Periodontal tissue engineering using an apatite/collagen scaffold obtained by a plasma- and precursor-assisted biomimetic process.

BACKGROUND AND OBJECTIVES: In the treatment of severe periodontal destruction, there is a strong demand for advanced scaffolds that can regenerate periodontal tissues with adequate quality and quantity. Recently, we developed a plasma- and precursor-assisted biomimetic process by which a porous collagen scaffold (CS) could be coated with low-crystalline apatite. The apatite-coated collagen scaffold (Ap-CS) promotes cellular ingrowth within the scaffold compared to CS in rat subcutaneous tissue. In the present study, the osteogenic activity of Ap-CS was characterized by cell culture and rat skull augmentation tests. In addition, the periodontal tissue reconstruction with Ap-CS in a beagle dog was compared to that with CS. METHODS: The plasma- and precursor-assisted biomimetic process was applied to CS to obtain Ap-CS with a low-crystalline apatite coating. The effects of apatite coating on the scaffold characteristics (i.e., surface morphology, water absorption, Ca release, protein adsorption, and enzymatic degradation resistance) were assessed. Cyto-compatibility and the osteogenic properties of Ap-CS and CS were assessed in vitro using preosteoblastic MC3T3-E1 cells. In addition, we performed in vivo studies to evaluate bone augmentation and periodontal tissue reconstruction with Ap-CS and CS in a rat skull and canine furcation lesion, respectively. RESULTS: As previously reported, the plasma- and precursor-assisted biomimetic process generated a low-crystalline apatite layer with a nanoporous structure that uniformly covered the Ap-CS surface. Ap-CS showed significantly higher water absorption, Ca release, lysozyme adsorption, and collagenase resistance than CS. Cell culture experiments revealed that Ap-CS was superior to CS in promoting the osteoblastic differentiation of MC3T3-E1 cells while suppressing their proliferation. Additionally, Ap-CS significantly promoted (compared to CS) the augmentation of the rat skull bone and showed the potential to regenerate alveolar bone in a dog furcation defect. CONCLUSION: Ap-CS fabricated by the plasma- and precursor-assisted biomimetic process provided superior promotion of osteogenic differentiation and bone neoformation compared to CS.

[Attitude survey among elderly outpatients in a hospital concerning driving after the implementation of a new road traffic act].

Following the passage of a new traffic law in March 2017, an inquiry survey was performed for 202 patients (men 60.9%, women 39.1%) in a medical center for neurocognitive disorders in Japan. Half of the 108 patients who currently had a driver's license had experienced traffic problems, including nearly crashing accidentally, in the past, but only a few of the men were willing to return their driver's license to the government, regardless of age (<75 and ≥75 years old). They mainly worried about how they would manage daily activities without a car, such as shopping for necessities, visiting the clinic, having the chance to get outside. They also worried about increasing the burden of other family members. In contrast, the other 94 patients who either did not have a driver's license or had already returned them to the government expected only slight issues due to the law, or even felt positive about losing their license. However, roughly half of those 94 patients did not get exchanging benefits (traffic discount card and license record card) on losing licenses probably due to less knowledge about such benefits. The present study revealed various aspects of elderly patients' thoughts concerning their driver's licenses in a local city of Japan.

Antibacterial and Antibiofilm Photodynamic Activities of Lysozyme-Au Nanoclusters/Rose Bengal Conjugates.

Antibacterial photodynamic therapy (aPDT) utilizes reactive oxygen species such as singlet oxygen (1O2) and free radicals via photosensitizers, which are light and light-sensitive agents, to reduce bacterial infections. It has been utilized as a treatment for dental diseases in place of antibiotic therapies. However, aPDT does not always cause the desired therapeutic effect due to the instability of organic photosensitizers and the formation of bacterial biofilms. To promote the antibacterial and antibiofilm effects of aPDT, we have proposed a lysozyme (Lys)-gold nanoclusters (Au NCs)/rose bengal (Lys-Au NCs/RB) conjugate as a novel photosensitizer. This conjugate was found to effectively impede the growth of both gram-positive and gram-negative bacteria when exposed to white light-emitting diode (LED) irradiation. The photoexcited Lys-Au NCs/RB showed significantly higher antibacterial activity than photoexcited Lys-Au NCs or RB alone. The synergistic effect is a result of the combination of Lys (an antibacterial protein) and enhanced 1O2 generation related to resonance energy transfer (RET) in the Au NCs/RB conjugate. Photoexcited Lys-Au NCs/RB increased the effects of aPDT in a dose- and time-dependent manner. Furthermore, the photoexcited Lys-Au NCs/RB successfully decreased Streptococcus mutans biofilm formation. However, in contrast, it did not have a negative effect on the proliferation, adhesion, or spread of mammalian cells, indicating low cytotoxicity. Lys-Au NCs/RB is a novel photosensitizer with low cytotoxicity that is capable of bacterial inactivation and the suppression of biofilm formation, and could help to improve dental treatments in the future.

Antibacterial coating of tooth surface with ion-releasing pre-reacted glass-ionomer (S-PRG) nanofillers.

OBJECTIVES: Surface pre-reacted glass-ionomer (S-PRG) fillers release antibacterial borate and fluoride ions. We fabricated nanoscale S-PRG fillers (S-PRG nanofillers) for antibacterial coating of tooth surfaces and assessed the antibacterial effects of this coating in vitro. In addition, we creating a canine model of periodontitis to evaluate the effectiveness of S-PRG nanofiller application on tooth roots and improvement of periodontal parameters. METHODS: Human dentin blocks were coated with S-PRG nanofiller (average particle size: 0.48 µm) and then characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectrometer (EDX), and ion-releasing test. Antibacterial effects of dentin blocks coated with S-PRG nanofiller were examined using bacterial strains, Streptococcus mutans and Actinomyces naeslundii. Next, we created an experimental model of periodontitis in furcation of premolars of beagle dogs. Then, S-PRG nanofiller coating was applied onto exposed tooth root surfaces. Periodontal parameters, gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL), were measured from baseline until 4 weeks. In addition, bone healing was radiographically and histologically examined. RESULTS: SEM and EDX revealed that S-PRG nanofillers uniformly covered the dentin surface after coating. Dentin blocks coated with S-PRG nanofiller showed ion-releasing property, bacterial growth inhibition, and sterilization effects. In the experimental periodontitis model, S-PRG nanofiller coating significantly reduced clinical inflammatory parameters, such as GI (P < 0.01) and BOP (P < 0.05), compared to uncoated samples. In addition, PPD and CAL significantly decreased by S-PRG nanofiller coating (2 weeks: P < 0.05; 3 and 4 weeks: P < 0.01), suggesting the improvement of periodontitis. Micro-CT and histology revealed that bone healing of furcation defects was enhanced by S-PRG nanofiller coating. CONCLUSION: S-PRG nanofiller coating provides antibacterial effects to tooth surfaces and improves clinical parameters of periodontitis.

In situ precipitation of amorphous calcium phosphate nanoparticles within 3D porous collagen sponges for bone tissue engineering.

Amorphous calcium phosphate (ACP) plays an important role in biomineralization within the three-dimensional (3D) collagen network in human hard tissues, and exhibits osteoconductivity. Porous collagen sponges coated with ACP nanoparticles could be considered as potential scaffolds for use in bone tissue engineering. In this study, such composite materials were fabricated via homogeneous ACP precipitation using a supersaturated calcium phosphate (CaP) solution. Homogeneous ACP precipitation was induced in situ within the sponges by a temperature-controlled coating process composed of two steps. In the first step, the CaP solution was cooled to 4 °C to suppress precipitation until the solution penetrated fully into the sponge's internal pores. In the second step, the CaP solution was warmed up to 25 °C with continuous shaking to induce ACP precipitation within the sponges. The resulting sponges were therefore coated with ACP nanoparticles on their inner and outer surfaces. A simulated body fluid (SBF) test indicated osteoconductivity of the collagen sponges coated with ACP nanoparticles. Further, ACP-coated collagen sponges immobilizing basic fibroblast growth factor (bFGF) were fabricated using the CaP solution supplemented with bFGF. The fabricated sponges allowed the sustained release of bFGF in a culture medium and enhanced proliferation of osteoblastic MC3T3-E1 cells. Such ACP-coated collagen sponges have the potential to be used as scaffolds in bone tissue engineering if pursued for further in vitro and in vivo studies.

Photodynamic inactivation of oral bacteria with silver nanoclusters/rose bengal nanocomposite.

Antimicrobial photodynamic therapy (a-PDT) is a promising anti-infective technique for generation of singlet oxygen (1O2) to target dental disease. However, conventional organic photosensitizers have problems for clinical use in terms of cytotoxicity, quenching of a-PDT activity by self-dimerization, and the lack of long-term antibacterial effect. We herein propose silver nanoclusters/rose bengal nanocomposite (AgNCs/RB) as a novel photosensitizer with two primary antibacterial effects: (1) 1O2 generation by irradiated RB and (2) Ag+ ion release from AgNCs. AgNCs/RB irradiated with white light-emitting diode (LED) for a short irradiation time of 1 min significantly decreased the bacterial turbidity of Streptococcus mutans, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans (P < 0.05). In SEM, TEM and LIVE/DEAD staining images, photoexcited AgNCs/RB reduced S. mutans colonization, destroyed the cell membrane, and increased the number of dead cells. The antibacterial efficiency of photoexcited AgNCs/RB was greater than that of AgNCs or RB alone (P < 0.05), suggesting a synergistic effect of 1O2 and Ag+ ions from photoexcited AgNCs/RB. By contrast, photoexcited AgNCs/RB did not affect WST-8 and LDH activities and morphology of NIH3T3 mammalian cells, indicating low cytotoxicity. Interestingly, the antibacterial activity of AgNCs/RB on S. mutans was maintained even after the cessation of LED irradiation, indicating a long-term antibacterial effect due to released Ag+ ions. The present AgNCs/RB photosensitizers provide effective synergistic antibacterial effects for dental a-PDT via 1O2 and Ag+ ions coupled with low cytotoxicity.

Bone forming ability of recombinant human collagen peptide granules applied with ß-tricalcium phosphate fine particles.

Recombinant human collagen peptide, developed based on human collagen type I, contains an arginyl-glycyl-aspartic acid (RGD)-rich motif to enhance cell behavior and is anticipated as a xeno-free polymer material for use in tissue engineering. We fabricated granules containing recombinant human collagen peptide (RCP) applied with beta-tricalcium phosphate fine particles (RCP/ß-TCP) as bone filling scaffold material and assessed the bone forming ability of RCP/ß-TCP. Recombinant peptide was thermal crosslinked and freeze-dried to prepare RCP. An aqueous dispersion of ß-TCP fine particles was added to RCP to obtain RCP/ß-TCP. Subsequently, RCP/ß-TCP were characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDX), and cell culture assessments. Furthermore, RCP/ß-TCP were implanted into rat cranial bone defects for radiographic and histological evaluations. In SEM and EDX analyses of RCP/ß-TCP, ß-TCP particles dose-dependently covered the surface of RCP. Cell culture tests showed that RCP/ß-TCP remarkably promoted proliferation and mRNA expression of various genes, such as integrin ß1 and osteogenic markers, of osteoblastic MC3T3-E1 cells. Histomorphometric assessment at 4 weeks showed that RCP/ß-TCP significantly promoted new skull bone formation compared to RCP (p < 0.05) and control (no application) (p < 0.01). Accordingly, these findings suggest RCP/ß-TCP possess bone forming capability and would be beneficial for bone tissue engineering therapy.

Comparative biological assessments of endodontic root canal sealer containing surface pre-reacted glass-ionomer (S-PRG) filler or silica filler.

Surface pre-reacted glass-ionomer (S-PRG) filler releases several ions, such as fluoride, borate and strontium ions, to exert bioactive effects. We fabricated an endodontic root canal sealer containing S-PRG fillers (S-PRG sealer) and then evaluated the antibacterial and anti-inflammatory properties of S-PRG sealer compared with sealer containing conventional silica fillers (silica sealer). Antibacterial tests showed that S-PRG sealer significantly reduced the turbidity of Enterococcus faecalis compared with silica sealer. Implantation of S-PRG or silica sealer blocks in rat subcutaneous tissue showed that S-PRG sealer decreased the proinflammatory response compared with silica sealer at 10 days post-implantation. In addition, immunostaining revealed that infiltration of CD68- and peroxidase-positive cells around the S-PRG sealer was significantly lower than that in silica sealer. Therefore, it was suggested that S-PRG sealer exhibits antibacterial and anti-inflammatory effects.

Bovine serum albumin-capped gold nanoclusters conjugating with methylene blue for efficient 1O2 generation via energy transfer.

Bovine serum albumin (BSA)-capped gold nanoclusters (BSA-Au NCs) are attractive photosensitizers for efficient singlet oxygen 1O2 generation owing to their high-water solubility, low toxicity, and the broad absorption from UV to visible wavelengths, and the long lifetime of the electronic excitations (of the order of microseconds). However, the 1O2 generation efficiency of BSA-Au NCs is relatively low. In the present study, a conjugate of BSA-Au NCs and methylene blue (MB) (BSA-Au NC-MB conjugate) has been developed to improve 1O2 generation for antimicrobial photodynamic therapy (aPDT). The BSA-Au NC-MB conjugate demonstrated enhanced 1O2 generation compared to the case of BSA-Au NCs and effective aPDT ability under white-light LED illumination for only 1min due to the resonance energy transfer from the Au NCs to the MB in the conjugate. To the best of my knowledge, this is first report of Au NCs on the resonance energy transfer application for efficient 1O2 generation. Therefore, the BSA-Au NC-MB conjugate is a novel photosensitizer for 1O2 generation that shows great potential for aPDT, and the present study also develops a very simple strategy to fabricate albumin-based nanoparticles for PDT.

Laser-assisted wet coating of calcium phosphate for surface-functionalization of PEEK.

Calcium phosphate (CaP) coating is an effective method for surface-functionalization of bioinert materials and for production of osteoconductive implants. Recently, we developed a laser-assisted biomimetic process (LAB process) for facile and area-specific CaP coating. In this study, the LAB process was applied to chemically stable and mechanically durable poly(etheretherketone) (PEEK), which has become widely used as an orthopedic and dental implant material. The LAB process was carried out by irradiating pulsed Nd:YAG laser light (355 nm) onto a PEEK substrate that was immersed in supersaturated CaP solution. The CaP coating applicability depended on laser fluence, i.e., CaP successfully formed on PEEK surface after the LAB process at 2 W/cm2. Further increase in laser fluence did not result in the successful formation. At the optimal fluence of 2 W/cm2, the laser-irradiated PEEK surface was modified and heated to induce heterogeneous CaP precipitation within 10 min in CaP solution, followed by further CaP growth over the irradiation time (tested up to 30 min). The LAB process improved the cytocompatibility of PEEK surface with osteoblastic MC3T3-E1 cells. Furthermore, the LAB-processed CaP-coated PEEK substrate formed a dense hydroxyapatite layer on its surface in the simulated body fluid, suggesting the osteoconductivity of this material. The present LAB process can be a useful new tool to produce osteoconductive PEEK-based implants.

Preparation of micro/nanopatterned gelatins crosslinked with genipin for biocompatible dental implants.

Background: Collagen is a basic component of the periodontium and plays an important role in the function of the periodontal unit. Therefore, coating with collagen/gelatin has been applied to enable dental implants to positively interact with peri-implant tissues. Although the micro/nanoscale topography is an important property of the surface of dental implants, smaller collagen/gelatin surface patterns have not been sufficiently developed. Furthermore, only few reports on the behavior of cells on gelatin surfaces with different patterns and sizes exist. In this study, we developed micro/nanometer-scaled gelatin surfaces using genipin crosslinking, with the aim of understanding the use of patterning in surface modification of dental implants. Results: Grooves, holes, and pillars, with widths or diameters of 2 µm, 1 µm, or 500 nm were fabricated using a combination of molding and genipin crosslinking of gelatin. The stability of the different gelatin patterns could be controlled by the degree of genipin crosslinking. The gelatin patterns at 20 mM concentration of genipin and 41% crosslinking maintained a stable, patterned shape for at least 14 days in a cell culture medium. A cell morphology study showed that the cells on groves were aligned along the direction of the grooves. In contrast, the cells on pillars and holes exhibited randomly elongated filopodia. The vinculin spots of the cells were observed on the top of ridges and pillars or the upper surface of holes. The results of a cell attachment assay showed that the number of surface-attached cells increased with increasing patterning of the gelatin surface. Unlike the cell attachment assay, the results of a cell proliferation assay showed that Saos-2 cells prefer grooves with diameters of approximately 2 µm and 1 µm and pillars with diameters of 1 µm and heights of 500 nm. The number of cells on pillars with heights of 2 µm was larger than those of the other gelatin surface patterns tested. Conclusion: These data support that a detailed design of the gelatin surface pattern can control both cell attachment and proliferation of Saos-2 cells. Thus, gelatin surfaces patterned using genipin crosslinking are now an available option for biocompatible material patterning.

Characterization and evaluation of graphene oxide scaffold for periodontal wound healing of class II furcation defects in dog.

INTRODUCTION: The 3-dimensional scaffold plays a key role in volume and quality of repair tissue in periodontal tissue engineering therapy. We fabricated a novel 3D collagen scaffold containing carbon-based 2-dimensional layered material, named graphene oxide (GO). The aim of this study was to characterize and assess GO scaffold for periodontal tissue healing of class II furcation defects in dog. MATERIALS AND METHODS: GO scaffolds were prepared by coating the surface of a 3D collagen sponge scaffold with GO dispersion. Scaffolds were characterized using cytotoxicity and tissue reactivity tests. In addition, GO scaffold was implanted into dog class II furcation defects and periodontal healing was investigated at 4 weeks postsurgery. RESULTS: GO scaffold exhibited low cytotoxicity and enhanced cellular ingrowth behavior and rat bone forming ability. In addition, GO scaffold stimulated healing of dog class II furcation defects. Periodontal attachment formation, including alveolar bone, periodontal ligament-like tissue, and cementum-like tissue, was significantly increased by GO scaffold implantation, compared with untreated scaffold. CONCLUSION: The results suggest that GO scaffold is biocompatible and possesses excellent bone and periodontal tissue formation ability. Therefore, GO scaffold would be beneficial for periodontal tissue engineering therapy.

Antimicrobial photodynamic activity and cytocompatibility of Au25(Capt)18 clusters photoexcited by blue LED light irradiation.

Antimicrobial photodynamic therapy (aPDT) has beneficial effects in dental treatment. We applied captopril-protected gold (Au25(Capt)18) clusters as a novel photosensitizer for aPDT. Photoexcited Au clusters under light irradiation generated singlet oxygen (1O2). Accordingly, the antimicrobial and cytotoxic effects of Au25(Capt)18 clusters under dental blue light-emitting diode (LED) irradiation were evaluated. 1O2 generation of Au25(Capt)18 clusters under blue LED irradiation (420-460 nm) was detected by a methotrexate (MTX) probe. The antimicrobial effects of photoexcited Au clusters (0, 5, 50, and 500 µg/mL) on oral bacterial cells, such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis, were assessed by morphological observations and bacterial growth experiments. Cytotoxicity testing of Au clusters and blue LED irradiation was then performed against NIH3T3 and MC3T3-E1 cells. In addition, the biological performance of Au clusters (500 µg/mL) was compared to an organic dye photosensitizer, methylene blue (MB; 10 and 100 µg/mL). We confirmed the 1O2 generation ability of Au25(Capt)18 clusters through the fluorescence spectra of oxidized MTX. Successful application of photoexcited Au clusters to aPDT was demonstrated by dose-dependent decreases in the turbidity of oral bacterial cells. Morphological observation revealed that application of Au clusters stimulated destruction of bacterial cell walls and inhibited biofilm formation. Aggregation of Au clusters around bacterial cells was fluorescently observed. However, photoexcited Au clusters did not negatively affect the adhesion, spreading, and proliferation of mammalian cells, particularly at lower doses. In addition, application of Au clusters demonstrated significantly better cytocompatibility compared to MB. We found that a combination of Au25(Capt)18 clusters and blue LED irradiation exhibited good antimicrobial effects through 1O2 generation and biosafe characteristics, which is desirable for aPDT in dentistry.

Dose effects of beta-tricalcium phosphate nanoparticles on biocompatibility and bone conductive ability of three-dimensional collagen scaffolds.

Three-dimensional collagen scaffolds coated with beta-tricalcium phosphate (ß-TCP) nanoparticles reportedly exhibit good bioactivity and biodegradability. Dose effects of ß-TCP nanoparticles on biocompatibility and bone forming ability were then examined. Collagen scaffold was applied with 1, 5, 10, and 25 wt% ß-TCP nanoparticle dispersion and designated TCP1, TCP5, TCP10, and TCP25, respectively. Compressive strength, calcium ion release and enzyme resistance of scaffolds with ß-TCP nanoparticles applied increased with ß-TCP dose. TCP5 showed excellent cell-ingrowth behavior in rat subcutaneous tissue. When TCP10 was applied, osteoblastic cell proliferation and rat cranial bone augmentation were greater than for any other scaffold. The bone area of TCP10 was 7.7-fold greater than that of non-treated scaffold. In contrast, TCP25 consistently exhibited adverse biological effects. These results suggest that the application dose of ß-TCP nanoparticles affects the scaffold bioproperties; consequently, the bone conductive ability of TCP10 was remarkable.

Physicochemical fabrication of antibacterial calcium phosphate submicrospheres with dispersed silver nanoparticles via coprecipitation and photoreduction under laser irradiation.

We achieved rapid, surfactant-free, and one-pot fabrication of antibacterial calcium phosphate (CaP) submicrospheres containing silver nanoparticles by combining physical laser and chemical coprecipitation processes. In this physicochemical process, weak pulsed laser irradiation (20min) was performed on a labile CaP reaction mixture supplemented with silver ions as a light-absorbing agent. The silver content in the submicrospheres was controlled for a wide range (Ag/P elemental ratio varied from 0.60 to 62.0) by tuning the initial concentration of silver ions (from 5 to 20mM) in the CaP reaction mixture. At the silver concentration of 5mM, we obtained unique nanocomposite particles: CaP submicrospheres (average diameter of approximately 500nm) containing metallic silver nanoparticles dispersed throughout, as a result of CaP and silver coprecipitation with simultaneous photoreduction of silver ions and spheroidization of the coprecipitates. These CaP submicrospheres containing silver nanoparticles (ca. 0.3mg silver per 1mg submicrospheres) exhibited antibacterial activity against major pathogenic oral bacteria, i.e., Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis. Moreover, the CaP submicrospheres dissolved and neutralized the acidic environment generated by Streptococcus mutans, demonstrating their potential as acid-neutralizing and remineralizing agents. The present process and resulting antibacterial CaP-based submicrospheres are expected to be useful in dental healthcare and infection control. STATEMENT OF SIGNIFICANCE: Nano- and microsized spheres of calcium phosphate (CaP) containing silver nanoparticles have great potential in dental applications. Conventional fabrication processes were time-consuming or weak regarding the size/shape control of the spheres. In this study, we achieved a simple (one-pot), rapid (20-min irradiation), and surfactant-free fabrication of CaP submicrospheres containing silver nanoparticles by pulsed laser irradiation to a mixture of calcium, phosphate, and silver ion solutions. The resulting CaP submicrospheres contained metallic silver nanoparticles dispersed throughout in a sequence of reactions: CaP and silver coprecipitation, laser-induced melting and spheroidization of the coprecipitates, and photoreduction of silver ions. These submicrospheres showed antibacterial activity against oral bacteria and acid-neutralizing property in the bacterial suspension, and hence are worth considering for dental applications.

Teachers' knowledge, beliefs and attitudes concerning schizophrenia- a cross-cultural approach in Japan and Taiwan.

BACKGROUND: Mental health literacy of the general public is essential for the effective promotion of society's mental health. However, there has been no investigation of the general public's mental health literacy with Japanese and Taiwanese socio-cultural backgrounds. METHODS: A total of 129 Japanese and 150 Taiwanese elementary school teachers were surveyed about knowledge, beliefs and attitudes concerning schizophrenia by means of a questionnaire with a vignette describing a case of the disease. Identification of the case, cause of the disease, coping behavior for the case, and perception of stigmatizing and supporting attitudes by parents and neighbors of the case were investigated. RESULTS: As a common finding with the studies in Western countries, only small percentages of the Japanese and Taiwanese respondents were able to make a correct identification. A further common finding was the emphasis on psychosocial factors as a cause of schizophrenia, as was the rejection of psychotropic medication, although future study is required to determine to what extent the respondents know about therapeutic procedures utilized by psychiatrists. Significantly stronger stigma perception was shown in the Japanese respondents than in the Taiwanese, which may be attributable to the high institutionalization rate in Japan. CONCLUSIONS: Japanese and Taiwanese teachers' knowledge, beliefs and attitudes regarding schizophrenia were similar to those found in the general public in Western societies. Although the present study is limited in sampling and the components of the mental health literacy investigated, several working hypotheses have been extracted from it to be tested in future investigations on the Japanese and Taiwanese and other Asian general public's mental health literacy.