介護老人保健施設の入所者24名を対象として, 食事形態など食事内容, ADLなど全身的状況, 要介護状況を質問項目とした質問紙調査 (記入は担当看護師に依頼) を実施し, 口腔, 義歯の状況については口腔診査を行い, 分割表分析により食事形態 (普通食群, 特別食群に群別) と全身・口腔状況との関連性を検討した。
その結果, 口腔状況のうち義歯装着 (p<0.01), 機能歯数 (p<0.05) は, 食事内容により有意差が認められ, 義歯を装着し機能歯数の増加を図ることが食事内容の改善に影響すると考えられた。また, ADL要介助項目数 (p<0.01), 要介護度 (p<0.01), BDR要介助項目数 (p<0.01) で食事内容により有意差が認められ, 全身機能, 要介護状態と食事内容との関連が認められた。
これら結果から, 歯科医師は食事内容や日常生活機能なども把握した上で歯科治療にあたる必要があり, 積極的に口腔機能の維持・向上を図ることで, 要介護者の食事内容が改善されQOL向上に寄与できる可能性が示唆された。今後は, 義歯未装着者への対策を中心に, 要介護者の口腔保健の向上について検討する余地がある。

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最近歯科診療の環境汚染問題が再認識され, 水銀 (以後Hgとする) を含むアマルガムの排水中への流出問題についても見直す時期にきている.著者らは排水中のアマルガム分離装置 “FINAL” の効果とその実用性について2種の実験を行って検討した.1) 実験室における基礎実験, 2) 臨床におけるモデル実験.各実験において “FINAL” 通過後の排出液のHg濃度を測定し, その結果からHg排出率を求めて考察した.実験室における基礎実験の結果は良好であり, 原液中Hgに対するHg排出率は平均0.2-0.3%であったが, 臨床におけるモデル実験では実験室の場合よりHg排出率が高くなり, 2.2-4.9%を示した.今回の実験結果より, アマルガム分離装置 “FINAL” は排水中のアマルガム除去に効果があると思われる.しかし, 診療の場ではアマルガム捕集器内の清掃管理, センサーの設置方法による流入水の感知, 感度の差などがその効果を発揮する上で大きなポイントになり, 今後さらに臨床での実際の使用結果を見ていくことが必要と思われる.

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介護老人福祉施設入居者における唾液中の歯周病関連細菌数と口腔内状態, および全身状態との関連について検討を行った。対象は介護老人福祉施設6カ所の入居者で, 同意と協力の得られた37名 (男性13名, 女性24名, 平均年齢82 .1歳) とした。入居者の唾液を採取し, PCR-Invader法により唾液10μ1当たりのAggregatibacter actinomycetemcomitans (A.a), Prevotella intermedia (P.i), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d) の菌数を測定した。測定した菌数と入居者の年齢, 性別, 介護度, BMI, 歯周病の臨床パラメーター, 舌苔付着量, 食物残渣量との関連を検討した。
その結果, 重度歯周炎のある群に, P.g, T.f, T.dが軽中等度群と比較して有意に多く検出され (p<0.05, p<0.05, p<0.01), 介護度, BMI, および食物残渣量と各細菌数との問に有意な関連は認められなかった。これらの結果より, 唾液から検出される歯周病関連細菌は, 入居者の全身状態にかかわらず, 主に歯周組織の状態と関連して検出されることが示唆された。

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歯科口腔外科を有する病院併設の施設入所者に対する歯科治療について実態調査を行い, 今後の適切な治療提供体制や方向性について検討を行った。対象は2007年1月から2009年12月までの3年間に新潟中央病院歯科口腔外科を初診した病院併設の介護老人保健施設入所者63名 (男性19名, 女性44名)。受診者の平均年齢は83.2歳で, 男性が75.6歳, 女性が86.4歳であった。期間中新規入所者の受診率は58.0%と半数以上を占めていた。全身疾患については, 高血圧症や心疾患などの循環器疾患が57.1%と過半数にみられており, 次いで脳血管疾患が42.9%にみられた。なお, 抗血栓薬を内服している患者は34.9%であった。受診理由は義歯不適合が圧倒的に多く, その他, 義歯破損, 義歯紛失など義歯に関連するものが多くを占めていた。治療内容については, 義歯の修理ないし調整処置を要した患者は81.0%で, 義歯新製に関しても55.6%に行われていた。歯冠修復は31.7%, 歯冠補綴, 根管治療はともに20.6%に行われていた。歯周治療は50.8%に行われたが, 有歯顎者についてみると約8割の患者で行われていた。抜歯は63.5%に行われていた。認知症等により意志の疎通が十分ではない場合でも, 治療に対してある程度の協力性が得られる傾向がみられた。治療途中で中断となった患者は20.6%であった。入所期間の長期化等の社会情勢を鑑みれば, 今後, 施設入所の要介護者に対しても予後を考慮した歯科治療の提供を心がける必要性が高まるであろう。

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本論文は軟化象牙質を特異的, 化学的に溶解すると言われているG K - 1 0 1 液を,(I) 切削された窩洞に, (II) 更に露髄して, (III) 根端に穿孔し露髄した根部歯髄に注入して,このGK-101液の歯髄に対する影響を病理組織学的に調べようとした論文である.本研究には幼雑犬23頭を用いた.この研究の結果,GK-101液は歯髄に与える直接の悪影響は少なく,しかも回復が早いことが判明した.

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歯科診療においてアマルガムは重要な充填材料であるが, アマルガム使用による水銀の環境汚染が新たな問題となってきた。とくに最近, 河川や魚介類の水銀汚染が社会問題になり, 排水基準も5ppb以下に規制されるようになった。そこで, 歯科診療における各ステップの排水や排水口のスラッジ, 周辺の土壌などの水銀濃度を分析して, 歯科診療による水銀の排出, 環境への汚染の実態を調べた。バキューム管で吸引され。汚物水, うがい水, ユニット直下の排水, そして歯科診療所の最終排水と大量の流水に希釈されるに従って排水中水銀濃度が減少しているが, 排水を通じての水銀の放出は決して少なくはないことが明らかとなった。とくに最終排水中水銀濃度は平均値で11.3ppbであり, ほとんどの歯科診療所は現在の排水基準値の5ppbを上まわっていた。また歯科診療所周辺の土壌中にも比較的高い水銀濃度を認め, さらに排水口のスラッジでは10600ppmと非常に高く排水中の水銀を濃縮していることを示した。
以上のことから歯科診療から排出された無機水銀は, メチル水銀に変換する危険性が余りないとはいえ, 排水を通じて環境への水銀汚染は, 土壌やスラッジヘの蓄積によりかなり高濃度となっていることが明らかとなったので, 対策の必要性を改めて確認した。

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To make clear of histological, physiological and dynamical attitudes for stress in periodontal membranes are very important in dentistry. It is especially valuable in prosthetics, periodontics and orthodontics fields. For adequately treate the tooth in prosthetics, it is important not only discuss the mobility or bitting forces of tooth which applied bucco-lingual or on axial direction loads, but also discuss stretch out or horizontally applied pulling stress to the teeth.
The author has been measured the resistance attitudes for stretching forces by using the author newly designed intra-oral pulling loads divice. The subjects were 50 male in 20 years age groupe whose were having healthy permanent dentitons, normal dental arches, normal interdesitations and normal excentric relationship. The resistance for pulling foces were measured along tooth axis direction (Vertical pulling forces), and on horizontal bucco-lingual direction (Horizontal pulling forces). From all of those findings can be summarized as follows.
1. The vertical pulling forces were aligned in orders from low to high as follows. On maxillary teeth were same on both side, Lateral incisor≅aCentral incisor<Second premolar≅First premolar≅Cuspid<Second molar≅First molar.
On the mandible teeth were same on both side, Central incisor≅Lateral incisor<First premolar≅Second premolar≅Cuspid<Second molar≅First molar.
(≅means no significant difference between two teeth, <means significant difference between two teeth.)
2. The horizontal pulling forces were aligned in orders from low to high as follows. On the maxillary teeth were same on both side, Lateral incisor≅Central incisor<Second premolar≅First premolar≅Cuspid. On the mandible teeth were also same on both side, Central incisor≅Lateral incisor<First premolar<Second premolar≅Cuspid.
3. Comparing the vertical and horizontal pulling forces on same teeth, right side teeth were slightly higher than the others. However there were no significant difference between each teeth.
4. Comparing the vertical and horizontal pullig forces on same group teeth between two arches, maxillary teeth were higher than mandible teeth. There were no significant difference except on central incisor.
5. The vertical pulling forces and horizontal pulling forces were compared on same teeth, the horizontal pulling forces were greater than the others on both arches and both side. Howerver there were no significant difference except on central and lateral incisors.

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Down症候群は,常染色体異常のなかで最も多い疾患である.近年,障害者介護技術の進歩に伴って平均寿命が増加し,Down症候群患者に対する歯科材料の細胞毒性レベルにおける感受性を知る必要性が増していると考えられる.しかし,臨床現場で歯科材料を選択する場合に基準となる生物学的基礎データがほとんど皆無である.そこで,Down症候群皮膚由来線維芽細胞様細胞(Detroit 539)と健常者皮膚由来線維芽細胞様細胞(HUC-F)を用いて,根管充填材,覆髄剤および根管治療剤の細胞毒性レベルを単層培養法およびType 1コラーゲンゲルによる3次元培養法を用いて検討した.その結果,Detroit 539はHUC-Fに比べてほとんどの材料で弱い細胞毒性を示し,両細胞の細胞増殖度の違いがその原因として考えられた.単層培養法での50%阻害濃度(IC₅₀)および3次元培養法でのcell viabilityは,両細胞間で相関性が示されたことから,Detroit539を用いた細胞毒性試験の有用性が示唆された.

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The author performed the vital pulpotomy on deciduous teeth using Calvital and Dycal from calcium hydroxide, FR from condensed compound of guaiacol and formaldehyde, and FC process from formocresol and a histological examination was made on healing after pulpotomy on vital pulp of deciduous teeth. The results were as follows : 1. Formation of a necrotic layer directly below the plane of section was extensive with Calvital, FR and FC process, but slight with Dycal. 2. With Calvital, cells with a large nucleus appeared on the third day after operation and calcified tissues were observed in some. Findings of calcified barriers and dentin barrier in the early stage were seen from seven to fourteen days after operation. 3. With Dycal, slight hyalinization and cellular infiltration were observed in the pulp three days postoperatively. From 7 to 14 days, calcified barriers were formed in the plane of section and the inner most layer contained organic matters stained lightly in Eosin. After 35 days, dentin barriers were observed but still incomplete, and odontoblasts also were irregular in construction. 4. With FR, hyalinization and slight inflammatory cellular infiltration were observed in the cases in which demarcation was seen directly below the plane of section. From 7 to 14 days, findings of dentin barriers in the early stage were seen and organic matrics were seen in some of the innermost layers of the barriers. After 35 days, dentin barriers were formed and argrophilic fibers were beginning to be observed. 5. With FC, findings of inflammation in the dental pulp tissue continued as long as 35 days after operation. Although healing of the dental pulp by inflammatory granulation tissues and fibrosis, findings of internal resorption were markedly seen. 6. Internal resorption was observed with FC but not with Calvital, Dycal and FR.

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The author performed the vital pulpotomy on deciduous teeth using paste type Procal from calcium hydroxide, paste type Cavitec from zinc oxide eugenol, and FC process from formocresol and examined them histologically about healing after pulpotomy on vital pulp of deciduous teeth and the results are as follows : 1. Forming of necrosis layer is observed on the part given vital pulpotomy ; it is rather extensive in case of using FC process and comparatively slight in the case of using Procal and Cavitec. 2. Fourteen days after operation, in the case of using Procal, the pulp surface touched with agent becomes hyalinized and inflammatory cells infiltration, congestion and bleeding were observed in the lower part of the pulp. In the case of using Cavitec, infiltration of inflammatory cells and bleeding are remarkably observed in the pulp surface, and diffuse infiltration is seen to the lower part of pulp tissue. In the case of using FC process, infiltration of inflammatory cells is observed, in the pulp surface, but the whole pulp becomes fibrous and it stains light purple by silver impregnation and light red by Elastica van Gieson. 3. From 21 days to 92 days after the operation, in the case of using Procal, inflammatory cells infiltration is clearly observed and inflammatory granulation tissue remarkably proliferates after 21 days. When 35 days pass, calcareous tissue is formed between necrosis layer and the pulp and seals cells inside. A layer stained dark purple by silver impregnation, and light red by Elastica van Gieson appears. When 92 days pass, a hard tissue made of osteoid dentin containing cells of different thickness is recognized in the pulpotomy. It stains dark purple or blackish purple by silver impregnation, and light red or red by Elastica van Gieson. Therefore it is recognized as collagen stroma, but is uneven in appearance and partly remains fibrous. In the case of using Cavitec, abscess is found in the pulp surface and proliferation of inflammatory tissue is remarkable in the pulp below. The pulp farther below is healthy and vital. In the case of using FC process, fibrous change found after 14 days continued till the 92nd day. 4. Internal resorption is observed on the 35th day for Procal, on the 21st day and the 92nd day for Cavitec, and the 21st day for FC process.

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This study was carried out to investigate the healing effect of various pulp capping agents on the exposed pulp using the calcium hydroxide preparations such as Calvital, Dycal, Hydrex and pure calcium hydroxide and a zinc oxide eugenol preparation such as Cavitec in the lower molars of dogs. The results were as follows : 1. With Calvital, Dycal and pure calcium hydroxide, the dentin barrier formation, which was considered as an ideal healing process, occurred in most of the cases after fourteen days. However, no dentin barrier formation was observed with Hydrex and Cavitec. 2. The dentin barrier formation was classified into six types according to its structure and the rate of inducing the dentin barrier formation was estimated in each material. It was observed that the dentin barrier was mostly Types I and II in the teeth treated with Calvital and there were few Types IV and V with the amorphous structure, and the dentin barrier with the best quality was formed. The dentin barrier formation of Types I and II decreased in the teeth treated with Dycal, and the teeth treated with pure calcium hydroxide showed a greater decrease. With Hydrex and Cavitec, no Type I or II was formed and the formation of Types IV and V was observed. 3. The dentin barrier formation of Types I and II, which indicated the structure of dentin, occurred only where a necrotic zone and a border zone were evident in the superficial layer of the pulp contacting the capping agents. 4. In the pulpal inflammatory response with five agents, a mild cell infiltration was observed in early stages and gradually subsided with the least irritation in the teeth treated with Calvital. The severity was similar in the pulps treated with Dycal and pure calcium hydroxide. In the pulps treated with Cavitec a cell infiltration was severer than those in the pulps treated with Dycal and pure calcium hydroxide, and the pulps treated with Hydrex showed the severest inflammatory response and the suppurative inflammation in many cases even with a long term observation. 5. In the occurrence of the degenerative changes in the pulps with five agents, the pulps treated with Calvital showed the least rate followed by the pulps treated with Dycal, pure calcium hydroxide or Cavitec, which did not vary greatly in findings, and the pulps treated with Hydrex presented the most manifestiations.

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After giving vital pulpotomy to deciduous teeth, by using Calvital and Dycal from calcium hydroxide, PV from formocresol, and FR-condensed compound of guaiacol and formaldehyde, the auther observed the process of recovering histopathologically, and concluded as follows : 1. In the amputated part of the pulp a necrosis layer is formed in using Calvital, FR and PV, but when Dycal is applied we can find little formation of it and sometimes not any of it. 2. Three days after the operation a thin calcificated tissue is formed on the boundary of the necrosis layer and the vital pulp, and it turns light yellowish red by van Gieson staining and dark purple by silver impregnation staining, and it is recognized as collagen stoma. Close to it we can observe spindle cells and round cells in the pulp clearly. In case of using Dycal and FR, the part becomes glassy and calcium is deposited there. In case of using PV, between three days and fourteen days fiber constituent increases. 3. After seven days have passed, in case of using Calvital, dentin barrier begins to be formed, and we can see big spindle cells - pre-odontoblast - there. 4. Between 21 days and 35 days, in case of using Calvital, predentin is found in the dentin barrier, and then odontoblast connects with odontoblast of root canal. In case of van Gieson staining method the dentin barrier turns dark yellowish red-purple, and dark red-purple by silver impregnation staining, and the fibers in the pulp and the dentin barrier are gitterfaser. Calcificated tissue remains a little roughly fibrous. In case of using Dycal, in about 21 days it is calcificated, and between 35 days and 62 days the dentin barrier is formed. In case of FR, the dentin barrier is formed and spindle cells, round cells and multiple cells are observed. At this stage it has the same process as the case of Calvital. In case of using PV, inflamatory cells, which chiefly consist of neutrocyte are observed in the pulp in the middle part of the root canal. 5. In case of using Calvital, FR and Dycal, between 62 days and 92 days the dentin barrier becomes broad and thick and turns red with acid fuchsin by van Gieson staining, purple by silver impregnation staining evenly as primary dentin. On the surface of the pulp rough fibrous tissue remains, and in the barrier a rather thick gitterfaser lies screwing towards predentin through odontoblast. In case of using PV, inflamatory cells continues to infiltlate and it sometimes develops to suppurative inflamation. 6. In case of using Calvital, FR and Dycal internal absorption is not observed, but in using PV we can find it in 35 days.

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A total of 48 puppies was used as materials to utilyze their immature teeth with large sized pulp cavity. The pulp of lower premolar teeth of these animals was amputated in both sides of jaw and the heeling processes involving repair of cavity shape, further growth of the root and possible change of periodontal tissues were studied by means of radiological and patho-histological methods. Results were summarized as follows. 1. On the Ist day following the vital amputation of pulp, the X-ray showed no sign of opaque at amputated site, but patho-histological findings showed a clear boundary formed between vital and necrotic pulpal tissues. 2. The 3rd day showed a thin line of radiopaque at amputated site, and here in the surface layer of the pulp was seen a great number of spindle cells appearing and an increased volume of collagenous fibers, a picture corresponding the usual finding at the early stage of dentine barrier formation. 3. By 5 to 7 days after the pulp amputation, the thin line of radiopaque became expanded to a more distinguishable band, and here was seen the partial formation of a new dentine barrier. At the same time there could be seen odontoblasts which had been observed since the 3rd day of vital amputation as immature forms resembling odontoblasts. 4. By 10 to 14 days, the opaque band increased its depth and became ever more distinguished, and this stage seems to represent the most accerelated growth of dentine barrier to attain the broadest band. In the mature teeth this occurs at about 21 days. 5. By 21 days after the amputation the dentine barrier became thicker toward lower direction and eventually covered the intact pulp completely. 6. Above findings suggested that the growth of dentine barrier in the immature teeth was somewhat faster than in root-completed teeth. 7. Of the hard tissues constituting the dentine barrier, some constituents resembled the usual dentine substance and other the oeteoid dentine, and the former covered the pulp tissues all over while the latter failed to do so completely and permitted frequently the pulp tissues to penetrate it. 8. By about 21 days, the pulp and the periodontal membrane at apical part of the root was bordered by formation of cellular cementum, and the apical foramen began to be closed. This process went on not later nor sooner than that in the control teeth. 9. No appreciable difference was existed in the course of dentinal growth in the cavity wall and in the recovery of the cavity shape between the experimental and control teeth groups. 10. Present study showed that the vital amputation of pulp administered to the root-immature teeth did not exert any deleterious effect on the vitality of tooth pulp, and it rather accerelated the formative process of dentine barrier in the experimental teeth. These evidences would suggest that the present method may well serve as one of valuable means for the conservation of such teeth in endodontic practice.

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