This article reports the Dr. Tsukiboshi’s lecture delivered in the Healthcare Meeting on November, 2007. His lecture began with the consideration on the general idea and the concept of Minimum Intervention Dentistry. He emphasized the importance of diagnosis of dental pulp by using electric pulp tester and called attention to active healing capacity of dental pulp by showing the case of transient apical breakdown, the dental pulp that once lost vital reaction and began changing color came alive, and the case of crown fracture with pulp exposure. Four healing progresses of root fracture: 1st: healing with calcified tissue, 2nd: interposition of connective tissue, 3rd: interposition of bone and connective tissue and 4th: interposition of granulation tissue, were presented with respective typical clinical cases. The treatment of dislocated tooth, reimplantation of traumatic desorbed tooth, reimplantation of deciduous tooth were also commentated mainly with the focus on the diagnosis of them. He presented the clinical cases to indicate that the apical lesion was not the index to measure the necrosis of pulp and that, regarding the total pulpitis derived from trauma, the younger the patients were, the more their dental pulp could be preserved. Finally, he showed the clinical case of autoplasty practiced on the wisdom tooth with incomplete root and positioned this treatment technique to be at the peak of minimal intervention dentistry.

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In order to assess the effectiveness of regular preventive oral health management for preventing the caries development, the sample patients were divided into two groups; one group who agreed to receive the regular oral health management and the other group who did not agree. They were assessed the severity of caries by deep caries and dental pulp extraction treatment. The sample patients were the children under 6 years old who visited the dental offices for the first time during the six years after January 1, 1990 and revisited them after January 1, 2005. The numbers of the patients relevant for the assessment were 48: Group A with 17 patients (with present average age of 17.9 years) who visited dental offices 5 times and more during 5 years from 2003 to 2007 and Group B with 31 patients (with present average age of 19.8 years) who visited dental offices less that 5 times during 5 years. More than half of patients in Group A had the caries free, while more than half of patients in Group B had DMFT with higher than 3. Group A showed 1 case of dental pulp extraction treatment resulted from trauma and 1 case of deep caries, while Group B had 9 cases of deep caries and 7 cases of dental pulp extraction treatment. The factors which prevented the caries from the progress are cited that the regular visit to the dental office (1) allows the dentists to tell the patients of the risk factors at the each age in advance, (2) handles local risk caused by the eruption of permanent tooth when the baby teeth molt to permanent teeth and (3) detects the indication of caries severity ahead of time by the regular radiography. Whether patients continue to receive the regular oral health management or not seem to depend largely upon the difference in the conscious mind of the patients by themselves and their parents. If the motivation to receive the regular oral checkup is provided, the caries development will be positively prevented.

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Our association recommend the member dental offices to record and accumulate clinical information on their patients. For this purpose, last year we started the research business which annually compiles clinical information on new patients at the cooperative dental offices. This year, our second business year, 27 member dental offices participated in and compiled the basic clinical information on their new patients who visited them during January 1 to December 31, 2006. 10,555 patients fitted the survey requirements, compiling DMFT by 10 - 70 age group, DMFT by age from 5 to 20 year old, the number of remaining tooth by 20 and older age group (by 5 years) and the specific degree of periodontal disease development by age group and also by smoker and non-smoker. It clarifies that DMFT of 12 years old child is 1.68 and DMFT of 20 year-old adult is 7.76. It also clarifies that, regarding the correlation of smoking with periodontal disease progress, the more the cigarette consumption increases, the more the number of patients infected with middle periodontitis there are. The Survey of Dental Diseases by MHLW is a valuable data to comprehend the patient’s actual condition on the national scale. It is the randomly selected and stratified household survey on the basis of National Livelihood Survey and is regarded to possess with higher reliability as field work. However, the numbers of sample patient are decreasing by every survey; the numbers of sample patient in the survey of 1957 were more than 30,000, but those in the survey of 2005 decreased to 4,606 (consultation rate was 37.2%), especially, there was a significant decrease in the adult between 20 and 24 year old to only 47 sample patients in all. There is a fear that the reliability to the survey declines. Our survey is a hospital statistics of the patients, not a survey over the nation. But the accumulation of epidemiological data at the clinical job site becomes increasingly important.

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Most of smokers have their first taste of smoking when they were in the junior high school. Accordingly, the right knowledge on the health hazard caused by smoking has to be educated repeatedly in the school. “Organization to think about problem over smoking, Chiba” (TMKC: represented by Kazunori Nakakuki in 2006 and Mitsuoko Otani in 2007) was entrusted of the delivery classroom business for smoking prevention by Positive Health Supporting Section, Health Welfare division, Chiba Prefecture and had the smoking prevention classrooms at the local schools. I had smoking prevention classrooms for 758 school pupils at 8 schools. For the pupils of upper grade (4th to 6th grade), many pictures and videos were used to commentate on the harmful effect of smoking. The questionnaire survey was conducted before and after the classrooms to assess the change in the conscious mind of the pupils. For the pupils of lower grade (1st to 3rd grade), the harmful effect of smoking was told with illustrated picture cards and the explanation followed. The questionnaire survey for the pupils of upper grades revealed that 58% of pupils had a smoker or smokers in their home and a majority were accessible to cigarette. To the question “Do you think to have a cigarette when you grow up?” before the classrooms. 25% of pupils answered “Don’t know” or “Yes”. “Have a cigarette” and “Yes” dropped to 7% after the classrooms.

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