan Health Dental Outcome Research Projects”, which increases the social evaluation of dental treatment with a series of activities including giving feed back to patients and society. The following research, surveys 1 to 4 listed below, were our initial approach. 32 dental offices over 13 prefectures participated in this study.

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There are few patients who visit dental offices with dental prevention as a main purpose at the first stage of examination. On this account, it is then important as a baseline of the dental treatment system to comprehend the actual situation of new patients. For example, what dental condition do new patients have when they visit dental offices?. “Report on the survey of dental diseases”, the field survey, has been referred to for this purpose. Member dental offices of our association have accumulated clinical information on their patients in the common protocol as a database. Therefore, I made a template for selecting data of necessary items to understand patient’s actual condition at the first visit after excluding the identifiable individual information and collected the data on patients from many dental offices effectively. This method allowed for collecting patients’data with little difficulty by area and dental office from 30 dental offices in 13 prefectures. After having sorted the data, I categorized by sex, the number of existing teeth and the agespecific degree of gingival disease progress.

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The Japan Health Care Dental Association has made strong efforts to prevent caries developments of the children’s permanent teeth since their establishment. It appears that a risk assessment and a regular oral health management are indispensable for preventing caries developments. But, there has been no survey that compared the clinical index of regular checkup receivers to occasional checkup receivers. When the schoolchildren from the low grades of the primary school to the junior high school were divided into the two age groups, the first half group with the age of 6-10 and the second half group with the age of 11-15 and even the same regular oral health management was applied on the both groups, it appeared that there were more caries developments in the latter half group than in the first half group. Then, the DMF increase cases were surveyed on the first and second groups and regular checkup receivers and occasional checkup receivers in the observation period with the cooperation of the members of the Japan Health Care Dental Association. The survey revealed that DMF increase cases were significantly less in the first half group than in the latter half group. Its difference was especially remarkable in the serious cases with more than 2 and 3 of DMF increase. It also revealed that the latter half group showed more caries development than the first half group, which was true on the both regular checkup receivers and occasional checkup receivers. In the future, the aim for effective caries preventions will be required by pursuing the causes of the difference in the caries development between two age groups and also between regular checkup receivers and occasional checkup receivers.

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There are extremely few reports on the results of the of maintenance care (regular dental checkup and regular debridement of subgingival biofilm). Therefore, in order to initiate a study on the relation of maintenance care of adults to the number of tooth loss, 15 dental offices investigated their patients over 40-years (2,869 patients receiving continuous maintenance care for over 5 years with the latest inspection date after September 1, 2005) on the age, the number of caries found at the first examination, the number of existing teeth at the first examination, the degree of periodontal disease progress, the number of remaining teeth at the first treatment and in the most recent visit, the number of tooth loss during maintenance care, and the period of maintenance care. The results showed that the average number of tooth loss per 10 years of maintenance care in 10 -15 years were 0.19 ± 0.499 in 40s, 0.81 ± 1.331 in 50s, 1.11 ± 1.469 in 60s and 1.53 ± 2.172 in 70s.

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Periodic maintenance management is assessed to work favorably on the oral health related index, such as tooth loss. However, the oral condition does not only have an influence on dietary habits, but also plays an important role on the ability to speak and appearance. Therefore, the assessment of QOL (Quality Of Life) should focus specifically on the maintenance care of adults. Within this context then, a survey on the association of oral condition in maintenance care with various QOL measures was conducted on patients over 40 years old at 28 dental offices across the country among “The Japan Health Care Dental Association” members from August 20 through September 20, 2006. 3,238 patients were selected for analysis from 4,317 patients who were asked for their cooperation (effective ratio of respondents: 75%) The baseline data indicates: ①The more remaining teeth there are and the more corresponding contacts are retained, the higher the physical QOL is, ②Mental QOL has a weak association with oral condition, ③Oral health related QOL shows a strong association with oral health related index, including number of remaining teeth, DMFT, Eichner’s classification, PD and periodic medical examination, ④Oral health related QOL shows a strong association with dejection, and ⑤Annual number of maintenance is associated with oral health QOL, but not with the entire body QOL. The follow-up study will continue on those patients to examine how much effect maintenance care has on the improvement or sustenance of QOL index.

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