The utility of microbiome (microbiota) and exosomes in dentistry.

The concept of the oral-systemic link is important in both basic and clinical dentistry. The microbiome (microbiota) and exosomes are two prevalent issues in the modern medical researches. The common advent of oral and general microbiological investigation originated from the initial observations of oral bacteria within the dental plaque known as oral microbiome. In addition to oral diseases related to oral microbiome, the disruption of the oral and intestinal microbiome could result in the onset of systemic diseases. In the past decade, the exosomes have emerged in the field of the medical researches as they play a role in regulating the transport of intracellular vesicles. However, with the rapid advancement of exosomes researches in recent years, oral tissues (such as dental pulp stem cells and salivary gland cells) are used as the research materials to further promote the development of regenerative medicine. This article emphasized the importance of the concept of the oral-systemic link through the examples of microbiome (microbiota) and exosomes. Through the researches related to microbiome (microbiota) and exosomes, many evidences showed that as the basic dentistry developed directly from the assistance of the basic medicine, indirectly the progress of the basic dentistry turns back to promote the development of the basic medicine, indicating the importance of the concept of the oral-systemic link. The understanding of the oral-systemic link is essential for both clinicians and medical researchers, regardless of their dental backgrounds.

Ethnicity, gender, and geographical distribution of dentists in Taiwan in 1939 (Showa 14).

Background/purpose: Taiwan's dentistry entered into a new era of modernization and flourished during the Japanese colonial period. However, we know very little about the composition of dentists at that time. This study attempted to analyze the ethnicity, gender, and geographical distribution of dentists in Taiwan in 1939 (Showa 14). Materials and methods: The methods of documentary analysis and secondary data analysis were adopted to find the composition of dentists during the late Japanese colonial period through a name list of contract dentists for the Postal Savings Insurance published in August 1939 (Showa 14) by the Taiwan Government Transportation Department Information Bureau. Results: The total number of contract dentists was 368, accounting for 86.79% of the 424 practicing dentists in Taiwan in 1939 (Showa 14). Of the 368 contract dentists (328 males and 40 females), 225 (61.14%) were Taiwanese and 143 (38.86%) were Japanese. Among the 8 prefectures in Taiwan, Tainan Prefecture had the largest number of dentists (97), followed by Taipei (84) and Taichung (78) prefectures. The number of contract dentists per 100,000 people was 6.24, equivalent to 16,021 people served by each contract dentist in 1939 (Showa 14). The chi-square test for the trend analysis of gender distribution indicated a significantly higher proportion of male than female contract dentists in either Taiwanese or Japanese ethnic group. Conclusion: In the late Japanese colonial period, the number of Taiwanese dentists exceeded that of Japanese dentists. Furthermore, there were more male than female dentists in either the Taiwanese or the Japanese population.

The relationship between graduation school background and geographical distribution of dentists in Taiwan.

Background/purpose: Taiwan's eight dental schools are all located in the western region. This study attempted to analyze the relationship between the geographical distribution of dentists in Taiwan and their graduation school background and to develop several statistical indicators to analyze the geographical distribution of dentists. Materials and methods: The method of the secondary data analysis was adopted to collect the open information related to the number of the practicing dentists based on their graduation schools and practice locations by cities and counties in Taiwan in January 2023. The data were used to develop several statistical indicators to analyze the geographical distribution of dentists. Results: There were 16,533 practicing dentists in Taiwan in January 2023. Of the 16,533 dentists, 15,687 (94.88 %) graduated from domestic dental schools and 846 (5.12 %) graduated from foreign dental schools. For the school location, the coefficient of variation, Gini coefficient, population proportion index, and population density index were the largest (168.57 %, 0.47, 10.76 %, and 3927.01 people/square kilometer) in the dentists graduating from the northern dental schools. In overall, the dentists were concentrated in municipalities, cities, and the northern region of Taiwan, especially those graduating from the northern dental schools. Conclusion: In Taiwan, the geographical distribution of dentists is highly related to their graduation school background. Promoting a balanced distribution of dental enrollment quotas and dental student sources from different geographical locations and inducing the movement of dentists to the dentist-shortage areas may be the more feasible ways to solve the uneven geographical distribution of dentists in Taiwan.

Correlation between dental professionally topical fluoride application and children's dental use for dental caries under the National Health Insurance system in Taiwan from 2008 to 2021.

Background/purpose: Dental caries is one of the most common oral diseases in children worldwide, especially in Taiwan. This study investigated dental professionally topical fluoride application (PTFA) and children's dental use for dental caries under the National Health Insurance (NHI) system in Taiwan from 2008 to 2021. Materials and methods: The population data and medical records of the NHI system were obtained from the websites of the Ministry of the Interior and the Ministry of Health and Welfare, respectively. The dental PTFA services and dental use indicators for dental caries were analyzed from 2008 to 2021. Results: The number of out-patient visits for dental PTFA services increased from 221,675 in 2008 to 1,078,099 in 2021. The total increase of the out-patient visits was 856,424 with a total increase rate of 386.34%. The one-year increase was 65,879 with a one-year increase rate of 29.72%. Among the 3 age groups of children, their dental use indicators almost presented decreasing trends from 2008 to 2021. Moreover, in general, the dental use indicators showed a negative correlation with the number of the overall out-patient visits for dental PTFA services from 2008 to 2021. Conclusion: In Taiwan, there is a negative correlation between the dental use indicators in NHI system and the number of the overall out-patient visits for dental PTFA services from 2008 to 2021. However, the problem of dental caries in children is still serious and there is still a space for improvement in the oral health education for child caregivers and children.

Morbidity and mortality of oral cancer in Taiwan: Trends from 2000 to 2021.

Background/purpose: Oral cancer is a major cause of cancer morbidity and mortality worldwide, especially in Taiwan. This study investigated the morbidity and mortality of oral cancer in Taiwan from 2000 to 2021. Materials and methods: The population data and the records of cancer registry were obtained from the websites of the Ministry of the Interior and the Ministry of Health and Welfare, respectively. The numbers of oral cancer cases and deaths were analyzed from 2000 to 2021. Results: The numbers of oral cancer cases and deaths increased from 3378 to 1494 in 2000-8277 in 2020 and 3395 in 2021, respectively. The total increase of oral cancer cases was 4899 with a total increase rate of 145.03%, while the total increase of oral cancer deaths was 1901 with a total increase rate of 127.24%. The changes in the numbers of all cancer cases and deaths, as well as the morbidity and mortality of oral cancer or all cancers also showed similar trends. Furthermore, the death-to-case ratio of oral cancers decreased from 44.23% in 2000 to 40.84% in 2020. The total decrease was 3.39% with a total decrease rate of 7.66%. Conclusion: In Taiwan, people's awareness of oral mucosal health is still inadequate. Obviously, there is still much room for improvement in the oral mucosal health education for our people. With the expertise and responsibility for taking good care of oral health of our people, the dental personnel should take active roles in the prevention and screening for oral cancers.

Overview of dental professionally topical fluoride application in public health measure in Taiwan in 2021.

Background/purpose: In Taiwan, it has been 16 years since the policy of children's dental professionally topical fluoride application (PTFA) services was implemented. This study investigated the differences in the number of children's dental PTFA outpatient visits among cities and counties or different regions of Taiwan in 2021. Materials and methods: The population data and medical records of the number of children's dental PTFA outpatient visits were obtained from the websites of Ministry of the Interior and Ministry of Health and Welfare, respectively. The secondary data were divided by cities and counties to analyze the urban-rural gap and regional differences in the number of children's dental PTFA outpatient visits in Taiwan in 2021. Results: In Taiwan, municipalities had the largest number of dental PTFA visits (721,338, 66.91% of the total dental PTFA visits), while remote and outlying island counties had the smallest number of dental PTFA visits (84,509, 7.84%). The northern region had the largest number of dental PTFA visits (466,728, 43.29%), while outlying islands had the smallest number of dental PTFA visits (25,055, 2.32%). Based on the children aged 3-5 years, municipalities had the lowest dental PTFA use rate (171.70%), while remote and outlying island counties had the highest dental PTFA use rate (482.96%). Conclusion: In Taiwan, there is a higher number of children's dental PTFA outpatient visits in municipalities than in non-municipalities or remote and outlying island counties as well as in northern region than in each of other four regions (central, southern, and eastern regions and outlying islands).

Overview of dental education system and gender distribution of undergraduate dental students in Taiwan.

Abstract Background/purpose: The gender distribution of dentists in Taiwan has been dominated by male dentists for a long time. This study analyzed preliminarily the appearance of the current dental education system and the gender distribution of undergraduate dental students. Materials and methods: This study used documentary analysis and secondary data analysis to survey mainly the current dental education system and the gender distribution of undergraduate dental students in Taiwan. Results: There were a total of 2474 dental students and 394 dental graduates in Taiwan in 2021. The numbers of male students (1435, 58.00%) and male graduates (207, 52.54%) were higher than those of female students (1039, 42.00%) and female graduates (187, 47.46%). The numbers of male dental students in the northern (629), central (428), and southern (378) regions were all higher than those of female dental students (423, 373, and 243, respectively). The chi-square test indicated the significantly higher proportion of male dental students in the northern and southern regions (P < 0.01). Besides, there were a total of 15,857 registered dentists. The number of male dentists (10,997, 69.35%) was higher than that of female dentists (4,860, 30.65%). Compared with population, the chi-square test showed the significantly higher proportion of male dental students and male registered dentists (all P-values < 0.001). Conclusion: In Taiwan, the dental education system must promote female students' interest in dentistry and elevate the proportion of female dental supervisors to increase the proportion of female dental students and female dentists in the future.

Correlation between the beverage serving activities and the dental use of health care resources of National Health Insurance for common oral diseases.

Background/purpose: : Taiwanese get use to drinking hand-shaken beverages. However, excessive sugar intake is strongly associated with the occurrence of dental caries. This study evaluated the correlation between the beverage serving activities and the dental use of National Health Insurance (NHI) for common oral diseases in 2016. Materials and methods: Data on the population, the beverage serving activities, and the dental records of NHI were obtained from the related websites of government. These data were divided by cities and counties to investigate the beverage serving activities and the dental use of NHI for common oral diseases in 2016. Results: In Taiwan, the value of beverage consumption per person had a moderate to high positive correlation with the dental use rate, the number of out-patient visits per 1,000 people, and the medical expenses per person for common oral diseases. For dental caries, diseases of pulp & periapical tissues, and gingivitis & periodontal diseases, their Pearson's r values were 0.52-0.61, 0.18-0.40, and 0.58-0.65, respectively. These results indicate that the higher the beverage consumption per capita, the higher the dental use per capita. Conclusion: There is a long-term benefit for oral health and systemic health through reducing or avoiding unnecessary excessive sugar intake. Therefore, from a cost-effectiveness viewpoint, Taiwan government should develop a better oral health care policy including a health education strategy of appropriate sugar intake to prevent dental caries and other non-communicable diseases in Taiwanese people.

A retrospective study of the admission ways in the School of Dentistry of National Taiwan University from 2000 to 2021.

Background/purpose: In Taiwan, dental schools have gradually become a popular choice for high school graduates to enter in the universities. This study mainly analyzed the various admission ways to enroll students into the School of Dentistry of National Taiwan University (SODNTU) from 2000 to 2021. Materials and methods: The data on the numbers of enrollees and those enrollees who had completed registration in the SODNTU from 2000 to 2021 were available online to the public and included in this study. Results: The total number of enrollees in the SODNTU over the past 22 years was 764 with an annual mean of 34.73. The registration rate ranged from 90.91% to 100% with a mean registration rate of 96.86% from 2000 to 2021. The examination admission, individual application admission, and numerous stars initiatives admission were the three main admission ways to enroll students into the SODNTU from 2000 to 2021 with a total of 662 enrollees (86.65% of a total of 764 enrollees). The number (proportion) of enrollees through examination admission showed a decreasing trend year by year from 26 (78.79%) in 2000 to 15 (45.45%) in 2021. On the contrary, those enrollees through individual application admission and numerous stars initiatives admission showed an increasing trend year by year from 4 (12.12%) in 2000 to 14 (42.42%) in 2021. Conclusion: Although the examination admission is still the predominant admission way, the individual application admission and numerous stars initiatives admission gradually play pivotal roles to enroll students into the SODNTU recently.

Overview of education system for oral hygienists in Taiwan.

Background/purpose: Currently, Taiwan has a very complete education system of oral hygiene, but there is still no licensing system for oral hygienists. This study explored mainly the profile of education system for oral hygienists in Taiwan from 2017 to 2021. Materials and methods: This study used the documentary analysis and secondary data analysis to survey mainly the development of oral hygiene education system in Taiwan, and the changes of oral hygiene students and graduates from 2017 to 2021. Results: In Taiwan, currently, there are 8 oral hygiene schools which offer associate, bachelor, and master degrees in oral hygiene. The oral hygiene enrollment quotas determined by the Ministry of Education increased from 343 quotas in 9 programs in 2017 to 500 quotas in 13 programs in 2021, while new oral hygiene students who completed registration increased from 282 students in 2017 to 353 students in 2021. The registration rate of the five-year training program of junior college was significantly higher than the other programs. The number of oral hygiene students with official student status increased from 604 students in 2017 to 1349 students in 2021. The total increase was 745 students from 2017 to 2021 with a total increase rate of 123.34%. Conclusion: In Taiwan, although the manpower of oral hygienists is important for public oral health, they usually work as dental assistants or change their careers. It is imperative to continue to promote the certification system for oral hygienists to improve the professionalism of this occupation.

Overview of dental assistants in Taiwan from 2009 to 2021.

Background/purpose: The development of dental assistants in Taiwan has been over a century. This study explored mainly the profile of dental assistants and the occupation survey about them in Taiwan from 2009 to 2021. Materials and methods: This study used the documentary analysis and secondary data analysis to survey mainly the changes of manpower of dental assistants in Taiwan from 2009 to 2021, and the association of their wages with economic indicators. Results: According to occupation survey from government, the number of dental assistants increased from 4315 in 2009-7909 in 2021. When estimated based on the data of the United States showing 1.86 dental assistants per dentist, the estimated number of dental assistants increased from 21,113 in 2009 to 28,698 in 2020. Although the mean monthly wage of dental assistants increased from 22,127 NT dollars in 2009 to 26,795 NT dollars in 2021, the proportion of the mean annual wage of dental assistants to the gross domestic product per capita decreased from 47.43% in 2009 to 34.78% in 2021. Moreover, the proportion of the mean monthly wage of dental assistants to the basic monthly wage of labor decreased from 128.05% in 2009 to 111.65% in 2021. Conclusion: In Taiwan, although the manpower and work content of dental assistants are important for dentists, they usually work with a low wage from 2009 to 2021. It is imperative to continue to promote the certification system for dental assistants to improve the professionalism and the wage structure of this occupation.

The current dental school admissions: An overview of the admission process and the geographical distribution of dental school enrollees in Taiwan.

Background/purpose: There is no specific admission system for dentistry in Taiwan. The aims of this study were to describe and analyze the current admission processes for entry into dental schools through the university admission system and to compare the geographical distribution of dental school enrollees. Materials and methods: All seven dental schools of general universities in Taiwan were included to analyze the admission protocols in 2019 and 2020. All data of dental enrollment quotas and dental school enrollees presented in this study were collected from information available to the public on the related websites. Results: The total dental enrollment quotas via the university admission system were 381 in 2019 and 397 in 2020. Those admitted via the special program for indigenous peoples and offshore island peoples were both 27 in 2019 and 2020, respectively. The main dental school admission way was individual application, and the main providers of dental enrollment quotas were northern dental schools and private dental schools. In addition, dental school enrollees were concentrated in the northern region, municipalities, and cities in Taiwan. Conclusion: Further advancement is needed to expand participation and broaden the sociodemographic profile of dental school applicants. The dental schools would benefit from a long-term prospective study about the correlation of admission methods with students' performance in dental schools. The special program is impacting the equality of admission opportunities. It is necessary to track the practice dynamics of these dental school graduates who were enrolled via the special program as a basis for policy adjustment.