Recently, the prevalence of periodontal disease in the elderly has been increasing in Japan. The purpose of this study was 1) to investigate the periodontal condition in elderly residents at nursing homes, and 2) to register the baseline data for a longitudinal study. A clinical examination was carried out on 215 elderly subjects from 54 - 101 years of age, resident in 9 nursing homes in Tokyo and Yamanashi prefectures. The parameters evaluated were: remaining teeth, plaque index (PlI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP). The subjects were divided into the four age groups, < 65, 65-74, 75-84, > 85 years. The results revealed that in the 75-84 years age group and > 85 years age group, the remaining teeth were significantly fewer and the mean PlI scores significantly higher than in the other 2 groups. The mean values of PPD, CAL and BOP were 2.6 ± 0.8 mm, 3.0 ± 1.1 mm and 32.0 ± 29.7%, respectively. Of the total, 39.5 % of the subjects had sites with a PPD ≥ 6mm, 76.5% had ≥ 5 mm; 17.8% had an attachment loss of ≥ 9 mm. It is necessary to identify the population at high risk of periodontitis and professional to provide them guidance on oral hygiene, to prevent worsening of periodontal disease.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(3) : 229-237,2009.

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Aim: The purposes of this survey were to help develop dental hygienist practice, to serve as a basis for the development of education programs for dentists and dental hygienists, and to develop a team approach in dental practice. Method: A questionnaire survey on the cooperation between dentists and dental hygienists was conducted in 459 dental clinics in Japan, with at least one dentist who was a Japan Society of Periodontology (JSP) Board certified periodontist. Result: A total of 202 replies (44%) were obtained. A significantly positive correlation was found between the length of the dental clinic director's period and the number of dental units for dental hygienists. Furthermore, the number of dental units for dental hygienists significantly correlated with the number of periodontitis patients, the number of JSP Board Certified Dental Hygienists, the involvement levels of dental hygienists in periodontal therapy, and so on. Conclusion: Our results revealed dental hygienist practice in dental clinics, the high ability of dental hygienists in dental practices, and the important factors involved in the scope of work performed by the dental hygienist. We propose additional learning goals for dental hygiene education and suggest potential ways on which to expand job categories for dental hygienists.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(3) : 238-251,2009.

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The purpose of this study was to investigate the effects of anti-inflammatory agents, vitamins and bactericidal agents in liquid dentifrices on experimentally induced periodontitis in the rat. Three liquid dentifrices -1) liquid dentifrices containing anti-inflammatory agents ("ε-amino capronic acid and dipotassium glycyrrhizinate), vitamins (tocopheryl acetate) and bactericidal agents (3-methyl-4-isopropylphenol and cetylpyridinium chloride), 2) liquid dentifrices containing only bactericidal agents, and 3) liquid dentifrices without any anti-inflammatory agents, vitamins or bactericidal agents (control) were compared. Periodontitis was induced by a ligature on the mandibular first molars of both sides in 26 male Wistar rats (8-week-old) for 4 weeks. After removal of the ligature, 20 rats were divided into 3 experimental groups and each liquid dentifrice was topically applied to the gingival sulcus of the mandibular first molars of both sides once a day for 2 weeks. The remaining 6 rats served as the baseline. The mandible was resected, fixed, decalcified and then paraffin-embedded to obtain bucco-lingual sections. The sections were stained with hematoxylin and eosin, Mallory staining and immunohistochemical staining for tumor necrosis factor (TNF)-alpha or 8-hydroxy-2`-deoxyguanosine (8-OHdG), and then analyzed histometrically. The liquid dentifrices containing anti-inflammatory agents, vitamins and bactericidal agents and those containing bactericidal agents alone significantly decreased the numbers of polymorphonuclear leukocytes and blood vessels in the subepithelial connective tissue of the junctional epithelium, and the number of TNF-alpha-positive cells in the periodontal ligament compared to the control dentifrice. Rats receiving topical application of liquid dentifrices containing anti-inflammatory agents, vitamins and bactericidal agents showed a higher density of collagen and lower number of 8-OHdG cells as compared to those receiving topical application of the liquid dentifrices containing bactericidal agents and the control dentifrice. In addition, there were no significant differences in the numbers of polymorphonuclear leukocytes or blood vessels between the baseline and the control dentifrice group. These results showed that anti-inflammatory agents, vitamins and bactericidal agents in liquid dentifrices have additional effects of improving inflammation in periodontal tissues.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(3) : 252-259,2009.

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Epidemiological evidence has been accumulated to suggest a relationship between periodontal degradation and smoking. However, the mechanism underlying this effect is unknown and may be related to the host responses. The aim of this study was to investigate the effects of active/secondhand smoking on the gingival neutrophil elastase activity and the biochemical markers of periodontal degradation. Ninety-two healthy male subjects with no clinical signs of periodontitis volunteered to take part in the investigation. Clinical records of the probing pocket depth (PPD), plaque index (PlI), gingival index (GI) and amount of gingival crevicular fluid (GCF) were prepared for each individual. The extracellular elastase activity was measured in the GCF samples using a chromogenic low-molecular-weight substrate, while the levels of α1-antitrypsin, elastase-α1-antitrypsin complex and salivary cotinine levels were measured by ELISA. The following results were obtained. 1, Based on the salivary cotinine levels, 40 of the self-reported non-smokers were actually secondhand smokers, and 14 were actually non-smokers. 2, There were no significant differences in the clinical parameters between non-smokers, secondhand smokers and active smokers. 3, The salivary cotinine levels were correlated with the extracellular elastase activity and free elastase levels in secondhand smokers. 4, The salivary cotinine levels were negatively correlated with the active elastase-α2-macroglobulin complex levels in active smokers. These results indicate that active/secondhand smoking enhanced gingival neutriphil elastase activity during the initial phase of activity of the periodontal host defense system. In other words, the results appeared to underline more strongly that secondhand smoking as well as active-smoking are major environmental factors for periodontal disease. Furthermore, in addition to measurement of the GCF extracellular elastase activity, measurement of the salivary cotinine levels was also suggested to be a useful index.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(3) : 260-268,2009.

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We report a case of drug-induced gingival hyperplasia in a patient with intractable epilepsy, motor disabilities and moderate mental retardation, which was managed initially by periodontal therapy and subsequently by supportive periodontal care, with maintenance of a good oral condition for 13 years. An 18-year-old male patient was referred to our clinic with the chief complaint of caries and gingival swelling. He had been prescribed antiepileptic drugs from the age of 3. Oral examination at the first visit revealed supra-and subgingival plaque and calculus formation and gingival overgrowth with severe inflammation. Initial periodontal therapy resulted in improvement in the gingival overgrowth. Thereafter, the patient was maintained on supportive periodontal therapy (SPT). After the age of 20, because of the frequent epileptic seizures and gradual decrease in motor functions, it became difficult for the patient to visit our clinic regularly, and the oral condition deteriorated. At the age of 26, the patient became paralyzed as a result of a split-brain procedure, and even oral self-care became difficult. Consequently, recurrences of deep periodontal pockets were observed and periodontal surgery was performed. Training in oral hygiene and brushing technique was then imparted to support self-help for oral prophylaxis, with monitoring of the periodontal condition under monthly SPT. Although more than 13 years have passed since the patient's first visit, the periodontal condition remains satisfactory under bimonthly SPT. Through the treatment of this case, we have demonstrated that it is possible to obtain significant improvement in gingival hyperplasia induced by multiple antiepileptic drugs, and that its recurrence can be prevented by good plaque control. It is important to support of self care according to the life stage and systemic condition while respecting the patients'wishes, and provide appropriate professional care for long-term health support.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(3) : 269-278,2009.

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