Purpose: This study investigated the dental hygienist activities of caring for the elderly in a nursing facility and the relationship between dental hygienist activities and degree of support/level of care needed by the patients.

 Methods: Six nursing facilities for the elderly were selected in which the facilities were visited to perform common dental treatments by the Department of Comprehensive Dental Support, Asahi University Medical and Dental Center. A total of 384 patients (men: 123 and women: 261, mean age: 83.9 years) with certified levels of long-term support/care needs were surveyed. The number of items of dental hygienist activities (tooth cleaning, denture management, care of oral mucosa, oral functional training, meal rounds, and feeding function training) was counted from the patients’ clinical records and dental hygienists’ daily work records. The patients were categorized by degree of support (1 and 2) and level of care needed (1 to 5). The relationship between dental hygienist activities and degree of support/level of care needed was statistically analyzed using Pearson’s chi-squared test, Fisher’s exact test, and odds ratio with 5% significance level.

 Results: Items, such as meal rounds and feeding function training, were not recorded. Dental hygienist activities for the patients that needed only support were tooth cleaning and denture management, while oral mucosa care and functional training were included in the group that needed care. Dental hygienist activities tended to be performed more often for patients with level of care needed of ≥3.

 Conclusion: The items of dental hygienist activities were influenced by the degree of support/level of care needed by the patients.

 Purpose: An increase in chromatin accessibility arises from the stretched chromatin structure, which enables the association of transcription complexes with local genomic DNA, and thus induces target mRNA transcription. This is one of the main molecular frameworks for epigenetic regulation of gene expression. In this study, the changes in whole-genomic chromatin accessibility that occur during induced differentiation of human dental pulp stem cells (hDPSC) were analyzed by assay for transposase-accessible chromatin with high-throughput sequencing (ATAC-seq).

 Methods: hDPSC were cultured in a mineralization induction medium. ATAC-seq samples were prepared before and after the 12-day culture. Bioinformatics analyses were conducted, involving open chromatin peak extraction, sample comparison, consensus DNA binding (CDB) sequence identification, and gene ontology (GO) analysis of neighboring genes for each peak.

 Results: The bioinformatics analyses identified 45,493 and 45,370 open chromatin peaks at day 0 and day 12, respectively. The CDB sequences of transcription factors, including TEADs, bZIPs, and RUNXs, and insulators, including CTCF and BORIS, were commonly enriched in these peaks. Furthermore, GO analysis of neighboring genes of CTCF-CDB revealed an accumulation of the genes associated with the Hippo signaling pathway, in which TEADs act as the essential transcription factors, at day 12 but not at day 0. Additionally, the gene loci of the odonto/osteogenic genes, such as BMP2 and BMPR1B, were identified as accessible chromatin regions controlled by CTCF-CDB at day 12 but not at day 0. From these results, the types of CDB in the stretched chromatin region were not drastically changed before and after hDPSC differentiation. However, because CTCF participates in the dynamic genomic organization to regulate local chromatin accessibility and restrict the territory of distal enhancers and suppressors, CTCF aids TEADs in finding and associating with odonto/osteogenic gene loci, inducing odonto/osteogenic gene expression during differentiation.

 Conclusion: Bioinformatics analysis indicated that local epigenetic alteration mediated by the insulators may play pivotal roles in hDPSC differentiation, and therefore, chromatin accessibility modulation may have therapeutic potential for inducing odontogenic differentiation of hDPSC.

 Purpose: Root-end surgery has clinical limitations in terms of accessibility. To overcome this difficulty, Targeted Endodontic Microsurgery (TEMS) has been proposed as one of the treatment options for surgical intervention. We performed TEMS for a chronic apical abscess caused by the palatal root of the maxillary first molar, which was not healed by nonsurgical root canal retreatment, and obtained favorable healing progress.

 Methods: A 45-year-old woman presented with recurrence of swelling on the palatal side after initial root canal treatment of the maxillary left first molar. There was no percussion pain or tenderness on the tooth, but there was a sinus tract near the apex on the palatal side. Radiographic examination revealed periapical radiolucency on the mesiobuccal and palatal roots. The tooth was diagnosed as previously treated and with a chronic apical abscess. Although non-surgical retreatment was performed, swelling remained on the palatal side. Based on additional examination by dental cone-beam CT (CBCT), it was determined that the palatal root was indicated for root-end surgery. Only the palatal root canal was filled with MTA, and the other root canals were filled with gutta-percha and sealer. An impression of the maxillary dentition was taken to prepare a surgical template. Prior to root-end surgery, the acquired digital data was incorporated into a dental implant treatment planning support program, and a surgical template was designed so that approximately one-third of the apex of the palatal root could be removed with a trephine bur, and 3D printing was performed. Root-end surgery was performed by inserting a trephine bur from a predesigned position and drilling to a set depth to remove the palatal apex. After resection, the granulation tissue inside the cavity was scraped off, washed with saline, and then sutured.

 Results: Follow-up was performed until 6 months after surgery. Periapical radiolucency of the palatal root subjected to TEMS decreased over time. In addition, periapical radiolucency of the mesiobuccal root decreased after the non-surgical root canal retreatment.

 Conclusion: The palatal root of the maxillary first molar which did not respond to non-surgical root canal retreatment was successfully treated with TEMS. When performing TEMS, it is necessary to consider the cost and difficulties involved, but in applicable cases, it is less invasive and can be performed accurately in a shorter operating time than conventional root-end surgery from the palatal side. It is suggested that TEMS may be an option as a surgical endodontic technique.