Traditionally there have been two systems of dental education in Europe: stomatology and odontology. Odontology focuses on the anatomy, development and diseases of the teeth, whereas stomatology is an area of medicine encompassing the mouth and its diseases. Stomatology was originally practiced by physicians, and was a standard medical specialty through the early 20th century in Europe. During the past two decades, medical and dental education in Europe have faced enormous changes. The reform has primarily been promoted by the political initiative for an integrative European Union （EU）. The EU directives and Bologna declaration, including the European Credit Transfer and Accumulation System （ECTS）, have defined the integrative curriculum structure of European higher education. For the health sector the EU has recognized “dentist （dental practitioner）” as an independent profession. The EU has pursued the odontological model, in which dental education is autonomous and separate from medical education for the “physician （doctor）”. Accordingly, those EU states with a stomatology model were required to change. In the recent reform, however, social and medical issues — such as demographic changes associated with increasingly elderly populations — were hardly taken into consideration. The reforms in medicine and dentistry were carried out independently. Moreover, dentistry has become more odontological. Consequently, the gap between medicine and dentistry once filled by stomatology has increased. This makes coordination and collaboration of the disciplines of medicine and dentistry difficult — especially in complex clinical cases. A good and topical example is treatment of medication-related osteonecrosis of the jaw （MRONJ）, which involves oncologists, orthopedists, radiologists, general practitioners, oral & maxillofacial surgeons, and dentists. The most critical group is cancer patients with bone metastasis, who receive bisphosphonates intravenously at regular intervals. Another group includes patients with osteoporosis. Depending on the clinical situation, doctors and dentists with various areas of specialization are involved. Complex treatments must be well coordinated, but in practice this is not easy. There are differences of opinion between the treating doctors, in particular over the question of how aggressively MRONJ should be treated. In fact, there has been no effective standardized treatment concept for definite healing. From the medical, psychological and social points of view, it is important to maintain sufficient quality of life in patients receiving ongoing oncologic or orthopedic treatment. The aim of the treatment is, therefore, to return the clinically manifested MRONJ to the symptom-free condition of “at risk category”. Official guidelines for treatment are conservative, recommending clinical observation, antibacterial rinses of the lesion and application of antibiotics. However, it is known that — once the necrosis is visible in the oral cavity — complete healing of the lesion does not occur with non-operative treatments alone. MRONJ progresses rather slowly, but finally reaches an advanced condition. On the other hand, surgical treatment, which is designed to achieve a complete elimination of the necrotic lesion, is often associated with complications such as wound dehiscence and persistent infection. Moreover, the need for antiresorptive therapy and “drug holidays” has been discussed but is often disputed. Even at the stage of “at risk category”, several questions remain in determining which option is most suitable for dental prosthetic treatment in those patients. View PDF for the rest of the abstract
Under my leadership and in consultation with Member States, partners and staff, WHO in the Western Pacific Region has developed a vision for the next five years. Together, we identified four priorities that must be addressed to reach our goal: making the WHO Western Pacific Region the healthiest and safest region. One of the priorities is NCDs and Ageing. Every country in the Western Pacific Region is experiencing a surge of noncommunicable diseases （NCDs） like heart disease, stroke, cancer, diabetes and chronic respiratory diseases. At the same time, many countries’ populations are growing older. Inevitably, all countries will face an ageing population- it is just a matter of time. We will support countries to measure and analyse changes in disease patterns and lifestyles, to reduce the risk factors that can lead to NCDs, like tobacco, excessive alcohol consumption and unhealthy diets and to orient health systems towards services that focus on people and ‘accompany’ them through their life and their changing needs. We want a Region where NCDs are prevented and mental health and wellbeing is promoted. We need primary health care and other health services that better manage NCDs and mental health conditions and keep people well. This means building health systems and social services that support all people to live long, healthy, productive lives. Oral health is a key indicator of overall health, well-being and quality of life. It encompasses a range of diseases and conditions that include dental caries, Periodontal disease, Tooth loss, Oral cancer, Oral manifestations of HIV infection, Oro-dental trauma, Noma and birth defects such as cleft lip and palate. The Global Burden of Disease Study 2017 estimated that oral diseases affect 3.5 billion people worldwide, with untreated dental caries being among the most prevalent noncommunicable diseases. According to the International Agency for Research on Cancer, the incidence of oral cancer was within the top three of all cancers in some Asian-Pacific countries in 2018. Most oral diseases and conditions share modifiable risk factors with the leading NCDs （cardiovascular diseases, cancer, chronic respiratory diseases and diabetes）. These risk factors include tobacco use, alcohol consumption and unhealthy diets high in free sugars, all of which are increasing at the global level. There is a proven relationship between oral and general health. It is reported, for example, that diabetes mellitus is linked with the development and progression of periodontitis. Moreover, there is a causal link between high sugars consumption and diabetes, obesity and dental caries. In 2015, the Tokyo declaration on dental care and oral health for healthy longevity was adopted. This calls upon health policy makers and professionals to significantly reduce the global burden of disease related to oral health, to promote greater access and equity in oral health services, and to integrate oral health programs into the larger development agenda. The WHO Oral Health Programme is currently implementing a three-year roadmap （2019-2021） comprising a mix of normative work and practical support to countries over five priority activities aligned to the GPW13. One of the top priority is to develop the WHO Global Oral Health Report （one of a WHO Global Public Health Goods） as a robust advocacy document to reinforce the commitment to oral health among policymakers, and to pave the way for the further development of a global oral health action plan towards 2030.
近年，わが国では，超高齢社会の進展とともに有病者の割合も増加し，診療現場においても，骨吸収抑制関連顎骨壊死（antiresorptive agents－related osteonecrosis of the jaw：ARONJ）に遭遇する機会は増加傾向にある。歯科医師には適切な治療が望まれているが，ARONJ治療の予後因子は明らかではない。われわれは，これまでにARONJ治療についての検討を行ってきた。本論文では当院を受診したARONJ 100症例の経過を調査し，その寛解に対する予後因子の解析を行った。 ARONJの初診時のステージは，ステージ2が68％，ステージ3が12％であった。治療後は，寛解が40％で，アップステージが3％と，大多数が制御可能であった。予後因子の結果では，原因疾患（骨粗鬆症）［p＜0.001，オッズ比5.766］，治療方法（外科療法併用）［p＝0.007，オッズ比0.272］が有意な因子となった。積極的な外科療法が，ARONJ治療成績の向上にもつながると考えられる。そのためには，原因疾患の治療医とより密な医療連携を行い，適切な外科治療を進めることが重要である。しかしながら，がん治療への適応の場合は，外科療法が行えない方も多いのが現状である。一方で，今回の研究では，保存療法だけでも，多くの症例が制御可能であった。ただ，このような場合には，より早期からの歯科的介入や，歯科治療への対策が必要と考えられた。 本稿は，単施設での検討であるため，症例数が限られ，外科療法の時期や切除範囲の設定など，課題も見られた。今後も，症例数を蓄積するとともに，多施設共同研究や前向き研究も検討していきたい。
Introduction: Oral healthcare management during hospitalization has been widely practiced; however, the outcomes are not always favorable. This indicates that oral conditions and problems associated with the needs of patients should be analyzed accurately. Thus, the Japanese Stomatological Society conducted an extensive survey targeting inpatients in general hospitals, aiming to comprehensively investigate the current status of oral functions and needs concerning oral healthcare management, and to enhance the current dental care system. Methods: Data was collected using a questionnaire survey of patients who received treatment in general hospitals in either November 2017 or January 2018. Results: The survey was conducted and a total of 2,280 valid responses （1,223 men and 1,057 women） were received from 26 medical and dental institutions. The mean age was 57.3 years and the mean length of hospital stay was 15.6 days, with a median of 9.0 days. At the time of discharge, 72.2% of patients had subjective symptoms related to the oral cavity. In contrast, the proportion of patients who saw a dentist during hospitalization was low （18.2%）. The oral health of the hospitalized patients included common dental diseases, such as dental caries, periodontal disease, and diseases related to dental prostheses, but also those of oral dysfunctions, such as dry mouth, taste disorder, and difficulty in swallowing. Regarding diet type, 11.3% of the patients could not ingest a regular diet at the time of discharge. Of those, 82.6% wished to improve their diet type, and 67.5% believed that they could have their desired diet type if they improved their oral health condition. In terms of community cooperation after discharge, 80.5% of patients had a family dentist and only 46.1% of them visited their dentist on a regular basis. Discussion: This research indicated that many inpatients suffered from oral health problems and needed proper management. However, due to short hospitalization duration, there were limited opportunities to consult and undergo aggressive treatments for most inpatients, suggesting that there are serious issues to be resolved. Dental professionals, experts in diagnosis and treatment planning for oral care, should also contribute through extensive participation in diet and nutrition management. The data suggests that enhanced functional alliance between dentists and attending medical teams （i.e. medical doctors and other medical staff） and education of patients seeking their desired treatment during hospitalization itself would be crucial for the effective management of oral function during hospitalization. This could also lead to the maintenance of healthy oral functions at home.