Association between tooth loss and adherence to oral maintenance in a dental clinic: A retrospective study of more than 20 years.

OBJECTIVES: The relationship between adherence to professional oral maintenance visits and tooth loss is generally accepted in periodontal treatment; however, this relationship has not been clarified in general dental practices. We evaluated the effectiveness of adherence to professional maintenance by a retrospective survey in a private practice. METHODS: We retrospectively extracted data of 395 patients in a general dental practice who had been followed for more than 20 years. For comparisons, two patient groups were created based on oral maintenance rates: a high- (≥75%) and a low- (<75%) adherence groups. Additionally, multiple logistic regression analysis for tooth loss was conducted with the same two adherence groups and three adherence groups (<50%, ≥50% and <75% and ≥75%), adjusting with risk factors including sex, age, decayed, missing, and filled teeth (DMFT), periodontal status, smoking status, and diabetes at the beginning of maintenance. RESULTS: The number of teeth lost and increased DMFT over time were significantly lower in the high-adherence group than in the low-adherence group. Multiple logistic regression analysis for tooth loss in the two adherence groups yielded an odds ratio (95% confidence interval) of 6.50 (3.73-11.32) in the low-adherence group relative to the high-adherence group. Further analysis with the three adherence groups showed highest risk in the low-adherence group and a higher risk in the moderate-adherence group than the high-adherence group. CONCLUSIONS: Patients with high adherence to maintenance schedules for more than 20 years demonstrated significantly less tooth loss. Dental practitioners should promote high adherence to professional maintenance in general dental practices.

A survey of oral health status, subjective oral symptoms and oral health behaviors among first-year dental students at a Japanese university.

PURPOSE: The rapid deterioration of oral health in young adults is an alarming problem in Japan. The aim of the present study is to investigate the oral health status, subjective oral symptoms and oral health behaviors of dental students. METHODS: Participants were 108 first-year students attending dental school in 2018-2019. Oral examinations were performed to assess dental caries indices, oral hygiene status, gingival bleeding on probing (BOP) and pocket depth. A self-administered questionnaire was used to assess subjective oral symptoms and oral health behaviors. RESULTS: The prevalence of decayed teeth (DT) and gingivitis (BOP ≥ 10%) were 43.5% and 50.0%, respectively. Having DT and gingivitis were significantly associated with poorer oral hygiene. No association was observed between DT and subjective symptoms. Having gingivitis was significantly associated with xerostomia, mouth-breathing and less use of interdental cleaning tools. Multiple logistic regression analysis for gingivitis yielded an odds ratio of 1.41 (95% confidence interval: 1.19-1.67) for plaque score, and 2.75 (1.27-5.98) for xerostomia. CONCLUSION: Since a relatively high ratio of students had DT and gingivitis without clear subjective symptoms, they require regular dental visits for early treatment and oral hygiene maintenance from the start of their time at university.

Assessment of psychological changes in young children during dental treatment: Analysis of the autonomic nervous activity and electroencephalogram.

BACKGROUND: Understanding the emotional changes in children during dental treatment is necessary for providing stress-free care. AIM: To objectively assess the stress associated with dental treatment in children, based on the autonomic nervous activity and the electroencephalogram (EEG). DESIGN: Twenty-two children aged 4-9 years were recruited from outpatients of a paediatric clinic. Electrocardiogram and EEG were recorded throughout the treatment to analyze the autonomic nervous activities and the powers of brain waves, respectively. Changes in these measurements during each treatment process were evaluated in two age groups: 4-6 years and 6-9 years. RESULTS: Elevations in sympathetic activities accompanied by decreased parasympathetic activities induced by stress were observed during rubber dam setting (RD) in the age group of 4-6 years and during infiltration anesthesia (IA), RD, and cavity preparation with a dental turbine (CP-T) in the age group of 6-9 years. Stress-related beta wave increments in EEG were observed during IA and CP-T in the age group of 6-9 years but not in the age group of 4-6 years. CONCLUSION: Monitoring the autonomic nervous activities during treatments is useful in assessing stresses in a wide age of young children, whereas EEG monitoring is applicable only to children older than 6 years.

Perception of pungent, gustatory and olfactory stimuli in patients with congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disease caused by a mutation in the nerve growth factor (NGF) receptor, which results in an absence of Aδ and C fibers. It can be considered that this defect may also lead to deterioration of oral sensations. The aim of the present study was to clarify the ability of CIPA patients to perceive pungent, gustatory, and olfactory stimuli, which is essential for eating function, and the impact of the defect on dietary habits. Sensitivities to capsaicin and the five basic tastes were evaluated by measuring their threshold values, and dietary habits were examined using a questionnaire. Additionally, odor identification ability was evaluated using the odor stick method. The detection threshold for capsaicin and the recognition threshold for sour taste were significantly higher in the patients than in healthy volunteers. The questionnaire responses showed that the patients consumed spicy food more often. All patients were able to identify the tested odors, except those to which they had not been well accustomed. Since the abilities of CIPA patients to perceive taste and smell were not basically impaired, despite their lower sensitivity to capsaicin, it was suggested that their dietary habits were only minimally affected, except for intake of pungent foods.

Trends in domiciliary dental care including the need for oral appliances and dental technicians in Japan.

The need for domiciliary dental care (DDC) for people requiring long-term nursing care is increasing as the super-aged society of Japan grows still older. Dysphagia diagnosis and rehabilitation are becoming more important in DDC; thus, the need for prostheses used for dysphasia rehabilitation is presumed to be increasing. To identify DDC trends in Japan, as well as the need for prostheses and dental technicians for DDC, we sent a self-administered questionnaire to dentists providing DDC and analyzed responses from 138 dentists (valid response rate, 39.8%). The results showed that 37.7% of respondents reported treating ≥50 patients per month. The most frequently performed procedures were removable prosthetic treatment and oral care, followed by dysphagia rehabilitation. Use of palatal augmentation prostheses was experienced by 54.3% of respondents, and most indicated that the prostheses were effective for improvement of oropharyngeal function. The rates of cooperation with primary care doctors and nursing care professionals were 76.8% and 85.5%, respectively. Only 6.5% of respondents reported accompanying dental technicians to DDC. The present analysis of trends in DDC indicates that oral care and dysphagia rehabilitation have become more frequent and that cooperation with healthcare professionals other than dental technicians has increased in recent DDC.

Effects of oral stimulation with capsaicin on salivary secretion and neural activities in the autonomic system and the brain.

BACKGROUND/PURPOSE: Although it has been reported that capsaicin ingestion has effects of protecting stomach mucosa and promoting energy consumption, physiological responses to oral stimulation with capsaicin has not been elucidated. Therefore, we investigated the effect of oral capsaicin stimulation on oral health and mental conditions by measuring changes in salivation, autonomic nervous activity and electroencephalogram (EEG). MATERIALS AND METHODS: Eighteen healthy adults participated in this study. The stimulus concentrations of capsaicin and five basic taste solutions were determined based on the measured threshold of each stimulus in each subject. The weight of secreted saliva and the changes in concentrations of salivary secretory immunoglobulin A (SIgA) induced by capsaicin and taste stimuli were measured. Salivary α-amylase activity and heart rate variability (HRV) were measured as indicators of autonomic nervous activity. From EEG, psychological condition was analyzed by measuring the powers of theta, alpha, and beta bands. RESULTS: The salivary secretion rate was significantly increased by stimulation with capsaicin, NaCl, and citric acid compared with deionized water, and capsaicin demonstrated the most potent effect among tested stimuli. The secreted amount of SIgA per minute was elevated by capsaicin stimulation. Salivary α-amylase activity and HRV analysis demonstrated an elevation of sympathetic nervous activity induced by capsaicin. EEG analysis showed a significant increase in beta band power. CONCLUSION: These results suggest that oral stimulation with capsaicin may be effective in improving oral conditions by increasing salivary flow and SIgA secretion, and in enhancing physical and mental conditions as indicated by sympathetic nerve and EEG changes.

[Survey of Dental Treatment Situation and Needs for Prostheses in Veterinary Practice].

PURPOSE: In today's society, pets have become important members of families since they give mental peace and healing to families. Although veterinary dentistry is recognized to be essential for animal health, there are few reports on dental treatments of animals and the relationship between veterinarians and dental technicians. The purpose of the present study was to clarify the current situation of dental treatments of animals and to discuss the involvement of dental technicians in veterinary dental treatments and their collaboration with veterinarians. METHODS: Anonymous self-administered questionnaires were mailed to 16 university hospitals for animals, 17 animal clinics, and 87 zoological gardens, and handed out to 36 participants at the oral disease seminar organized by Nippon Animal Hospital Association. The questionnaires included questions on veterinary dental treatments, ways to learn veterinary dentistry, and details of prosthodontic treatments. RESULTS: Eighty-two valid responses (51.3%) were obtained. While 93.8% of veterinarians recognized the need for veterinary dental treatments, 67.9% were actually implementing dental treatments. Only 23.5% of veterinarians who conducted dental treatments experienced prosthodontic treatments, and the major prostheses used for treatments were fillings and crowns. Most veterinarians had fewer opportunities to acquire knowledge and skills about dental treatments. In addition, the recognition of dental technicians and their specialties was low among veterinarians. CONCLUSION: The results suggested that the dental technician, as a member of a multi-disciplinary team, can contribute to animal health by providing prosthetic appliances and should make efforts to enhance awareness of their specialty.

Characteristic changes of saliva and taste in burning mouth syndrome patients.

BACKGROUND: Burning mouth syndrome (BMS) is characterized by chronic pain with a burning sensation of the tongue and oral mucosa and reported to be often accompanied by subjective xerostomia and dysgeusia. Since the etiology of BMS has not been elucidated, to understand the characteristics of BMS, we measured some components of saliva and taste sensitivity and compared the measured values between BMS and healthy subjects. METHODS: Unstimulated saliva was collected from 15 female BMS patients and 30 healthy women. The flow rate, viscosity (spinnability) and concentration of secretory IgA (SIgA) of saliva and serum antioxidant capacity were measured. The recognition thresholds for sweet, salty, sour, bitter, and umami tastes were measured by whole-mouth method. The statistical analyses were performed using Student's t-test, and P < 0.05 was considered to be significant. RESULTS: In BMS group, the flow rate of saliva was significantly lower and the spinnability was significantly higher compared with healthy group. The secreted amount of SIgA per min and serum antioxidant capacity was significantly lower in the patients. The threshold for sourness in patients was significantly higher, while those for other tastes did not differ from healthy group. CONCLUSIONS: BMS patients showed lower salivary flow and higher salivary spinnability. These results together with decreased SIgA amount, suggest that BMS may be relevant to the deterioration of salivary condition, which could in turn affect taste function. Furthermore, the lower antioxidant capacity in patient's serum suggests that it can serve as a diagnostic tool for BMS.

Emotional relationships between child patients and their mothers during dental treatments.

BACKGROUND/PURPOSE: The behavioral control of child patients is an important issue in pediatric dentistry. The emotional states of the mothers of patients may influence the attitudes of their children. The aim of this study was to investigate the emotional states estimated from physiological responses of child patients and the subjective anxieties of their mothers during dental treatments and discuss the emotional relationships between children and their mothers. MATERIALS AND METHODS: To assess physiological responses associated with emotional changes induced by dental treatments in child patients aged 3-6 years, activity in the autonomic nervous were analyzed from variations in inter-beat intervals in electrocardiogram. Anxiety levels of accompanying mothers were examined using the State Trait Anxiety Inventory, which was filled out during the treatment of their child. RESULTS: Regarding the stress of child patients from the aspect of autonomic nervous activities during dental treatments, comparison between the cooperative and uncooperative patient groups showed that the uncooperative group demonstrated significantly higher sympathetic nervous activity and significantly lower parasympathetic nervous activity relative to the cooperative group, and their accompanying mothers showed significantly higher state anxiety scores relative to the mothers of cooperative children. Moreover, positive correlation between state anxiety scores of mothers and sympathetic nervous activities of their children was observed. CONCLUSION: These results indicated that uncooperative child patients undergo more stress and their mothers feel more anxiety from dental treatments, resulting in an emotional relationship between children and their mothers, which requires dental professionals to make special considerations to calm the anxiety of the mother, as well as the stress of the child patient.

Analysis of physiological responses associated with emotional changes induced by viewing video images of dental treatments.

Since the understanding of emotional changes induced by dental treatments is important for dentists to provide a safe and comfortable dental treatment, we analyzed physiological responses during watching video images of dental treatments to search for the appropriate objective indices reflecting emotional changes. Fifteen healthy young adult subjects voluntarily participated in the present study. Electrocardiogram (ECG), electroencephalogram (EEG) and corrugator muscle electromyogram (EMG) were recorded and changes of them by viewing videos of dental treatments were analyzed. The subjective discomfort level was acquired by Visual Analog Scale method. Analyses of autonomic nervous activities from ECG and four emotional factors (anger/stress, joy/satisfaction, sadness/depression and relaxation) from EEG demonstrated that increases in sympathetic nervous activity reflecting stress increase and decreases in relaxation level were induced by the videos of infiltration anesthesia and cavity excavation, but not intraoral examination. The corrugator muscle activity was increased by all three images regardless of video contents. The subjective discomfort during watching infiltration anesthesia and cavity excavation was higher than intraoral examination, showing that sympathetic activities and relaxation factor of emotion changed in a manner consistent with subjective emotional changes. These results suggest that measurement of autonomic nervous activities estimated from ECG and emotional factors analyzed from EEG is useful for objective evaluation of subjective emotion.

Effectiveness of an oral health educational program on community-dwelling older people with xerostomia.

AIM: The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia. METHODS: Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention. RESULTS: A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05). CONCLUSIONS: The present study suggests that the educational program targeting oral function improvement is effective among the independent older population.

Objective assessment of internal stress in children during dental treatment by analysis of autonomic nervous activity.

AIMS: The aim of this study was to assess the internal stress of children during dental treatment based on autonomic nerve activity and facial muscle activity. METHODS: We recorded the electrocardiogram of children during the treatment of composite resin restoration and analysed autonomic nerve activity by means of power spectral analysis of heart rate variability. Simultaneously, electromyography (EMG) activity of the corrugator muscle was recorded in children during dental treatment, and the relationship between sympathetic nerve activity and corrugator EMG activity was analysed. RESULTS: In all subjects, the mean sympathetic nerve activity was significantly higher during oral examination and after treatment compared with pre-treatment. Depending on the sympathetic nerve responses to the other treatment procedures, the subjects could be classified into two groups: the stress group and the nonstress group. Sympathetic nerve activity was significantly higher during infiltration anaesthesia and cavity preparation compared with pre-treatment activity in the stress group, whereas it was consistently lower than the pre-treatment levels during most treatment procedures in the nonstress group. The mean amplitudes of the averaged corrugator muscle EMG during dental treatment did not differ between the stress and nonstress groups. CONCLUSION: The present results suggest that the measurement of autonomic nervous activity, especially sympathetic nervous activity, is quite useful in assessing the internal stress of children, even when no expressed sign of unease are present during dental treatment.

[Career history and perceptions of dental hygiene education programs--questionnaire mail-in survey of alumni of the School of Dental Hygiene in Tokyo Medical and Dental University].

This study was conducted to investigate the career history and perceptions about dental hygiene education programs among the alumni (1952-1999 graduates) of the School of Dental Hygiene in Tokyo Medical and Dental University. A questionnaire containing demographic, practice characteristics and views on the programs was mailed to 997 alumni in 1999, and 576 alumni (57.8%) responded. Three hundred and forty-one respondents worked as dental hygienists. The majority who responded were in clinical practice. One hundred and thirty-one of the respondents worked in private clinics, 76 in public health centers, and 72 in clinics in companies. The rate of them who worked in public health centers was much higher than the national average cited in the Statistical Report on Public Health Administration and Services. Two hundred and ninety-one respondents reported inadequate programs. The rate of them who reported inadequate programs was significantly higher in alumni who were working than in alumni who were not. The items cited as insufficiently taught at the school were clinical practice, instrumentation, foreign language, psychology, counseling, and nursing related subjects. Thus, many alumni suggested the need for better programs and continuing education. From these results, it was suggested that dental hygienists need to change their education programs in order to meet the present and future needs of more diversified society. This view was particularly prevalent among alumni who were working. The result showed that dental hygiene educators and dental hygienists urgently need to reconsider the professionalism of their field.

[In vitro susceptibilites to levofloxacin and various antibacterial agents of 11,475 clinical isolates obtained from 52 centers in 2002].

The susceptibilities of bacteria to fluoroquinolones (FQs), especially levofloxacin, and other antimicrobial agents were investigated using 11,475 clinical isolates collected in Japan during 2002. Methicillin susceptible staphylococci, Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis, the family of Enterobactericeae, Haemophilus influenzae and Acinetobacter spp. exhibited stable and high susceptibilities to FQs. The rate of FQs-resistant MRSA was 80 approximately 90%, being markedly higher than that of FQs-resistant MSSA. The FQs-resistance rate of MRCNS was also higher than that of MSCNS, however, it was lower than that of MRSA. No FQs-resistant clinical isolates of Salmonella spp. were detected in any of the surveys. Thirteen of Escherichai coli 696 isolates, 8 of Klebsiella pneumoniae 630 isolates and 33 of Proteus mirabilis 373 isolates produced extended-spectrum beta-lactamase (ESBL), furthermore 6 of 13 in E. coli, 1 of 8 in K. pneumoniae and 14 of 31 ESBL-producing isolates, and in P. mirabilis were FQs resistant. Attention should be focused in the future on the emergence of ESBL in relation to FQs resistance. The rate of FQs-resistant P. aeruginosa isolated from urinary tract infection (UTI) was 40 approximately 60%, while 15 approximately 25% of isolates from respiratory tract infection (RTI) were resistant. IMP-1 type metallo beta-lactamase producing organisms were found in 49 of P. aeruginosa 1,095 isolates, 7 of S. marcescens 586 isolates and 4 of Acinetobacter spp. 474 isolates, respectively. Glycopeptide-resistant enterococci or S. aureus was not found.

Influences of aging on taste perception and oral somatic sensation.

BACKGROUND: Many elderly persons report reduced taste perception of the foods they eat. Any disturbance of taste and oral somatic sensations can induce this phenomenon. To determine the cause of decreased taste perception in older persons, the authors investigated age-related changes in taste perception and somatic sensations in the anterior tongue. METHODS: Thirty healthy young and elderly persons participated in this study. Recognition thresholds of four basic tastes (sweet, salty, sour, and bitter) and the threshold of irritating sensation induced by capsaicin were measured by local stimulation using filter-paper disks. Two-point discrimination thresholds were measured to evaluate the spatial acuity of touch sensation. All measurements were carried out at the tip of the dorsal tongue. RESULTS: The recognition thresholds of all four basic tastes of elderly participants were significantly higher than those of young participants. On the contrary, age-associated changes were not observed in 2-point discrimination and capsaicin sensation. CONCLUSIONS: Significant age-associated deterioration was observed in taste but not somatic sensations such as touch and burning pain in the tongue, showing that aging affects taste perception and oral somatic sensations differently. This suggests that decreased taste perception of foods in elderly people may be caused primarily by perceptual loss of taste among oral sensations.

[Activities of antimicrobial agents against 8,474 clinical isolates obtained from 37 medical institutions during 2000 in Japan].

A survey was conducted to determine the antimicrobial activity of fluoroquinolones and other antimicrobial agents against 8,474 clinical isolates obtained from 37 Japanese medical institutions in 2000. A total of 25 antimicrobial agents were used, comprising 4 fluoroquinolones, 13 beta-lactams, minocycline, chloramphenicol, clarithromycin, azithromycin, gentamicin, amikacin, sulfamethoxazole-trimethoprim, and vancomycin. A high resistance rate of over 85% against fluoroquinolones was exhibited by methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium. Isolates showing resistance to fluoroquinolones among methicillin-resistant coagulase-negative Staphylococci, Enterococcus faecalis, and Pseudomonas aeruginosa from UTI accounted for 30-60%. However, many of the common pathogens were still susceptible to fluoroquinolones, such as Streptococcus pneumoniae (including penicillin-resistant isolates), Streptococcus pyogenes, methicillin-susceptible S. aureus (MSSA), methicillin-susceptible coagulase-negative Staphylococci, Moraxella catarrhalis, the Enterobacteriaceae family, and Haemophilus influenzae (including ampicillin-resistant isolates). About 85% of P. aeruginosa isolated from RTI were susceptible to fluoroquinolones. In conclusion, this survey of sensitivity to antimicrobial agents clearly indicated trend for increasing resistance to fluoroquinolones among MRSA, Enterococci, and P. aeruginosa isolated from UTI, although fluoroquinolones are still effective against other organisms and P. aeruginosa from RTI as has been demonstrated in previous studies.

Improvement of taste sensitivity of the nursed elderly by oral care.

It has been suggested that oral care is essential for improving the quality of life (QOL). The aim of oral care involves not only maintenance of oral health but also enhancement of mastication and appetite by means of improving taste sensitivity. There are, however, few studies that have investigated the effect of oral care on taste sensitivity. In the present study, we focused on tongue brushing among oral care and examined the changes in taste sensitivities by mild tongue brushing in the nursed elderly. Ninety subjects, over 64 years old with ability to communicate, were divided into 2 groups, one was the cared group (subject's tongue was brushed) and the other was the control group (not brushed but rinsed). The thresholds for four primary tastes such as saltiness, sourness, sweetness and bitterness were measured before and after treatments using the whole mouth method. The mean recognition thresholds for salty and sour tastes significantly decreased after tongue brushing in the cared group, while those for all four tastes were not changed after mouth rinsing in the control group. The present result suggests that mild tongue brushing may enhance taste sensitivity of saltiness and sourness in the nursed elderly.

Leptin and sweet taste.

Leptin, the product of the obese (ob) gene, is a hormone primarily produced in adipose cells, and also at smaller amounts in some other peripheral organs. It regulates food intake, energy expenditure, and body weight. Leptin is thought to promote weight loss, at least in rodents, by suppressing appetite and stimulating metabolism. Mutant mice that lack either leptin or functional leptin receptors, such as ob/ob and db/db mice, are hyperphagic, massively obese, and diabetic. Central hypothalamic targets are mainly responsible for the effects of leptin on food intake and weight loss. However, there are also direct effects on peripheral tissues. Recently, the taste organ was found to be one of the peripheral targets for leptin. The hormone specifically inhibits sweet taste responses in lean mice and not in db/db mice. Thus leptin appears to act as a modulator of sweet taste, provided a functional leptin receptor is expressed by the taste cells. This chapter reviews the genetics and molecular biology of leptin and its receptors, the receptor mechanisms for sweet taste, the modulating action of leptin on taste receptor cells, and the consequences for the regulation of food intake.