Dysphagia Rehabilitation, Oral Health & Clinical Science, Tokyo Dental College
The nutrition knowledge for the dentist in regional medical cooperation
Nutrition guidance in dentistry is necessary for all ages, not just for the elderly. The content of the guidance is not only for mastication disorders due to dental disease and dental treatment, deterioration of oral function, dysphagia, and nutrition consultation for developmental stages, but also for metabolic syndrome, sarcopenia, and frailty. Dentists must have the required knowledge of nutrition and be able to liaise with managing dietitians and dietitians to contribute to the local community.
Nutrition, Oral frailty, Dietary education
Department of Physiology, School of Dentistry, Aichi Gakuin University
Taste map in a tongue and brain
Although there are species and phylogeny differences in taste, it is common for animals, including humans, to prefer sweet and low-concentration salty tastes and to avoid bitterness, sourness and high-concentration salty tastes. The areas involved are likely to be different among the tongue, taste receptor cells, gustatory nerves, nucleus of solitary tract, parabrachial nucleus, and gustatory cortex. The old “tongue map” has been repudiated, but it is thought that although there is overlap in the brain, information important for life support is sent from the tongue to different regions of the cerebral cortex.
Taste map, Nucleus of solitary tract, Parabrachial nucleus
Saito Dental Clinic, Koto-ku, Tokyo
Role of family dentists as seen from long relationships with patients
Assuming a long relationship with patients, it is often the case that even if a risk is diagnosed, the situation is left on its own with no immediate decision made, then the initial worries end up as being just worries. The changes and clinical responses for risks at the various stage of life—youth, middle age, and old age—are not the same at all. The role of and what has been learned as a family dentist closely connected to the community is considered through an examination of this choice of waiting while learning more about the patient’s lifestyle, and how this waiting was actually done.
Lifestyle habits, Family dentist, Putting dental treatment on hold
Dental Office Panda, Kitanagoya-shi, Aichi
Alleviating composite resin restoration concerns !
Composite resin (CR), which allows aesthetic restoration based on the MI (Minimal Intervention) concept, is now a standard part of treatment as one type of permanent restoration. In this change, some patients may claim that they are concerned about the brown lines along the margins or that eating cold things stings, or it hurts when they bite, following CR restoration. This paper considers the causes of these issues, and presents the author’s style of treatment which aims to avoid problems as much as possible.
CR restoration, Brown line, Postoperative pain
Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Tokyo
Antimicrobial stewardship in dentistry from the viewpoint of antimicrobial resistance: prevention of surgical site infection and treatment of odontogenic infection
Inappropriate use of antimicrobials has led to an increase in deaths due to antimicrobial resistance (AMR) and is becoming a serious problem worldwide. As dentists, we have many opportunities to prescribe antimicrobials in daily clinical practice. Therefore, it is necessary to reconsider whether such prescription is really necessary, and whether the appropriate antimicrobials are being administered for the proper usage and in the proper dosage, that is, whether antimicrobial stewardship (AMS) is being performed. This article describes AMR action plans in Japan and the prevention of surgical site infection and treatment of odontogenic infection based on AMS.
Antimicrobial resistance (AMR), Antimicrobial stewardship (AMS), Surgical site infection (SSI)
Department of Pediatric Dentistry, School of Dentistry, Showa University
Caries prevention in infants according to their stage of development
Dental caries is a disease caused by both bacterial infection and lifestyle. Infancy is a period of remarkable mental, physical and dental development, and changes in lifestyle such as eating habits are also remarkable. Therefore, the risk factors of dental caries vary according to an infant’s stage of development. For the prevention of dental caries in infants, it is important to control caries risk in accordance with the stage of development, and to support the establishment of a better lifestyle in children through dental caries prevention.
Mutans streptococci, Eating habits, Oral cleaning habits
Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital
Areas of obstetrics and gynecology that every dental professional needs to know about
Obstetrics and Gynecology (Ob/Gyn) is closely tied to dentistry in many respects. Each of the four subspecialties of Ob/Gyn has areas related to dentistry, such as the association between periodontal disease and adverse pregnancy outcomes in perinatology, the effects of the oral environment on fertility in reproductive endocrinology, the prevention of HPV-related cancer (e.g., uterine cervical cancer and oral cancer) by HPV vaccine in gynecologic oncology, and the amelioration of oral diseases after menopause by hormone replacement therapy in women’s health care. Collaboration between Ob/Gyn and dental professionals based on this knowledge will improve the QOL of Japanese women.
Pregnancy outcome, HPV, HRT
Shoko GAMOH 1), Shinya KOTAKI 2)
1) Health Promotion Division, Public Health Bureau, Osaka City Government
2) Department of Oral Radiology, Osaka Dental University
Best use of oral radiology in the practice of contemporary dentistry: possible pitfalls
Oral radiology is a eld of dentistry that has developed as a result of technological innovations and continues to change in accordance with the latest knowledge. Yet, no matter how speedy the technology advances, initial clinical choices are always made based on conventional intraoral and/or panoramic radiography. Therefore, it is crucial for dental clinicians to understand the signicance of radiology when interpreting radiological ndings, the principles of imaging, as well as possible pitfalls in regard to such things as infection control and radiological protection. We herein describe these basic techniques, with tips on using x-ray effectively from a radiological point of view.
Imaging diagnosis, Radiological protection, Oral and maxillofacial radiology specialist
Sachiyo TOMITA, Atsushi SAITO
Department of Periodontology, Tokyo Dental College
Periodontal disease and preterm birth / low birth weight: current evidence and considerations indental treatment
Periodontal disease is associated with various systemic diseases, including preterm birth and low birth weight. It has been reported that periodontal treatment during the 2nd trimester does not prevent the occurrence of preterm or low birth weight, and periodontal treatment for the purpose of preventing preterm birth or low birth weight is not recommended. However, appropriate periodontal treatment during pregnancy can improve periodontal inammation in pregnant women. Obstetrician-gynecologists and dentists should cooperate to engage in educational activities about the need for dental examinations prior to becoming pregnant to reduce the incidence of preterm birth or low birth weight.
Periodontal disease, Preterm birth, Low birth weight
Department of Pediatric Dentistry, Division of Oral Structure, Function and Development, School of Dentistry, Asahi University
Effects of mastication on stress during pregnancy on cerebral dysfunction in offspring
We examined the effects on offspring of pregnancy stress and maternal chewing during pregnancy stress. Mice were divided into three groups: a control group, stress group and chewing group. Pregnancy stress increased corticosterone levels in the dam, which induced anxiety-like behavior and deficiencies in learning ability and cerebral function in the offspring. However, cerebral dysfunction in offspring caused by pregnancy stress can be ameliorated by maternal mastication. It is therefore suggested that mastication during pregnancy is an effective method of coping with stress.
Cerebral dysfunction of offspring, Pregnancy stress, Mastication
Rena OKAWA 1), Kazuhiko NAKANO 2)
1)Department of Pediatric Dentistry, Osaka University Dental Hospital 2)Department of Pediatric Dentistry, Graduate School of Dentistry, Osaka University
Hypophosphatasia: a disease all dentists should be aware of
Hypophosphatasia (HPP) is an inherited skeletal disease caused by low alkaline phosphatase (ALP) activity. It is caused by an ALPL gene mutation that leads to low activity by the tissue non-specific ALP enzyme. The main manifestation is bone hypomineralization and early exfoliation of primary teeth, the latter being caused by disturbed formation of cementum. A clinical nding of early exfoliation of primary teeth enables diagnosis of mild HPP. HPP is a progressive disease, for which early diagnosis and management by a medical doctor is necessary. Therefore, medical and dental collaboration is very important for early diagnosis followed by management of patients.
Hypophosphatasia, Early exfoliation of primary teeth, Medical and dental collaboration
Takaoka Dental Clinic, Minato-ku, Tokyo
A re-examination of normative X-ray photography
Dental problems are characterized by a chronicity that makes outcomes dif cult to predict. Dentists are therefore burdened with the task of conveying outcomes of problems whose outcomes are dif cult to predict to patients who want to know what lies ahead. With the future not being easily read, we as dentists must refrain from invasive procedures and observe the progress of the subject over the course of time. The basis of our treatment of dental problems should be the compiling of detailed clinical records. X-ray photographs being representative of clinical records, this paper addresses the knowledge required to acquire high-quality X-ray photographs and discusses the significance of clinical observation based on X-ray photographs accumulated over time.
X-ray photography, Standardization, Chronic disease
TF Sakae Orthodontic Clinic, Nagoya-shi, Aichi
What's happening to the dentition and jaws of Japanese children: management of mandibular second molar eruption disturbances
Japanese children have come to eat mainly soft and easy-to-eat foods. With the morphology of the mandible being made smaller by a decrease in functional masticatory load, the incidence of malocclusion has been increasing, and eruption disturbances such as impaction of the mandibular second molar are often encountered in daily clinical practice. This paper reveals the etiology of eruption disturbances of the mandibular second molars and looks at how they can be predicted, prevented, and dealt with.
Mandibular second molars, Eruption disturbances, Short mandibular body length
Yuko OGUMA 1), Yoshinobu SAITO 2)
1)Sports Medicine Research Center & Graduate School of Health Management, Keio University
Promotion of physical activity, considering the systems approach and connection with dentistry
Physical activity has many health benefits, yet inactivity is widespread worldwide. The World Health Organization (WHO) launched the “Global Action Plan on Physical Activity 2018-2030 (GAPPA)” in June 2018. Promotion of physical activity also contributes to the achievement of the 2030 Sustainable Development Goals. It is important to create co-benefits through multidisciplinary cooperation and system thinking. We also cover Japanese policies, the progress and achievements of community-wide physical activity promotion in the form of the Fujisawa +10 Project in Fujisawa City, as well as the possibilities of collaboration with dentistry.
Systems approach, Sustainable Development Goals (SDGs), Co-benefit
Division of Pediatric Dentistry, Department of Human Development and Fostering, School of Dentistry, Meikai University
What should a general practitioner do in dental treatment for children?
For highly specialized dental treatment requiring oral surgery or orthodontics, it is common to introduce the patient to a specialized dentist. Nevertheless, in the case of children, except those with a disability, it is usual for the general practitioner to provide such treatment. On the other hand, much attention has been paid to the occurrence of accidents in the dental treatment of children, making it problematic for general practitioner to know what to do about treating children. This paper seeks to determine what the general practitioner should do in regard to children, identifying cases where children should be introduced to a specialized dentist, and stressing the importance of cooperation among general practitioners, pediatric-specialized dentists, and advanced medical institutions such as university hospitals.
Pediatric-specialized dentist, Hospital and clinic cooperation, Medical safety
Takayanagi Dental Clinic, Satte-shi, Saitama
How to select and use tools for toothbrushing based on behavioral science
Toothbrushing not only helps prevent oral disease but also has a greatly positive effect on dental treatment; therefore, support for daily toothbrushing is key to maintaining good oral health. In giving toothbrushing instructions, it is important to recommend solutions by which oral health behavior can be improved by daily action, and in a fun way, keeping in mind the practicalities that this might involve for the patient. Therefore, dental professionals should have a complete understanding of how tools such as the toothbrush function, and provide patients with evidence-based oral healthcare support.
Tooth brushing instruction, Fluoride toothpaste, Toothbrush
Department of Restorative Dentistry and Endodontology, Division of Oral Infection and Disease Control, Graduate School of Dentistry, Osaka University
Guidelines-compliant dental caries treatment: a dental caries management-based clinical strategy
The minimal intervention (MI) policy has been accepted worldwide. To help disseminate this policy and make it a part of general practice, the Japanese Society of Conservative Dentistry developed an evidence-based clinical guideline for restoring carious permanent teeth in adult patients. The guideline offers a practical expert view on how to treat caries with minimal intervention, incorporating the best scienti c evidence, the latest techniques, the preferred materials and the general consensus of expert clinicians. This paper discusses non-invasive treatments of incipient caries on the enamel, management of root caries in the elderly, and pulp protection against deep carious lesions.
Caries, Clinical guidelines, MI
Kuroe Dental Ofﬁce, Nanyo-shi, Yamagata
Noncarious cervical lesions（NCCLs）revisited
Noncarious tooth surface loss at the cervical region is termed noncarious cervical lesion (NCCL) and is a commonly encountered dental hard tissue lesion. Abrasion, erosion and abfraction have been proposed as the causes of NCCLs. However, abfraction was a hypothesis with weak scientic evidence when it was introduced and has not been verified to date. Therefore, recent literature reviews on NCCLs do not support the abfraction hypothesis; yet, most Japanese dentists are not aware of this fact. This article reconsiders NCCLs by summarizing the historical background and current status of the abfraction hypothesis.
NCCL, Tooth wear, Abfraction
Division of Hygiene and Oral Health, Department of Special Needs Dentistry, School of Dentistry, Showa University
Evaluation of and support for oral function: developmental dysfunction and functional decline
Japan is facing new challenges due to its declining birthrate and aging population. In pediatric dentistry, oral function has become a focus of attention thanks to a decrease in the incidence of caries, and in geriatric dentistry, thanks to more than 50% of the over-80-year-old population now retaining at least 20 teeth. It is well known that childhood oral dysfunction causes dentition irregularities and gingivitis, and that geriatric oral hypofunction can lead to malnutrition, tooth loss, and, in severe cases, choking; so, from here on out, dental care providers must strive to maintain this level of attention to oral function.
Feeding, eating and swallowing function, Developmental insufficiency of oral function, Oral hypofunction
Department of Pediatric Dentistry, School of Dentistry, Osaka Dental University
Prevention of traumatic dental injury and management of root fractured teeth
Traumatic dental injury (TDI) is a common occurrence and a recent paper reported that permanent dentition prevalence is 13 ~ 17% and primary dentition prevalence 17 ~ 29%. With such a high frequency of TDI, prevention becomes the primary goal. In addition, due to a lack of scientific research on TDI, management methods are varied, based on clinical experience, and practiced on a case-by-case basis. In order to improve TDI treatment results, it is necessary to educate practitioners in appropriate management methods for traumatized teeth. This article therefore reviews the current state of TDI in children and young adults (among whom there is a high prevalence), preventive measures, and the management of traumatic root fractures.
Traumatic dental injury (TDI), Prevention, Root fracture
Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology
Oral health care for older people living with dementia: for good eating-based living support
For people suffering from dementia, social interaction and activity can be challenging due to their cognitive decline. For people with dementia to live in the community and enjoy eating in their fi nal days, it is important to provide them with integration support according to the progression of the disease. Importantly, to realize a dementia-friendly community, it is necessary for dental professionals to understand the characteristics of dementia, and to provide oral health care and oral intake support that makes life easier for older people with dementia.
Dementia, Oral health care, Disease characteristics
Nakai Dental Office, Kyoto-shi, Kyoto
The science of prosthodontics on missing teeth: what tooth loss means?
Tooth loss is a disability, not a disease; so, in treating it we should not set an absolute treatment goal, but engage in rehabilitation that attends to the patient's true needs as determined by each case. The scientifi c basis for dealing with multiple tooth loss has to date not always been adequate, but it has come to be understood that there is more to it than just delivering dental prosthesis and expecting them to improve oral health-related quality of life and nutrition intake without fail. This being the case, it is essential to carry out a wide-ranging, comprehensive diagnosis when looking to prosthetic intervention.
Tooth loss, Cure, Dentures
Taniguchi Dental Office, Nagano-shi, Nagano
Regenerative periodontal therapy for furcation involvement: review and clinical cases
Furcation involvement poses a clinical challenge in periodontal treatment and often leads to tooth loss. Regenerative periodontal therapy for furcation involvement can improve the condition and allow long-term tooth survival. In diagnosing an indication, it is important to consider various factors in order to achieve a successful outcome. In addition, CBCT can be used to obtain more detailed information about the defect before treatment and after regenerative therapy.
Furcation involvement, Regenerative periodontal therapy, CBCT
Department of Cardiology, Osaka Medical College
What dentists should know in an era of widespread antithrombotic drug use
The structure of cardiovascular diseases is changing with rapid aging of the population. Antithrombotic agents are required for all of the increasingly common incidents of arteriosclerotic diseases, heart failure, atrial fi brillation and so on. The frequency of encountering patients in dentistry who are taking antithrombotic drugs is increasing. Discontinuation of antithrombotic drugs is dangerous in areas of dental treatment such as tooth extraction. But with antithrombotic therapy becoming ever more diverse and complex, the risk of bleeding and thrombosis needs to be assessed individually. Medical and dental cooperation is key in modern medicine.
Antithrombotic drug, Bleeding risk, Thrombotic risk
Department of Removable Partial Prosthodontics, Tokyo Dental College
Development of double crown system in Germany
The double-crown-retained removable partial denture is standard in Germany. Training in how to fabricate it is included in the university curriculum, and its clinical skills test forms part of the national dental examination. Clinical treatment using a double crown has progressed with the application of implant treatment and CAD/CAM technology, and research has focused on the use of new metal-free materials. Nevertheless, even with such CAD/CAM technology advances, fabricating a good double crown requires the cooperation with a skilled dental technician.
Double crown, Removable partial denture, Germany
Department of Oral Health Science, School of Health Sciences, Meikai University
Saliva research and the oral environment
Oral health is important for general health, and saliva is important for the health of the oral cavity. Saliva protects teeth from acid, contributes to the chewing and swallowing functions, cleans the oral cavity, and maintains the homeostasis of the oral environment. Countless microbes freely inhabit in the oral cavity, which, in comparison to their size, forms a veritable universe. In order to maintain oral health, it is not enough to consider the oral cavity as one uniform space; rather, it is necessary to understand site specifi city. This paper looks at recent fi ndings in saliva research that identify saliva’s importance for the oral environment, such as unstimulated saliva fl owrate, the mechanism of oral dilution, and changes in pH.
Saliva, Saliva pH, Oral environment
Sakura Park Nomoto Dental Office, Chiyoda-ku, Tokyo
Accuracy and possibilities in prosthesis manufacture of the intraoral scanner
The penetration rate for intraoral scanners is around 4% in Japan, making it a device that few dentists are familiar with. However, it is set to become an essential device for future dental treatment. By using an intraoral scanner, it is possible to create a prosthesis directly from digital data of the oral cavity, enabling a seamless digital workfl ow. This will benefi t patients as well as dental clinics and dental laboratories. This paper considers the accuracy and possibilities of the intraoral scanner, including in clinical cases.
Intraoral scanner, 3D printer, CAD/CAM
Junko TANAKA, Masahiro TANAKA
Department of Fixed Prosthodontics, Osaka Dental University
Dual-arch impression method using silicone impression material for domiciliary dental care
The dual-arch impression method is a technique in dental care that came to be covered by health insurance in Japan in 2020. Due to the popularization of portable units for home visits and the increase in the number of remaining teeth in the elderly, the number of fixed dental prostheses is increasing. However, in treating patients with systemic diseases, it is important to reduce the burden on the body compared with that for healthy people. With the dual-arch impression method, the impression of the abutment tooth and the opposing tooth, as well as maxillomandibular registration, can be performed at the same time, and the articulator can be attached in one block. An accurate occlusal surface shape prosthesis can thereby be fabricated. As a result, medical treatment time is shortened and the burden on the patient reduced, which is effective for visiting medical care.
Domiciliary dental care, Dual-arch impression method, Silicone impression material
Dental Office Saburi, Nagoya-shi, Aichi
Interdisciplinary dentofacial therapy
Interdisciplinary dentofacial therapy uses dentofacial analysis to achieve an objective comprehensive diagnosis by which a treatment goal is determined. The specic treatment method uses a fusion of concepts in periodontal treatment, implant treatment, orthodontic treatment and prosthetic-occlusal treatment. Among them, the latest topics are periodontal regenerative therapy, periodontal plastic surgery and surgically facilitated orthodontic therapy (SFOT). Furthermore, by combining these with prosthodontic/orthodontic occlusal reconstruction treatment, it becomes possible to pursue the ideal dentofacial treatment outcomes.
Interdisciplinary dentofacial therapy, Dentofacial analysis, Surgically facilitated orthodontic therapy (SFOT)
Hiroyuki SUMIKAWA, Tomoyoshi UCHIDA
Shimane Dental Association
The prospect of no dental clinics: the case of Shimane prefecture
The purpose of this study is to achieve stable provision of dental care in low upland areas of Japan by getting a concrete picture of districts there that, after 2025, will likely be without dentists, and the estimated number of patients there. The data for the study and resulting estimates for districts in Shimane Prefecture that will be without dentists in 2032 are based on the distribution of dental clinics and estimated number of patients. The issue of surplus dentists is being addressed throughout the whole of Japan, while a shortage of dentists in rural areas is foreseen for the near future. This means that there is an undeniably uneven distribution of dentists in Japan.
Districts without dentists, Uneven distribution, Dental clinic attrition
Yasushi Nishii 1), Takashi Takaki 2), Keisuke Sugahara 3)
1)Department of Orthodontics, Tokyo Dental College,
2)Department of Oral and Maxillofacial Surgery, Tokyo Dental College,
3)Department of Oral Pathobiological Science and Surgery, Tokyo Dental College
Progress and future of surgical orthodontic treatment: patient-centered dentistry for precise, stable treatment results
Surgical orthodontic treatment is a treatment that aims not just to improve facial appearance, but to acquire normal, stable occlusion for each patient and improve mastication, pronunciation and dental aesthetics. For this reason, preoperative orthodontic treatment is important, and ongoing studies are reducing patient discomfort in preoperative orthodontics. In orthognathic surgery, too, highly accurate and stable treatment results are required, so 3D simulation is used to predict the movement of the mandible in three dimensions, and a surgical method is adopted based on the prognosis. In addition, CAD/CAM and Mixed Reality are applied to orthognathic surgery to find solutions that, to date, have depended on the experience and technical finesse of the surgeon.
OQLQ, 3D simulation, CAD/CAM
Katsura Dental Clinic, Sendai-shi, Miyagi
The most basic operation method of class 2 metal inlay restorations
Adhesive resin restoration is now the most widely performed restoration thanks to the development of and improvements in adhesive resin materials. But in the case of major tooth defects, restoring good proximal contact and tooth shape is difficult. Furthermore, biting force can fracture resin restorations and residual tooth substance, and deterioration over time of the interface between the resin materials and the teeth can lead to secondary caries and marginal fracture. Metal inlay restoration is the best surgical procedure for solving these problems. In order to obtain a good postoperative result, it is necessary for less experienced practitioners to obtain accurate knowledge and to train adequately. This paper explains the basic concepts behind inlay restoration.
Caries, Cavity preparation, Metal inlay
Yuichi OHNISHI, Masahiro NAKAJIMA
Second Department of Oral and Maxillofacial Surgery, Osaka Dental University
Early detection of oral cancer: a detection method using optical instruments
Early detection of high-risk disease could greatly reduce both mortality and morbidity due to oral cancer. We describe a simple handheld device that facilitates the direct visualization of oral-cavity fluorescence for the detection of precancerous and early cancerous lesions. Blue excitation light (400 to 460nm) is employed to excite fluorophores in the oral mucosa to produce green-red fluorescence. This technology is based on the premise that normal cells will glow when exposed to excitation light, whereas abnormal cells (precancerous and early cancerous lesions) will absorb excitation light and appear dark. We envisage this device as a suitable adjunct for oral cancer screening and margin setting. In this report, we introduce “lesion visualization” for early detection and treatment of oral precancerous and early cancerous lesions using optical engineering.
Optical instruments, Lesion visualization, Oral cancer
National Center for Geriatrics and Gerontology
Periodontal disease and Alzheimer’s disease: associations and evidence
Alzheimer's disease (AD) is the most common form of dementia in the elderly. However, the etiology of the disease remains unclear and there are no interventions that can control the onset or progression of the disease. Recently, there have been many reports that Porphyromonas gingivalis may be involved in the etiology of AD. Controlling P. gingivalis infection may help to regulate the onset and progression of AD.
Porphyromonas gingivalis, Bacterenemia, Brain inflammation
Yawaragi Clinic, Ikoma-gun, Nara
Health maintenance for dental practitioners— how to go about it: screening, ordinary physical examinations, thoroughgoing physical examinations, and vaccines
Today, there is a host of different kinds of physical examination available. This paper summarizes from a general medical practitioner's perspective the information—evidence-based and of an appropriate volume—needed for health maintenance for the extraordinarily busy dental practitioner. Decisions must be made regarding what cancer screenings, vaccines, and the like, are suitable in terms of one’s age, gender, etc., taking into account such factors as risks and benefits, life expectancy, and cancer screening bias.
Health maintenance, Physical examination, Recommended preventive treatment
Department of Dentistry and Oral Surgery, Hyogo College of Medicine
In dentistry until now, we have implemented nosocomial infection measures as a standard precaution against mainly blood-borne infection such as hepatitis B. For this reason, the use of personal protective equipment (PPE) in the form of a surgical mask and gloves has become widespread. Fortunately, there have been no reports of any large-scale COVID-19 clusters in dentistry at present, yet aerosol-borne infection measures are required, and additional PPE such as face shields is desirable for prevention. An ongoing approach to planning ever improved nosocomial infection measures will be important.
COVID-19, Standard precautions, Aerosol
Kenichi IMAI 1), Ryutaro KOBAYASHI 2)
1) Department of Microbiology, Division of Immunology and Pathobiology, Dental Research Center, Nihon University School of Dentistry 2) Oral Surgery Department, Nippon Dental University Hospital
The novel coronavirus disease (COVID-19): its significance for the oral cavity and the importance of oral health management
The novel coronavirus (SARS-CoV-2) pandemic greatly impacts people's daily life, including their dental treatment. The oral cavity is an important portal for ingress of SARS-CoV-2, being an entryway to the bronchial tubes, alveoli, and the rest of the lower respiratory tract, in which inflammation by viral infection is caused. There is the possibility that aspiration of oral bacteria in saliva into the lower respiratory tract may be a complicating factor for COVID-19. Also, it has been reported that patients with COVID-19 co-morbidities, such as chronic obstructive pulmonary disease or diabetes, are at greater risk of disease aggravation and a higher death rate, and that these co-morbidities have a strong connection to periodontal disease and oral bacteria. Furthermore, with host receptors for SARS-CoV-2 having been found on the tongue and with oral mucosae and saliva being used recently for COVID-19 testing, the oral cavity has come under renewed scrutiny. Because oral health management such as oral hygiene instruction and plaque control is effective in preventing pneumonia, oral health management not only prevents the co-morbidities involved in aggravating COVID-19 but may also be effective against the progress of COVID-19 itself, the main symptom of which is inflammation of the lower respiratory tract. SARS-CoV-2 can be transmitted via non-symptomatic carriers, which calls for renewed anti-infection measures in place at the time of dental treatment, including those against microdroplets and aerosol spray. This paper addresses the significance and importance of the oral cavity in terms of COVID-19 prevention, mainly in the form of insights based on oral health management and dental research. Simultaneously, it discusses infection control measures in dental practice during the time of the novel coronavirus.
Novel coronavirus (SARS-CoV-2), Novel coronavirus disease (COVID-19), Oral health management
Edited by the task team on the development of the guidance on the dental practice, Japan Dental Association
In August 2020, the Japan Dental Association published the “Guidance on the dental practice in response to new infectious diseases (fi rst edition)”. The Guidance was developed by the task team on the development of the guidance on the dental practice in response to new infectious diseases (chaired by Dr. Kenro Hori, the President of the Japan Dental Association), consists of six chapters and two reference materials. In this article, we would like to introduce Chapter 4 to Chapter 6 of the Guidance as well as the reference materials (excerpt). We have made slight changes in the chapter/fi gure numbers as well as the layouts of the reference materials and texts for the convenience of the readers. Furthermore, the contents of Chapter 2 and 3 of the Guidance are explained in more details in the article titled “The novel coronavirus disease (COVID-19): its signifi cance for the oral cavity and the importance of oral health management” in this edition (January 2021). The full text is available on the website of the Japan Dental Association. Click here: https://www.jda.or.jp/dentist/coronavirus/upd/file/
Novel coronavirus disease (COVID-19), Infection prevention, Dental practice
Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital
Preventing the spread of COVID-19 in dental practice
Transmission of COVID-19 occurs mainly via airborne droplets and contact. Case reports suggest transmission may also occur via aerosols (smaller droplets that remain suspended in the air). Masks are effective not only to prevent the spread of droplets and aerosols containing SARS-CoV-2 but also to provide some protection from transmission. SARSCoV-2 is detected in saliva. Staff members are required to wear personal protective equipment including a face mask, gloves, and an eye shield in dental practice. Cleaning, disinfecting with alcohol, and ventilation are necessary to prevent patients and staff from infection. It should also be borne in mind that there is a risk of COVID-19 spreading through close contact, eating, drinking, and conversation in the staff room.
COVID-19, SARS-CoV-2, Dental practice
Suese Dental Clinic, Ikoma-shi, Nara
Points for clinical application of anterior CAD/CAM crown
Medical insurance coverage was extended in 2014 to CAD/CAM crowns for treating premolars, and six years later, in 2020, this coverage is to be extended to CAD/CAM crowns in the anterior region. When applying a CAD/CAM crown to an anterior tooth, esthetic considerations are required in addition to the abutment preparation, adaptation and bonding procedures. The resin block to be used is positioned as Type 4, and a laminated structure of three or more layers is required in consideration of color tone reproducibility. From the perspective of possibly having to later remove restoration work from the oral cavity, if the conditions are right, then an advanced CAD/CAM crown can be used for restoration from the anterior teeth to the first molars.
Anterior CAD/CAM crown, Medical insurance treatment, Esthetic restoration
Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences
An introduction to intraoral sonography
Among the cross-sectional imaging techniques including CT, MRI, and other imaging modalities, ultrasonography is a convenient, safe, and noninvasive technique that provides real-time imaging with excellent spatial resolution of soft tissue. However, ultrasonography has a difficulty in visualizing the internal structure of the hard tissue and this major disadvantage makes it difficult to adapt the ultrasonography to the general dental practice. Even so, I do think that the intraoral sonography will be one of the promising alternative techniques for the point-of-care approach in the dental diagnostic imaging field if the dedicated inexpensive ultrasound probe optimized for intraoral scanning will be released.
Diagnostic imaging, Ultrasonography, Intraoral sonography
Hiroyasu KOIZUMI 1), Hideo MATSUMURA 2)
1) Department of Dental Materials, Nihon University School of Dentistry
2) Department of Fixed Prosthodontics, Nihon University School of Dentistry
Cast titanium in molar restorations
Milled titanium has been used extensively as dental implant material due to its biocompatibility and mechanical properties. There is, however, room for improvement in casting performance and handling properties, especially when grinding and polishing titanium in order to cast restorations and dentures. This article describes the characteristics of titanium casting compared with those of other dental metal alloys also used in casting. It also discusses differences in technical characteristics between cast restoration and restoration using computer-aided design and computer-aided manufacture (CAD/CAM). In conclusion, titanium casting appears to be useful with patients for whom other dental metal alloys are unsuitable. Also, castings, including those made of titanium, have broad use in numerous cases where fabrication of restoration using CAD/CAM is difficult.
Argon gas, Calcium aluminate, Magnesia
Department of Pediatric Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Dental caries specific to childhood
Recent studies have shown an overall reduction in dental caries during childhood in Japan, though a bipolarized trend has also become prominent with the number of children affected by severe dental caries increasing. Severe dental caries appearing in childhood is caused by inappropriate lifestyle behavior, thus instructions to improve daily habits are crucial for guardians as well as patients. It is important for dentists and dental clinic staff to understand etiologic factors related to the various types of dental caries identified in children, so as to provide effective guidance to help their patients make appropriate lifestyle choices based on an understanding of the reasons for occurrence of dental caries in individual cases.
Dental caries, Childhood, Lifestyle
Nishimoto Dental Clinic, Nagahama-shi, Shiga
Can the dental pulp be saved or not? : the true reason for failure in vital pulp therapy
One of the most important factors for success in vital pulp therapy is prevention of bacterial infection. Diagnosis requires appropriate examination and proper interpretation of what is observed in order to establish whether the pulp is necrotic or not. The integrity of direct pulp capping, indirect pulp capping and nal restoration is a critical factor in preventing bacterial microleakage. These procedures affect the success rate of vital pulp therapy.
Vital pulp therapy, Direct pulp capping, Indirect pulp capping
Tsurumi University School of Dental Medicine
Adult caries risk and its internationally standardized management
Caries risk is defined as “the probability of new caries occurrence and progression of existing caries in the future of an individual.” Cariology has been warning us that the true goal of caries treatment is neither operative nor restorative, but to suppress caries risk throughout one’s life. In this article, lifelong caries risk is explained for each life stage. Evidence-based management of the risk is then presented according to internationally standardizing systems, including ICDAS. To control the progression of existing caries, the clinically relevant efficacy of fluoride materials used in self-care and professional care is emphasized.
Caries risk, Fluoride, ICDAS
Tokiwa Orthodontic Clinic, Shinjuku-ku, Tokyo
Diagnosis and treatment for impacted teeth taking into account the development of normal occlusion: points for sharing with general dentists
Disturbed tooth eruption, for whatever cause, results in permanent teeth remaining in the alveolar bone and becoming impacted; and, if left untreated, it hinders the completion of normal permanent dentition. It is therefore important that the treatment of impacted teeth is approached not only according to the timing and symptoms after various thorough examinations, but also that diagnosis and treatment take future individual normal occlusion into account and are carried out in cooperation with each medical specialist concerned.
Impacted teeth, Fenestration and retraction, Orthodontic treatment
Takashima Dental Clinic, Mino-shi, Osaka
The importance of childcare support at the dental clinic
Quality of oral function is closely related to quality of life. In particular, development of oral function is closely related to the environment during the fetal period and the two years after birth. Dental support may be needed from an earlier stage than ever for a child to grow up with high quality oral function. We believe that it is possible to relieve anxiety and support the health-related behavior of both mother and child by providing support at the dental clinic for problems related to baby food and tooth brushing, which are often raised as problems in child-rearing. In this article, I explain how to do that.
Childcare, Baby food, Tooth brushing