ご自身の歯・口を一生美しく健康に保つ方法 From Hideki Yoshikawa

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2010年 09月 02日

アクセルソン先生の30年にわたるの予防歯科の研究

アクセルソン先生はスウェーデンのイエテボリ大学の予防歯科の教授で2004年に
Journal of Clinical Periodontologyに予防歯科の30年にわたる研究を発表した。

これを読んでみると口腔清掃がいかに大切かが解る。

私たちの医院でもこのような予防歯科を実践しているのでご紹介いたします。

J Clin Periodontol. 2004 Sep;31(9):749-57.
The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance.

虫歯と歯周病における30年のプラークコントロールプログラムの長期間の効果でどのくらい歯を保つことが出来るかという研究。30年のメインテナンスの結果。

Axelsson P, Nyström B, Lindhe J.
Department of Periodontology, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden. per.axelsson@karlstad.mail.telia.com


Abstract
BACKGROUND: The biofilm that forms and remains on tooth surfaces is the main etiological factor in caries and periodontal disease. Prevention of caries and periodontal disease must be based on means that counteract this bacterial plaque.

バックグラウンド:歯の表面に形成されるバイオフィルムが虫歯と歯周病の主な病気の要素です。
虫歯と歯周病を予防するにはこの細菌性のプラークをたたくことに基づかねばならない。

OBJECTIVE: To monitor the incidence of tooth loss, caries and attachment loss during a 30-year period in a group of adults who maintained a carefully managed plaque control program. In addition, a comparison was made regarding the oral health status of individuals who, in 1972 and 2002, were 51-65 years old.

この研究の目的:定期健診でプラークコントロールプログラムを規則正しく受けてお口の中のケアの仕方を教育された患者様の歯は、失わずに、何本くらい残るのか? そして、何本くらい虫歯になるのか? そして、歯周病によって、どのくらい歯周組織が失われるのだろうか。そして個人の口腔の健康状態の比較が 1972年と2002年に51~65歳であった患者さんの口腔の状態が比較されました。


MATERIAL AND METHODS: In 1971 and 1972, more than 550 subjects were recruited. Three hundred and seventy-five subjects formed a test group and 180 a control group. After 6 years of monitoring, the control group was discontinued but the participants in the test group was maintained in the preventive program and was finally re-examined after 30 years. The following variables were studied at Baseline and after 3, 6, 15 and 30 years: plaque, caries, probing pocket depth, probing attachment level and CPITN. Each patient was given a detailed case presentation and education in self-diagnosis. Once every 2 months during the first 2 years, once every 3-12 months during years 3-30, the participants received, on an individual need basis, additional education in self-diagnosis and self-care focused on proper plaque control measures, including the use of toothbrushes and interdental cleaning devices (brush, dental tape, toothpick). The prophylactic sessions that were handled by a dental hygienist also included (i) plaque disclosure and (ii) professional mechanical tooth cleaning including the use of a fluoride-containing dentifrice/past


研究のマテリアルと方法:1971年と1972年に550人以上の患者様が集められた。375人はテストグループ、180人はコントロールグループに分けられた。テストグループは予防をしたグループ、コントロールグループは予防をしないグループに分けられた。6年後にコントロールグループは解散した。何故ならば倫理的な理由で黙って歯が失われるのを傍観していられないからでしょう。

それぞれの患者さんはご自身の口の中の状態を良く理解して、予防について良く理解した。最初の2年間は2ヶ月に一度、定期健診に来院しました。3年後から30年後の間は3~12ヶ月に一度定期健診に来院しました。定期健診では、適切なプラークコントロールプログラムの方法、手段を教えてもらいました。その方法手段は、

歯ブラシの使い方
歯間の清掃器具の使い方:歯間ブラシ、デンタルフロス、デンタルテープ、トゥースピック

それぞれの口腔清掃のセッシションは、歯科衛生士によって行われセッションでは次のことが行われました。

プラークの染め出し
PMTC(Professional Mechanical Tooth Cleaninng)を行った。


RESULTS: Few teeth were lost during the 30 years of maintenance; 0.4-1.8 in different age cohorts. The main reason for tooth loss was root fracture; only 21 teeth were lost because of progressive periodontitis or caries. The mean number of new caries lesions was 1.2, 1.7 and 2.1 in the three groups. About 80% of the lesions were classified as recurrent caries. Most sites, buccal sites being the exception, exhibited no sign of attachment loss. Further, on approximal surfaces there was some gain of attachment between 1972 and 2002 in all age groups.

その結果、30年間の間、ほとんど歯は失われませんでした。年齢によっても差はあっ たが0.4本~1.8本歯は失われました。ほとんどの歯を失う理由は歯根破折でした。たった21本だけは、虫歯、歯周病で失われました。新しい虫歯の発生は年齢によっても異なりますが、1.2本、1.7本、2.1本でし た。虫歯の発生の約80%は、再発性の虫歯、つまり、過去に虫歯になって修復済みのところが、再び虫歯になる2次カリエスというものでした。 ほとんどの部位でアタッチメントロス(歯周組織がなくなる)はみられませんでした。(30年の間)


CONCLUSION: The present study reported on the 30-year outcome of preventive dental treatment in a group of carefully monitored subjects who on a regular basis were encouraged, but also enjoyed and recognized the benefit of, maintaining a high standard of oral hygiene. The incidence of caries and periodontal disease as well as tooth mortality in this subject sample was very small. Since all preventive and treatment efforts during the 30 years were delivered in one private dental office, caution must be exercised when comparisons are made with longitudinal studies that present oral disease data from randomly selected subject samples.

結論として、この研究では、30年間の長期にわたって、患者様は定期的に診療室を訪れ、注意深く予防歯科の処置を受けました。そして、30年間の成果が集積されました。また、患者様は口腔衛生の高い水準を維持することの利益を認識し、予防歯科のプログラムを楽しみました。結果は、歯の喪失も、虫歯の発生も、歯周病の進行もほとんどありませんでした。

PMID: 15312097 [PubMed - indexed for MEDLINE]

千葉市美浜区の歯科 歯周病・インプラントなら吉川歯科医院

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