Some instruments used in daily life can cause an unexpected accident, including toothbrushes provided by dentists while giving dental advice, which can cause damage to the oral cavity. To develop measures to prevent injuries caused by toothbrushes (entry wounds in the oral mucosa), a questionnaire survey was given to pediatric and other dentists to examine the status of injuries caused by brushes and dentist awareness. The results were as follows.1.Injuries caused by toothbrushes occurred most frequently in patients “two to three”, followed by “four to five” years old.2.Most injuries were in the “buccal mucosa” and “palate.” There was no marked relationship between the site of injury and patient age.3.The most common cause of injury was “fall with toothbrush in the mouth.” No significant association was noted between the situation in which an injury was caused and the age of the patient.4.The most common treatment method was “follow-up examination.”5.More than 70% of the surveyed dentists provided training for using toothbrushes for children under four years old. Although 84.1% of the dentists warned their patients of the risk of injury caused by improper use of a toothbrush, some who recognized that risk did not.6.No marked association was noted between “dentist experience with providing diagnosis of toothbrush-related injury” and “appropriate age considered by dentist for children to start using a toothbrush.”7.According to the results of text-mining analysis, specific instructions provided by dentists during tooth-brushing training included “brushing while lying on the back,” “observation,” and “not allowing children to walk around during tooth brushing.” Dentists with clinical experience of 25 years or more placed emphasis on “advice for younger children” and “not letting children walk around.”

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Patients with an autistic spectrum disorder (ASD) generally have impaired language and communication skills, and exhibit unusual patterns of physical behavior, which can cause problems during dental treatment. Therefore, it is important for dental health care providers to acquire sufficient knowledge regarding developmentally challenged patients with an ASD. The Special Needs Dentistry Center of the Nippon Dental University Niigata Hospital has been endeavoring to develop its capacity to meet the needs of ASD patients more aptly since 2006. The purpose of this study was to examine the results of our efforts by analyzing trends of patients with developmental disabilities and treatments they received in the past 10 years. The following results were obtained.1.ASD patients represented the largest percentage of all developmentally disabled patients in the last decade and have continued to increase since 2006.2.The number of patients who live in areas 30 to 40 km from our hospital has been increasing since 2006.3.Answers regarding why patients chose our hospital revealed that referral from another facility topped the list for the past 10 years, due to the fact that the number referred to our hospital has risen sharply from 2006.4.Dental caries made up the majority of cases in the past decade, a trend that has remained unchanged since 2006.5.Behavioral training was the management technique used most frequently with ASD patients during the period under review. The ratio for this method was consistently high as compared to all other techniques in our behavior management program implemented from 2006.

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Although female dentists constitute approximately 40% of the members of the Japanese Society of Pediatric Dentistry (JSPD) members, it is difficult for them to continue active work under the present situation. Thus, it is considered necessary for the JSPD to investigate what kind of support female pediatric dentists require in order to continue working and exhibit their abilities. Questionnaires were sent to all 1766 female pediatric dentists who are JSPD members to survey their career intentions. We received responses from 724, for a return rate of 41%. The results indicated that the working environment has not been adequately improved, though many wish to continue working. From the answers, it was assumed that many enlisted help from family members because of an insufficient working environment. In addition, a number of members required day nursery assistance during the congress and seminars supported by the JSPD. Some respondents proposed that the site for seminars be closer to their residence and the ability to attend seminars from home. There was also much interest expressed in the application and renewal process of the accredited specialty board. Diversity management is important for diverse competent professionals to be involved at clinical sites performing pediatric dentistry. Therefore, new measures that are sensitive to life stage, such as the need to care for children and aged parents are required. Consequently, it is suggested that support systems for female pediatric dentists be investigated and established to improve their working environment.

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An Er : YAG laser is useful for treatment in both general and pediatric dentistry practice, and many reports on its effectiveness for hard tissue cutting have been published. However, only clinical studies have been presented showing its effectiveness for soft tissue surgery and evidence-based research of soft tissue surgery with an Er : YAG laser is considered to be important. The aim of this study was evaluate of the effectiveness of an Er : YAG laser in 49 patients who underwent soft tissue surgery. The most frequent procedure performed was frenectomy of the labial frena, lingual frenum, and gingivectomy. In most cases, local anesthesia was used (mean±SD, 1.1±0.80 ml), though no suturing of the surgical site was required in any of the patients. Although some reported pain after surgery with the Er : YAG laser, all patients showed a good prognosis. Our results suggest that an Er : YAG laser is a useful tool for soft tissue surgical treatment in pediatric dentistry.

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We previously showed that fluoride remains in dental plaque after a single mouth rinse with an NaF solution (250 ppm fluoride) and inhibits production of lactic acid following a glucose rinse. However, the rise in fluoride level due to NaF rinse is only temporary and unlikely to have long-term effects. On the other hand, Pearce et al. reported that fluoride remained in dental plaque for many hours after an ME-MFP rinse. In the present study, we examined the effects of an ME-MFP (250 ppm fluoride) rinse on production of lactic acid following a glucose rinse. The fluoride level measured after ME-MFP rinse followed by glucose rinse 30 minutes later (short-interval group) was 23.4 ppm, while that after ME-MFP rinse followed by glucose 5 hours later (long-interval group) was 14.6 ppm. The fluoride level in the control group was 4.8 ppm. The calcium level was 450.8 ppm and 339.7 ppm in the short- and long-interval groups, respectively, while that in the control group was 79.1 ppm. The difference in fluoride and calcium levels was statistically significant (p＜0.05) between the short-interval and control group, but not between the long-interval and control group. Furthermore, lactic acid was 91.8 ppm and 126.5 ppm in the short- and long-interval groups, respectively, while that in the control group was 147.0 ppm, with no significant differences among the groups. Our findings showed that an ME-MFP rinse increases fluoride and calcium levels, especially when applied shortly before a glucose rinse. However, no inhibitory effect of rinsing with ME-MFP on lactic acid production was confirmed.

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A number of reports have shown that the caries susceptibility of children with Down syndrome is lower than that of normal children. However, the factors related to this phenomenon have not been fully elucidated due to their diversity. We compared children with Down syndrome with normal children using biochemical analysis and histological observations before and after acid treatment of the outer layer of deciduous teeth. Mandibular deciduous canines without caries or cracks were extracted from 6 children with Down syndrome and 6 normal children. Atomic concentrations of calcium and phosphorus in the core regions of the enamel prism before and after acid treatment were analyzed using an Electron Probe MicroAnalyzer, with histological observations simultaneously conducted. In addition to subjective comparisons of such factors as enamel prism outlines and orientations, the percentage in the enamel prism core (P/I area ratio) was also calculated. A Mann-Whitney U-test was performed for comparisons between children with Down syndrome and normal children, while Wilcoxon's signed-rank test was used for comparisons before and after acid treatment. The following results were obtained. 1.A comparison of calcium concentrations showed no significant difference between children with Down syndrome and normal children. However, that after acid treatment was significantly lower in the normal children. 2.There was no significant differences between the groups regarding phosphorus concentration. On the other hand, that in normal children was significantly decreased with acid treatment, while the phosphorus concentration in those with Down syndrome showed an increasing tendency. 3.There was no significant difference between the groups for Ca/P ratio, which was significantly decreased with acid treatment in both groups. 4.Enamel prism outlines in children with Down syndrome showed heterogeneous patterns, with some incompletely formed. Findings for the enamel surface revealed a three-dimensional structure in normal children as compared to smoothness in children with Down syndrome. Furthermore, the rod sheath of enamel contained an organic matter-like structure in the children with Down syndrome and the prism core was similar to the interprismatic substance in terms of crystal structure. 5.The P/I area ratio before and after acid treatment was significantly lower in children with Down syndrome. The concentrations of calcium and phosphorus, the main components of enamel, were not significantly different between the groups. However, because of the different reactivity to acid, the histological structure in children with Down syndrome did not have a three-dimensional appearance like that seen in the normal children. Our findings indicate that calcification of deciduous teeth in children with Down syndrome is insufficient due to a lack of breakaway of organic materials.

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A decreasing birth rate and trend toward nuclear family living situations are social phenomena in Japan related to the reduction in total fertility rate to 1.39 in 2011. Situations that demand a dental examination and how to select a dental clinic for children in Japan are unclear issues, with only a few studies reported. We performed a questionnaire-based survey to understand the impression of guardians regarding an ideal pediatric dental clinic in order to provide better pediatric dental care. The subjects were 183 children (age range 3−6 years) who underwent a dental examination in June, 2010,who attended a single kindergarten in Yokosuka City, Kanagawa. The following results were obtained.1.The return rate of the questionnaire was 69.4% (127/183 respondents).2.Twenty-five children (19.7%) attending the kindergarten did not have prior experience with a dental examination or treatment.3.We classified the subjects into 4 clusters by cluster analysis and defined the reason for selection of a dental clinic to each cluster.Our results indicate that information showing the need of periodical dental examinations along with knowledge of the characteristics of each group were effective.

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Fluorescence-based devices such as the DIAGNOdent 2095 are adjunctive tools employed for caries detection. Recently, a DIAGNOdent pen (Pen) was introduced, which is a handheld device equipped with two types of tips, one to detect caries on occlusal and smooth surfaces, and the other to detect approximal caries. Although the device is expected to be utilized in pediatric dentistry, there are few reports of its use for primary or immature permanent teeth. We compared measurements obtained using a Pen device with lesion depth shown on bitewing radiograph images in primary and immature permanent teeth for detection of approximal caries. We examined 18 patients aged from 4 to 13 years old. For detection of approximal caries, examinations of 69 caries sites in primary teeth and 54 sites in immature permanent teeth were performed. Values obtained with the Pen for approximal caries in primary and immature permanent teeth were 24.5±2.41 and 6.9±0.71, respectively, while lesion depth values obtained using bitewing radiographs were 0.7±0.07 and 0.1±0.03 mm, respectively. Spearman's correlation coefficient was used to compare between the Pen and lesion depth and obtained R values of 0.82 and 0.78, respectively, for approximal caries in primary and immature permanent teeth. Values for both types of teeth showed high correlation coefficient values. Our findings suggest that the Pen is useful for diagnosis of the progress of approximal caries in primary and immature permanent teeth.

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Alagille syndrome is an extremely rare autosomal dominant hereditary disorder, while hepatic ductular hypoplasia is one of its main characteristics, as well as other four abnormalities appearing in the heart, eyes, vertebrae, and face. Liver transplantation from a living donor is performed for many of these cases. We have supported 2 girls with Alagille syndrome with consistent dental health care from an early age (1 year 7 months, 1 year 11 months old, respectively, at first visit). The notable dental findings in these cases are as follows.1.Dark-green discoloration was observed in all primary teeth.2.Enlarged pulp chambers were found in primary teeth with radiographic examinations.3.No abnormalities were observed in soft tissues.4.Multiple dental caries were detected in 1 of the patients.Based on our experiences with dental health care from a very young age, we concluded that it is very important to support healthy growth and development of children with Alagille syndrome by continuous oral care, starting as soon after birth as possible.

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