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There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1‐ and 3‐year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.

Background: As infrequent social interaction is a potential risk of dementia, oral malodor may increase the risk of dementia, including Alzheimer’s disease.Objective: This study investigated the association between malodor and dementia.Methods: We used the Japan Public Health Center-based Prospective Study data obtained at Yokote City. A total of 1,493 individuals aged 56 to 75 years underwent a dental examination and self-reported survey from May 2005 to January 2006. Follow-up for the onset of dementia was conducted using long-term care insurance data from 2006 to 2016. Hazard ratios of oral malodor on dementia were estimated by the Cox proportional hazards model. The inverse probability-weighted Cox model was used as a sensitivity analysis.Results: The study comprised 1493 participants (53.6% women) with a mean age of 65.6 (SD = 5.8) years old; at the end of the follow-up, 6.4% (n= 96) developed dementia, and the percentage was 20.7 in severe malodor group. Throughout 15274.133 person-years of follow-up, the average incidence rate for the onset of dementia per 1000 person-years was 6.29. The highest incidence rate was seen in participants with severe malodor (22.4 per 1000 person-years). After adjusting for confounders, compared to those with no malodor, there was a 3.8 (95% confidence interval: 1.5 to 9.4) times greater hazard of developing dementia in participants with severe malodor. The inverse probability weighted Cox model confirmed the same trend with an adjusted marginal hazard ratio of 4.4 (1.2 to 16.4).CONCLUSIONS: A significant association between oral malodor and the onset of dementia exists.

Japan's universal health insurance covers a wide range of dental treatments, and the co-payment rates differ by age. We investigated whether the inequality in gingival bleeding and dental visits was smaller amongst those with lower co-payment rates.

BackgroundPrevious studies suggest that experience of natural disasters may heighten present bias. Research also suggests that impaired self-control (in particular, heightened present bias) could be linked to delayed-onset post-traumatic stress symptoms (PTSS) among survivors of natural disasters. We examined a hypothesis that the association between disaster experiences and delayed-onset PTSS is mediated through present bias among older survivors of the 2011 Japan earthquake and tsunami.MethodsThe baseline survey was conducted for older adults who lived in a city located 80 km west of the epicentre 7 months before the disaster. Approximately 2.5 and 8.5 years after the disaster, we surveyed older survivors to assess the trajectory of PTSS (2230 participants). We implemented analyses by three analytical groups: (1) resilient versus delayed-onset, (2) resilient versus improved and (3) resilient versus persistent.ResultsLogistic regression models showed that major housing damage was linked to raised present bias in all analytical groups (OR 2.47, 95% CI 1.04 to 5.87; OR 2.75, 95% CI 1.20 to 6.29; OR 2.65, 95% CI 1.15 to 6.10, respectively). The present bias, however, was significantly associated with only delayed-onset PTSS (OR 2.05, 95% CI 1.14 to 3.69). In the group of resilient versus delayed onset, housing destruction was also associated with delayed-onset PTSS (OR 2.44, 95% CI 1.11 to 5.37), and the association was attenuated by present bias (OR 2.36, 95% CI 1.07 to 5.18).ConclusionsPresent bias could mediate the association between housing damage and delayed-onset PTSS among older survivors of a natural disaster.

ABSTRACTPurposeOrthodontic patients frequently exhibit signs and symptoms of temporomandibular disorder (TMD) in combination with symptoms around the stomatognathic region (i.e. headache). Although maxillofacial morphology and malocclusion have been widely investigated as risk factors for TMD and headache, their relationship remains unclear and functional factors have not been verified. This study investigated associations among TMD, headache, craniofacial morphology, and premature contacts in female children and adolescents with malocclusion.Materials and methodsOne hundred twenty female children and adolescents (mean age, 11.4 ± 2.5 years) who sought orthodontic treatment were randomly selected from a cohort of orthodontic patients. The patients were divided into three groups (no condition, at least one condition, ≥ 2 conditions: TMD, headache, and/or shoulder pain). Premature contacts were determined using the functional wax bite method; craniofacial morphology was analysed using lateral cephalometric radiographs. The χ2test, Tukey test, and ordered logistic regression were used for statistical analysis.ResultsPatients with TMD and headache had a steep mandibular plane angle (odds ratio = 1.11), but there were no significant differences among groups in other craniofacial morphology parameters. Patients with premature contacts had a higher incidence of combined TMD and headache (odds ratio = 7.72). Premature contacts more strongly contributed to pathogenesis than did mandibular plane angle or age.ConclusionTMD and headache are associated with both craniofacial morphology and premature contacts.

The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society.

AbstractAimsPrevious studies have reported inconsistent findings regarding the association between post-traumatic stress (PTS) and post-traumatic growth (PTG). Three major issues could account for this inconsistency: (1) the lack of information about mental health problems before the disaster, (2) the concept of PTG is still under scrutiny for potentially being an illusionary perception of personal growth and (3) the overlooking of PTS comorbidities as time-dependent confounding factors. To address these issues, we explored the associations of PTS and PTG with trauma-related diseases and examined the association between PTS and PTG using marginal structural models to address time-dependent confounding, considering pre-disaster covariates, among older survivors of the 2011 Japan Earthquake and Tsunami.MethodsSeven months before the disaster, the baseline survey was implemented to ask older adults about their health in a city located 80 km west of the epicentre. After the disaster, we implemented follow-up surveys approximately every 3 years to collect information about PTS and comorbidities (depressive symptoms, smoking and drinking). We asked respondents about their PTG in the 2022 survey (n= 1,489 in the five-wave panel data).ResultsPTG was protectively associated with functional disability (coefficient −0.47, 95% confidence interval (CI) −0.82, −0.12, P< 0.01) and cognitive decline assessed by trained investigators (coefficient −0.07, 95% CI −0.11, −0.03, P< 0.01) and physicians (coefficient −0.06, 95% CI −0.11, −0.02, P< 0.01), while PTS was not significantly associated with them. Severely affected PTS (binary variable) was associated with higher PTG scores, even after adjusting for depressive symptoms, smoking and drinking as time-dependent confounders (coefficient 0.35, 95% CI 0.24, 0.46, P< 0.01). We also found that an ordinal variable of the PTS score had an inverse U-shaped association with PTG.ConclusionPTG and PTS were differentially associated with functional and cognitive disabilities. Thus, PTG might not simply be a cognitive bias among survivors with severe PTS. The results also indicated that the number of symptoms in PTS had an inverse U-shaped association with PTG. Our findings provided robust support for the theory of PTG, suggesting that moderate levels of psychological struggles (i.e., PTS) are essential for achieving PTG, whereas intense PTS may hinder the attainment of PTG. From a clinical perspective, interventions that encourage social support could be beneficial in achieving PTG by facilitating deliberate rumination.

BackgroundDifficulties in communication due to vision, hearing and tooth loss have a serious impact on health. We compared the association between and attribution of each of these factors on social interaction.MethodsThis cross-sectional study examined data from the 2016 Japan Gerontological Evaluation Study (n=22 295) on community-dwelling people aged ≥65 years in Japan. The dependent variable was the frequency of meeting friends as a measure of social interaction, and less-than-monthly was defined as fewer social interactions. The independent variables were self-reported degrees of vision, hearing (5-point Likert scale) and tooth loss (five categories), with ‘poor’ or ‘0 teeth’ defined as the worst category. Sex, age, educational attainment, comorbidity and residential area were used as covariates. Poisson regression analysis with multiple imputations was used to estimate the prevalence ratios (PRs) of fewer social interactions by each status. Subsequently, the population attributable fraction (PAF) was calculated to assess the public health impact.ResultsThe number of participants with fewer social interactions was 5622 (26.9%). Proportions of fewer social interactions among those with the worst vision, hearing and number of teeth categories were 48.7%, 40.1% and 32.0%, respectively. Their corresponding PRs of fewer social interactions were 1.72 (95% CI 0.97 to 3.05), 1.35 (95% CI 0.99 to 1.85) and 1.23 (95% CI 1.10 to 1.37), respectively. The total PAF for vision, hearing and number of teeth was 8.3%, 5.0% and 6.4%, respectively.ConclusionSelf-reported vision, hearing and tooth loss were associated with fewer social interactions. The magnitude of these impairments was largest in vision, followed by tooth and hearing loss.

The March 2011 Great East Japan Earthquake, tsunami, and nuclear leak were complex traumas. We examined psychological distress in the years following the earthquake using growth mixture modeling to classify responses from 2,599 linked respondents (2012–2016). We identified four classes of trajectories following the disaster: resilient (76% of respondents), delayed distress (8%), recovery (8%), and chronic distress (7%). Compared with the resilient class, other class members were less likely to be female and had less social support. Survivors in the recovery group were more likely to live in prefabricated housing. Although distress has decreased over time, specific populations continue to require targeted intervention.

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Second‐hand smoke (SHS) is considered a risk factor for a number of oral diseases. However, its influence on tooth loss, which is the final consequence of periodontal disease and caries, remains unknown. We aimed to evaluate the association between SHS experience and the number of remaining teeth among non‐smoking older Japanese individuals. Cross‐sectional data from the Japan Gerontological Evaluation Study (JAGES) 2013 were used. From the 27,561 people ≥65 years of age who responded to a self‐reported questionnaire (response rate = 71.1%), data of 18,865 respondents who had never smoked were analysed. Multinomial logistic regression with multiple imputations was applied to estimate the odds ratio of the frequency of SHS exposures on the number of remaining teeth. The prevalence of participants with ≥20 teeth, 10–19 teeth, 5–9 teeth, 1–4 teeth, and no teeth were 53.2%, 20.4%, 9.9%, 6.6%, and 9.9%, respectively. The proportion of participants with SHS was 37.5%. After adjusting for sex, the SHS experience tended to be associated with a lower risk of having the fewer number of remaining teeth (P< 0.05). However, after being adjusted for age and sex, participants with SHS exposure at “a few times a week” and “almost every day” were significantly associated with the fewer number of teeth. After adding all other covariates, compared to the participants without any exposure to SHS, the odds ratio for having no teeth rather than having ≥20 teeth among the participants with daily exposure to SHS was 1.35 (P< 0.01). Daily second‐hand smoke was significantly associated with fewer remaining teeth based on the self‐reported survey among older Japanese people.

ABSTRACTObjectives:Experience of a major disaster can potentially impact on tobacco consumption. Our objective was to explore the determinants of increasing tobacco consumption after the Great East Japan Earthquake (GEJE).Methods:We conducted a cross-sectional study using data from the Miyagi Prefectural Health Survey 2014: a total of 2632 people were randomly selected from residents aged ≥20 years in Miyagi, Japan. Of 2443 respondents (response rate = 92.8%), 551 current smokers (411 men) were included in the analysis. Odds ratios (OR) and 95% confidence interval (CI) for increasing tobacco consumption were calculated using multivariable logistic regression models including variables of age, sex, disaster-related job status change, education status, self-rated health, and age at smoking initiation.Results:After adjustments for all variables, significantly higher ORs for increasing tobacco consumption after the GEJE were observed in women (OR = 1.87; 95% CI = 1.10–3.15), 20–39 years old (OR = 5.18; 95% CI = 2.28–11.75), 40–59 years old (OR = 3.97; 95% CI = 1.76–8.94) and respondents who had lost their jobs (OR = 3.42; 95% CI = 1.06–11.05) than the counterpart categories.Conclusions:This study found 3 determinants of increasing tobacco consumption after a major disaster: being a woman, being of working age, and experiencing disaster-related job loss.

Although inequalities in dental implant use based on educational level have been reported, no study has used income as a proxy for the socioeconomic status. We examined: (i) income inequalities in implant use; and (ii) whether income or education has a stronger association with implant use in elder Japanese. In 2016, a self‐reported questionnaire was mailed to participants aged 65 years or older living across Japan as part of the ongoing Japan Gerontological Evaluation Study. We used data from 84,718 respondents having 19 or fewer teeth. After multiple imputation, multi‐level logistic regression estimated the association of dental implant use with equivalised income level and years of formal education. Confounders were age, sex, and density of dental clinics in the residential area. 3.1% of respondents had dental implants. Percentages of dental implant use among the lowest (≤ 9 years) and highest (≥ 13 years) educational groups were 1.8 and 5.1, respectively, and among the lowest (0 < 12.2 ‘1,000 USD/year’) and highest (≥ 59.4 ‘1,000 USD/year’) income groups were 1.7 and 10.4, respectively. A fully adjusted model revealed that both income and education were independently associated with dental implant use. Odds ratios for implant use in the highest education and income groups were 2.13 [95% CI= 1.94–2.35] and 4.85 [95% CI= 3.78–6.22] compared with the lowest education and income groups, respectively. From a model with standardised variables, income showed slightly stronger association than education. This study reveals a public health problem that even those with the highest education but low income might have limited accessibility to dental implant services.

Dentists, as prominent prescribers, are key stakeholders in addressing the antimicrobial resistance (AMR) crisis. Dental students’ perceptions about the topic have been underexplored in the Asia–Pacific region, a key location for the development and spread of AMR. Thus, the aim of this study was to evaluate the awareness and confidence to prescribe antimicrobials amongst dental students studying in the region.

To ascertain whether steroid therapy evokes dentin hypersensitivity (DH)-like tooth pain, we performed a study based on compelling evidence from patients receiving steroid therapy. An exploratory study was conducted using a questionnaire for 220 patients prescribed steroids who attended the Department of Hematology and Rheumatology of Tohoku University Hospital. Group comparisons between patients with and without steroid pulse therapy were analysed by statistical means. In this study, any DH-like tooth pain that commenced subsequent to steroid treatment was defined as steroid-derived (SD) tooth pain. The prevalence of SD tooth pain was 17.7% (39/220 patients). SD tooth pain was triggered in many vital teeth by cold and/or hot water (84.2% and 23.7%, respectively) with the pain characterised as continuous, in contrast to typical DH tooth pain. SD tooth pain was significantly more frequent in pulse therapy patients than in non-pulse therapy patients (p < 0.05). Logistic regression analysis adjusted for age and sex showed similar results (odds ratio = 3.74, p = 0.013). Moreover, a positive correlation was observed between the steroid dose and pain score (ρ = 0.642). Dose reduction or discontinuation of steroid therapy relieved SD tooth pain in all cases. Thus, steroid therapy can evoke DH-like tooth pain during treatment.

Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.

Oral health is closely related to systemic health. Periodontitis, a chronic inflammatory disease which is highly prevalent worldwide, interacts with a variety of noncommunicable diseases (NCDs). It is a risk factor in the complex pathogenesis of diabetes mellitus and cardiovascular disease and plays a role in the development of endocarditis and recurrent pneumonia in elderly people. However, the available data may be interpreted in different ways, and more and better‐designed studies are still needed to answer relevant questions about the causal role of periodontitis in NCDs. What is clear is that periodontitis contributes to the systemic inflammatory burden. As periodontitis shares many common risk factors with NCDs, close collaboration between physicians and dentists is needed to increase the chance of early detection and improve the prevention and control of these conditions.

No previous studies have examined that social capital mitigates impacts of natural disaster experiences on cognitive function. We aimed to examine prospectively whether social capital mitigates the adverse effects of natural disaster on cognitive decline.

We developed and validated an instrument to measure community-level social capital based on data derived from older community dwellers in Japan.

Dental check‐ups at the workplace provide the opportunity for early detection of dental diseases. Dental check‐ups during working hours could reduce the number of days of absence from work due to visits to dental clinics outside the workplace. Although health check‐ups are provided to workers in Japan, dental check‐ups is not mandatory. This study aimed to determine the association between the place of dental check‐ups and absenteeism due to visits to the dental clinic. This cross‐sectional study used data from an online self‐reported worker survey conducted for 2 weeks in March 2017. We applied linear regression analysis with robust variance to determine the association between the place of dental check‐ups and absenteeism due to dental clinic visits while adjusting for sociodemographic, health, and oral health covariates. The average age of the 3930 participants was 43.3 ± 11.7 years, and 52.3% were male. The number of days of absenteeism due to dental clinic visits in the past year for those who received check‐ups only at the dental clinic and at the workplace were 0.57 ± 2.67 days and 0.21 ± 1.20 days, respectively. After adjusting for covariates, it was found that those who received dental check‐ups at the workplace had 0.35 (95% CI, 0.12–0.58) fewer days of absence than those who received dental check‐ups at the dental clinic. Workers who received dental check‐ups at the workplace were associated with fewer days of absence due to dental visits than those who received at the dental clinic.

This study assessed associations between social relationships and oral health outcomes and whether these associations were explained by demographic, socioeconomic, and behavioral factors, and physical health.

Studies have shown that people with cognitive impairment have poor dental health. However, the direction of causality remains unknown. This prospective cohort study aimed to determine the association between four self-reported dental health variables and dementia onset in older Japanese people.

Visual display terminal (VDT) time has been reported to affect the development of temporomandibular disorders (TMDs). However, no study has investigated the association between VDT time at and outside of work with TMDs Adjusting for known TMJ risk factors. This study aimed to investigate whether TMDs were associated with VDT time at and outside of work after adjusting for various working conditions in Japanese workers. This cross‐sectional study was based on an internet survey of 3930 workers (2057 men and 1873 women), The TMD Screening Questionnaire (SQ‐TMD), occupational factors, VDT time at and outside of work, psychosocial factors, and habits were assessed. We applied logistic regression to estimate the odds ratio (OR) of VDT time on SQ‐TMD with adjustment for confounders. The mean age of the respondents was 43.3 ± 11.7 years, and 778 (19.8%) and 3152 (80.2%) subjects were at high and low TMD‐related symptoms (TRS). Logistic regression analysis adjusting for all covariates (Model 2), the prevalence of high TRS was significantly higher among those with VDT time at work of 60–179 min (OR = 1.52, 95% CI 1.18–1.94), 180–359 min (OR = 1.27, 95% CI 1.00–1.62), and more than 360 min (OR = 1.44, 95% CI 1.10–1.88) compared to those with 0–59 min. However, there was no significant difference in the prevalence of high TRS for VDT time outside of work. VDT time at work, but not VDT time outside of work, influences the prevalence of TRS. Since the association between VDT time at work and the prevalence of TRS was found even after adjusting for sociopsychological factors and habits generally associated with TMD, further investigation of other factors is needed.

The coronavirus disease 2019 (COVID‐19) outbreak and the resulting state of emergency have restricted work environments, which may contribute to increased duration of sedentary behaviors. This study investigated the self‐reported sedentary time of Japanese workers during and after the first state of emergency (April 7 to May 25, 2020) and examined differences in sedentary time after starting work from home and according to job type. We used cross‐sectional data from the Japan COVID‐19 and Society Internet Survey, a web‐based questionnaire survey conducted from August to September 2020 (n = 11,623; age range 15‐79 years; 63.6% male). Prolonged sedentary time was calculated by subtracting the sedentary time after the state of emergency (defined as the normal sedentary time) from that during the emergency, with adjustments using inverse probability weighting for being a respondent in an internet survey. An increase in sedentary time of at least 2 hours was reported by 12.8% of respondents who started working from home during the state of emergency, including 9.7% of salespersons and 7.7% of desk workers. After adjusting for potential confounders, the multivariate‐adjusted odds ratios (ORs) for a prolonged sedentary time ≥2 hours was significantly higher in respondents who started to work from home (OR: 2.14, 95% confidence interval: 1.78‐2.57), and certain job types (desk workers; OR: 1.56, 95% CI: 1.27‐1.91, salespersons; OR: 2.03, 95% CI: 1.64‐2.51). Working from home and non‐physical work environments might be important predictors of prolonged sedentary time.