Recently, liver disease caused by excess nutrition intake in individuals who do not drink alcohol,so-called non-alcoholic fatty liver disease, has received attention. In affected patients, advanced pathological changes related to inflammation and fibrosis in the liver are termed non-alcoholic steatohepatitis (NASH). Examinations of saliva specimens collected from NASH patients have frequently detected Porphyromonas gingivalis, a major periodontitis-related bacterium. Furthermore, analysis of NASH model mice fed a high-fat diet revealed that infection with P. gingivalis OMZ314, highly virulent for periodontitis, resulted in development of NASH conditions after only 8 weeks, while those model mice otherwise typically develop such conditions after at least 48 weeks. As for cariogenic bacteria,infection with the blood isolate Streptococcus mutans TW871 led to development of NASH within 8 weeks in the same model. Several in vitro analyses also revealed excess production of metallothionein, a cytokine related to oxidative stress, in TW871-infected mice, while inflammatory cytokine and chemokine levels were also elevated, which may be related to aggravation of NASH.

The probability of a Nankai trough giant earthquake striking the Shikoku and Kinki regions within 30 years is reported to be 70%. In such a disaster situation, children and individuals with disabilities will require help with evacuation. We surveyed disaster awareness in 60 families that included children or individual with disabilities. We divided the family into 2 groups : those with and without disabled individual. Although both groups were found to have strong disaster anxiety, there was a significant difference in regard to awareness of disaster prevention. Families with disabled children showed a higher level of awareness of disaster prevention and disaster mitigation in comparison to those with children without disabilities. On the other hand, our results showed that the place of residence for families with disabled children tended to be far from a community evacuation center. Individuals with disabilities can be seriously affected by a disaster, thus it is important to understand their specific needs in disaster situations. Dental professionals can contribute in major public health disaster relief efforts. However, a personal support system should be established prior to taking part in community disaster plans.

The pen grip is one of the recommended methods for holding a toothbrush, as it allows careful control of movement by the fingers. However, toothbrushing with a pen grip may be difficult for children because of limited dexterity. We evaluated the brushing movements in adults when toothbrushing with their non-dominant hand to simulate the instable movements of children.

Dental hygienists were employed as subjects, and asked to brush the buccal and palatal sides of the right and left upper molars. Toothbrush motion frequency and the joint angles of the shoulder, elbow,and wrist were examined. Furthermore, the motions of the toothbrush and arm during brushing were evaluated and compared between brushing with the dominant and non-dominant hand.

Study conclusions :

1)The peak frequency and effective arm motion while brushing the upper buccal left and palatal right and left molars were different between brushing with the dominant and non-dominant hand.

2)When brushing the upper left molars, a significant difference was noticed for peak frequency and effective arm motion when brushing with the dominant and non-dominant hand.

3)All arm joints must move in a synchronous manner in order to enable reciprocal motion of the toothbrush while brushing with a pen grip.

Our findings suggest that arm motion during tooth brushing with the dominant hand using a pen grip requires a certain level of learning and proficiency, while the coordinated movements of the joints of arm are reflected in reciprocal motion of the toothbrush.

Objective : Evaluation of autonomic nervous function using heart rate variability analysis is effective to non-invasively assess stress in real time, though the method is sensitive to body motion, making measurements difficult in patients who move during dental treatment. The purpose of this study was to determine an appropriate electrode mounting position for evaluating autonomic nervous function with body motion or suppression.

Subjects and methods : The subjects included 9 healthy volunteer adults, 7 healthy volunteer children, and 2 child patients.

1.We evaluated autonomic nervous function in the 9 adults with 5 different body motions and suppression using 6 electrode mounting positions.

2.We evaluated autonomic nervous function in the 7 volunteer children under suppression.

3.We evaluated autonomic nervous function in the 2 child patients during dental treatment by attachment of electrodes to the trunk as a trial.

Results : When the electrodes were attached to the trunk, autonomic nervous function was evaluated in over 84.0% of the attempts in the 9 adults with body motion and over 66.5% in those under suppression, while it was evaluated in 92.3% of the attempts in the 7 volunteer children under suppression, and in 90.1% and 97.7% of the attempts in the 2 child patients during dental treatment.

Conclusion : Based on our results, evaluation of autonomic nervous function for patients with body motion and suppression during dental treatment is most effective when the electrodes are attached to the trunk.

In this study we established a novel method for measuring lip form in children using a newly developed instrument (KD measurement). To examine the validity of our measurement method, we investigated the reproducibility between measurers. Also, errors with our novel method as compared to a conventional measurement method that utilized photos were compared. In addition, we examined the relationship between our KD measurement method and lip closure force in 15 children (age range 2 years 9 months to 6 years 1 month ; 6 boys, 9 girls). There were no significant differences for measurement values obtained by 10 different measurers with the KD measurement method. In addition, there were no significant differences between the values obtained by KD measurement and the conventional method using photos of the lips. These results showed that our novel KD measurement method has high levels of reproducibility and precision. As for the relationship between KD measurement and lip closure force in children, some correlations were observed, which were similar to previous studies. We consider that the KD measurement method is potentially effective for clinical applications.

We investigated 233 patients (154 males, 79 females ; age range 0−15 years) who visited the Department of Pedodontics of Matsumoto Dental University Hospital between April 2007 and March 2010 with a chief complaint of oral trauma. Those findings were compared to investigation results obtained 17 years prior.

1.Although the incidence of injury was highest at the late stage of infancy, it decreased from 45.5% noted 17 years ago to 38.2% in the present era. For patients in the late stage of school life, the incidence decreased from 15.6% to 10.7%. In contrast, for patients in early infancy, that increased from 13.8% to 25.3%.

2.The most common cause of injury noted 17 years ago was bruising (35.9%), following by falling (25.7%), and unknown because the parents did not observe the incident (24.6%). In the present era,the most frequent cause was a fall (55.4%), while the second most frequent was collision (18.9%).

3.Although the rate of infant patients with a past history of injury did not change, the rate of those with an unclear past history of injury decreased from 22.8% to 0.4%.

4.Injured areas were similar to those noted 17 years ago, with injury in the maxillary anterior teeth accounting for approximately 70%.

5.As for type of injury, complications with lacerated soft-tissue wounds were more frequently observed in the present era.

6.The percentage of patients who received treatment for the injury prior to visiting our department was approximately 15% in both eras. Although the most common treatment following the initial examination was course observation in many cases, procedures for reduction fixing therapy to maintain esthetics and functionality were increased in the present era.

To elucidate the conditions and management of children who visited our pediatric dental clinic with a chief complaint of traumatic tooth injury, we surveyed the following factors ; i) age and gender of patient, ii) elapsed days after injury, iii) presence or absence of referral letter from another clinic, iv) cause of injury, v) type and condition of injured teeth, and vi) management of injured teeth at the first visit.

We encountered 192 patients with injured teeth (238 primary, 107 permanent) among 1816 children who visited our clinic for the first time from January 2010 to December 2012. The following results were obtained.

1)Two years was the most frequent age among all patients with injured teeth, with 44% of all children aged 2 years or younger who visited our clinic showing dental trauma.

2)Regardless of primary or permanent teeth, dental trauma occurred more often in boys.

3)Many of the children with injured teeth waited to visit our hospital at 2−7 days after the injury,rather than within 24 hours.

4)In cases of primary injured teeth, 74% of those children had a referral letter from another clinic,whereas 54% of children with permanent tooth injury carried a referral letter.

5)The most common cause of injury was a fall.

6)Dislocation of primary teeth (58%) and crown fracture of permanent teeth (41%) were the most frequently reported injuries.

7)Maxillary central incisors were most frequently affected in both primary and permanent dentition.

8)Follow-up observations was the most common mode chosen to manage injured teeth.

Based on our findings, the characteristics of dental trauma in children in the Tokyo metropolitan area were consistent with previous reports. However, since conservative follow-up without treatment was frequently decided, it is suggested that several of the patients might have visited our dental college hospital for only a mild injury. In recent years, an increasing number of children have come to our institution with a referral letter from anther clinic. Technical knowledge and appropriate methods for treating dental trauma only available at a university dental hospital might be in high demand by private practitioners, as well as children and their parents.

A perioperative dental injury is a common anesthesia-related complication. During the mixed dentition phase, primary teeth with resorbed roots as well as permanent teeth with immature roots are unstable, thus more susceptible to injury. In addition, midline diastema, normally observed during this period, may isolate the central incisors and increase their susceptibility to injury.

Herein, we report a 7-year-old girl with lateral luxation of the developing left upper central incisor due to displacement of a biting bite block during emergence from anesthesia. She was referred to our clinic because of impacted mesiodens with midline diastema between the developing upper permanent central incisors. Although the left upper primary lateral incisor was not yet exfoliated, it was unstable because of root resorption. The right upper primary lateral incisor was exfoliated and the upper primary canine was located in proximity to the right central permanent tooth. We extracted the impacted mesiodens under general anesthesia. In addition, the left upper primary lateral incisor was extracted to prevent avulsion during anesthesia, which resulted in left permanent incisor isolation along with midline diastema. Following surgery, the bite block was inserted between the left molar teeth and fixed by taping. However, during emergence from anesthesia, the bite block was accidentally displaced to the anterior position by tongue movement, and the isolated left upper central incisor was injured and displaced labially due to biting force. The patient was then immediately treated using manual repositioning and fixation for 4 months. At an examination conducted 1 year 4 months after injury, the post-operative course was shown to be uneventful.

To prevent perioperative tooth injury during the mixed dentition phase, preoperative assessment should include detection of tooth instability associated with short roots as well as tooth isolation due to a combination of midline diastema and loss of adjacent primary incisors.

SAPHO syndrome is a rare condition characterized by aseptic inflammatory lesions of the bone and skin. In the oral and maxillofacial regions, the mandible is most often affected. However, involvement is more typically seen in the anterior chest wall, axial skeleton, and extremities. Mandibular bone lesions in this syndrome are often indistinguishable from more common types of osteomyelitis, which are caused by severe dental infections. Therefore, dentists may have difficulty in promptly distinguishing this condition from others.

We treated a 7-year-old girl diagnosed with SAPHO syndrome who had noninfectious osteomyelitis of the mandible and palmoplantar pustulosis. Pain and swelling developed on the right side of the face at 2 months after dental treatment. The initial clinical and radiographic findings suggested infectious osteomyelitis resulting from severe dental caries or a periapical infection. Antibiotics were administered, but were ineffective and she was referred to our clinic. Our initial examination found no infectious lesions in the intraoral region. The patient had a history of pustules and erythema of the palms and soles, which occurred along with the mandibular osteomyelitic symptoms. She was referred to the pediatrics department. Computed tomography, positron emission tomography, and magnetic resonance imaging revealed an osteolytic lesion with a periosteal reaction that was limited to the right mandibular ramus. Biopsy specimens of bone and skin lesions showed inflammatory tissues that were compatible with osteomyelitis and palmoplantar pustulosis, respectively. Cultures did not identify any infectious agents or strains. Based on the clinical manifestations, radiologic imaging, and histopathological findings, we made a diagnosis of SAPHO syndrome with noninfectious osteomyelitis of the mandible and palmoplantar pustulosis. The patient was administered nonsteroidal anti-inflammatory drugs, which improved clinical symptoms in both bone and skin.

The prognosis of SAPHO syndrome is generally good and pharmacologic therapy is usually effective. However, as the disease progresses, patients often suffer from deformities or growth defects with hyperostosis of the affected bones. SAPHO syndrome should be considered when pediatric dentists encounter children with jawbone inflammation with an unknown etiology.