| 特集名 | どうコントロールするか透析患者の感染症 | |
|---|---|---|
| 題名 | 臓器関連 : 重篤な感染症 (7) 歯科領域 | |
| 発刊年月 | 2009年 01月 | |
| 著者 | 新藤 潤一 | 神奈川歯科大学名誉教授 (口腔外科学) |
| 【 要旨 】 | 透析患者のう蝕歯数や歯周疾患罹患率は必ずしも高くない．しかし進行例が多く，喪失歯数は対照群の約2倍に達する．進行したう蝕は根尖に慢性病巣をもち，重篤な感染症の原因となる．一方，歯周疾患から重篤な感染症が発生することは少ない．感染予防のためにも透析患者のQOLの面からも歯科的管理が望まれる． 重篤な歯性感染症は過去10年間に10例報告されている．原因歯は下顎大臼歯が多く，う蝕からの進展が多い．顎骨周囲から顎下部，頸部に進行し，2例は縱隔に至っている．検出されるのは口腔常在菌で，Clostridiumは検出されない．複数回の切開・ドレナージが行われ，2例は死亡しているが，他は1 - 4カ月で治癒している． |
|
| Theme | Controlling Infections in Dialysis Patients | |
|---|---|---|
| Title | Serious oral infection | |
| Author | Junichi Shindo | Professor emeritus of Kanagawa Dental College |
| [ Summary ] | The number of advanced carious teeth and missing teeth are observed twice as many in patients who are receiving renal dialysis, compared to control groups. High scores of periodontal disease index are also observed in dialysis groups. All of dental caries with gangrenous pulp include apical inflammatory lesions, and these lesions have the possibility to cause serious infections. Dental care is important to prevent these infections and to maintain QOL for these patients. Ten cases of serious odontogenic infection were reported in these 10 years. These cases were caused from periapical lesions associated with carious teeth particularly mandibular molars, and spread to lesios in the perimandibular region and then cervical region. Oral indigenous bacteria were detected in all of these lesions. In two patients infection spread to the mediastinum, and they did not survive. Other petients recoverd in 1 - 4 months after treatment, including prescription for antibiotics and repeated incision and drainage. |
|