INDEX
Why do I put my aim of dentistry in attaing good health?
We cannot expect that the disease called caries which we dentists handle cannot be healed naturally if it progresses.
In addition, periodontal disease became to be understood that we cannot deal with a conventional doctor-orienteded treatment despite bacterial infections.
The onset and progress of both diseases are greatly influenced by the longtime "life style" including the eating habits of the patient.
In other words, it is a lifestyle-related disease.
However, the goal of conventional dentistry was aimed in coronal restoration, recovery of chewing function as the result of inadequate prosthesis.
By the above measures, I might get rid of the trouble of the patient primarily, but as the a cause of illness is still kept, I repeated revival, recurrence, extracting teeth, and I make a prosthesis by all possible means each time, and the teeth changed in sequence and eventually fall down in the slope to full dentures.
Dentistry itself may weaken the resistance of the patient practically.
It does not mean that I can cure disease in this way, and the trust of the patient is not provided, too.
If we are going to cure a disease fundamentally, we must remove the cause of illness.
We have to reexamine the life itself of patient to cure a life origin-related disease, and what we should check must be improved immediately.
However, the step to healing include namely noticing, change of consciousness, action transformation and the improvement of life, only after there is an independent action of patient, and a dentist cannot cure dental diseases depending on dentist leadership in this sense.
If a doctor only gives orders to the patient, instructs and force it, it does not link with the improvement but merely receive repulsion by the patient.
The weight of the medical aim should shift to maintenance, and the increase of health and to prevent disease naturally if we come to understand that it is very difficult to cure the disease which a patient is suffering from.
Dentistry can greatly contribute to maintenance of good health, an increase of the systemic health by maintaining and increasing health of the oral cavity.
That is why dentist should put the aim of dentistry in the systemic health.
The recovery treatments of the chewing function that was ever an aim of dentistry are only means to arrive at the aim of the health.
Therefore, by the removal of the etiology before reaching the improvement of life being carried out strictly, a dentist can prevent revival and recurrence of diseases and can achieve sustainable dentistry.
Health maintenance and the increase of the whole body by brushing.
Brushing aim to acquire healthy periodontium and maintenance, will show the effect in the health of the whole body.
Furthermore, awareness of the refreshment (stiff shoulder will soon completely go away) lets interest and will to face each other boil to make the health of the whole body and must virtually wrestle for the next problem with confidence.
To that end, dentist lets a patient use some supporting methods and utilize those correlation, synergy, and the brushing effect will increase more.
During several years, we confirme until the protective efficacy of a recurrence and the cavity, and the health of the oral organizations as a part of the whole body and its function is increased furthermore.
Words of Kintaro Yanagi are remembered, and it is the following words.
"There is “”Mens sana in corpresano” namely, "The healthy mind dwells in a healthy body" in the Greek old proverb, but I want to say that “Dentes sani in corpore sano” namely "The healthy teeth dwell in a healthy body"
(oral hygiene bulletin, Vol. 1 first August, 1952)
If the necessary supporting methods are accompanied with difficulty to change one custom, it is rather for the opposite effect for achievement of purpose.
In the point, f there is even a motivation, from the point, a method to be able to reduce resistance is desirable for the supporting method.
The effect of cure that an enforcement of the proper, appropriate brushing gives to periodontium particularly gingiva is recognized by the observation of the patient surely.
When we compare it with the color slide before measures in particular, the wonderful effect of "the directed medical treatment" that a patient performed by oneself of only several days lets him forget the pains of the effort and lays confidence of the self reform and raises the will for the new aim.
Should I not pay attention to all points to influence whole-person as well as gingiva depending on one of instruction at that time deeply?
In progress of this treatment, the patient learns the making of health (self-reform) through the experience that he restores health and maintain it and can increase more by the patient changing a part of one's lifestyle, and can recognize that the effect is remarkable.
If the recovery, maintenance and the increases of functions of oral organizations are a duty of dentistry, a dentist must instruct a patient until complete chewing is allowed and lets him achieve it about the chewing function.
To that end, the dentist provides these information, namely, the need of complete masticatory, the quantity of of saliva relating to masticatory, its secretion and the problem of the effect, exercise of masticatory muscles group and the problem of the effect, to a patient.
And a dentist must derive a patient until he enforces "one mouthful 50 times chewing" strictly.
For health maintenance, the increase of organizations, it should be included until food, the instruction of the breathing method, the correction of the pronunciation disorder not to mention complete masticatory meal instruction.
Therefore, the instruction about these matters must be carried out incidentally during a period before appropriate brushing becoming a custom,
Because dentistry contacts with every people through all generations of any people regardless of age or sex, there is not the appropriate thing as dentistry to accomplish the basic education of the making of health.
This recognition and self-confidence do not change ay present, in the past and in the future either.
Brushing is the leading role of required first action preparations (livingry) for making of health.
The dentist cannot cure a tooth. However, it is recognized as a dintist by management because a dentist restores a form, a function and prevent a recurrence and let teeth last a long time and can get over as if it was cured.
If oral organizations do not continue being healthy , a dintist cannot wish he let teeth and oral organizations last a long time .
The health of the oral organizations of the weakling is protected by special hygiene (adhering to an enforcement of the appropriate brushing) and is maintained.
However, the health cannot be healthy as the managed oral cavity of the healthy body.
The health of the oral cavity is born of a healthy body and the health is maintained and increased by the right eating habits, the right breathing method, right exercise and, based on the right chewing method.
For the restoration of health of the oral cavity and the continuation, a patient adopts a therapeutic method by the brushing and how to maintain the health as the supporting method and fix it as a lifestyle until completion of treatment.
After completion of treatment , the health of the oral cavity is maintained for a long time , and it is promoted the health of oral organizations by becoming it, and the health of the whole body is reinforced .
The brushing for treatment in dentistry becomes the means of the prevention of recurrence aiming at the continuation of the restoration effect at the same time.
Understanding was not necessarily an accepted thing about the need of union of a treatment and a prevention promptly from general hygienics and the situation of the public health.
In the flow, I thought to protect the right way of dentistry, and to spread, and had a hard fight.
As result at the medical existing stage, the medicine gained the dramatic decrease in exogenous infectious disease and it was remarkably extended the average life span now.
However, the state that various adult's diseases, lifestyle-related diseases to be said to be diseases incidental to civilization spread through came to right closely resemble a figure of the disease of oral cavity.
These treatment and prophylaxis is explored and considered in various quarters.
As a model, as one precedent and as a senior, the way of the dental practice will be reviewed, learned, and followed for a while in future.
If not only there is it as a specialist strengthening the basics of making of health, but also performs the remedial instruction of Mandibular movement, the dentist will have the role of the leader who right establishes the palace of the health.
All of them depend on brushing instruction. It is vital not to lose sight of a position and a meaning of the brushing instruction now.
This article is announced in 1981
Oral physiotherapy
Natural activation therapy
Oral physiotherapy mentioned Periodontics written by Goldman & Cohen is generally translated as the method of oral hygiene instruction. Oral physiotherapy consists of plaque control by the brushing, flossing, and gargling with drugs such as chlorhexidine. The main cause of the disease of oral infection is abnormal increase, stagnation of the oral indigenous bacteria. Therefore, in this context, to have the only solution in narrow sense is the removal of the cause, namely plaque control.
However, it is necessary for appropriate brushing in removing excortication stimulation and not to harm the lesion tissue weakened at the same time to completely remove the plaque.
Activation characteristics to promote the metabolism of the organization are possessed, and it will thereby draw the natural healing power that the organization is provided with originally.
However, this treatment is provided only for gingiva and does not intend to treat other part of periodontium.
Seen clearly in the study of Weston Andrew Price, is the basic etiology of the disease of oral cavity roots in the food of modern civilization, namely in dietary habits of incompleteness of chewing such as fried food, soft meal, food cooked in high temperature, sweet food, processed food and the instant food.
Therefore the removal of the cause of illness in the wide sense must be include dietary improvement and chewing habits.
Though planning adequate examination of ingredients, reexamination of hardness and the temperature of the food cooked, the number of times to chew, organization and activation by physiological stimulation such as the appropriate force of mastication is realized not only for gingiva but also periodontal membrane, cement, the alveolar bone.
From the above, I want to apply Oral physiotherapy, "Natural activation therapy" .
I remove not only the oral local etiology but also the cause of the systemic weakening and raise systemic resistance in this way.
This will promote the health of oral organizations, and prevent a revival recurrence again.
Such natural activation therapy is the basic cure for modern civilization lifestyle-related disease and, is the starting point to true health as well as treatment recovery of the illness.
NUTRITION AND PHYSICAL DEGENERATION
W. A. PRICE
A gem of a book which vividly shows the importance of the self-sufficient food and the physical degeneration and collapse with the processed food.
For approximately 10 years, Price visited around the world with his wife to search for the secret of health. People whom he chose as subjects of survey were healthy people not the people who suffered from disease. He clarifies how the amazing health is acquired but also shows how the good health collapsed.
Life in all its Fullness is Mother Nature Obeyed.
from the afterword of translator (Tsuneo Katayama)
Though I explain to each patient how bad effect of an inappropriate meal (even if it is expensive and luxurious food, it is not necessarily well balanced meal nutritionally) has on a body and about deep relation about the disease of oral cavity in particular, it is difficult to have a patient review dietary habits and be understood.
However there wasn't any an authoritative book with the scientific proofs and at the same time interesting story-like reading to let patient recognize about diet and health.
As for the book of Dr. Price, it seemed just right which the translator desired.
……
I thought it would be a great help to let people related to medicare, people who need all treatment, or parents in the middle of the child care, but also the aged people who are living the remaining life, just to see the photograph and caption.
I thought it would be a great motivation for the improvement of dietary .
Episode
How did you obtain the original book?
I knew that that an original work of Dr. Price existed, but was not able to check where it was in Japan and how I could obtain it.
The person who said that "I will check it" happened to be one of my patients .
His name was "Hironobu Suzuki", former NHK overseas staff.
First of all, he went to National Diet Library. Unfortunatey the book was not at Library. However, a library staff gave an advice that all the domestic medical books are registered at Keio University Medical Department Library.
And so it was found from registred document of Keio University that there was only one copy of Price's original book at Kyushu University Medical Department Library.
All the project began with the original book which Suzuki borrowed from Kyushu University only for one week.
Photographs in "NUTRITION AND PHYSICAL DEGENERATION"
Polynesian -isolated and modernized group-
Note the marked difference in facial and dental arch form of the two Samoan primitives above and two modernized below. The face bones are underdeveloped below cousin a marked constriction of the arches with crowding of the teeth. This is a typical expression of inadequate nutrition of the parents.
upper photo
The Samoan primitives
lower photo
The modernized Samoan
Endodontics
The endodontic treatment that Katayama carried out in the times when the root canal filling with cotton overflowed in those days was so accurate it surprised the student attending seminars. Katayama who sounded an alarm that there existed a gap between dental medicine and the real clinical practice carried out the root canal filling according to study.
This occured more than half a century ago.
The significant endodontic treatment is surprisingly lowly estimated. When we build a house, foundation work cannot be neglected.
New various appliances and materials and technique for endodontic treatment are introduced in sequence, but there is basically only one route.
from "Root Canal Anatomical Illustrated Book" written by Toranosuke Ono
Katayama explains the complexity of the root canal through the left photographs, and explained how difficult to achieve the purpose.
"If possible you should not take away the pulp easily."
"If you do it at all you should improve your technique and expect perfection."
About Abration
Normally, the teeth of each dental arch have a close proximal contact, which inconjunction with the form and position of the teeth protect the periodontal tissues against direct functional trauma.
As a result of progressive occlusal and proximal attrition, the interdental spaces become more narrow : the gingivae retract slightly; at the same time other changes occur in the hard and soft tissues of the tooth and in its support.
Typical responses are: retraction of the pulp, increasing density of alveolar bone corticals and reduction of the spongeosal hollows.
ln addition to occlusal attrition, the proximal surfaces become worn so that eventually contact surfaces arise in contradistinction to the contact points.
lt has been calculated that the whole dental arch as measured from third molar to third molar is generally diminished by about 10 mm by the age of 40.
This shortening of the dental arch may be due to retrusion of the upper incisors rather than to migration of the first molars. Compensatory tooth migration is accompanied by continuous bone resorption and deposition.
The dental arches are in a state of unceasing reconstruction but normal biological equilibrium is continuous. lt goes without saying that tissue rearrangement is not specific to the tissues of the masticatory system, but nevertheless it is emphasized here because this condition must be taken into account when judging the state of normality at different ages of the individual.
What is normal in a 20-year-old person is not normal in a person 45 years old.
[PHYSIOLOGY OF OCCCLUSON AND REHABILITATION ; P21,22 ULF POSSELT]
Condition of a person receiving a patient
Manner to understand a partner, and to sympathize with
The dealing of the receptionist begins as the first step of the contact with a patient.
I think that the manner of receptionist must be pleasant, simple and direct.
I think that the careful greeting to begin "May I help you" of an elevator girl and an information desk clerk of the department store are not anything else except the expression of the commercialism.
The sincere sympathy for the sick person who comes to the doctor's office while worrying should come with following word.
"Does it ache? Can you stand it?" or
"I will try qickly, but please wait for a while".
In the quality of the receptionist, ability of the compariable observation and the ability to understand mental state of the patient are necessary.
The reception with a gentle heart having a person to please and with a heart to sympathize vividly is important.
There should not be relation losing rapport as "superficial, business-like gentleness".
Even if an another person felt brusquely, it is saved in the result that a receptionist shows the real intention openly.
The maintenance phase of periodontal treatment
It has already been 20 years since the term, "maintenance" or "maintenance phase"，was found in publications with regard to periodontal therapy. This term is, however，understood and used still at present in very vague way.
In order to understand in a true sense, I have attempted to find a proper Japanese term corresponding to this word, and let it be used in a correct way. I defined "maintenance" as “Patient's care to correctly practice the instructions given by his dentist”.
I explained the reason why this definition was proposed and tried to distinguish the term from measures for the prevention of recurrence in order to avoid a confusion of idea， tried to build a theoretical frame work of therapy and attempted to set “maintenance” in a proper position within that frame work. A diagram Fig.2, shows such an attempt.
The first item of the treatment plan is complete elimination of etiological factor, and the second is improvement of vis medicatrix naturae （v. m. n.）from the view point of the principle of therapy. These two basic and essential treatments of therapy should precede any treatment. They are composed mostly of the treatment of surface cleaning including sca1ing and correct stimulation of regional tissues， of which that practiced by a dentist in his office is called “oral physiotherapy”.
The effect of the treatment and its durability can be expected only when the right brushing is practiced by a patient himself， i.e., maintenance.
When it takes much time for an attacked and denatured tissue to be Cured by the elimination of the cause and by the enhanced v. m. n.，and when its existence itself makes a cause of a bad turn， treatment for the alteration of the tissue will be executed.
Since cure is not brought by treatment simultaneously but by v. m. n. which follows， complete elimination of constantly asaulting etiologic factor and execution of treatment to improve v. m. n， which accelerates cure are essential conditions for the enrichment and for then duration of the effect brought by the treatment of the lesion（active therapy）and for completing cure. As mentioned above， there is no other way for these purposes than the right brushing by the patient， i.e., maintenance.
Thus，in the treatment plan of periodontal diseases， principles of therapy， “elimination of etiological factor” and “strengthening of v. m. n.” are basic treatments which can not be omitted in any case and are essential from the beginning to the end of the treatment plan. In case of periodontal diseases， therefore，practice of care by the patient， maintenance，is so important as to decide whether the treatment: is successful or not since such a plan is to be carried out mostly by the patient.
Periodontal therapy is effectively executed by realizing that the base of therapy lies on oral physiotherapy and by understanding that therapy consists of three phases, that is， therapy phase，nursing phase and maintenance phase.
To my great regret， however，effect of oral physiotherapy or that of right brushing as a care by a patient， i.e. maintenance，is not so positively shown as other treatments and， as a result，is hardly understood.
Results obtained in my 30 years’ clinical experiences proved its effect. Availing them， I reported an attempt of building a rough frame work regarding what position was to be given to the role of maintenance-presentation of some hypotheses of theorizing therapy and pre
vention，that is， medicine，of periodontal diseases.
I proposed a definition of fully explaining the meaning of maintenance as “Patient’s care to correctly practice the instructions given by his doctor”.
I picked up “motivation” as a key to a successful instruction of care.
Employment of both methods， disclosing the stained plaque for patients to realize its remains and showing the flora of micro-organisms included in the plaque through a phase contrast microscope， is most effective for motivation.
Since my experiences show that more than half of the patients can not see the activities of micro-organisms through a microscope directly with their own eyes， I improved this method and，at present， employ a method of projection to a TV screen as is shown in Fig.1
In order that such a frame work of dental therapy be generally established， it is a matter of course to say that understanding and effort of dentist， hygienist and patient are necessary.
Under the present conditions of Japan， however，it is like a dream to think that the above-mentioned frame work can be realized by them only.
Taking into consideration that a proper social policy with regard to medicine will either make it a dream or realize it， I emphasized that an effort for this objective is urgent and important.
This study was published in my special Lecture at The 13th Genera1 Meeting of Japanese organization for Research of Periodontology in 1970， and also in Dental 0utlook， 26(4)，777-790(1965)；The Nippon Denta1 Review， 288， 37-47(1966)；Denta1 0utlook， 32(5), 792-794，
833-841(1968)；The Journal of the Japan Denta1 Association， 23(12)，1209-1217(1971)；Dental 0utlook， 37(6)，978-983(1971).
