Dental Medicine Research
Online ISSN : 2186-540X
Print ISSN : 1882-0719
ISSN-L : 1882-0719
33 巻 , 1 号
選択された号の論文の16件中1~16を表示しています
総説
  • Tomohiro OKANO, Seema PATIL
    2013 年 33 巻 1 号 p. 2-11
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    This article reviews the current situation of CBCT in terms of the indications, the exposure dose to the patient and its reduction, and quality assurance in the use of CBCT. Plenty of articles related to these topics including several guidelines based on the scientific evidence have been published and these cover essentials for consideration in these tasks. Such evidences are helpful for clinicians when considering the application of CBCT, and suggest that clinicians should keep abreast of recent advances in CBCT technology.
  • 岡野 友宏, 玉置 幸道, 荒木 和之
    2013 年 33 巻 1 号 p. 12-22
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    診療に関わる様々な医療機器等を国際規格化しその普及を図ることは, 医療を安全に平等に供給し, 診療の質の向上を図り, また優良な医療機器関連製造業を育成するための必須要件と考える. しかし, 多くの歯科医師はこうした標準化の意義について, 十分な認識を持ち合わせていない. そこで, 本稿では筆者自身が直接関わっている歯科関連医療機器等の会議の現状とその成果について概説することとした. 対象はISO/TC106 Dentistryで扱う歯科器材・機器等, IEC/TC62 Electrical equipment in medical practiceで扱う歯科用X線装置, 医用画像の標準規格であるDICOMと, IHE医療情報統合における歯科診療記録, ICD国際疾病分類における医療用語の標準化である.
  • 向井 美惠
    2013 年 33 巻 1 号 p. 23-34
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    近年, 保健・医療領域を含めて日本の社会において食に関わる関心は強い. その中の一つに「摂食に関わる機能発達」がある. 小児保健領域では, 授乳や離乳をはじめ育児支援として医科歯科が連携した保健領域からの研究が多くなされている. また, 機能発達に遅れのある小児の医療や療育の場における訓練指導の根拠としての研究も多くなされ, 両領域が同時平行的に発展している. ここでは, 最近30余年で急激に発展してきた新しい分野である本分野を保健と医療に分けてわが国の1980∼1990年代を中心にその研究と臨床の歩みをまとめた. 摂食に関わる機能発達の障害の有無にかかわらず, 食を通して小児の心身の健康な発育を支援し, 命を支える歯科医療の果たす役割は今後ますます重要となろう.
  • 佐野 晴男
    2013 年 33 巻 1 号 p. 35-42
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    わが国は高齢化が進み, 有病患者が歯科医院に訪れる機会が増え, 歯科に対する社会のニーズは急速に高まってきている. 一医療機関ですべての患者に対応し, 治療を完結することが困難な場合が多くなってきた. 良質な医療を提供してゆくには地域の診療所と病院歯科が連携を組んで当たらねばならない. 筆者は大学を卒業以来, いろいろな病院で地域の開業医から患者の紹介を受ける立場にあった. 大学を卒業以来, 昭和大学歯科病院に至るまでの筆者の経過と連携実績, ならびに病診連携について述べたい.
  • 山田 庄司
    2013 年 33 巻 1 号 p. 43-50
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    慢性腎臓病 (chronic kidney disease: CKD) は罹患率が高く, 薬物の重要な排泄経路である腎臓の機能が低下した患者に歯科医師が抗菌薬を処方する機会も少なくないと思われます. ペニシリン系やセフェム系などのβラクタム系抗菌薬は歯科医師が処方することが多い薬物で, アレルギー性の副作用には常に気をつけているが, βラクタム系抗菌薬の多くが腎排泄型の薬物であるため, 半減期が延長しているCKD患者では減量が必要な薬物であることを認識している歯科医師は多くないと思われます. 腎排泄型薬物を半減期が延長しているCKD患者に健常者と同じように反復投与すると, 定常状態における平均血漿中薬物濃度 (Cssave) は高くなりすぎます. 腎機能が低下したCKD患者に対しては血清クレアチニン値 (Ccr) などから腎機能を評価して, 薬物動態理論に基づいた補正係数を用いることにより, 患者の腎機能に応じた薬物投与計画を立てることができます. また, 患者のCcr値から腎機能を評価して, 腎機能状態別の腎機能低下時の抗菌薬投与量一覧表で適切な用量・用法を知ることもできます.
平成24年度上條奨学賞(研究業績部門)受賞
原著
  • Makoto TANIGUCHI, Takafumi ARIMOTO, Takeshi IGARASHI
    2013 年 33 巻 1 号 p. 56-67
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    Streptococcus mutans uses two-component signal transduction systems (TCSs) to monitor and respond to the fluctuating pH levels to survive the human oral cavity. The TCSs modulate the expression of genes encoding products crucial to cell survival. CiaRH is one of TCSs that is thought to be responsible for the acid tolerance of this pathogen; however, the target molecules modulated by the CiaRH have been still unclear. In this study, we identified that a lipoprotein OpcC contributes to the acid tolerance of S. mutans. The opcC-deficient mutant showed higher acid sensitivity than the wild-type 109c. In addition, deletion of the gene encoding prolipoprotein diacylglyceryl transferase (Lgt) eliminated OpcC on the cell surface of S. mutans. These results suggest that OpcC is an acid-tolerance related lipoprotein that is lipid anchored in the cell membrane by Lgt. Relationship between opcC and CiaRH was assessed by transcriptional analysis of S. mutans in the acidic or neutral conditions. The opcC expression was increased in the wild type and ciaR mutant in the acidic environment. However, the opcC expression was not increased in the ciaH mutant by the acidic stress. These results suggest that acidic stress sensing by CiaH is essential for the increased expression of opcC. Collectively, S. mutans OpcC is an acid tolerance-related lipoprotein whose gene-expression is enhanced via CiaH by sensing the acidic stress. In this study, we clarify the partial mechanism mediating S. mutans survival in acidic environments by showing the link between CiaRH and OpcC.
  • Tsuneyasu TERAUCHI, Yukiko MATSUDA, Kazuyuki ARAKI, Kenji SEKI, Tomohi ...
    2013 年 33 巻 1 号 p. 68-75
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    To clarify 1) how the signal fading effect occurs and 2) the diagnostic quality of the signal fading image in caries diagnosis. The Digora Optime (Soredex, Helsinki, Finland) system was used. Aluminum step wedges of 1 to 10 mm thickness and 1-mm-thick lead were used. Exposed photo-stimulated phosphor imaging plates (PSP-IPs) were scanned at six different intervals: immediately, 3, 6, 24, 72, and 144 h. Two kinds of scanning modes were used: with and without auto enhancement correction (AEC). The gray value difference between the immediate and delayed scanning images in the same objective area was calculated as the signal fading effect value (FEV). Thirty extracted upper premolar teeth (carious: 42 surfaces) were used. Immediate, 3, 24, and 72 h delayed scan images were created. Four observers assessed them. The Friedman test was used for statistical analysis and statistical significance was p<0. 05. Analysis of the without AEC image revealed that the signal fading had the same gray value change. This change was not related to the initial gray value. In the processing of AEC, the middle part of the gray value tended to be more enhanced. Significant differences in gray value changes were observed after 3 h, but no statistically significant difference was seen in the caries diagnosis. The area under the receiver operating characteristic (ROC) curve (Az) from immediate, 3, 24, and 72 h delayed images was 0. 61±0. 17, 0. 56±0. 04, 0. 67±0. 04, and 0. 58±0. 06.
  • Misa OIKAWA, Kazuo ITOH, Mizuho KUSUNOKI, Nobuya KITAHARA, Takashi MIY ...
    2013 年 33 巻 1 号 p. 76-80
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    To avoid excessive excavation of carious dentin, we developed a caries-detecting agent composed of polypropylene glycol to stain caries-affected dentin. The purpose of this study was to evaluate the new agent by examining the characteristics of the dentin surface after removal of carious dentin. Eight extracted human teeth with dentin caries were used. The teeth were longitudinally sectioned through the center of the caries and micro Vickers hardness (MVH) was measured from the pulpal wall to the caries cavity every 200 μm. Carious dentin was then removed using a steel bur following Caries Check (Nishika, Yamaguchi, Japan) staining. After removal of the stained dentin, the MVH of the dentin was determined by observing the indentation on the dentin; the DIAGNOdent value (D-value) was measured using DIAGNOdent (Kavo, Biberach, Germany). Then a new caries-staining agent (Discover RED, Phoenix Dental, Inc., Fenton, MI, USA) was applied in the cavity, the stained dentin was removed, and the MVH and D-value were measured. Finally, such procedures were repeated using Caries Detector (Kuraray, Tokyo, Japan). After the final measurements, the microstructure of the dentin cavity wall was observed by scanning electron microscopy. The differences in the MVH and D-value between using Caries Detector and Discover RED were not significant. However, the differences in the MVH and D-value between the Caries Check and the other two methods were significant. Caries Check may be the most useful modality for the more precise excavation of carious dentin and preservation of sclerotic dentin.
  • Hideo ARIYOSHI, Shouji HIRONAKA, Mami MURATA, Kentarou ISHIKAWA, Akiko ...
    2013 年 33 巻 1 号 p. 81-87
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    With super aged society in Japan, the death rate from choking due to blockage of the oropharynx has increased; it is now greater than that from traffic accidents and it is believed that this rate will continue to increase. The shape and function of the oropharyngeal crossing with the respiratory tract are most influential in ensuring that food is carried from the oral cavity to the pharynx and the esophagus. We sought to clarify the changes in the shape and features of the oropharyngeal airway from teenagers to those in their 70 s. A total of 57 patients were grouped by age (teenagers, 20s, 30s, 40s, 50s, 60s and 70s), and all underwent cone beam computed tomography (CBCT) to measure the oropharynx volume, height, cross-sectional area, and length of the superior and inferior extremities. Kruskal-Wallis analysis indicated that the volume and height of the oropharynx did no significant difference among age groups, but there was a different tendency when cross-sectional areas of the superior and inferior extremities were compared between younger and older patients. Further, the shape of the inferior extremity was also different features between younger and older patients. In humans, the oropharyngeal airway plays an important role in carrying food through the esophagus and facilitating phonation. Ideally, it is important for this airway to maintain a constant volume and height. Recently, there has been an increase in the incidence of oropharyngeal airway blockage accidents among the elderly. Declines in feeding and swallowing functions and changes in the form of the oropharynx are major factors in these accidents.
  • Mao WATARAI, Rika AYANO, Takahiro FUNATSU, Takafumi OOKA, Mari TAKAHAS ...
    2013 年 33 巻 1 号 p. 88-99
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    Many aspects of the coordination of lip and mandibular movements in the process of eating have not yet been clarified. This time, aiming to objectively evaluate lip and mandibular movements when chewing, the movements of the corners of the mouth and the mandible during mastication were measured three-dimensionally and analyzed. The subjects were 20 healthy women with individual normal occlusion. The test food was a commercially-available biscuit with a weight of 1 g. With six measuring points set for the lips and pogonion, the movements at those measuring points were captured with two CCD cameras during mastication, and the resulting images were analyzed with a three-dimensional motion analysis system. The analysis result showed that X- and Z-axis movements occurred on the working-side corner of the mouth, with Z-axis movements preceding X-axis movements, while on the balancing-side corner of the mouth, X- and Z-axis movements occurred simultaneously. Data on the amount, time taken, and speed of movements measured at each anatomical landmark showed that the working-side corner of the mouth moved a greater distance at a faster pace and, therefore, in less time than that of the balancing-side corner of the mouth. This is conceivably due to the aforementioned differences in X- and Z-axis movements of the working-side and balancing-side corners of the mouth. Further comparisons and studies with expansion of the subjects to include children will be necessary.
  • Nobuhiro SAKAI, Tomio MOROHASHI, Shoji YAMADA
    2013 年 33 巻 1 号 p. 100-103
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    We examined the effects of fructooligosaccharide (FOS) consumption on gastrectomy-evoked osteopenia in rats. Forty-two 35-day-old male Sprague Dawley rats were equally divided into two groups and a sham operation group or a total gastrectomy group was performed. Four weeks after each surgery, 14 rats were killed in each group (BaseSH and BaseGX groups). Thereafter, the remaining rats were equally divided into two sub-groups; with or without 7.5% FOS (1.35 g/day)-feeding (SH, SH+FOS, GX and GX+FOS groups) for six weeks. Backscattered electron images of the tibial cross-sections were taken to calculate the cortical bone area (CBA). The CBA in BaseGX rats was markedly decreased. Thereafter, FOS-feeding significantly counteracted this reduction, but not to the level seen in SH rats. These results suggest that FOS consumption partially restored osteopenia in cortical bone following the gastrectomy.
臨床報告
  • 勝田 秀行, 曽我 大輔, 吉濱 泰斗, 近藤 誠二, 羽鳥 仁志, 新谷 悟
    2013 年 33 巻 1 号 p. 104-108
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    昭和大学歯科病院では2007年10月より, 口腔外科外来において口腔粘膜などに不安をもつ人を対象とした口腔がん無料相談を開始した. 予約制で毎週土曜日に相談を受けた. 今回, 2007年10月から2011年9月までの4年間に相談目的に当院へ来院した264名に対して, 年度別・性別・年齢別相談者数, および臨床診断, 相談者の居住地域, 口腔がん無料相談を知った媒体に関して検討を行ったので報告する. 1年間の相談患者数は平均66名であり, 臨床診断としては, 口内炎が最も多く, 次いで白板症, 良性腫瘍, 口蓋・下顎隆起, 歯科疾患と続き, 新たに2名の口腔がん患者を発見した.
クリニカル・テクノロジー
  • 尾関 雅彦
    2013 年 33 巻 1 号 p. 109-115
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    1952年にPer-Ingvar Brånemark (Sweden) がチタンと骨とが強固に結合するオッセオインテグレーション (osseointegration) という現象を偶然に発見して以来, 半世紀以上が過ぎた今日では, 歯や顎骨を欠損した患者に対する補綴治療において骨結合型インプラント (osseointegrated implant) は不可欠なものとなっている.
    その中で, インプラントに関連した材料や技術の開発や改良, ならびに長年にわたる多数の治療例の検証の結果, 患者 (生体) に対してインプラント治療をより低侵襲に行おうとする潮流がある.
    本論文では, 低侵襲インプラントに至るまでのインプラント治療の歴史的変遷とともに, 当科で行っている低侵襲インプラントの治療例について解説した.
    日進月歩のインプラント治療をできるだけ低侵襲に行うことは, 患者と術者の双方に非常に有益性が高いことから, 個々の患者の要望に応じた患者主導型 (患者中心型) の治療を行ううえで, 低侵襲インプラントは今後もますます需要が高まると思われる.
臨床講座
  • 山口 麻子, 佐藤 裕二, 北川 昇, 桑澤 実希
    2013 年 33 巻 1 号 p. 117-122
    発行日: 2013/03/31
    公開日: 2013/11/22
    ジャーナル フリー
    日本は急増する高齢者に対する医療施策として, 1986年から在宅医療を積極的に推進してきた. 1992年には医療法を改定し, 居宅 (自宅) は「医療提供の場」と位置づけられた. 老年人口割合 (高齢化率) が24%を超えた今日, 在宅医療は「外来」「入院」に次ぐ「第3の医療」として超高齢社会になくてはならないシステムとなった. これに伴い, 在宅歯科医療を利用する患者も増加し, 全身疾患や口腔機能障害の重篤度により, 求められるニーズも多様化している.
    本稿では, 在宅歯科医療の概論と患者のニーズへの対応法について述べる.
第32回昭和歯学会例会抄録集
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