The purpose of this study was to investigate the clinical effect of oral diazepam administered to fearful, combative pediatric dental patients.
A preliminary study examined changes in the plasma concentration of the diazepam following oral administration of a 0.3 mg/kg dose and changes in the concentration of the plasma catecholamines for injections for each of 9 health male volunteers, aged 19 to 25 years.
A preliminary study examined the clinical effect of oral administration of 0.3 mg/kg diazepam in the dental treatment to fearful, combative pediatric dental patients to each of 25 healthy, uncooperative children, aged 2 to 8 years.
The results were summarized as follows;
1. Peak plasma concentrations were observed 60 minutes post-administration in 6 of the 9 patients, the highest average concentration being 403.6 ng/ml 60minutes post-administration.
2. In the pre-administration group, the secretion of noradrenaline and adrenaline was accelerated by the injection, but only a small amount of secretion of these was found in the 60,90 minutes groups.
3. The behavioral scores of the diazepam phase were significantly lower than those of the control and placebo phase in any phase.
4. The effect rate of diazepam phase was higher than 60% in every time interval, the one exception being the local anesthesia injection procedure. In every procedure, the effect rate of the placebo phase was significantly lower, less than 20% that of the diazepam phase.
5. In slightly tense patients the rate of the overall clinical usefulness of the diazepam phase was 77.7% and the rate of the placebo phase was 22.2%. In combative patients the rate of the overall clinical usefulness of diazepam phase was 43.8% and the rate of placebo phase was 0%.

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New experimental cements, CPE and CPO, were produced as root canal sealers, and are composed of tetracalcium phosphate (4DP) powder with either eugenol or Oleic acid, respectively. In this study, we investigated the physical properties of these cements by measuring the pH change and six variables-that is, ffow, working time, setting time, film thickness, solubility and disintegration, radioopacity-according to ISO standards. The results fullfilled ISO requirements and showed that these cements have physical properties that are as favorable for root canal sealers as the propertics of commercially available zinc oxide eugenol sealer (ZOE) used as a control. In particular, solubilities and distintegration were 0.5-0.7 lower than those of other root canal sealers containing 4CP, which were reported previously. The measured pH values of the cements showed changes to the alkaline range though they, like ZOE, showed a neutral range immediately after mixing.

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The aim of this study was to clarify the trends in the caries experience in the primary dentition of nursery school children in Sendai City over a period of 20 years. An annual clinical dental examination of children aged two to five at 13 nursery schools in the north district of Sendai City was carried out in 1972,1977,1982,1987 and 1992. The df tooth surface ratios were calculated from the data of all five surveys and compared in each age group respectively.
The following results were obtained.
1. The df tooth surface ratios in all kinds of tooth surfaces in all age groups decreased during the 1970's but that reduction did not continue through the 1980's or the beginning of the 1990's.
2. In the upper and lower second primary molars, the df tooth surface ratios on the occlusal surfaces in 2-to 3-year-old groups increased through the 1980's or the beginning of the 1990's and those on the mesial surfaces in3to 5-year-old groups increased during the 1980's.
3. The most important factor for the decline in caries experience during the 1970's seems to be the increased awareness and knowledge of parents and school staff members concerning the oral health of children.
4. Both a decline in oral hygiene and reversion to poor food habits may have contributed to the small increment in caries experience in primary molars during the 1980's.

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The purpopee of this study was to investigate the effect of hydrophilic bonding agents on sealant bonding ability on permanent enamel. After 15second etching with phospholic acid, hydrophilic bonding agents of composite resin systems (Scotchbond Multi-Purpose Adhesive/3M or Light Bond/TOKUYAMA)were applied and light-cured on extracted human premolars, followed by the use of a filled (Palfique Light Sealant/TOKUYAMA) or an unfilled sealant (Concise Light Cured While Sealant/3M). The degree and distribution of the gap formations at the sealant-enamel interface were evaluated using the thermal cycling test and the dye penetration test.
Based on the findings obtained in the present study, the following conclusions were drawn.
1. In the cases of single application, the unfilled sealant showed fewer gap formations than the filled sealant, which indicates better bonding ability.
2. The incidence of gap formations generally decreased with the use of bonding agents, showing improved bonding ability.
3. There were still found more gap formations at the deeper portion of the fissures, although significant improvement was observed with the use of bonding agents.

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It is very rare to find the reports on fused teeth which are composed of three teeth including supernumerary teeth, among the many published papers on primary fused teeth. This paper reports on a fused tooth composed of three incisors in the maxillary left primary incisal region of a 6-year old boy. Furthermore, we investigated the influence on the eruptional and developmental process of the permanent successors.
The findings were as follows: (1) The fused tooth was considered to consist of the primary central and lateral incisors containing a supernumerary tooth, judging from their configuration and position. (2) It became apparent based on the use of histological examination that the major part of the fused area was dentin. The pulp chamber was connected between the supposed primary central incisor and supernumerary tooth area. (3) The fusion of the teeth was assumed to have started at the early stage of tooth development. (4) The presence of the fused tooth did not adversely influence the primary dental arch and occlusion. (5) The left permanent central incisor showed no tendency to erupt after the extraction of the fused tooth. The procedure of the gingival fenestration induced the eruption of the central incisor. The extracted gingiva included the accumulation of foamy cells and was diagnosed histopathologically as xanthoma. (6) Radiographically, the tooth germ of the permanent lateral incisor was clearly observed at the age of 7 years and 2 months, and has delayed developing and erupting. At present, we will continue to observe the developmental process of the lateral incisor tooth carefully.

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In 1937 Tokoro discovered and reported on the small pits of the crestal portion of human permanent molars which he named as crestal pits. SEM observation of the crestal pits on human permanent molars have already been reported by the authors. However, There has been little SEM observation of the crestal pits on human primary molars.
This paper presents the SEM observation of the crestal pits of 39 human primary molars, bilaterally on the same individual, which were obtained from 10 mandibulars dry skulls of Indian children. The results were compared with those of previously published crestal pits studies on permanent molars.
1) The crestal pits were observed in 7 mandibulars out of 10 mandibulars (70%).50 crestal pits were found in 20 teeth out of 39 observed teeth (51.3%).
2) No statistically significant difference was seen in the number of crestal pits and the number of teeth with crestal pits between the first and second primary molars.
3) Crestal pits of the human primary molars tended to be present bilaterally in the same individual.
4) Similar to that of permanent molars, the most common opening shape of crestal pits found on primary molars was the round shape (58.0%).
5) The highest concentration of crestal pits found on primary molars was located on the disto-buccal caspal portion.
6) The opening diameter of the crestal pits on primary molars was 172.2μm in average. This value is almost the same as that of permanent teeth (173.0μm).

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This study investigated factors related to failed and canceled appointments of pedodontic outpatients at a pedodontic clinic in fiscal 1992.
The results were as follows:
1) The children who had a short commute to the dental clinic showed a tendency toward an increased number of canceled appointments.
2) Cooperative children showed a tendency toward an increased number of canceled appointments, when the child was under five years of age.
3) The children under five years of age who had been under treatment without local anesthesia, showed a tendency toward an increased number of canceled appointments.
4) The children who returned for periodic examinations showed a tendency toward an increased number of canceled appointments as the rate of the guardian's reasons increased.
It was therefor suggested that the factors of failed and canceled appointments were related to the number of the guardian's excuses and whether the guardian recognizes an urgent necessity of dental treatment.

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We have investigated the possibility of topical application of a fluoride (F)solution containing tannic acid (TA) for caries prevention in children. The purpose of this study was to clarify the effect of the concentration of TA in the F solution on F uptake in synthetic hydroxyapatite (HAp) and to elucidate the deposits formed on HAp treated with this solution. HAp was immersed in 2%NaF solutions containing 0.05-5% TA for 5 minutes,1 hour,1 day and 10days, and the amount of F in the HAp was determined. The deposits formed on the HAp were investigated by using scanning electron microscopy (SEM) and X-ray diffraction (XRD). The following results were obtained.
1) The F uptake in the HAp was increased by increasing the concentration of TA in the F solution.
2) Under the SEM, the deposits formed on the HAp treated with the F solution containing TA were large and morphologically different from those found on the HAp treated with the F solution without TA. The size of the deposits became larger with increasing of the concentration of TA in the F solution.
3) By XRD examinations, CaF₂ peaks were detected on the HAp treated with the F solution containig 5% TA for 1 day and 10 days and the specimens treated with the F solutions containing the lower percent TA or without TA for 10 days.
These results demonstrated TA accelerated the F uptake in HAp. However, since the deposits might be a mixture of CaF₂ and the complex composed calcium and TA, we must investigate how these products would be retained in the mouth.

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The reliability and validity of a 20-item,10-point behaviorally-anchored confidence in the child management scale was established by Weinstein et al.. The purpose of this study was to reexamine the reliability and validity of the questionnaire translated into Japanese concerning a practitioner's confidence in child management. There were 22 dentists from the Department of Pediatric Dentistry, Hiroshima University School of Dentistry as the subjects. The internal consistency and test-retest reliability of the Japanese questionnaire was examined. Cronbach's coefficient α was calculated for the internal consistency. After these subjects were requested to fill out the additional questionnaire one week later, the correlation coefficient between the first confidence scores and the second ones was calculated to estimate the stability. The validity was examined by analyzing the contrast among the three groups with the various levels of clinical experience.
The results are summarized as follows.
1) The acceptable level of the reliability on this questionnaire was shown on the internal consistency and the stability.
2) The confidence scores depended on the clinical experience and significant differences were found between the groups.
The reliability and validity of the Japanese questionnaire for a practitioner's confidence in child management were established.

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It is important for treatment that we develop rapport with child patient. For that reason it is essential that dentists obtain the ability to communicate with child patients. In the Japanese dental education system, however attention is focussed on the cognitive domain and the psychomotor domain, and is not focussed on the affective domain. The little interpersonal skill training is conducted in Japan. Therefore, we implemented behavioral management sessions for the seven dentists belonging to the Department of Pediatric Dentistry, Hiroshima University, School of Dentistry. This training was the simulation type using videotaped feedback and role-playing. We distributed questionnaires concerning confidence in child behavior management before and after the training. This data was compared with the data of the control group consisting of the seven dentists who had no training and subjected to the statistical analysis. The following conclusions were obtained.
1. None of the comparisons of the control group with the training group's first questionnaire showed any significant difference. When compared to the control group, the training group's scores for the second questionnaire were significantly higher. (p<0.05)
2. The confidence scores of the training group remained higher than those of the control group on all items of the second questionnaire. Five of these twenty items were significant beyond the.05 level and one of these twenty items was the.01 level.
3. We obtained high training effects on “acquisition of advice”, “generalization” and “self-expression on the interpersonal skill”.
We came to the conclusion that the behavioral management training with child patients was effective.

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This study investigated post-operative complications with sedation involving intranasal administration of midazolam for handicapped patients under 20 years old. Thirty-nine handicapped patients received either 0.2 mg/kg (19 patients) or 0.3 mg/kg (20 patients) of intranasal midazolam, and then received dental treatment composed of nitrous oxide/oxygen inhalation (20-40% N₂O/80-60% O₂). The dental treatment was performed in the morning and all the patients were allowed to leave the dental clinic when they recovered to the same condition as pre-administration of midazolam. The period of the investigation of the postoperative complications was from the time of leaving our dental clinic after the dental treatment until the next morning.
All data in this study was collected by questionnaire given to the guardians of the 39 handicapped patients. It also investigated the guardians' anxieties about the dental treatment under the sedation administered to their children, and their judgment for the next treatment of their children in the same way.
The majority of the post-operative complications appeared before the patients arrived home. The rates of the complications were 21.1% in the doses of 0.2mg/kg and 40.0% in the doses of 0.3 mg/kg. The majority of symptoms were ‘being Sleepiness’ and ‘Staggering’. Most of the patients, however, recovered befored they went to bed. There were no significant differences between the appearance-rates of post-operative complication with both doses. There were no serious post-operative complication at any stage of this study.
The rate of the guardians who had no anxiety about their children's dental treament using this technique was approximately 80%. The rate of the guardians who wished for their children to under go the next dental treatment using this technique was approximately 85%.

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The purpose of this study was to clarify the difference in mastication efficiency between adult Japanese and Chinese with difference dieatary habits. The subjects were a total of 110 adult Japanese and Chinese males and females. A dental prescale 30H series was used. According to the tooth types of the permanent molars in the maxilla and mandible, the mean occlusal pressure, occlusal contact area, and occlusal force were compared between the Japanese and Chinese subjects. The following results were obtained.
1. The mean occlusal pressure was larger on the premolars than on the molars in both the Japanese and Chinese males and females. In both the maxilla and mandible, the mean occlusal pressure was significantly higher on the first premolars than on the second premolars among the Chinese males and on the first molars than on the second molars among the Japanese males. Comparison between the Japanese and Chinese showed a higher occlusal pressure in the maxilla and mandible among the Japanese than among the Chinese in both male and female; significant differences were observed on the first molars among the males and on the first and second molars among the females.
2. The occlusal contact area and occlusal force showed similar results, which were inversely related to the occlusal pressure. Higher values were observed on the molars than on the premolars, according to the occlusal contact area and occlusal force. On the premolars, the second premolars showed higher values than the first premolars. On the molars, the first molars showed higher values than the second molars in the maxilla, and the second molars showed higher values than the first molars in the mandible. However, only Japanese males showed higher values on the second molars in the maxilla and mandible. When the Japanese and Chinese were compared, the occlusal contact area and occlusal force of molars in both maxilla and mandible among the Chinese males and females showed twice the values of the Japanese males and females. These differences were more marked among the adults.

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In order to clarify the interocclusal relationship between the occlusal facets on opposing upper and lower primary molars during lateral excursions in children, a new system which can analyze both the morphology of the occlusal facets and the lateral excursions on the same region of the mandible within the uniform three-dimensional coordinate system was developed in this study.
In this system, the occlusal facets were measured using laser beams, and the lateral excursions were measured using the analyzing system of multiple required points for mandibular movement utilizing the Selspot. The three-dimensional coordinates of the occlusal facets were transformed into the uniform coordinate system with the analyzing system of the mandibular movement. The evaluation of the accuracy of measurement using this system proved to be highly precise.
The facets on the primary second molars at the working side of the children with Hellman's dental age IIIA (8 years 6 months) were analyzed using this system. As a result, it was suggested that the facets on the primary second molars at the working side had a coordination with the lateral excursions of the mandible.
In conclusion, the application of this system will be usefull to analyze the relationship between the morphology of the occlusal facets on the teeth and the lateral excursions of the mandible in children.

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The purpose of this study was to analyze the condylar movement during the protrusive mandibular movement in children. The subjects comprised of 14children at Hellman's dental stage IIA (4 boys and 10 girls, with a mean age of 5 years 11 months) and 14 adults (7 men and 7 women, with a mean age of 24 years 2 months).
The mandibular movements were measured with six degrees of freedom jaw movements with the analyzer “TRI-MET”. The mandibular movements were displayed and analyzed with the 3-D graphic work station “IRIS Crimson”. The 3 cycles of movements were performed automatically starting from the intercuspal position and were analyzed. Reference points were the incisal point and the left and right condylar points. To compare the data of the children with that of the adults, the protrusive movements were standardized by the distance from the intercuspal position as follows: The distance on the incisal point was divided at 0.5 mm in the distance of 0.5 to 5.0 mm. The directions of the mandibular movements were calculated for the three reference points at each distance. The track of the protrusive mandibular movements at the condyles were projected to the sagittal plane, horizontal plane and frontal plane.
In addition to the above analysis, the minimum and regular movement of the condyles was sought by calculating the outermost area of these tracks threedimensionally.
The results were summarized as follows:
The values of Hellman's IIA group were statistically smaller than those of the adult group, concerning the angles at the incisal and condylar points in the sagittal projection. The coefficient of variation within individuals was large in the IIA group in comparison with those of the adult group.
The values of the IIA group were larger than those of the adult group, as for the angular difference between the incisal point and the condylar point in the sagittal projection. Also the values of the IIA group were larger than those of the adult group, about the minimum area of the outermost three cycles of the protrusive mandibular movements at the condyle in the sagittal, horizontal and frontal projection. These results may indicate that the temporomandiblar joint at the period of primary dentition was more mobile than that of the adult group.

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There are many papers on the dental caries incidence in child patients with cleft lip and palate (CLP) and the necessity of dental care from the period of infancy has been refered to in these papers.
The purpose of this study was to survey the dental caries incidence in the children with CLP who visited the Dental Hospital of Tohoku University. The subjects were 335 CLP child patients (170 boys and 165 girls) aged 0 to 8 years.
The caries incidence was compared with those of CLP patients reported by the authors in 1977 and 1986, and nursery school children in Sendai.
The following results were obtained.
1) The tendency toward a decrease and a delay of the dental caries incidence in deciduous teeth was found as compared with our past reports. However a higher caries prevarence was still recognized among the older children.
2) It was found that the higher caries incidence of the deciduous teeth in the group of the cleft palate type was higher than in other cleft type groups at an earlier age. In the group with the CLP type, the caries prevarence in the cleft site of the maxillary anterior region was significantly higher than the healthy site in the group with the CLP type.
3) The tooth surface showing a high caries incidence was the occlusal one of the maxillary and mandibular deciduous second molars among the nursery school children, and the mandibular anterior teeth and the palatal surfaces of the maxillary deciduous molars among the CLP patients.
4) The increase of caries in the deciduous teeth was mainly found in the molars of the nursery school children but happend in the order of the anterior teeth, posterior teeth and canine in the CLP group according to age.

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In this study, the retention and wear of a trial material of light-activated glass ionomer cement specifically designed for pit and fissure sealing was evaluated clinically over a period of 12 months. A total of 65 first and second permanent molars of 42 children aged 5-12 years were selected. After cleaning pits and fissures with ultrasonic equipment, each tooth was isolated with cotton rolls and dried with air. GC Dentine Conditioner was then applied for 20 seconds, rinsed with water and dried with air. The powder and liquid of a light-activated glass ionomer were mixed and applied to the teeth, followed by light illumination for 20 seconds.
At the recall visits after 3 months(90±45 days),6 months(180±45 days),9 months(270±45 days)and 12 months(360±45 days), the retention and wear of the sealant were clinically examined. The results showed that 40/41 teeth,30/31 teeth,41/44 teeth and 28/31 teeth were regarded as having complete retention in the respective examination period. In some of the cases, replicas were prepared, which were subjected to examination under the scanning electron microscopy. The results showed that 40/41 teeth,30/31 teeth,35/42 teeth and 12/24 teeth were regarded as having complete retention in the respective examination period.
Examination under the scanning electron microscopy revealed that the partial loss of sealant materials which resulted in the partial exposure of the enaumel surfaces in certain grooves occurred in some cases; partial loss of sealant was observed in the grooves connecting the mesiobuccal pit and mesial pit for the upper molars and in the buccal grooves at the corner of the occlusal surface and the buccal surface for the mandibular molars. Howevar, neithere complete loss of sealant nor the development of secondary caries was observed in any cases over a period of 12 months.

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The effects of animated TV program during dental teatment were evaluated. Thirty seven preschool children (3 years 0 month to 5 years 11 months, average 4 years 4 months) were divided into two groups, with 18 control children who saw no television during their visits, while the 19 remainding children watched animated TV program as they sat in the dental chair.
The child's behavioral and emotional reactions during dental treatment were estimated before the child sat in the dental chair by “The Young Children's Behavioral and Emotional Estimate Test in the Dental Setting” developed by K. Harada. The child's behavioral and emotional reactions during dental treatment in fact were evaluated using a modified Frankl's Scale.
The results were as follows:
1) Cooperative children during dental treatment amounted to 77.8% in the no television control group, with 68.4% in the group watching animated TV programs.
2) In the control group,10 of 12 children were estimated as cooperative and were in fact cooperative while 2 of 6 children were estimated as uncooperative and were in fact uncooperative. And the success rate was 66.7%. In the TV watching group,10 of 12 children estimated as cooperative were in fact cooperative and 4 of 7 children estimated as uncooperative were in fact uncooperative, then the success rate was 73.7%. In TV watching group, cooperative child enjoyed animation TV program, but uncooperative child could not afford to watch television.
Based on these results, it was concluded that in preschool children watching animation TV program during dental treatment had no effects on clinical anxiety and cooperative behavior.

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To investigate whether cerebral palsy (CP) patients experience abnormal mandibular sensations, we compared the dimension-discrimination abilites (DDAs)of CP patients with those of normal subjects.
The number of subjects in each group was six. DDA was evaluated by having the subjects bite a 10.0 mm-thick reference stick and test sticks of 8.0-9.5 mm or 10.0-12.0 mm thickness between their first incisors, asking them whether the test sticks were thicker or thinner than the reference stick based on their perception of jaw opening magnitude and analyzing the ratios of mis-estimation (RMEs) calculated from the results.
The RMEs of the patients were higher than those of the normal subjects for jaw opening magnitudes smaller than the refcrence stick jaw opening magnitude.
Based on this results, it may be suggested that some abnormality exists in the mandibular sensation afferent system from the peripheral to the central nervous system in CP patients.

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In order to clarify the differential process of the odontoclasts in the starting period of root resorption and the relationship to the surrounding cells, this study was undertaken to observe the histochemical localization of tartarate-resistant acid phosphatase (TRAP) and alkalinephosphatase (ALPase) activity in the deciduous teeth of rabbits from 2 days to 20 days after birth.
After detecting the TRAP and ALPase activity using the azo-dye methods, the sections were observed under lightmicroscopy. In its early stage (2 days), the odontoclasts and the precurser cells showing TRAP positive activity were observed on the root surface of deciduous teeth and in the connective tissue consisting of mesenchymal cells and cementoblasts, showing ALPase positive activity, surrounding to root. In this area, it was obvious that the odontoclasts were to be multinucleated. It was observed that the odontoblasts were to be flat, or disappeared when root resorption arrived at pulp chamber.
These findings suggest strongly that the differentiaticn of the odontoclasts is similar to the osteoclasts, and that mesenchymal cells around the root of deciduous teeth closely participate in the differentiation and activation. It is also showed that transformation of the odontoblasts is similar to the change of the osteoblasts.

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The purpose of the study was to investigate the functional change of the perioral muscle activities during breast feeding in infants after birth.
Fifty six normal fullterm infants participated in the study. The infants were classified into five groups; from the 1st,2nd,3rd,4th and 5th month depending on their age in months after birth. Each subject was breast-fed by its mother sitting on a chair in a shielded room. During breast feeding, electromyograms (EMG) were obtained unilaterally from the temporalis (TM), the masseter (MM), the orbicularis oris (OM) and the suprahyoid muscles (SM) of the baby using bipolar surface electrodes. EMG signals were recorded on a thermal array recorder and a data recorder. At the same time, maxillofacial movements during sucking were recorded by a video camera. Employing a video formatter and frame synchronizer, EMGs and maxillofacial movements were simultaneously scanned on a monitor, and this then was recorded on a video-recorder. EMG activities and the sucking cycles were measured on the first ten rhythmical EMGs at the start of breast feeding, and these were then compared between groups.
Following were results;
1. The SM activity intensified as the age incrcased. There was a significant difference between the 1st and 5th month babies (p <0.05), while no increase was noticed in the TM, MM, OM activities.
2. The total muscle activities intensified remarkably through the ages of the 1st to the 3rd month in babies, while any apparent changes from the 3rd to 5th in month were seen.
3. The sucking rhythm did not vary between age groups. The sucking cycle time was 0.6-0.7s.
It may be concluded that during sucking movement in breast-feeding babies, both the perioral and the suprahyoid muscles play a leading role, which suggest an active functioning of the tongue during sucking.

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The purpose of this stndy was to assuage the anxiety and fear experienced by two-to four-year-olds toward dental treatmrnt with the help of dental drawings and coloring in the hope of giving them a sense of security and gaining their cooperation. Dental drawings were prepared that show, in an easily understood manner, how dental treatments are divided into six major stages, and how the instruments and procedures are to be used in each stage. Children were asked to color those dental drawtngs before each treatment. Our dental staff investigated the adaptive behavior of children to given treatment according to ages and also that of children to the instruments used in each stage.
Thc subjects were 5,070 children aged from two to four years. We treatmented them in each aforementioned stage, using the denral drawings, at our institution between January 1984 and December 1991.
The dental treatment was divided into the following six stages. Stage 1, tooth-brushing; stage 2, fluoride application; stage 3, sealant filling; stage 4, filling; stage 5, pulp treatment; and stage 6, treatment conclusion. We conducted observations and assessments for the 'overall procedures and for the main instruments used. Thc Results and Discussion were as follows.
1. I analyzed the ratio of adaptive behaviors of all two- to four-year-olds to the instruments used in each treatment stage. The criterion used here was based on the rate of adaptation to the toothbrush on their first visit (75.7%).
1) There was a slight decline in stage 2 toward the vacuum and syringe, but it increased significantly in stages 3-5.
2) There was a decrease throughout stages 3-5 toward the engine (86.3%to 75.8% to 70.0%).
3) Percentages were significantly low for the turbine in stages 4-5 (69.3%to 64.4%) and the injector in stages 5 (67.3%).
2. Aeaptive behavior toward overall procedures at each treatment stage according to age.
1) Up to and including stage 3, a gradually increasing percentage of twoyearolds showed adaptation (68.8%). The percentage dropped in stage 4 (56.4%) and stage 5 (31.8%) when the turbine and anesthetic injector were used. Still unable to adapt to harsh irritation, these children reflexively rejected the treatment; the precipitous decline in the adaptation rate showed that coloring the dental drawings had hardly any effect.
2) Three-and four-year-olds exhibited comparatively stable adaptation. In stages 1-4 the percentage for three-year-olds was about 75%, and in stage 5 it was 65%. The figure for four-year-olds in stages 1-4 was 88%, and in stage 5 it was 75%, showing that many of the young patients were able to adapt to highly irritating procedures. I believe this resulted from giving information in advance by means of the drawings, and due to the growth of their comprehension.
The foregoing results suggest that even young children do not show the irritation caused by various dental instruments but rather they can distinguish them.

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We performed a three-dimensional study of tooth position and anteroposterior and lateral occlusal curvature with linked cusp tips, to investigate anterior cross bite in the deciduous dentition.
Dental casts of the maxilla and the mandible were obtained from 36 subjects (16 males,20 females) showing anterior cross bite in the deciduous dentition. A three-dimensional measurement device (Xyzax) was used to reproduce the spatial relationships of the incisal edges, buccal cusp tips and lingual cusp tips to the standard plane, and then the continuous curves of the incisal edges and either the buccal cusp tips or lingual cusp tips were reproduced. The lines of the buccal and lingual cusp tips were also reproduced.
On the continuous curve of the incisal edges and buccal cusp tips, the upper peak in the maxilla was found on the lateral incisors in both males and females whereas the lower one in the maxilla was found on the first molars in males and on the cuspids in females. In the mandible, the upper one was found on the cuspids and the lower one was found on the distal cusp tips of the first molars in both males and females.
On the continuous curve of the incisal edges and lingual cusp tips, in the maxilla, the upper peak was found on the lateral incisors whereas the lower one was found on the mesial cusp tips of the second molars in both males and females. In the mondible, the upper peak was found on the cuspids and the lower one was found on the distal cusp tips of the first molars in both males and females.
Regarding the angles subtended by the lines of the buccal and lingual cusp tips and the standard plane, the value for the second molars was larger than that for the first molars in the maxilla but in the mandible the value for the first molars was larger than that for the second molars in both males and females.
The degree of curvature of the continuous curve of the incisal edges and buccal cusp tips tended to be greater in subjects with a deep overbite than in those without it.

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The aim of this study was to detect candidate chromosomes in order to perform the classical and molecular genetical approach on the mouse GSR. We also tested the differences of the incidence rates of the GSR on M2 molars among a total six mutant strains.
The following were the results of the present investigation.
1) The GSR appeared only in five strains of inbred mice, AKR/J, C3H/HeJ, C57BR/cdJ, C57L/J and RFLJ. We could classify the incidence rates of the GSR into three types as a phenotype, High, Middle and Low.
2) The observation that the relationship between the incidence rates of the GSR and haplotype was high suggest that Chromosome 19 may be a candidate Chromosome for studying the genetical effects on the GSR formation.
3) In six mutant stocks which had mutation genes such as scid, db, dw, nu, dy and ob, none of them was observed the mice with GSR. It is considered that six mutated genes do not have the potential for inducing the GSR on the second molars (M2).
It was suggested that Chromosome 4,6,10,11 and 16 were eliminated as candidate chromosomes and Chromosome 19 was selected as the candidate to form the GSR.
Finally, it would be possible that the genetical effects on the mice with GSR can be evaluated by using the phenotypical traits among the inbred mice.

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The purpose of this study was to provide information on the identification between the right and left of the mandibular deciduous incisors. The materials were 25 casts of three years old children with normal occlusion and little attrition. Cross sectional tracings of the crowns were made at 0.5 mm,1.0 mm,1.5mm and 2.0 mm from the incisal edge in cross section. We then compared with the area of mesial side and distal side.
The results were as follows. Areas of the mesial side were larger than the distal side, in about 80% of all cases of the deciduous central incisor, and in about all cases of the deciduous lateral incisor.

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With the decrease of the Japanese birth-rate, interest in dentistry is on the increase. The caries index of children is decreasing every year. Compared with cases a few years ago, children with rampant caries are difficult to find. While the caries index is decreasing, cases of traumatic teeth appear to be increasing.
A boy,4 years and 3 months old, had a primary anterior tooth depressed by a blow, and came to get a dental examination at Department of Pediatric Dentistry, Kyushu Dental College. A report was made as follows.
The patient had bumped against a pole, A was depressed and there was bleeding. He came to our department after one day. His dental formula was _??_ and Hellman's Dental Age was IIA.
In the dental X-ray film, the alveolar hard line of A was clear; the periodontal membrane space was wide; and the trabecular around it was clear. There were no appreciable changes in the succedaneous teeth covered with the Dental Sack, in the other teeth or in the alveolar bone. About a half of the tooth crown of A was depressed and there was bleeding from the gingiva at that tooth. We made a reduction and fixation on _??_. Using electric pulp tester, A showed no reactions.
The prognosis was observed once a week with the electric pulp tester and on X-ray film. We removed the reduction and fixation one month later. At that time, there were no appreciable changes other than expansion of the periodontal membrane space observed on the X-ray film. The clinical symptoms were favorable. The electric pulp tester turned (+). Prognosis was favorable one year later.
Summary
A case of traumatic primary anterior tooth was encountered in a boy,4years old.
1. In the clinical findings, about a half of the tooth crown of A was depressed, and tenderness, spontaneous pain and bleeding were seen.
2. For treatment, reduction and fixation on _??_ with rehs in and wire were made.
3. Prognosis is favorable one year later.

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This report summarizes our findings of the speech tests which we were able to perform before and after a frenectomy was performed on a four-year elevenmonth old child who was brought to this hospital with a speech disorder caused by ankyloglossia. Before treatment, because the articulation points of “t” followed by a vowel and “d” followed by a vowel were towards the dorsal of the tongue rather than at the tip, the pronunciation was closer to “k” followed by a vowel. Articulation of “s” followed by a vowel was frequently omitted during sentence repetition. Articulation of “r” followed by a vowel was often omitted during sentence repetition. During repetition of a word or syllable it became like “k”followed by a vowel because the articulation point moved to the dorsal of the tongue. It also became confused with “d” followed by a vowel.
After treatment, articulation of “s” followed by a vowel became clear. Although pronunciation of “t” followed by a vowel, “d” followed by a vowel and “r” followed by a vowel became somewhat clearer, the sounds were produced by placing the tip of the tongue between the maxillary and mandibular anterior teeth. This mistake in articulation is often seen in infants, and is considered part of the process whereby the child learns the correct articulation point after the tip of the tongue has been freed up by the frenectomy.
It is important to have a firm grasp of the child's articulation capacity, to perform the surgery of course, and to also provide appropriate guidance in language development before and after surgery.

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Pituitary dwarfism is a growth retardation resulting from a lack of the growth hormone which is one of the anterior pituitary hormones. This condition is often accompanied by a lack of other pituitary hormones, and requires a certain care in dental treatment.
The authors experienced dental treatment for a 9 year old boy with pituitary dwarfism. He suffered from complete lack of the growth hormone, partial lack of the thyroid hormone and depression of the adrenocorticotropic reserve. He had been given growth hormones and thyroid hormones since he was 4 years of age. Now, however, his dental age was 7 years ± months and bone age was 5 years, and was noticeably retarded.
The parents wanted to have his dental caries treated. Initial oral examination revealed nine deep cavities. The patient was also retarded mentally, and showed maladjusted behavior against dental procedures. Accordingly, he was treated under general anesthesia as the intensive dental treatment. Nine teeth (two of them required endodontic treatment) were restored. To be prevent possibility of shock accompanying this case required decrease of the adrenocorticotropic hormone. The treatment was therefore performed under steroid covering and completed smoothly.
Since then, his dental health has been maintained with the periodical dental check-up system of our hospital.

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In daily clinical work, injuries to teeth are encountered quite often. Among these, the upper central incisors among the permanet teeth are often subject to injury and most of them are with immature roots.
We have encountered an eight-year-old girl who had bruised the right upper central inciror.
1) At first the right upper central incisor showed a coronal fracture with the pulp exporured by the bruising. Because the tooth had immature roots, apexogenesis was performed. At that time, Finapec APC with hytoapatite as the main constituent was applied on the pulpotomy surface. The prognosis was favorable.
2) Three months after the apexogenesis, the site was bruised again and root fracture occurred. The fracture site was under the cervical margin and an abscess was found in the labial gingive. The coronal (bone) chips were therefore removed and then apexogenesis was performed again. At the same time, orthodontic extrusion was performed with the use of a lingual arch, an orthodontic rubber band(s), and ligature wire.
3) Orthodontic extrusion was deemed to be completed at the time of extrusion to the gingival margin and completion of the root formation.
4) After completion of the root formation, apexification was performed to induce apical closure.
5) After confirming the apical closure, permanent root filling was performed with a Gutta-percha cone. The abutment tooth was thereafter rebuilt and a temporary prosthesis was applied.
6) After about two years and nine months, cold pain occurred due to periodotal disease of 1 and caries of _??_. Therefore, pulp treatment of _??_and periodontal surgery were performed. After curing of the site, measures were taken for permanent prosthesis.
As described above, apexogenesis and apexification performed in accordance with the development state of roots resulted in a favorable course. Positive treatment effects of this method were indicated.

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A case of Di George Syndrome is presented.
The results of the clinical oral findings are as follows
1) The patient was a 3-year and 11-month old boy.
2) The general examination showed delayed growth for one year.
3) Roentgenographic examination showed a regional enamel hypoplasia in all primary teeth, but radiographic findings showed no anomaies.
4) It seems that enamel hypoplasia was caused by the decrease of serum Ca concentration in a hypoparathyroidism.
5) Enamel hypoplasia was ameliorated by the improvement of the whole body condition.

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Apert's syndrome is a relatively rare disease caused by the autosomal dominant mode of inheritance. It is characterized by certain facial deformities such as premature craniosynostosis with associated skull deformity, maxillary hypoplasia, high arched palate and other dental problems. In this study, the authors reported on a case of Apert's syndrome with a review of the literature regarding the dental and maxilofacial findings.
On her fist visit, the patient was a 4-year-old female,107 cm in height and with a weight of 16.2 kg. Although minor mental retardation was found, her past medical and family history revealed no significant findings. The cranifacial findings included the hypoplastic of the middle third of the face, proptosis due to shallow orbits, hypertelorism and strabismus.
The dental findings showed a pseudo-cleft due to the presence of hypertrophic palatal gingivae, infraversion of the maxillary deciduous canines, supernumerary tooth, lingual transversion of the mandibular canines and anterior open bite. Moreover, congenitally missing permanent teeth were found on x-ray examination.

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An 8Y10M-old Japanese boy was referred to our clinic and he had a complaint of pain and prolonged ulcer on bilateral buccal mucosa. Two months before the first visit, he bit the left buccal mucosa, and then he started to have habitual jaw move from side to side and repeatedly thrust his finger or tongue into the wound. As a result, deep bilateral ulcers were formed and became infected. He suffered from systemic prostration because of pain and he was hospitalized to control the local and systemic symptoms for 1 month. Even after being discharged, he still screamed in pain and took analgesics very often.
We prepared and set the bite plate on his upper jaw to avoid touching the upper and lower first molar cusps. The wound healed in 2 weeks, and his mental and physical conditions became stable. However, after the appliance was removed, he bit again and formed multiple ulcers on the tongue, lower lip as well as bilateral buccal mucosa. These ulcers healed in only 2 weeks with oral disinfectant irrigation without special appliances. Seven months after the first visit, he bit the right buccal mucosa severely and this resulted in infection with fever, hemi-facial cellulitis in the right, and dehydration. The patient was supplied with electrolytic water and antibiotics by intravenous instillation, and the soft resin splint (Erkopress splint®) was set over the upper dental arch simultaneously. This treatment enabled him to make a quick recovery without hospitalization.
The local cause of the bite injury in this case was considered to be malposition of the erupting first molars. However, the self-mutilating habit induced complicated and prolonged oral as well as systemic symptoms. The patient was neither mentally retarded nor had organic disorders.
Children may manifest self-mutilating behavior as a means of gaining attention or as a sign of various emotional disturbances, and such a behavior can be thought to be neurotic self-excoriation. In this case, it was important for the success of the treatment to support the patient mentally and psychologically. A bite plate or a soft resin splint like those used in the present case can be applied effectively to control or prevent oral multilation.

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First and Second Branchial Arch Syndrome is one of the congenital diseases with the deformities of the organs or the tissues derived from the corresponding portions of an embryo. It is differentiated from other syndromes such as Treacher Collins or Goloenhar according to its different clinical findings.
We obtained several interesting findings about facial and mandibular morphology and the stomatognathic function in the case of a 7 year old girl diagnosed as First and Second Branchial Arch Syndrome, who visited the Pediatric Dental Clinic of Tokyo Medical and Dental University Hospital. The Findings were as follows;
1) Craniofacial asymmetry because of under-developed maxilla, zygoma, temporale and mandible.
2) Deep over bite and disto-occlusion because of micrognathia (Bird-like face).
3) Closure of the left external auditory canal and deformity of left pinna, extra ear tag and conductive deafness.
4) Partial defects of the mandibular ramus and chewing muscles on the left side.
5) The electromyogram of the chewing muscles (temporal and masetteric)showed an inactive and irregular pattern of activities on the left side.
6) Mandible was shifted to the left side during the movement and retracted severely due to the deformities.
Considering the mandibular growth, function and psychological aspect, we need to make proper reconstruction of the mandibular joint and the ramus, and to improve its occlusion in future by cooperating with other specialities.

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[in Japanese]

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[in Japanese]

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