妊産婦に向けたう蝕予防対策が子供のう蝕経験に与える影響

Effect of caries preventive measures directed to expectant mothers on caries experience in their children.

抄録

この前向き研究の目的は、妊娠中に開始したう蝕予防対策が、初産婦とその乳児のう蝕経験に及ぼす効果を明らかにすることであった。社会的背景の低い81名の妊婦を、活動的なう蝕病変の有無に基づいて選択し、無作為に対照群（38名）と実験群（43名）に分けた。臨床検査により初期の歯の状態（DMFSと白斑病変）を確定した。予防措置は、妊娠中と出産後6ヶ月と12ヶ月に繰り返された。両群ともプライマリーケアによる介入を受けた。両群は、う蝕の病因に関連した指導を受け、口腔衛生キットを受け取りました。口腔衛生の指導は、双方向のブラッシングによって強化された。実験群では、抗菌治療（予防直後と3日後、5日後にNaFとヨウ素液の局所塗布）とグラスアイオノマーセメントによる修復治療が行われた。2歳になるまでに、対照群では33.3％、実験群では14.7％の乳幼児にう蝕活動性が認められた。目に見える歯垢がある子供とない子供では、う蝕の有病率に有意な差が見られた。う蝕病巣（脱灰領域を含む）を有する歯面の平均数は、実験群と比較して対照群の小児で多かった（6.3×3.2）が、統計的有意差は認められなかった。母親の齲蝕増加率は、小児の齲蝕経験に影響を与える重要な要因であった。これらのデータは、幼児におけるう蝕の有病率と臨床的（歯垢）および母親の要因との関連性を示すエビデンスを支持するものである。

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3% of the infants in the control group and 14.7% in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors.