Faculty Profiles - YOSHIHARA Akihiro

Improvement in Gingivitis by Prevention Program at the Elementary School with the Use of Dental Floss

YOSHIHARA Akihiro, FUKAI Kouichi, MOROZUMI Yuko, HIROTOMI Toshinobu, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 51 ( 5 ) 822 - 827 2001

Language：Japanese Publisher：Japanese Society for Oral Health

According to the Japanese National Oral Health Survey in 1999, the prevalence of gingivitis among 5-14-year-old children is 47.4%. The use of dental floss is important in preventing gingivitis. The present study investigated the effect of a gingivitis prevention program with the use of dental floss. Thirty-nine 5th graders at "M" elementary school (test group) and eighteen 5th graders at "Y" elementary school (control group) were included in this study. Subjects in the test group were instructed by dental hygienists to use dental floss for anterior teeth in combination with regular toothbrushing after lunch. Measurements were carried out by the same dentist at the baseline and at 6 months, using the modified papilla bleeding index and the plaque index for the anterior 10 papillae. At the baseline, there were no differences between the percentages of proximal bleeding sites per person, of plaque per person, or the percentage of subjects using dental floss in their own home. During a 6-month period, the number of bleeding sites per person decreased from 4.67 (SD=3.01) to 3.03 (SD=2.70) in the test group, and increased from 4.59 (SD=2.50) to 5.41 (SD=3.43) in the control group. There was a significant difference in the reduction of bleeding sites in both groups (p=0.003, Mann-Whitney U test). The number of plaque sites per person decreased from 4.64 (SD=3.02) to 3.41 (SD=2.68) in the test group, and increased from 5.12 (SD=2.93) to 6.41 (SD=2.62) in the control group. There was a significant difference in the reduction of plaque sites in both groups (p=0.003, Mann-Whitney U test). The percentages of subjects using dental floss in their home after instruction during the baseline period was 51.5% for the test group and 22.2% for the control groups (p=0.023, chi-square test). These results show that a gingivitis prevention program including the use of dental floss contributes to the prevention of gingivitis in school children. It is suggested that the program in the present study is relatively easy to include in a school-based dental program and can be widely used.

DOI： 10.5834/jdh.51.5_822

高齢者における歯周組織破壊のRisk Indicatorについて

小川祐司, 広富敏伸, 葭原明弘, 安藤雄一, 宮崎秀夫

新潟歯学会雑誌 30 ( 2 ) 264 - 264 2000.12

YOSHIHARA Akihiro, SAKUMA Shihoko, WANG Jing, MATSUMURA Seishi, SHIMONO Tsutomu, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 50 ( 1 ) 83 - 88 2000

Language：English Publisher：Japanese Society for Oral Health

This cross-sectional study investigated factors related to dental caries prevalence in a low caries group. The subjects consisted of 89 schoolchildren aged 12 years. The children had participated in a fluoride mouth rinse program since 5 years of age at nursery schools. Furthermore, pit and fissure sealants were applied to teeth with sticky fissures when detected at dental check-ups twice a year. Clinical examinations were conducted to obtain data on caries prevalence (dfs and DMFS). The salivary level of mutans streptococci, the salivary level of lactobacilli, and the acid production by bacteria in the plaque were measured using Dentocult SM Strip ® , Dentocult LB Dip Slide ® , and Cariostat ® , respectively. In addition, we obtained information on gender, sum of permanent tooth surfaces sealed, toothbrushing frequency, sweet snack frequency, sweet drink frequency, use of fluoridated toothpaste, and stimulated salivary flow rate. Stepwise backward logistic multiple regression analysis was used to estimate the relationship between caries prevalence and 11 total independent variables. Furthermore, we obtained information about some reasonable linear discriminators that could identify subjects with high caries experience using the final logistic multiple regression model. Thereafter, we calculated sensitivity, specificity, and Youden's index according to the classification table. As the results of stepwise backward logistic multiple regression analysis, three variables (number of sealants, the level of Cariostat R , and frequency of sweet snacks) were selected as independent variables in the final model. The level of CariostatR showed the highest odds ratio (Odds ratio : 6.87, p=0.02). The cutpoints at which Youden's index showed the highest value, sensitivity, and specificity were 76.9% and 75.7%, respectively. According to these findings, it is safe to say that we could propose that the plaque level of Cariostat ® might be the most important variable related to caries prevalence.

DOI： 10.5834/jdh.50.1_83

A Comparative Study of Glass Ionomer and Resin-based Material Used as Fissure Sealants on the First Molars -with Incipient Remineralization

YOSHIHARA Akihiro, SAKUMA Shihoko, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 50 ( 5 ) 777 - 782 2000

Language：Japanese Publisher：Japanese Society for Oral Health

Pit and fissure sealants have been accepted as a caries preventive strategy and have a great effect on preventing dental caries on the pit and fissure surfaces of permanent molar teeth. The retention for resin-based sealant is better than for glass ionomer sealant, but the difference in caries prevention remains equivocal. The aim of this study was to compare the caries preventive effect and retention of a glass ionomer cement (GIC) and a resin-based sealant (RBS). GIC (n=61) or RBS (n=82) was applied on the occlusal surfaces of permanent first molars with Sticky Fissure in school children (n=108), mean age=9.50±1.57 (S. D.). All sealants were applied by two operators using standard procedures and were assessed at baseline and every 6 months thereafter. Assessment criteria were based upon the inefficient status rate (Sticky Fissure or dental caries) and on the occurrence of caries. After 2 years, the ineffective status rate was 23.2% on the RBS compared to 36.1% on the GIC (p<0.05, Wilcoxon's test). For the evaluation of material for sealing, logistic multiple regression analysis was performed. As dependent variables, inefficient status (yes=1, no^O) was used. As independent variables, age, sealant material (RBS=1, GIC=2), DMFT at baseline and jaw (upper=1, lower=2) were used. The inefficient status was associated with the sealant material (Odds ratio: 1.61, p=0.04), after adjusting for age, DMFT at baseline and jaw. In addition, there were a total of eight occurrence of caries, three (4.9%) in teeth sealed with GIC and five (6.1%) in teeth sealed with RBS. The difference in the percentage of the occurrence of caries between teeth sealed with RBS or GIC was not significant. In conclusion, there was no significant difference in caries prevention using GIC compared to RBS. However, there was significantly better retention with RBS.

DOI： 10.5834/jdh.50.5_777

Survival of Fissure Sealants and Preventive Resin Restorations Applied over Early Occlusal Carious Lesions

SAKUMA Shihoko, YOSHIHARA Akihiro, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 50 ( 5 ) 765 - 771 2000

Language：Japanese Publisher：Japanese Society for Oral Health

The purpose of this study was to evaluate the clinical success of fissure sealants (SR) and preventive resin restorations (PRR) which were applied over occlusal carious lesions and to discuss the availability of these methods in a program which manages recently erupted permanent molars by means of prevention and treatment of occlusal dental caries. A preventive resin restoration is a conservative treatment that involves limited excavation to remove carious tissue, restoration of the excavated area with a composite resin, and application of a sealant over the surface of the restoration and the remaining sound, contiguous pits and fissures. Subjects were 57 children aged between 8 and 14 years, at the last examination and who had teeth treated with either SR or PRR. They had been participating in a school-based fluoride mouthrinse program from the age of 5 years, which was combined with a targeted sealant-sealant was selectively applied on the fissure detected as sticky using an explorer-in elementary school. Sixty six teeth-64 first and 2 second permanent molars-were evaluated. Carious lesions that did not exceed a width of 2 mm in a pit or fissure of these teeth were detected. Accordingly, SR or PRR were applied on them. An excavation performed with a small round bur (# 1/2) was indicated for SR, while excavation using a bigger bur was indicated for PRR. After these lesions were treated with either SR or PRR, they were assessed twice a year. The mean period of observation was 3.4 years, with a range of 1 to 7.5 years. Out of 45 teeth to which we applied SR, 9 teeth developed secondary caries. In the case of PRR 3 teeth out of 21 teeth developed secondary caries. The cumulative survival rate for subject teeth after 7.5 years was 71.9±8.0 (SE)% as detected by Kaplan-Meier survival functions; thus, the cumulative incidence of secondary caries was 28.1%. There was no significant difference between the cumulative survival rate for SR (71.0 ± 9.1%; after 7.5 years) and that for PRR (75.2 ± 14.8%; after 5.5 years) as determined by generalized Wilcoxon analysis. And stepwise multivariate logistic regression analysis indicated that the school grade at which carious lesion was detected first had a significant impact on the development of secondary caries after SR or PRR application. A cavity detected at the 1st and 2nd grade was at a larger risk (odds ratio=4.56) than that was detected at higher grades. Similar findings have been reported earlier. It is, therefore, recommended that these treatment methods, which are indicated for small and discrete pit or fissure caries, be adopted in dental clinics practicing preventive measures of dental caries, including fluoride use. It is also suggested that the condition of sealant or resin restoration be observed periodically, in order to maintain it properly.

DOI： 10.5834/jdh.50.5_765

An Evaluation and Comparison of Visual Inspection, Electrical Caries Monitor and Caries Detector Dye Methods in Detecting Early Occlusal Caries in Vitro Study

WANG Jing, SAKUMA Shihoko, YOSHIHARA Akihiro, KOBAYASHI Seigo, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 50 ( 2 ) 223 - 230 2000

Language：English Publisher：Japanese Society for Oral Health

The purpose of this study was to evaluate and compare three diagnostic methods in detecting early caries in occlusal surfaces. Three different methods, namely, visual inspection (VI), electrical caries monitor (ECM) and a caries detector dye (Dye) were used to diagnose occlusal caries in extracted teeth. One hundred sixty-one sites in a total of 42 extracted teeth were examined by three examiners with VI and ECM methods, whereas the Dye method to detect caries was tested by only one examiner. Histological examination of the teeth served as a validating criterion to evaluate the ability of each method to diagnose caries. Of 161 sites, 82, 96 and 96 sites were diagnosed as having caries by the VI, ECM and Dye methods, respectively, compared with 85 sites by histological validation. ECM showed the highest level in sensitivity (85%), followed by VI (67%) and Dye (63%). In the ROC analysis, the areas under ROC reached 0.73, 0.89 and 0.61 for the VI, ECM and Dye methods, respectively. The kappa values ranged from 0.64-0.80 and 0.75-0.82 in intra- and inter-examiners for ECM, respectively, and between 0.53-0.82 and 0.29-0.70 for VI. It was concluded that the ECM method is more valid and reproducible than VI or Dye for the diagnosis of occlusal caries.

DOI： 10.5834/jdh.50.2_223

個別保健指導及びパンフレット郵送の成人歯科保健に対する有効性成人女性を対象として

葭原明弘, 八木稔, 澤村恵美子, 金子昇, 宮崎秀夫

口腔衛生学会雑誌 49 ( 5 ) 809 - 815 1999.10

Language：Japanese Publisher：(一社)日本口腔衛生学会

2歳時健康診査受診者の内,3歳児健康診査も受診した244人の母親を対象とした.テスト群(177人)には,歯科衛生士が対象者1人あたり約10分の個別指導を実施した.母親の口腔健康状態には1年間で変化は認められなかった.歯間ブラシ又はフロスを補助清掃用具として使用している割合は,コントロール群では15.0%(ベースライン)から17.3%(1年後)と同様の使用率であったのに対し,テスト群では17.1%(ベースライン)から28.2%(1年後)と有意に増加した.又,1年後の補助用具の使用の有無に対し,有意な要因として選択されたものは,ベースライン時の補助用具の使用,歯科医より歯周疾患の情報入手及び歯科衛生士による個別指導の3変数であった

DOI： 10.5834/jdh.49.5_809

The Incidence Risk for Dental Caries from Brown-Stained Pit and Fissure in the First Molars of Schoolchildren

YOSHIHARA Akihiro, SAKUMA Shihoko, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 49 ( 3 ) 324 - 328 1999

Language：Japanese Publisher：Japanese Society for Oral Health

The purpose of this study was to obtain information on the caries risk of brown-stained pits and fissures in the first molars. Six hundred thirty-three elementary schoolchildren were selected as sample subjects. The children had participated in a fluoride mouthrinse program since 5 years of age at nursery schools, in addition to having received routine dental education. The screening method consisted of two steps. First, we selected questionable caries for observation (CO teeth) at the school examination. Next, at the second step, we classified the CO teeth into those having brown-stained pits and fissures or sticky fissures, determined at a dental clinic examination. The progression of caries from the brown-stained (86 teeth) and sound (168 teeth) pits and fissures during the next 6 months was compared using the ratio of relative risk. In addition, we evaluated the factors related to the caries progression for 6 months by logistic regression analysis. As a dependent variable, caries occurrence (0: DMFT=0, II DMFT ≥ 1) was used. As independent variables, school grade (1-6), the number of DMFT (0-4), the number of teeth with brown-stained pits and fissures (0-4) and the number of teeth with sticky fissures (0-4) at baseline were used. The percentage of teeth progressing to caries during this 6 month period was 1.2% (2 out of 168) of sound teeth, and 7.0% (6 out of 86) of teeth with brown-stained pits and fissures. The difference in the progression ratio between the two groups was statistically significant (p = 0.02, Fisher's exact test) and the ratio of estimated relative risk was 5.86 in the teeth with brown-stained pits and fissures against the sound teeth. Furthermore, according to logistic regression analysis, only DMFT showed a significant odds ratio (Odds ratio: 2.38, p=0.02). The results of the study demonstrated that the influence of caries activity on teeth with brown-stained pits and fissures might be low. Furthermore, the risk of progression of teeth with brown-stained pits and fissures to dental caries might be lower than the risk of teeth with sticky fissures, according not only to the results of this study, but also to the results of our previous report on the same school as in this study. We should concentrate on caries prevention especially for teeth with sticky fissures because of their high susceptibility to caries. For making a more efficient caries prevention program, we should make a new connection system between screening examinations at school and treatment for prevention with detailed examination at a dental clinic.

DOI： 10.5834/jdh.49.3_324

Economic Aspects of Pit and Fissure Sealants as Caries Preventive Measures Reviewed

YOSHIHARA Akihiro, SAKUMA Shihoko

JOURNAL OF DENTAL HEALTH 47 ( 5 ) 703 - 716 1998.1

Language：Japanese Publishing type：Thesis (other) Publisher：Japanese Society for Oral Health

A number of clinical studies on treatment of pit and fissure sealants have been made and have concluded that sealants are an effective measure for dental caries prevention. However, it has not yet been established whether sealant application is cost-effective or not. The purpose of this study was to evaluate the cost-effectiveness of sealant application by different standard and to define a major factor which influences the most effective standard. 854 sound 1 st permanent molars in 290 primary schoolchildren between the 1 st and 3 rd grades were selected for this study. When 4 different kinds of adaptation standards were adopted for sealant for the 1 st permanent molars, each cost-effectiveness was compared by simulation in the subjects. The criteria chosen as standards were 1) only teeth with slight sticky fissure (SF), 2) healthy teeth contralateral to one which was carious or filled, 3) all 4 teeth only in subjects whose all 4 second primary molars were decayed or filled, and 4) all 4 teeth in all the subjects. The expected utility value (the costs for sealant and, if needed, for restorative treatment per tooth over time) and cost-effectiveness ratio were calculated for the 4 different adaptation standards, respectively. When adopting each standard, the clinical decision analysis showed that standard # 2 (the opposite tooth was carious) was the lowest at 199 yen, standard # 1 (SF) was the next (289 yen), followed by standard # 3 (all the second primary molars were carious ', 526 yen) and standard # 4 (all teeth ; 1,520 yen). In same way, the cost-effectiveness ratio showed that standard # 1 (SF) was 6,004 yen, # 2 was 10,193 yen, # 3 was 17,668, and # 4 was 27,282, respectively. The cost-effectiveness for sealant was estimated to be changeable with different level of caries prevalence by population group. If there are relatively few people with carious molars, the sealant should be applied only to the sticky fissures. On the other hand, the sealant should be applied to all pits and fissures in groups having high caries prevalence, such as the case simulated in this study where more than 80% of first molars were affected by dental caries for 3 years. In conclusion, these results clearly indicate that the sealant program adopting only sticky fissures as an adaptation standard is the most cost-effective, and that the sealant program, including a decision for adaptation standard, should be planned by caries prevalence level in population groups or sub-groups.

DOI： 10.5834/jdh.47.5_703

Evaluation of a Preventive Program for Dental Caries in Primary Dentition from Early Stage of Life

SAWAMURA Emiko, YOSHIHARA Akihiro, YAGI Minoru, MIYAZAKI Hideo

JOURNAL OF DENTAL HEALTH 47 ( 3 ) 292 - 297 1997

Language：Japanese Publisher：Japanese Society for Oral Health

A preventive program for dental caries in primary dentition from 10 months to 1 year and 6 months of age was evaluated. The program began in 1990. Subjects were 230 children who lived in a town of Niigata Prefecture, Japan. Topical fluoride application with acidulated 2% sodium fluoride was a major tool of the program. The program also included dental health education with tooth brushing and milk feeding instructions. Principally, the subjects were recalled at intervals of about 3 months. However, some children regarded as having a high risk of dental caries were recalled according to an original screening criteria. In the town, prevalence of dental caries in primary teeth had remained moderate to high before introduction of the program. Dental examination at 1 year and 6 months of age was carried out from 1991 to 1993. The percentage of children with dental caries decreased from 22.9% in 1991 to 8.0% in 1993 (reduction of 14.9 points, p<0.01). The mean number of decayed, missing, and filled teeth declined from 0.77 to 0.28 in 1991 and 1993, respectively (63.6% reduction, p<0.05). It is concluded that the program motivated the guardians of the children to receive topical fluoride application and to improve oral hygiene habits of the children. The program is considered to be good and feasible for any community with moderate to high level of dental caries in primary teeth.

DOI： 10.5834/jdh.47.3_292

The Reliability of Self-assessment of Number of Remaining Teeth Using Questionnaires

ANDO Yuichi, IKEDA Satoshi, YOSHIHARA Akihiro

JOURNAL OF DENTAL HEALTH 47 ( 5 ) 657 - 662 1997

Language：Japanese Publisher：Japanese Society for Oral Health

The purpose of this study was to compare numbers of remaining teeth from questionnaires and clinical examination and to determine whether information collected through questionnaires is sufficiently reliable for use at community level. The subjects studied were 2,496 adults living in 3 municipalities in Niigata Prefecture. The number of remaining teeth was determined not only from replies to questionnaires by subjects but from clinical examination by 19 dentists. The average score of remaining teeth was 19.59 by questionnaire and 19.60 by oral examination. The difference between the 2 average scores was very small and insignificant by t-test. In each age group, this difference was also small and insignificant. Correlations between questionnaires and clinical examination were extremely high (r = 0.93). In conclusion, questionnaires can give sufficiently reliable data about remaining teeth even if data from clinical examination are not obtained.

DOI： 10.5834/jdh.47.5_657

Caries Prevalence and Missing Teeth among the Workers at the Prefectural Office of Niigata

YOSHIHARA Akihiro, KOBAYASHI Seigo, TAKATOKU Yukio, KAZIYAMA Toru, ANDO Yuichi, HORII Kin-ichi

JOURNAL OF DENTAL HEALTH 45 ( 5 ) 826 - 828 1995

Treatment and Posttreatment Effects of Fluoride Mouthrinsing after 17 Years

Seigo Kobayashi, Hiroshi Kishi, Akihiro Yoshihara, Kin‐ichi Horii, Akihito Tsutsui, Tatsuo Himeno, Alice M. Horowitz

Journal of Public Health Dentistry 55 ( 4 ) 229 - 233 1995

The Prevalence of Dental Fluorosis and Non-fluoride Enamel Mottling in the Natural Fluoride Areas, Japan.

TSUTSUI Akihito, TAKIGUCHI Toru, SAITO Shin-ichi, TAMURA Takuya, YAGI Minoru, ANDO Yuuichi, KISHI Hiroshi, KOBAYASHI Hideto, YANO Masatoshi, YOSHIHARA Akihiro, WATANABE Yuzo, KOBAYASHI Seigo, SAKUMA Shihoko, NOGAMI Shigeki, KOIZUMI Nobuo, NAKAMURA Munetou, WATANABE Takeshi, HORII Kin-ichi, SAKAI Osamu

JOURNAL OF DENTAL HEALTH 44 ( 3 ) 329 - 341 1994

Language：Japanese Publisher：Japanese Society for Oral Health

The optimal fluoride concentration has not been determined because there were few epidemiological studies about dental fluorosis in Japan. The purpose of this study was to investigate the relationship between the prevalence of enamel mottling and fluoride concentration in drinking water in Japan. We began to look for naturally fluoridated areas in central Japan in 1978. As a result, we found 7 communities in 5 prefectures. There were 26 water supply systems in their communities, and their fluoride concentrations ranged from 0 to 1.4ppm. Subjects for analysis were 1, 081 children aged 10-11 who had lived in the communities from birth. Dean's Index was used for the classification of dental fluorosis, and non-fluoride enamel mottling was classified in the same way as Dean's Index, too. A significant positive correlation (r=0.485, p<0.05) was found between the prevalence of dental fluorosis (very mild or mild types) and fluoride concentration and a negative correlation (r=-0.429, p<0.05) was found between the prevalence of non-fluoride enamel mottling and fluoride concentration. There was no relationship (r=-0.129, ns) between the prevalence of all enamel mottling and fluoride concentration. We could not find moderate or severe types of dental fluorosis in these investigations and CFI ranged from 0.04 to 0.30. We concluded that there was no problem concerning dental fluorosis from 0 to 1.4ppm fluoride concentration in the drinking water in these communities. We believe that these findings make up for the insufficiency of the epidemiological study of dental fluorosis in Japan.

DOI： 10.5834/jdh.44.329

A Reasonable Sealant Program for First Molars of Schoolchildren in a FMR Program.

Other Link： http://search.jamas.or.jp/link/ui/1995065921

YOSHIHARA Akihiro, KOBAYASHI Seigo, SAKUMA Sihoko, ANDO Yuichi, MINETA Kazuhiko, HORII Kin-ichi, TAKIGUCHI Toru

JOURNAL OF DENTAL HEALTH 44 ( 3 ) 260 - 266 1994

Language：Japanese Publisher：Japanese Society for Oral Health

In order to establish a more efficient program combining pit and fissure sealant with school-based fluoride mouthrinsing, we designed a program based on a screening method in which pits and fissures with higher caries sensitivity were selected using 4 indices and sealed. These 4 indices were sticky fissures diagnosed as CO, occlusal index, occlusal plaque index (O.P.I), and school grade. The purposes of this study are the evaluation of the usefulness of the program. The subjects, 1st to 3rd graders, were 465 children in elementary school Y and 175 children in elementary school W. The children lived in two neighboring villages which are similar in socioeconomic environment. They had participated in a school-based fluoride mouthrinsing program (FMR) since nursery school. The FMR consisted of rinsing daily with 0.05% NaF from 4 years of age at in nursery school and rinsing weekly with 0.2% NaF after entrance to elementary school. The screening method consisted of two steps. In the first step, sticky fissures in the occlusal surfaces, buccal pits, and lingual grooves of all 4 first permanent molars were diagnosed as CO. In the second step, the CO surfaces were evaluated based on occlusal index, O.P.I., and school grade. The surfaces evaluated as being in poor condition by these indices were distinguished as high risk CO (H-CO) from the other CO surfaces estimated as low risk CO (L-CO). In school Y light-polymerized opaque sealants were applied to H-CO surfaces and L-CO surfaces were left without any application until the next examination 6 months later. In school W both H-CO and L-CO surfaces were left without any application. The progression of caries from the previous level, i.e., sound, sealant applied, H-CO, or L-CO, was compared every 6 months. In school Y the percentage of surfaces progressing to above C1 after 6 months was 0.3% in sound, 12.5% in L-CO, and 0% in sealant-applied surfaces. The percentage of complete retention of sealant was 93.1%. The ratio of relative risk estimated was 50.0 in L-CO surfaces against sound surfaces. In school W the percentages of progressing surfaces were 1.6% in sound, 32.9% in H-CO, 17.6% in L-CO, and 30.1% in the total CO surfaces. The ratio of relative risk estimated was 18.8 in the total CO surfaces against sound surfaces and 1.9 in H-CO against L-CO. It was confirmed that CO surfaces, especialy H-CO surfaces selected by this screening method had more risk of dental caries. The relative risk of sound surfaces in progressing to dental caries was very low. Accordingly it was reasonable that the sealings were applied only to occlusal surfaces selected by the screening method without sealing all the occlusal surfaces. It was concluded that this program of selecting CO surfaces and applying sealant particularly to H-CO surfaces was appropriate for decreasing the cost of sealant application.

DOI： 10.5834/jdh.44.260