慢性歯周炎患者の歯周病原細菌および揮発性硫黄化合物に対する包括的口腔ケアの効果  [in Japanese] Effect of a Comprehensive Oral Care Regimen for Periodontopathic Bacteria and Volatile Sulfur Compounds in Chronic Periodontitis Patients  [in Japanese]

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Author(s)

    • 藤岡 陽介 FUJIOKA Yosuke
    • 新潟大学大学院医歯学総合研究科口腔生命科学専攻摂食環境制御学講座歯周診断・再建学分野:藤の丘歯科医院 Division of Periodontology, Department of Oral Biological Science, Course for Oral Science, Niigata University Graduate School of Medical and Dental Sciences:Fujinooka Dental Clinic
    • 両角 俊哉 MOROZUMI Toshiya
    • 新潟大学大学院医歯学総合研究科口腔生命科学専攻摂食環境制御学講座歯周診断・再建学分野 Division of Periodontology, Department of Oral Biological Science, Course for Oral Science, Niigata University Graduate School of Medical and Dental Sciences
    • 久保田 健彦 KUBOTA Takehiko
    • 新潟大学大学院医歯学総合研究科口腔生命科学専攻摂食環境制御学講座歯周診断・再建学分野 Division of Periodontology, Department of Oral Biological Science, Course for Oral Science, Niigata University Graduate School of Medical and Dental Sciences
    • 吉江 弘正 YOSHIE Hiromasa
    • 新潟大学大学院医歯学総合研究科口腔生命科学専攻摂食環境制御学講座歯周診断・再建学分野 Division of Periodontology, Department of Oral Biological Science, Course for Oral Science, Niigata University Graduate School of Medical and Dental Sciences

Abstract

目的:歯周炎患者口腔内のあらゆるニッチ(未処置の歯周ポケット,舌,粘膜,扁桃)には主要な歯周病原細菌が定着しており,口腔内伝播が起きている.本研究の目的は,慢性歯周炎患者の口蓋扁桃,舌苔,歯周ポケットにおける歯周病原細菌数および揮発性硫黄化合物(VSCs)濃度に対する包括的口腔ケア(ブラッシング,フロッシング,リンシング)の微生物学的効果を検討することである.材料と方法:中等度〜重度の広汎型慢性歯周炎患者43名を無作為に2群(実験群:N=23,対照群:N=20)に分け,口腔内3カ所における試料採取(口蓋扁桃拭い液,舌苔,歯周ポケット内プラーク)およびVSCs濃度測定を行った.その後,実験群は包括的口腔ケアを,対照群は通常の口腔清掃(ブラッシングのみ)を継続した.4週後,再び試料採取および測定を行った.得られた試料からInvader PLUS assay変法により,総細菌数,Porphyromonas gingivalis数,Prevotella intermedia数およびTannerella forsythia数を定量した.VSCs濃度測定は簡易ガスクロマトグラフィー(Oral Chroma)により硫化水素とメチルメルカプタンのガス濃度が測定された.結果:実験群では,口蓋扁桃拭い液の総菌数(p<0.05),P. intermedia数(p<0.01)およびT. forsythia数(p<0.05)が有意に減少した.また,歯周ポケットの総菌数(p<0.05)とT. forsythia数(p<0.05)も有意に減少した.VSCs濃度測定では,メチルメルカプタンの臭覚閾値より高値を示す被験者数が,実験群において有意に減少した(p<0.05).対照群では,いずれの項目においても有意な変化は示さなかった.結論:包括的口腔ケアは,口蓋扁桃や歯周ポケットの細菌数,およびメチルメルカプタン濃度を減少させるのに有効であることが示唆された.

Purpose: Major periodontopathic bacteria settle in all niches of the oral cavity of periodontitis patients, and spread throughout the oral cavity. The purpose of this study was to examine the microbiological effects of a comprehensive oral care regimen (brushing, flossing, gargling) on periodontopathic bacterial counts and the concentration of volatile sulfur compounds (VSC) in the palatine tonsils, tongue coating, and periodontal pockets of chronic periodontitis patients. Methods: Forty-three chronic periodontitis patients were randomly divided into two groups (test group, N=23; control group, N=20), and the concentration of intraoral volatile sulfur compounds (VSCs) was measured and samples were collected in several niches of the oral cavity (palatine tonsil swabs, tongue coating, subgingival plaque). The test group continuously underwent a three-step regimen (brushing, flossing, gargling), and the control group continuously underwent conventional mouth cleaning (brushing only). Measurements and sampling were performed again after 4 weeks. Periodontopathic bacterial counts were quantified using a modified Invader Plus assay, and VSC concentrations were measured by simple gas chromatography. Results: In the test group, the total bacteria (p<0.05), Prevotella intermedia (p<0.01), and Tannerella forsythia (p<0.05) counts of the palatine tonsil swabs decreased significantly. In addition, the total bacteria (p<0.05) and T. forsythia (p<0.05) counts of the periodontal pockets also decreased significantly. There were no significant differences in any of the species or sites in the control group. A significant reduction in the number of individuals showing values above the methyl mercaptan olfactory threshold level was exhibited in the test group (p<0.05). There were no significant differences of H_2S and CH_3SH in the control group, and H_2S in the test group. Conclusion: The comprehensive oral care was effective in reducing bacterial counts in the tonsils and periodontal pockets, and CH_3SH concentrations.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 56(6), 551-559, 2013

    The Japanese Society of Conservative Dentistry

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