Overview of community-based oral health support activities at the shelter care facilities and dental caries prevalence of children during temporary custody

Child abuse is a serious social issue, with the number of consultations having rapidly increased in recent years. Major incidents that threaten children's lives occur constantly; thus, child abuse is a crucial problem that must be solved as quickly as possible. When children undergo dental examinations or emergency medical treatment, an understanding of their words, their actions, and their oral health statuses may yield clues that lead to early detection and reporting of child abuse. Therefore, dental health professionals are anticipated to play a role in preventing child abuse. We conducted a survey study of children sheltered at three temporary shelter care facilities in Hiroshima Prefecture, Japan. We investigated dental examinations, oral health instruction, and other support activities provided for these children. The survey results yielded the following findings. 1) The number of children sheltered due to child abuse was comparable to the number of children sheltered for other reasons. 2) Among the abused children, the most prevalent age group was elementary school children (ages 6-11years; 48.4%). followed by preschool children (ages 0-5 years; 29.9%). and junior high school/high school children (ages 12-18 years; 21. 7%). 3) Compared with average children, children in shelter care were more likely to have experienced dental caries and to have untreated teeth; these children demonstrated a high average number of teeth that had experienced dental caries, as well as a high average number of untreated teeth. 4) In contrast, no difference in the morbidity of dental caries was observed between children sheltered due to abuse and children sheltered for other reasons. These results indicate that proactive support is necessary for children who demonstrate oral health problems, such as a high prevalence of dental caries, regardless of whether they have been abused, since such manifestations can be interpreted as signs of maltreatment

MPP+ toxicity and plasma membrane dopamine transporter: study using cell lines expressing the wild-type and mutant rat dopamine transporters

AbstractThe Parkinsonism-inducing neurotoxin 1-methyl-4-phenylpyridinium (MPP+) causes specific cell death in dopaminergic neurons after accumulation by the dopamine transporter (DAT). COS cells, a non-neuronal cell line insensitive to high doses of MPP+, becomes sensitive to MPP+ when transfected with the rat DAT cDNA. We analyzed the bi-directional transport of MPP+ and its toxicity in several cell lines expressing wild or mutant DATs. Cell death in COS cells expressing wild DAT by exposure to MPP+ was concentration-dependent and cocaine-reversible. Increased wild DAT expression caused higher sensitivities to the toxin in HeLa cells. Although several mutant DATs demonstrated greater transport activity than the wild-type, they displayed similar or lower sensitivity to MPP+ toxicity. Reverse transport of preloaded [3H]MPP+ through DAT was facilitated in COS cells expressing certain mutant DATs, which consistently displayed less sensitivity to MPP+ toxicity. These results suggest that re-distribution of MPP+ due to influx/efflux turnover through the transporter is a key factor in MPP+ toxicity

MPP+ toxicity and plasma membrane dopamine transporter: study using cell lines expressing the wild-type and mutant rat dopamine transporters

AbstractThe Parkinsonism-inducing neurotoxin 1-methyl-4-phenylpyridinium (MPP+) causes specific cell death in dopaminergic neurons after accumulation by the dopamine transporter (DAT). COS cells, a non-neuronal cell line insensitive to high doses of MPP+, becomes sensitive to MPP+ when transfected with the rat DAT cDNA. We analyzed the bi-directional transport of MPP+ and its toxicity in several cell lines expressing wild or mutant DATs. Cell death in COS cells expressing wild DAT by exposure to MPP+ was concentration-dependent and cocaine-reversible. Increased wild DAT expression caused higher sensitivities to the toxin in HeLa cells. Although several mutant DATs demonstrated greater transport activity than the wild-type, they displayed similar or lower sensitivity to MPP+ toxicity. Reverse transport of preloaded [3H]MPP+ through DAT was facilitated in COS cells expressing certain mutant DATs, which consistently displayed less sensitivity to MPP+ toxicity. These results suggest that re-distribution of MPP+ due to influx/efflux turnover through the transporter is a key factor in MPP+ toxicity

Requirement for Improved Undergraduate Education in Oral Traumatic Injuries

口腔外傷に関する教育の基準や指導内容が日常臨床を反映したものか否かを評価することを目的として、歯科医師国家試験(第95～ 104回) 3,510問題のうち口腔外傷に関する77問題について調査、検討を行った。 結果を以下に示す。 1.口腔外傷関連問題は各年約1～3%であった。 2.関連領域別では、口腔外科学(歯科放射線学を含む)、小児歯科学の順に多かった。 3.内容別では、一般問題においては「特徴」が多く、臨床実地問題においては「破折歯」の「治療」が最も多かった。 4.外傷の「予防」についての出題は無く、「児童虐待」に関する問題数は極めて少なかった。 5.臨床実地問題の約90%に視覚素材が使用されており、「口腔内写真」、「デンタルエックス線写真」の順に多かった。 本調査より、近年の歯科医師国家試験問題は概ね口腔外傷の診断や処置をする上で重要な項目について出題されていた。反面、近年注目されている「口腔外傷」と「児童虐待」との関係や「口腔外傷の予防」などの臨床上重要であるにも関わらず出題が無い、もしくは少ない項目もみられた。今後、これらの項目について、その重要性を裏付けするエビデンスの集積や、日本外傷歯学会ガイドラインへの追加などを行うことの必要性が示唆された。With remarkable developments in dentistry, the diagnosis and treatment of oral traumatic injuries have become relatively sophisticated. Dental students should be taught to respond to these developments through special dental education. This training should be taught in dental schools in accordance with fixed standards within dentistry teaching outlines, core curricula, CBT, and the standards of national dentistry examinations. However, there is a lack of data with regard to whether these standards of education in oral trauma are being met, making it difficult to evaluate whether a suitable education in oral trauma is being provided to students. We report here the results of an investigation of exam questions relating to dental trauma from ten consecutive national dentistry examinations (2002-2011). Questions regarding oral traumatic injuries represented only 1.3% of the total. We examined these questions for their subject, content and form. Most of the questions were asked in the section about "Oral Surgery (including Dental Radiology)" and the second highest number asked in "Pedodontics". For general dentistry, the contents of the questions were mostly related to "features" of the trauma and second about their "treatment" . For clinical practice, most of the questions were related to "treatment" and the next highest related to their "diagnosis" . No questions addressed the "prevention" of dental trauma, and very few questions concerned "child abuse." These are important aspects of a rounded education in oral trauma and it is suggested that the Association of Dental Traumatology plays a major role in collating new evidence and creating new guidelines for better dental education

The Investigation on Oral Condition of 1-year-old Infants and the Contents of Dental Consultation with Their Parents at the Time of Oral Examination

某病院小児歯科で歯科健診を受けた1歳児1,529人を対象として, 健診結果と健診時の保護者の相談内容について集計した。その結果, 以下の結論を得た。 1. 萌出歯数は1歳0か月では7.5本, 1歳6か月では13.8本であった。 2. 齲蝕に罹患していた小児の割合は3.6%であった。また, 1歳0か月～1歳5か月までの3.2%, 1歳6か月～1歳11か月までの10.7%の小児が齲蝕に罹患していた。 3. 齲蝕に罹患した小児のうち, 85.5%が卒乳していなかった。また, 61.8%に就寝前または夜間の母乳の摂取, 29.1%に哺乳瓶による就寝前または夜間の飲料の摂取の習慣があった。 4. 1歳児を持つ保護者への「何か気がかりなことはありますか」という質問に対し, 最も多かった回答は「歯みがきを嫌がる」であり, 以下順に「歯ならび」, 「歯みがきの方法」であった。 5. 歯科健診を受けた1歳の小児のうち, 43.0%が健診を契機に引き続き同病院小児歯科を定期的に受診するようになった。そのうち, 健診をした時点で齲蝕に罹患していたのは4.4%であった。また, 定期的に受診するようになった小児の保護者のうち, 44.4%が歯科健診時に「特に気になることはないという回答をしていた。このことから, 齲蝕治療などの特別な動機がなくても, 1歳時の歯科健診を契機に定期的に小児歯科を受診するようになる小児が多く存在することが判明した。The results of dental examinations and the contents of consultation with parents or guardians at the time of examination were compiled for 1,529 1-year-old infants without having any particular motivation who received dental examinations. The results of this study were as follows: 1. The mean number of erupted teeth in infants aged 1year and 0 months was 7.5. 2. Dental caries affected 3.2% of the infants aged 1year and 0 to 5 months and 10.5% of the infants aged 1year and 6 to 11 months. 3. Among the infants afflicted with caries, 85.7% had not been weaned. 61.8% were generally breast-fed before going to bed or during the night, and 29.1% were bottle-fed before going to bed or during the night. 4. When parents with 1-year-old infants were asked if they felt anxious about their children's oral health, the most common response was "aversion to teeth-brushing", followed by "teeth alignment" and "methods of brushing their children's teeth". 5. Of the infants who received dental examinations at age 1, 43.0% continued to receive regular pediatric dental care. Among those infants who become regular patients, only 4.4% were afflicted with caries in examinations at age 1. Moreover, 44.4% of the parents of infants who came to receive regular care had answered at the dental examination that they had "no particular anxieties". Thus it was clear that even without caries or a particular motivation, there are many infants who come to receive regular pediatric dental care due to the approach of the dentist

Individualized Support Based on Characteristics of Patients with Autistic Spectrum Disorder in Pediatric Practice

自閉症スペクトラム障害(Autism Spectrum Disorder以下ASD)の小児には,知的障害の有無に関わらず整理統合が困難で視覚優位である者が多い。また,ASD児の能力には個人差があるため,支援者は障害特性に配慮した個別対応が要求される。ところが,歯科診療時におけるASD児の対応法に関する情報はいまだ不十分である。 そこで,当科にて歯科診療時に行ったASD児への個別対応のうち効果的であったものを報告する。 症例1 初診時2歳11か月,男児,高機能自閉症・AD/HD(注意欠如・多動性障害) この患児は,3歳時既に全ての干仮名と数字が読めた。そこで,診療に対する混乱の除去のため,文字情報で予定を可視化した(Word Schedule)。予定の最後を「ごほうび」と記し、強化子として患児の好きなキャラクターの塗り絵を使用した。 症例2 初診時6歳11か月,男児,白閉症(知的障害を伴う) 絵カードを予定の順に並べ(予定の構造化),入室前に患児へ見せた。治療のステップが1つ終わる度に,褒め言葉と同時に○のサインボードを見せた。これは,言葉だけでなく視覚的にもできたことや褒められたことを認識できるようにするための援助である。 以上の対応により,スムーズに診療が行えた。このように,ASD児の歯科診療の際には,個々の発達レベルや行動を十分に観察した上で個別化された支援方法により対応することが有効と考えられた。Many children with autistic spectrum disorder (ASD) and with or without intellectual disability have weak central coherence and a tendency to learn in a visual manner. Because of individual differences in the developmental status of ASD children, personalized support is optimal. However, there is scant published information about methods for providing individualized support in dental practice for children with ASD. Here, we describe effective strategies for providing individualized support in dental practice for children with ASD treated at our clinic. Case 1 : Boy, aged 2 years 11 months, with high-functioning autism and AD/HD This child was able to read hiragana letters and numerals at the age of 3. Therefore, we showed him information about the clinical procedures (Word schedule) to remove emotional confusion about dental practice. We noted "reward" in red to give him a clear concept of the finish. The reward was included as a "reinforcer" and we used a drawing of his favorite cartoon character. Case 2 : Boy, aged 6 years 11 months, with autism and intellectual disability Picture cards portraying the events of the dental procedures in sequential order were shown to the child prior to and during therapy, with the picture card for each event removed when that step had been completed and a signboard with a red circle containing words of praise shown to the child. Thus, he received praise visually as well as through verbal encouragement. We also showed the child a timer that counted down the seconds until the procedure would be completed. Using these approaches, we were able to successfully facilitate dental treatments for children with ASD. It is clear that an individualized method, generated by assessing the development and behavior of each child, is advantageous for providing support of children with ASD

Expression and function of variants of human catecholamine transporters lacking the fifth transmembrane region encoded by exon 6.

BACKGROUND: The transporters for dopamine (DAT) and norepinephrine (NET) are members of the Na+- and Cl--dependent neurotransmitter transporter family SLC6. There is a line of evidence that alternative splicing results in several isoforms of neurotransmitter transporters including NET. However, its relevance to the physiology and pathology of the neurotransmitter reuptake system has not been fully elucidated. METHODOLOGY/PRINCIPAL FINDINGS: We found novel isoforms of human DAT and NET produced by alternative splicing in human blood cells (DAT) and placenta (NET), both of which lacked the region encoded by exon 6. RT-PCR analyses showed a difference in expression between the full length (FL) and truncated isoforms in the brain and peripheral tissues, suggesting tissue-specific alternative splicing. Heterologous expression of the FL but not truncated isoforms of DAT and NET in COS-7 cells revealed transport activity. However, immunocytochemistry with confocal microscopy and a cell surface biotinylation assay demonstrated that the truncated as well as FL isoform was expressed at least in part in the plasma membrane at the cell surface, although the truncated DAT was distributed to the cell surface slower than FL DAT. A specific antibody to the C-terminus of DAT labeled the variant but not FL DAT, when cells were not treated with Triton for permeabilization, suggesting the C-terminus of the variant to be located extracellulary. Co-expression of the FL isoform with the truncated isoform in COS-7 cells resulted in a reduced uptake of substrates, indicating a dominant negative effect of the variant. Furthermore, an immunoprecipitation assay revealed physical interaction between the FL and truncated isoforms. CONCLUSIONS/SIGNIFICANCE: The unique expression and function and the proposed membrane topology of the variants suggest the importance of isoforms of catecholamine transporters in monoaminergic signaling in the brain and peripheral tissues

A Two-year Longitudinal Study on the Periodontal Health Educationfor Junior High School Students using the Oral Rating Index

中学生における歯周状態の変化を把握するために広島市内の中学生を対象として経年的に調査した。検診後には歯周保健指導を行い,歯周状態の変化について検討した。対象は1998年度に1年次であった生徒, 116名(男子59名,女子57名)であった。歯周状態の評価は, Oral Rating lndex (0RI)を用いた。検診後は生徒自身のORI値による評価を知らせ,歯周病に関するプリント「保健室便り」を配布した。1. 3年次を除き0町の平均値に性差が認められ,女子の方が男子よりも歯周状態は良好であった(1年次:p<0.05,2 年次:p<0.0l)。2. 男子では学年が上がるにしたがってORIの平均値が上昇した(p<0.05)。女子においては3年次でORIの平均値が減少したが, 1年次から2年次にかけてORIの平均値が上昇した(p<0.0l)。3. 男子は学年が上がるにしたがって歯周状態が不良を示す一1の割合が減少した。女子においてー1あるいは-2を占める割合が減少した。以上より,経年的調査においてORIによる歯周状態の評価とプリント形式で配布される「保健室便りJを活用した歯周保健指導が生徒の口腔衛生意識向上の一助になると思われた。The purpose of this study was to assess the gingival health and oral hygiene status in junior highschool students and to compare the effectiveness of periodontal education. A two-year longitudinalsurvey was conducted for 116 school students from 1998 to 2000 in Hiroshima, Japan. The Oral RatingIndex (ORl) was used for assessing periodontal status and hislher result was given to each student.A brochure has been provided since 1995, following completion of the fIrst survey. The meanORl score of females was signifIcantly higher than that of males at each grade level, except the thirdgrade in 2000. The mean ORl score of males from 1998 to 2000 signifIcantly increased (p<0.05).There were no signifIcant differences in the mean ORI score of females from 1998 to 1999 signifIcantlyincreased (p<0.01).In conclusion, the results of the present study indicate that an informational brochure on periodon-/tal diseases could be helpful to improve the periodontal condition of junior high school students

A Third Supernumerary Tooth Occurring in the Same Region: A Case Report

The presence of a supernumerary tooth is one of the most common dental anomalies, and surgical treatment is often required to address this anomaly. Moreover, it may lead to malocclusion, and long-term follow-up is important to monitor its status. A 4-year-and-11-month-old boy was referred to our hospital for dental caries treatment. At 5 years and 5 months of age, a radiographic examination showed a supernumerary tooth (first supernumerary tooth) near the permanent maxillary left central incisor, and it was extracted 6 months later. Eighteen months after the extraction of the first supernumerary tooth, a new supernumerary tooth (second supernumerary tooth) was detected in the same region, which was extracted when the patient was aged seven years and seven months. Seven months later, another supernumerary tooth (third supernumerary tooth) was detected and extracted immediately. However, the permanent maxillary left central incisor did not erupt spontaneously even after 6 months. Therefore, surgical exposure was performed, and the central incisor erupted into the oral cavity. This report describes our experience with this patient with three metachronous supernumerary teeth and their management until the eruption of the permanent tooth. This report highlights the importance of long-term follow-up after supernumerary tooth extraction until the permanent teeth in that region have erupted completely