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20歯以上保有している高齢者の要因
Get PDF松本歯科大学博士（歯学）2018甲第209号application/pdf【背景と目的】近年，我が国は世界でも類をみないスピードで高齢化が進み超高齢社会を迎えた．医療や福祉の視点から考えても，このような社会においては高齢者が健康であることが重要である．そこで，1982年に8020運動が提唱され歯の重要性が検証され始めた．その後，健康増進法が施行され、それに沿った健康日本21（第２次）の目標には「口腔の健康の維持」として各年齢における齲蝕や歯周病の状態等の具体的な数字が挙げられている．自分の歯で咀嚼して食事をする事は，“美味しい食事”“食べる喜び”に直結し，高齢者のQOLの向上に繋がる．今後の歯科界では，高齢になっても多くの歯を残し口腔機能を維持できるような歯科治療および歯を残すための歯科予防における指導方針を確立する事が必要である．そのためには，まず歯を多数残すために必要な要因を認識しておかなければならない．そこで，高齢者における現在歯数を20歯以上保持する要因を口腔内の状態，口腔保健行動，Breslowの生活習慣から調べた．【材料と方法】本研究は2016年から2018年に松本歯科大学病院口腔診療部に来院された65歳以上の57名（男性31名，女26名）を対象に，現在歯数，刺激唾液量（ml/5min），唾液緩衝能（4段階評価），プラーク・コントロール・レコード（PCR），プロービングデプス（PD）の平均，歯周検査時出血率（BI: Bleeding Index），動揺歯率（検査歯数における動揺歯の比率）を調べた．さらに，Breslowの7つの生活習慣（喫煙・運動・飲酒・睡眠時間・体重維持・朝食・間食）とそれらを総合した健康指数（HPI: Health Practice Index）を算出した．また，口腔衛生習慣としてフッ化物の使用状況における質問を実施した．これらの結果を基に，現在歯数と各項目との相関を調べ，年齢，刺激唾液量，唾液緩衝能，PCR，平均PD，BI，動揺歯率，HPI，フッ化物の使用状況を独立変数，現在歯数20歯以上/未満を従属変数としたロジスティック回帰分析を実施し，20歯以上を保持する要因を検討した．【結果】現在歯数と各項目のSpearmanの順位相関係数は，年齢-0.17, 刺激唾液量0.24, 緩衝能0.60，PCR-0.33，平均PD-0.42，BI-0.50，動揺歯率-0.61，HPI0.33，フッ素0.460であった．緩衝能，PCR，平均PD，BI，動揺歯率，HPI，フッ素の使用状況と現在歯数との間に有意な相関を認めたが，年齢および刺激唾液量との間には相関は認められなかった．ロジスティック回帰分析の結果，緩衝能（オッズ比 5.23；95％信頼区間1.43-19.23），動揺歯率（オッズ比0.88；95％信頼区間0.80-0.98），HPI（オッズ比3.07；95％信頼区間1.30-7.25）及びフッ化物の使用（オッズ比2.32；95％信頼区間1.15-4.67）であり，これらの項目と現在歯数を20歯以上有することとの間に有意な関連（p＜0.05）を認め，唾液緩衝能，HPI，フッ化物の使用は現歯数を20歯以上保有する要因であり，動揺歯率は20歯未満となるのを促進する要因であることを示した．【結論】本研究より65歳以上において現在歯数を20歯以上保つ要因は，唾液緩衝能が高いこと，歯周組織が安定し動揺歯がないこと，規則正しい生活習慣を保つこと、習慣的にフッ化物を使用することが示された．したがって，高齢になっても現在歯数を多く残すには，20代や30代から唾液検査や歯周基本検査を実施し，歯が喪失する可能性を持つハイリスク者を早期に抽出する必要がある．そして，各個人における危険因子を説明した上で理解していただき，日常生活の中で本人自身でも気をつけていただくことが重要である．医療者側は，緩衝能が低い人には定期検診の短期化を勧め齲蝕の罹患を予防する．また，継続的な歯周治療を推進し，さらに食生活を含む生活習慣の改善を指導するとともに適したフッ化物の使用などの口腔保健指導が必要であると示唆された．doctoral thesi
Comparisons of foveal thickness and slope after macular hole surgery with and without internal limiting membrane peeling
Get PDFapplication/pdfBackground: We have shown that the foveal contour was asymmetrical after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The purpose of this study was to determine whether these morphological changes differ in eyes after PPV without ILM peeling.Methods: Ten eyes of 10 patients that underwent PPV without ILM peeling and 12 eyes of 11 patients with ILM peeling were studied. The MH in all eyes was ,400 μm in diameter. Six months after the PPV, the macular thickness and foveal slope around the closed MH were determined by spectral-domain optical coherence tomography. The thickness of the ganglion cell complex was measured by another spectral-domain optical coherence tomography instrument .6 months after the surgery.Results: The mean parafoveal retinal thickness in the non-peeled group was 367.1 μm in the nasal (N), 353.0 μm in the temporal (T), 366.9 μm in the superior (S), and 357.3 μm in the inferior (I) sectors. The T, S, and I sectors were significantly thicker than the corresponding sectors in the ILM peeled group (p=0.0008, 0.003, and 0.03, respectively). The mean ganglion cell complex was thicker not only in the N sector but also in the T sector in the non-peeled group. The mean retinal slopes in the non-peeled group (N, 40.2°; T, 37.6°; S, 41.2°; I, 39.5°) were flatter than those in the peeled group (N, 52.3°; T, 43.6°; S, 50.8°; I, 51.9°; p=0.009, 0.09, 0.008, and 0.017, respectively).Conclusion: The symmetrical fovea after MH surgery in the non-ILM peeled eyes indicates that the asymmetrical fovea after ILM peeling was probably due to the ILM peeling.journal articl
Phenotypic alteration of basal cells in oral lichen planus; switching keratin 19 and desmoglein 1 expression
Get PDFapplication/pdfIn oral lichen planus, extracellular matrix and basal cells are damaged by T-lymphocytes. As a consequence, changes in expression of collagen fibers within the connective tissue and cytoskeletons of the epithelial tissue can be observed. With the goal of examining the characteristic changes undergone by basal cells as a consequence of T-lymphocytes damage in oral lichen planus, we investigated protein expression in the epithelial-connective junction. We selected 20 cases of oral lichen planus and 5 control samples of buccal mucosa. Subsequently, we divided the oral lichen planus cases into thin and thick parts based on the mean values of epithelial thickness from the control samples, and counted the positive rate of collagen IV, keratin 19, desmoglein 1, and Ki-67. Collagen IV immune-reactivity partially disappeared or thickened in oral lichen planus. The keratin 19 positive rate in oral lichen planus cases was significantly lower than in the controls. Desmoglein 1 positive rate of the thick part was significantly higher compared to the thin part of oral lichen planus. Thus, modifications in basal cells with both reduced keratin 19 expression and alterations of desmoglein 1 expression suggest that in oral lichen planus, as a consequence of cell injury or regeneration in the interface area, there is a disappearance of the “true basal cell nature”.journal articl
THE CHANGES OF TOUCH THRESHOLD ON THE FACE OF PATIENT WITH TRIGEMINAL NEURALGIA
Get PDFapplication/pdfGamma knife surgery (GKS) has reported to be an effective and safety method for trigeminal neuralgia (TN). However, it has reported that after having received GKS, several percent of patients has felt numbness on the face. Then we measured the touch threshold on the facial skin to search the detail of them. Five patients diagnosed with TN of second branch were irradiated a maximum dose of 90 Gy at retro Gasserian after the target area were coordinated with MRI and CT. All patients were investigated the touch threshold on the lateral of nasal wing, subocular region and ear anterior parts using Semmes-Weinstein monofilaments before and 1, 3, 6, and 12 months after GKS. We compared with thresholds between healthy side and disease side. Though they had severe pain on the lateral area of nasal wing at first visiting, amblyaphia was assessed at the three areas, which showed individual characteristic. Touch threshold of totally 3 areas on the disease side was significant higher than that on the healthy side before and 1,3 months after GKS. This result suggested that the amblyaphia might be cognized on the wide area of face, which resulted from severe pain of TN and radiation.journal articl
Chapter 6 : Bone marrow masenchymal cell contribution in maintenance of periodontal ligament homeostasis.
Get PDF978-1-78984-971-4application/pdfIn general, remodeling phenomenon of the periodontal ligament (PDL) is occurring in all times. Thus, in the chapter, the word “maintenance” was used, and the chapter title is “Maintenance of Periodontal Ligament Homeostasis.” Our experimental data on the remodeling of the PDL with cell acceleration at the furcation area in this experimental model are recovered using the cells in situ and the bone marrow-derived cells (BMCs).BMC migration into the PDL tissues using green Ěuorescent protein (GFP)bone marrow-transplanted model mouse was examined. BMCs have abilities of cell migration and diěerentiation into tissues/organs in the body. The immunohistochemistry revealed that GFP-positive cells were detected in the PDL.GFP-positive cells were also positive to CD31, CD68, and Runx2 suggesting that ębroblasts diěerentiated into osteoclasts and tissue macrophages. In this way, Notch signaling involvement considered in our tentative examinations revealed that the experimentally induced periodontal polyp was examined; the cytological dynamics of the cells in granulation tissue are mainly from migration of undiěerentiated mesenchymal cells of the bone marrow and diěerentiate into the tissue-specięed cells. Furthermore, the data suggest that cell diěerentiation is due to Notch signaling.Edited by Thomas Heinbockel and Vonnie D.C. Shields : Published in London : IntechOpen, 2019.boo
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Get PDF9784905130062application/pdfEdited by Thomas Heinbockel. : London : IntechOpen, 2019.boo
高齢者における随意的口唇閉鎖調節能力の特性
Get PDF松本歯科大学大学院独立研究科博士（歯学）学位申請論文 ; 大学院歯学独立研究科 硬組織疾患制御再建学講座（主指導教員：山田 一尋 教授）application/pdfothe