歯の破折症例の現状ならびに課題:—歯内療法専門外来初診患者にみる現在の歯科臨床のニーズ—  [in Japanese] The Present Situation and Problems of Tooth Fracture:—The Present Demands of Dental Practice Revealed through a Survey of New Patients of an Endodontic Outpatient Clinic—  [in Japanese]

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Author(s)

    • 和達 礼子 Reiko WADACHI
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 口腔機能再構築学講座 歯髄生物学分野 Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
    • 吉岡 俊彦 Toshihiko YOSHIOKA
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 口腔機能再構築学講座 歯髄生物学分野 Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
    • 花田 隆周 Takahiro HANADA
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 口腔機能再構築学講座 歯髄生物学分野 Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
    • 原田 直子 Naoko HARADA
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 顎顔面頸部機能再建学講座 顎顔面矯正学分野 Department of Maxillofacial Orthognathics, Division of Maxillofacial and Neck Reconstruction, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
    • 海老原 新 Arata EBIHARA
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 口腔機能再構築学講座 歯髄生物学分野 Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
    • 須田 英明 Hideaki SUDA
    • 東京医科歯科大学 (TMDU) 大学院医歯学総合研究科 医歯学系専攻 口腔機能再構築学講座 歯髄生物学分野 Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Medical and Dental Sciences Track, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)

Abstract

 目的 : 歯科治療の大多数は一般歯科医院にて行われているが, 経過不良症例は高次歯科医療機関で対応することがある. これらの症例を分析することにより, 一般歯科医師ならびに患者が解決に苦慮している問題点が明らかになると推測される. 一方, 近年歯の喪失の原因として歯の破折が増加していることが指摘されているが, わが国での具体的な調査は少ない. 本研究の目的は, 大学病院の歯内療法専門外来の初診患者のうち, 主訴が歯の破折にかかわる症例を調査することにより, 現在の歯科臨床の現状ならびに問題点を明らかにすることである. <br> 対象と方法 : 対象は, 平成23年6月中の22日間に東京医科歯科大学歯学部附属病院むし歯外来の歯内療法専門外来を受診した初診患者とした. 主訴の患歯について, 受診後に歯科診療録ならびにデンタルX線写真を参照し調査を行った. <br> 結果 : 歯内療法専門外来における当該月間の初診患者数は計462人であり, 主訴が歯の破折であった者は118人 (25.5%) であった. このうち, 破折線が確認された症例は44人 (37.3%), 破折線は確認されなかったがほかの所見から歯の破折が疑われた症例は74人 (62.7%) であった. 受診経緯は, ①他歯科医院を受診せず患者の意思で直接本院を受診した者が134人 (29.0%), ②他歯科医院からの依頼状を持参し本院を受診した者は111人 (24.0%), ③他歯科医院を受診するも症状が改善せず, 担当歯科医師の了承を得ずに依頼状を持参せず患者の意思で本院に転院した者は76人 (16.5%), ④他歯科医院での診断・治療方針について, 担当歯科医師以外の意見を求める, すなわちいわゆるセカンドオピニオンを希望し本院に転院した者は55人 (11.9%), ⑤本院の他診療科の担当歯科医師からの依頼状を持参し受診した者は86人 (18.6%) であった. 受診経緯①~⑤の各群における破折症例の割合は, ①が20人 (14.9%), ②は25人 (22.5%), ③は26人 (34.2%), ④は25人 (45.5%), ⑤は21人 (24.4%) であった. <br> 結論 : 本研究により, 歯の破折症例について以下のことが明らかになった. 1. 歯内療法専門外来に対する需要が高い. 2. 一般歯科医師に診断法を普及させる必要がある. 3. 客観的な確定診断法の確立が求められる. 4. 患者に歯の喪失原因になりうるという知識を普及させる必要がある.

 Purpose: Most dental treatments are performed at private dental clinics, while some of them are referred to secondary or tertiary dental care institutions. Although the number of missing teeth caused by fracture has been increasing recently, there are few reports on the present situation of tooth fracture in Japan. The purpose of this study was to identify the problems and demands of present dental practice by surveying patients with tooth fracture visiting the endodontic outpatient clinic of a university dental hospital.<br> Methods: The subjects were new patients who visited the endodontic outpatient clinic of Tokyo Medical and Dental University for 22 days in June 2011. Their teeth and chief complaints were surveyed based on dental records and X-ray films after examination.<br> Results: The number of patients was 462. Of these, the chief complaint of 118 patients (25.5%) was thought to be caused by tooth fracture. A fracture line was found in 44 (37.3%) of the 118; whereas tooth fracture was not found but was inferred from other findings in the other 74 patients (62.7%). Of the 462 patients, 134 (29.0%) consulted our hospital directly without consulting a private clinic and receiving a referral (①); 111 (24.0%) were referred from private clinics (②); 76 (16.5%) consulted our hospital without a referral even though they had been treated at a private dental clinic, as they wanted our hospital to treat or judge the validity of their treatment because the symptoms remained (③); 55 (11.9%) wanted our hospital to provide a second opinion about the validity of the diagnosis or treatment plan provided by a private clinic (④); 86 (18.6%) were referred from other outpatient clinics of our hospital (⑤). The number of tooth fracture cases of ① to ⑤ were 20 (14.9%), 25 (22.5%), 26 (34.2%), 25 (45.5%) and 21 (24.4%), respectively.<br> Conclusions: This survey revealed the following regarding tooth fracture.<br> 1. There is a great demand for endodontic outpatient clinics. 2. It is necessary to educate general dentists about diagnostics. 3. Objective diagnostics at an early stage should be established. 4. It is necessary to inform patients that tooth fracture may require tooth extraction.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 58(1), 1-9, 2015

    The Japanese Society of Conservative Dentistry

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