Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

Targeting individual empowerment to raise leaders for local oral health promotion in Japan.

The purpose of this study was to evaluate the characteristics of human resources for health promotion advocacy in a rural community. A 16-item questionnaire was sent to 1000 residents of a rural Japanese town. Items concerned demographics, participation in organizational activities, awareness of volunteer activities, and willingness to participate in community-based oral health activities. Responses were measured on a 5-point scale. The response rate was 57.4%. To reveal potential factors from the distribution of responses, a principal component analysis was performed, and 4 components were extracted. The components were interpreted as "Municipality initiative," "Personal initiative," "Worth volunteering," and "Internal health locus of control (HLC)," respectively. The results of multiple regression analysis using the above components stratified by gender and age- group revealed that potential leaders in oral health activities in Japan are presently participating in social activities of their own accord and highly value volunteer activity. Target groups are senior males and middle-aged females.

Career paths and aspirations among postgraduate dental trainees on completion of clinical residency program at Tokyo Dental College.

Career paths and aspirations were investigated among postgraduate dental trainees on completion of clinical training at Tokyo Dental College between 2006, when clinical residency became mandatory, and 2011. Overall, those finding employment with independent general dental practitioners accounted for the majority (34%), followed by those entering postgraduate courses at the Chiba Hospital (20%), those embarking on a postgraduate clinical specialty course at the Chiba Hospital (16%), and those going on to other universities (7%). At the Chiba Hospital, the number selecting postgraduate courses, residency training (including further residency training or a postgraduate clinical specialty course), or employment with a general dental practitioner was almost the same; however, the number selecting postgraduate courses at the Suidobashi Hospital was low, showing a strong tendency toward becoming a general or clinical practitioner. At the Ichikawa General Hospital, most of the trainees decided to remain at the same school or hospital as postgraduate students or residents, showing an aspiration toward further specialization. The results of the Fisher's exact test showed a significant difference in career paths between the Chiba, Suidobashi, and Ichikawa General Hospitals. Trends among postgraduate dental trainees from this and other schools completing the clinical residency program here and subsequently entering postgraduate courses, further residency training, or a postgraduate clinical specialty course at this school were investigated. No major difference was observed in the percentage of trainees remaining at the same school or entering postgraduate courses between those from this and those from other schools; however, more trainees from other schools selected further residency training, while fewer selected a postgraduate clinical specialty course.

Monitoring caries risks before the window of infection and later caries increment: a caries prediction study on rapid detection of Streptococcus mutans using monoclonal antibodies.

A new semi-quantitative enumeration system has been developed for the detection of Streptococcus mutans in saliva. Using two kinds of species-specific monoclonal antibodies, this system can quickly detect salivary S. mutans within 30 min and classify the results into three levels. The aim of this study was to evaluate the potential of this test kit in determining risk for the development of caries. Saliva samples collected during a compulsory dental examination from 56 children aged 18-months were tested. The children were classified into 3 groups according to the level of salivary S. mutans determined. After 18 months, 36 of the children underwent a second examination to investigate whether there was a correlation between salivary S. mutans level at the first examination and subsequent increment in caries. The results showed a good correlation between the two. This indicates that salivary S. mutans level before the window of infection is an indicator of caries risk and can be quickly detected using this test kit. This rapid test should be particularly useful in assessing risk of future caries in very young children.

Trends in percentage of postgraduate dental trainees at dental clinics.

A facilities-group system designed to provide clinical training at dental clinics was developed after postgraduate clinical training became mandatory for dentists in Japan in 2006. As a result, there has been a steady increase in the number of dental clinics collaborating with dental school hospitals under this program. A larger number of dental clinics have also been designated as single-system facilities, program management facilities or collaborating facilities. However, it remains to be determined whether this increase in the number of dental clinics designated as clinical training facilities has led to an increase in the amount of training offered. Therefore, the purpose of this study was to investigate trends in the percentage of postgraduate dental trainees at dental clinics between fiscal years 2006 and 2010. The results showed no significant correlation among (1) the percentage of dental clinics designated as single-system collaborating facilities, (2) the percentage of training programs at dental clinics, and (3) the proportion of training program recruitment offers by dental clinics compared to the total number of recruits. These findings showed that increasing the number of collaborating dental clinics did not lead to an increase in the amount of clinical training at dental clinics. The findings also suggest that increasing the number of single-system or program management dental clinics is important in promoting clinical training at dental clinics.

Does mandatory postgraduate clinical training worsen geographic distribution of dentists in Japan?

Postgraduate clinical training for dentists has been mandatory in Japan since 2006. Hirata et al. reported that the geographic distribution of postgraduate dental trainees by prefecture in 2006 was worse than that of practicing dentists. This suggests that the postgraduate clinical training system could intensify the problem of distribution of dentists. In this study, therefore, we reviewed the geographic distribution of postgraduate dental trainees and practicing dentists between 2006 and 2010 in detail by city, ward, town and village by using the Lorenz curve and Gini coefficient. The results showed that while there was no significant worsening of geographic distribution of postgraduate dental trainees, the distribution of practicing dentists continued to deteriorate. A number of reasons may explain these findings: the clinical training system is based on a one-year employment contract, and dentists subsequently relocate as driven by the market; and geographic distribution among cities, towns and villages has worsened as a result of the merger of municipalities. The geographic distribution of practicing dentists is expected to deteriorate further if the number of dentists takes a downward turn in the future. Therefore, it is necessary to continuously review the distribution of postgraduate dental trainees.

Recent trends among dental residents at Tokyo Dental College.

Trends among dental residents at Tokyo Dental College between 2006, at which time clinical residency became mandatory, and 2011 were analyzed and the following results obtained. Almost all the eligible students from our school participated in the orientation seminar on dental residency programs. Although the number varied slightly by year, approximately 70 to 150 students from other schools also participated in these orientation seminars. Almost all the students from our school and 60 to 80% of those from other schools participating in the orientation seminar each year applied to sit the dental residency entrance examination. The number of candidates was highest in 2006 (318) and lowest in 2010 (205) (average: 248), and the applicant-to-seat ratio for residency was 1.59. The examination pass rate was 59.02%. Approximately 10% of the students from other schools were admitted as dental residents.

Factor analysis on implementation of domiciliary dental care in Metropolitan Tokyo.

The need for domiciliary dental care has increased with the aging of Japanese society. The Tokyo Metropolitan Government and Tokyo Dental Association conducted a survey of dental institutions within Tokyo in order to clarify which factors influenced implementation of domiciliary dental care by dental institutions. The proportion was significantly higher in (1) dentists in their 50s or older, (2) those working in cooperation with primary care physicians, (3) those providing dysphagia rehabilitation, (4) those who give information on prevention of aspiration pneumonia, (5) those who attended training on medical or domiciliary dental care for the elderly in need of nursing care, and (6) those who attended training workshops and seminars provided by the Tokyo Dental Association in 2010. In the logistic regression analysis, a significant odds ratio was obtained for the same items, excluding age. Attendance at training on medical or domiciliary dental care for the elderly in need of nursing care had the highest odds ratio. Those who attended any kind of training course implemented domiciliary dental care significantly more often. Training conducted by the Tokyo Metropolitan Center for Oral Health of Persons with Disabilities, Tokyo Dental Association, and local dental associations showed a significant odds ratio, with the highest by the Tokyo Dental Association. Traditionally, education on domiciliary dental care in the elderly is not provided at the college level. The present results indicate the importance of educating students with regard to the unique challenges such work poses. Attending seminars hosted by the Tokyo Dental Association also significantly influenced implementation of domiciliary dental care. This seems to be an important result, suggesting the effectiveness of training provided by dental associations with regard to the promotion of domiciliary dental care. This indicates the need for dental associations to provide such training throughout Japan.

Evaluation of a Japanese "Prevention of long-term care" project for the improvement in oral function in the high-risk elderly.

AIM: The purpose of this study was to analyze the improvement in oral function and environment in high-risk elderly persons participating in a program to improve oral function organized by their local government. METHODS: Participants comprised 36 high-risk elderly and the mean age was 77.11 ± 7.24 years. The program involved training sessions carried out five or six times every 2-3 weeks for 3 months. Oral function and environment was evaluated before and after the program. The research period extended from 2008 to 2010. RESULTS: The effects of intervention were clearly observed in oral diadochokinesis score in the high-risk elderly. Persons with a lower repetitive saliva swallowing test (RSST) and oral diadochokinesis score before intervention showed a tendency toward even greater improvement. No significant changes were observed in saliva secretion or total amounts of Streptococcus mutans, Lactobacilli, Candida or total microorganisms. CONCLUSIONS: The effects of intervention were clearly recognized in regards to oral diadochokinesis. Improvement in RSST and oral diadochokinesis scores was marked in those persons showing a lower number of articulations before intervention.

Geographic distribution of dentists in Japan: 1980-2000.

OBJECTIVE: In the late 1950s and 1960s, Japan recognized that it had a shortage of dentists and that they were unevenly distributed. To solve these problems, four national and eight private dental schools were established, leading to a significant increase in the number of dental students in the 1970s and 1980s. The purpose of this study was to investigate the effects of this increased supply on the geographic distribution of dentists in Japan. METHOD: We determined the number of dentists and the population in each of Japan's 3252 municipalities. The ratio of the number of dentists to the population of an area was assessed using Gini coefficients calculated from Lorenz curves. RESULTS: From 1980 to 2000, the average number of dentists per 100,000 persons in Japan increased from 44 to 70. The Lorenz curve plotted for 1980-1990 appeared as a nearly diagonal line, with the Gini coefficient decreasing from 0.310 to 0.263. The Gini coefficient in the year 2000 was 0.255, indicating only a slight improvement in 10 years from 1990 to 2000. CONCLUSIONS: The results suggest that the geographical distribution of dentists in Japan is influenced by municipalities' population size. While the number of dentists in municipalities with populations of less than 5000 increased during the years from 1980 to 2000, 25.9 percent of these municipalities still had no dentists at the end of this period. This is an important issue that warrants prompt corrective action.

Factor analysis on oral health care for acute hospitalized patients in Japan.

AIM: We conducted a survey to investigate the status regarding the implementation of oral health care for inpatients aged 65 years and older who were in the acute stages of stroke and to examine the factors related to the details of excellent model hospitals. METHODS: We sent a questionnaire on oral health care targeting all 8089 hospitals in Japan. On the basis of the responses obtained from the hospitals, we conducted a survey to analyze the factors defining what are known to be excellent model hospitals. We then conducted a logistic regression analysis using a stepwise procedure. RESULTS: Replies were received from 2444 of the 8089 hospitals (30.2%): 91.8% of the hospitals reported that oral health care was a part of the daily nursing routine while 91.2% of the hospitals considered that aspiration pneumonia could be prevented by appropriate oral health care. Only 30% of the nurses had undergone oral hygiene training. Among the factors involved in excellent model hospitals, we observed a strong correlation with a sense of the necessity for oral health care, oral hygiene training for nurses and a large number of hospital beds. CONCLUSION: Large scale hospitals tend to be more interested in oral health care than smaller hospitals. Providing oral health care is already common in acute hospitals in Japan. There is a great demand for oral hygiene training and obtaining information from dental professionals. It is important to promote the cooperation between dental and nursing personnel within hospitals regarding oral hygiene training.

Matching system within clinical training facilities group of clinical dental training in Tokyo Dental College Chiba Hospital.

Since clinical dental training became mandatory in April 2006, Tokyo Dental College Chiba Hospital has been offering the following two types of training system: 1. a single system, and 2. a clinical training facilities group system. The clinical training facilities group system consists of program B, in which residents are trained in a cooperation-type clinical training facility for 3-4 months, and program C, in which residents are trained in two cooperation-type clinical training facilities for 7-8 months. A matching system within the clinical training facilities group is applied to select and decide on the cooperation-type clinical training facility for residents. In this system, the ranking of resident candidates that a cooperation-type clinical training facility would like to accept, and the ranking of training facilities that candidates choose are matched. The present study investigated the matching system within the clinical training facilities group in 2006, 2007, and 2008. The rate of matching to their third choice was more than 90% in program B and about 80% in program C in each year, suggesting a high matching rate. The percentage of cooperation-type clinical training facilities accepting dental residents dropped due to a decrease in the number of such residents. The distribution of accepted cooperation-type clinical training facilities is concentrated in Chiba Prefecture where our hospital, the management-type clinical training facility, is located, and the neighboring prefectures.

Geographic distribution of postgraduate dental trainees in Japan.

Postgraduate clinical training for dentists in Japan became mandatory in April 2006. Mandatory postgraduate clinical training for physicians has been criticized as having accelerated the imbalance in distribution of physicians. This suggests the danger that the same phenomenon might occur in distribution of dentists. It is also necessary to investigate the geographic distribution of dental trainees and practicing dentists in Japan. In this study, the number of dental trainees enrolled in each clinical training program and number that had actually received clinical training at each facility were compared by prefecture. The results suggest that disparities in the number of dental trainees among prefectures are being compensated for by movement across prefectural borders under the clinical training facilities-group system. Postgraduate dental trainees, however, showed a significantly greater imbalance in geographic distribution than practicing dentists. Continuation of the postgraduate clinical training for dentists under the existing system may accelerate this imbalance in distribution of dentists. To prevent this, practical measures should be taken in accordance with the coming review of the system, based on research regarding changes in geographic distribution of dental trainees.

[The meaning and problem of the 8020 movement in Japan].

In 1982 the Health and Medical Service Law for the elderly was enacted. Until 1982 medical services for the elderly were provided free or charge in Japan, causing rising health expenditure on the elderly. One purpose of the law was to introduce partial cost-sharing and health services for the elderly, but dental health services were not included in the Law. The 8020 Movement was therefore initiated to include dental health within the health service of the Law. The "8020" goal is based on research which reported that it is possible to eat almost all kinds of food with 20 teeth. In 1989 the Committee for Adult Oral Health of the Ministry of Health was established and as an objective for on oral health campaign, the 8020 Movement was proposed. Since 1992, activities for the 8020 Movement by local governments have been supported by the Central Government, initiating the success of the 8020 Movement.