A moisture checker of the skin is one type of device that is used to measure the moisture content in the stratum corneum of the skin. Applying the principles of such equipment, an oral moisture checking device was developed in order to measure the moisture content in the oral mucosa. There have been no previous reports of the relationship between the measured values of the oral moisture checking device and the actual moisture content in the oral mucosa. We therefore devised a method in which solid agar processed with varying moisture contents was used as measurement samples, and examined the accuracy of the oral moisture meters via the measurement of these samples.
Materials and methods: Solid agar was produced using powdered agar (standard quantity of moisture content 250 ml per 2g of powder). Maintaining the quantity of 2g of powder and increasing/decreasing the moisture content in 25-ml increments, a total of twelve types of liquid agar were thus prepared with a moisture content varying from 25 to 300 ml. These were then poured into round petri dishes so as to reach a certain volume and solidify at room temperature. Two types of oral moisture checking devices were used for the measurements: Moisture Checker for Mucus (“old type”) and Oral Moisture Checking Device Mucus (“improved type”). A specific sensor cover was attached to each device, and the moisture content of each sample of solid agar was measured three times each.
Results: The measured values showed increases as the contained moisture content increased under 75 ml with both types of the oral moisture checking devices. Furthermore, a close correlation was observed between the moisture content and the measured values, with a significant level 0.1% or less according to the Friedman rank test. In comparisons between the two types of oral moisture checking devices, the improved type showed higher measured values than the old one. The sensitivity was 75% in both types. The specificity was 95% in the old type and 100% in the improved one. The positive predictive value was 75% in the old type and 100% in the improved type. The negative predictive value was 95% in both. Therefore, both oral moisture checking devices were considered to have excellent precision as measuring instruments. However, the ability to accurately predict mouth dryness under clinical conditions was higher for the improved type than for the old type.

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Introduction: The moisture content in the oral mucosa is affected by foods and beverages. However, there have only been a few reports of these effects. Therefore, we studied the moisture content in the oral mucosa periodically for elderly residents of nursing facilities and examined the relationship between items that are associated with xerostomia and the moisture content in the oral mucosa.
Subjects and methods: 41 subjects (21 males, 20 females) with an average age of 79±8.5 years, who resided in the Tokyo Metropolitan Itabashi Nursing Home, took part inthe study. They had no history of diseases associated with xerostomia, and showed no symptoms such as fever during the study period. As for methodology, the moisture on the dorsal surface of the tongue and the buccal mucosa wasmeasured using an oral moisture checking device (Moisture checking device “Mucus”: hereinafter referred to as “improved type”). At one site, it was measured three times, and the mean was set as the measured value. It was measured three times a day; immediately after waking up in the morning, before having breakfast, after having lunch, and after having dinner. Furthermore, the relationshipwas examined between the moisture content in the oral mucosa and each of the following items: gender, whether or not any internal medicine was being taken, the presence orabsence of xerostomia and a history of smoking.
Results: It is suggested that the moisture content inthe oral mucosa is affected by foods and beverages. Significant differences were observed in the moisture on the dorsal surface of the tongue according to gender: in lower values were observed in females. No relationship was observedbetween the moisture content in the oral mucosa and the patient's smoking history, internal medicines or history of xerostomia.

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Recently various healthcare workers have taken steps to improve the oral health care in medical institutions, welfare facilities and even in the home. In this study, the presence of opportunistic infectious agent was examined in relation to the subject's general status to analyze its risk factors and adequate interventions.
The subjects in this study were 28 aged persons requiring care (mean age: 82.3±7.6 yrs) who had received a visit for dental health care. At that time, motivation was promoted by giving easily understandable instructions for carers in the use of standardized oral care as well as optical methods using an oral camera.
By using an ‘opportunistic infectious agent-detecting kit, ’ ten kinds of opportunistic infectious agent commonly isolated from the oral cavity and/or the upper air-way of infection-sensitive, which are often encountered in the daily clinical environment, were sent to an authorized laboratory for qualitative analysis. The general status was classified into three groups: of ADL factors, oral hygiene factors and oral functional factors. In consequence, few singly isolated strains were found. But the Pseudomonas aeruginosa complex was detected more frequently. In particular, a group of Pseudomonas aeruginosa was revealed to correlate with some of the oral hygiene functional factors. The factor of reducing the opportunistic infectious agent is the statistically-derived “Good Tooth Brush manipulation” (p<0.01).
It was therefore suggested that oral health care may be greatly helped by bacteriological examination. This examination can indicate whether the oral flora is composed of complex or simple bacteria, with special reference to the related factors including systemic oral hygiene ones.

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Objectives: Videofluorography (VF) is regarded as the gold standard for evaluationof dysphagia. Interpretation of VF studies is highly subjective, however, resulting in inconsistent therapeuticrecommendations. This study aimed to improve the inter-rater reliability in the interpretation of VF studies by modifying the evaluation criteria.
Methods: Seven dentists were asked to evaluate a series of VF images three times each, using our evaluation criteria and forms. Images included oral stage impairment, pharyngeal retention, aspiration before swallowing, aspiration at swallowing and aspiration after swallowing. Cohen's Kappa coefficient was calculated to estimate inter-rater agreement.
Results: The Cohen's Kappa coefficient increased with repeated viewing; the coefficient for all images was 0.28±0.26 for the first viewing, 0.37±0.26 for the second, and 0.43±0.28 for the third.
Discussion: The inter-rater coefficient improved using our modified evaluation criteria. To achieve higher rates of inter-rater agreement at our hospital, we have also initiated weekly conferences to discuss VF study interpretation. While development of consistent evaluation criteria is critical for reliable diagnosis and treatment protocols, professional discussions may also play an important role in ensuring that VF is interpreted appropriately.

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Abstract: For planning the therapeutic strategy, patients need to be aware of their diseases and fully cooperate with medical staff. This is especially true of patients with poor prognosis such as cases of multiple cancer.
We report here a case of synchronous multiple cancers (acute myelocytic leukemia, esophageal cancer and gingival cancer), who was failed to establish a good doctor-patient relationship.
A 69 year-old Japanese man was admitted to the emergency department of our hospital with a chief complaint of malaise and dyspnea. He was diagnosed as having myelodysplastic syndrome, and upper endoscopic examination and chest CT images revealed an esophageal cancer with metastasis to a regional lymphnode. Radiation therapy had started because he had rejected both chemotherapy and surgery. Two months after the beginning of radiation therapy, a following chest CT showed a metastatic tumor at the right costa and oral examination revealed a squamous cell carcinoma of the left maxillary gingiva. Radiation therapy for the gingival carcinoma had started, but soon had to be discontinued, since bone marrow evaluation showed transformation to acute myelocytic leukemia and imaging modalities revealed metastatic liver tumors and a pathologic fracture of the right femoral neck. Then skin papular eruptions and a hard tumor developing from the clavicle were recognized. The patient gradually weakened and died 7 months after admission. He had lived alone and had been estranged even from his key person. Although we educated him on diet and abstinence from drinking, he did not follow our instructions.
In conclusion, although establishing a good doctor-patient and doctor-patient's family relationship is mandatory for planning the therapeutic strategy, the present-day increase of the elderly population makes it more difficult, but more important than previously.

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Objectives: The purpose of this study was to clarify the relationship between the number of present teeth, the loss of teeth and medical care expenditure among the elderly.
Methods: The study examined approximately 40, 000 elderly residents who were aged 70 and over in Hyogo Prefecture. Using the National Health Insurance scheme, the number of present teeth for those who visited dental clinics between May 2002 and May 2005 was recorded and their information was matched with their subsequent annual medical records. The relationship between the number of present teeth and the patients' annual medical expenditure was examined. The number of remaining teeth at baseline, the number of teeth lost and the change of annual medical expenditure over three years were compared.
Results: Annual medical expenditure is higher with age, in males, and for those who have fewer present teeth, all statistically significant at p<0.001 level. On the other hand, no statistical significance was seen for the relationship between the three-year change of annual medical expenditure, the number of present teeth at baseline and the number of teeth lost.
Conclusion: Our research results imply that the maintenance of one's own teeth may lead to less medical expenditure, although tooth loss may not affect medical expenditure in a short term. It is recommended to further explore specific disease-based medical expenditure and a long-term follow-up study for the impact of loss of teeth on medical expenditure.

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