Factors of elderly people with 20 or more teeth

【背景と目的】近年，我が国は世界でも類をみないスピードで高齢化が進み超高齢社会を迎えた．医療や福祉の視点から考えても，このような社会においては高齢者が健康であることが重要である．そこで，1982年に8020運動が提唱され歯の重要性が検証され始めた．その後，健康増進法が施行され、それに沿った健康日本21（第２次）の目標には「口腔の健康の維持」として各年齢における齲蝕や歯周病の状態等の具体的な数字が挙げられている．自分の歯で咀嚼して食事をする事は，“美味しい食事”“食べる喜び”に直結し，高齢者のQOLの向上に繋がる．今後の歯科界では，高齢になっても多くの歯を残し口腔機能を維持できるような歯科治療および歯を残すための歯科予防における指導方針を確立する事が必要である．そのためには，まず歯を多数残すために必要な要因を認識しておかなければならない．そこで，高齢者における現在歯数を20歯以上保持する要因を口腔内の状態，口腔保健行動，Breslowの生活習慣から調べた．【材料と方法】本研究は2016年から2018年に松本歯科大学病院口腔診療部に来院された65歳以上の57名（男性31名，女26名）を対象に，現在歯数，刺激唾液量（ml/5min），唾液緩衝能（4段階評価），プラーク・コントロール・レコード（PCR），プロービングデプス（PD）の平均，歯周検査時出血率（BI: Bleeding Index），動揺歯率（検査歯数における動揺歯の比率）を調べた．さらに，Breslowの7つの生活習慣（喫煙・運動・飲酒・睡眠時間・体重維持・朝食・間食）とそれらを総合した健康指数（HPI: Health Practice Index）を算出した．また，口腔衛生習慣としてフッ化物の使用状況における質問を実施した．これらの結果を基に，現在歯数と各項目との相関を調べ，年齢，刺激唾液量，唾液緩衝能，PCR，平均PD，BI，動揺歯率，HPI，フッ化物の使用状況を独立変数，現在歯数20歯以上/未満を従属変数としたロジスティック回帰分析を実施し，20歯以上を保持する要因を検討した．【結果】現在歯数と各項目のSpearmanの順位相関係数は，年齢-0.17, 刺激唾液量0.24, 緩衝能0.60，PCR-0.33，平均PD-0.42，BI-0.50，動揺歯率-0.61，HPI0.33，フッ素0.460であった．緩衝能，PCR，平均PD，BI，動揺歯率，HPI，フッ素の使用状況と現在歯数との間に有意な相関を認めたが，年齢および刺激唾液量との間には相関は認められなかった．ロジスティック回帰分析の結果，緩衝能（オッズ比 5.23；95％信頼区間1.43-19.23），動揺歯率（オッズ比0.88；95％信頼区間0.80-0.98），HPI（オッズ比3.07；95％信頼区間1.30-7.25）及びフッ化物の使用（オッズ比2.32；95％信頼区間1.15-4.67）であり，これらの項目と現在歯数を20歯以上有することとの間に有意な関連（p＜0.05）を認め，唾液緩衝能，HPI，フッ化物の使用は現歯数を20歯以上保有する要因であり，動揺歯率は20歯未満となるのを促進する要因であることを示した．【結論】本研究より65歳以上において現在歯数を20歯以上保つ要因は，唾液緩衝能が高いこと，歯周組織が安定し動揺歯がないこと，規則正しい生活習慣を保つこと、習慣的にフッ化物を使用することが示された．したがって，高齢になっても現在歯数を多く残すには，20代や30代から唾液検査や歯周基本検査を実施し，歯が喪失する可能性を持つハイリスク者を早期に抽出する必要がある．そして，各個人における危険因子を説明した上で理解していただき，日常生活の中で本人自身でも気をつけていただくことが重要である．医療者側は，緩衝能が低い人には定期検診の短期化を勧め齲蝕の罹患を予防する．また，継続的な歯周治療を推進し，さらに食生活を含む生活習慣の改善を指導するとともに適したフッ化物の使用などの口腔保健指導が必要であると示唆された．2018博士（歯学）松本歯科大

Cooperative learning and its effect on Operative Dentistry education for 3rd–year students in the School of Dentistry, Matsumoto Dental University

The one–way passive lecture style of teachers leads to little long–term knowledge retention, and it is difficult to develop an ability to analyze/solve problems based on the knowledge possessed. We attempted to adopt active learning methods in Operative Dentistry education, in order to make students aware of their lack of knowledge, lack of understanding, and misunderstandings, further guide them to correct answers through collaborative work in groups, and deepen mutual understanding. This paper introduces our attempt and summarizes evaluations from students according to a post–implementation questionnaire. A yes/no test was conducted twice at two of the 30 lectures on Operative Dentistry in the third grade of Matsumoto Dental University in the school year of 2019. After testing, 3 or 4 students were randomly grouped and each answer was considered by them in a primary small group discussion (SGD). In addition, the two groups were combined and a secondary SGD was performed to consider the answers of both groups. After the secondary SGD, an anonymous questionnaire was given to the students who took the course. We also surveyed foreign students regarding their impressions of SGD in the Japanese language. More than half of the students answered that this exercise was meaningful. More than 90% of the students answered that they could more clearly comprehend their lack of knowledge. In addition, more than 90% of the students answered that they learned how to voluntarily look up information to solve problems in textbooks. More than half of the international students answered that the exercise helped improve their Japanese language. Students listening to the opinions of others, clarifying gaps in knowledge, searching for information in textbooks and clarifying it, and sharing the obtained knowledge with each other promoted their motivation for learning. It also contributed to improving the Japanese language skills of international student

Attempt to introduce a new educational program in the clinical clerkship of operative dentistry for 5th grade students, School of Dentistry,Matsumoto Dental University:Part 1. Collaborative learning through preparation of the examination questions regarding clinical cases

Summary In the academic year (AY) 2020, a new educational program began to be implementedduring the clinical training period of the fifth–year at the Department of Operative Dentistry,Matsumoto Dental University Hospital. The effectiveness of the introduction of one of these programs, preparation of the examination questions regarding clinical cases, was examined based on the evaluation of a questionnaire survey completed by the participating students. A total of 72 students of clinical clerkship program in the fifth grade of the AY 2020 participated in a preparation of the examination questions regarding clinical cases.Small group discussions were used for this exercise. Each group consisted of four students,and the exercise was conducted in two groups. One or two assistant professors or lecturer took turns serving as tutors for each session. First, visual materials of some cases were provided to the students, who discussed them in groups and identified clinical problems in each case. First, the students were provided with visual materials of four cases and discussed them in groups to identify clinical problems in each case. Then, in a one–hour group work, students prepared one examination questions regarding clinical cases according to the question preparation sheet. Next, the students presented the question prepared by each group, shared the question among the groups, and had a discussion to brush up the examination question among the students. The tutor explained the main points to make the exam questions better, focusing on the points raised by the students during the discussion. After the exercise, an anonymous questionnaire was administered to the participants regarding the difficulty level of the preparation of the examination questions regarding clinical cases, the effectiveness of the exercise in improving their knowledge of operative dentistry, and the group work. 94% of the students answered that the exercise was “very difficult” or “somewhat difficult,” but a very high percentage (99%)of the students answered that “this exercise was effective in deepening my knowledge ofoperative dentistry. In the group work, 68% of the students answered that their contribution was 60% or more. Therefore, the new educational program, collaborative learning through preparation of the examination questions regarding clinical cases, was generally well received by the students and was considered effective in improving their knowledge of operative dentistry

Utilization of online real–time feedback application service “Mentimeter” in the lecture of Operative Dentistry for steps in order to pass the National Board Dental Examination at Matsumoto Dental University

Summary Many attempts to utilize ICT (Information and Communication Technology) tools have been made to promote active and interactive learning between teachers and students. A major area has been the introduction of education using clickers for dental students, and some reports indicated their effects. However, the introduction of mobile devices and software and their maintenance and management very costly. On the other hand, almost allundergraduate students of Matsumoto Dental University have a smartphone, and can connect to the Internet in the lecture room. Therefore, we conducted online exercises to pre- pare for the National Board Dental Examination using students’ smartphones and the online real–time voting service“Mentimeter” at the lecture of Operative Dentistry for 6th–year dental students of Matsumoto Dental University, in the school year of 2019. We also conducted some anonymous online questionnaires using Mentimeter. Thirty percent of the participating students answered that they were not good at conservation and restoration studies. Although 97% of students answered that the test questions conducted in the exercise using Mentimeter were difficult, 92% of the students answered that the exercise was effective in deepening their knowledge of Operative Dentistry. The results of the questionnaires suggested the effectiveness of the interactive lecture using Mentimeter in order to deepen and retain knowledge of Operative Dentistry

Attempt to introduce a new educational program in the clinical clerkship of operative dentistry for 5th grade students, School of Dentistry,Matsumoto Dental University Part2.Simulation training of direct composite veneer restoration

Summary A simulation practice of direct composite veneer restoration was newly started during the clinical training period of the 5th year conservatory course of Matsumoto Dental University since the AY 2020. This manuscript presents an overview of the program and examines its educational effects based on the evaluation of an anonymous questionnaire by students who participated in the program in 2020. 72 students in total participated in the 5th year clinical internship in AY 2020, and the program was conducted 9 times for 8 students each in the Department of Operative Dentistry. After a lecture and demonstration by the instructor, four pairs of two students each were assigned to practice direct composite veneer restoration without tooth reduction by applying the layering technique. After the practice, a lecture on the technique,materials and equipment used was given, followed by exercises on the relevant questions of the National Dental Examination that were asked in the past. After the program, an anonymous questionnaire was administered to the participants regarding their level of knowledge of direct composite veneer restoration before and after the program and their self–evaluation of the completion of their practice. The response rate of the questionnaires was 100%. After the program, 68% of the respondents answered that they “understood the direct composite veneer restoration very well” and 31% answered that they “understood it somewhat well. None of the respondents answered that they “did not understand much” or “did not understand at all. When asked whether the contents of the program deepened their knowledge of operative dentistry, 83% of the respondents answered “Very effective” and 15% answered “Somewhat effective”, and none of the respondents answered “Not very effective” or “Not at all effective”. These results suggested that the program was effective in deepening the knowledge level of operative dentistry