臓器移植を受けた方の口腔衛生と歯科治療の重要性

Importance of oral health and dental treatment in organ transplant recipients.

抄録

目的:

本研究の目的は、臓器移植を受けた患者において、移植前後の歯科治療がどのように必要と考えられるか、また、これらの治療が実際にどのくらいの頻度で行われたかを調査することである。

OBJECTIVES: The purpose of the present study was to investigate which peri-transplant dental treatments were deemed necessary, and to determine retrospectively how often these treatments were actually performed, in patients who had received organ transplants.

材料と方法:

延世大学歯科病院の高度一般歯科部門の医療記録を検索し、2014年3月1日から2017年12月31日までに通院した肝臓または腎臓移植患者を特定した。合計418名の患者が特定され、彼らの医療カルテがレビューされた。性別，基礎となる全身疾患，口腔衛生状態，必要と思われる歯科治療，実際に行われた歯科治療，経過観察期間を集計した。

MATERIALS AND METHODS: Medical records of the Department of Advanced General Dentistry at Yonsei University Dental Hospital were searched to identify liver or kidney transplant recipients who attended from 1st March 2014 to 31st December 2017. A total of 418 patients were identified, and their medical charts were reviewed. Sex, underlying systemic disease, oral hygiene status, dental treatment deemed necessary, dental treatment actually performed and durations of follow-up were tabulated.

結果:

肝移植患者の半数以上（53.8％）は口腔衛生状態が不良であり，肝移植群では腎移植群（40.3％）よりも統計的に有意に多かった。移植前にスケーリングが必要と判断された肝臓移植者では、移植前に実際にスケーリングが行われた率が高かった（83.2％）。一方、移植前に抜歯や補綴を行った割合は、それぞれ12.8％、0％と低かった。腎臓病患者において、移植前に必要と判断されて実際に行われたスケーリング、抜歯、補綴治療の実施率は、それぞれ93.5％、10.0％、0.0％であった。

RESULTS: More than half (53.8%) of the liver transplant recipients had poor oral hygiene, and poor oral hygiene was statistically significantly more prevalent in the liver transplant group than in the kidney transplant group (40.3%). In liver recipients in whom scaling was deemed to be required pre-transplant, the rate of it actually being performed pre-transplant was high (83.2%). By contrast, the rates of tooth extraction and prosthetic treatment actually being performed pre-transplant were low (12.8% and 0%, respectively). In kidney recipients, the rates of scaling, tooth extraction and prosthetic treatment actually performed pre-transplant, when deemed to be required, were 93.5%, 10.0% and 0.0%, respectively.

結論:

臓器移植を受ける予定の患者には、口腔内の感染源となりうるものを取り除くために、事前にできるだけ早く歯科医院を紹介することをお勧めします。早期の歯科検診と移植前の歯科治療の重要性について、患者だけでなく、医師の教育も不可欠である。

CONCLUSIONS: We recommend that patients scheduled to receive an organ transplant be referred to a dental clinic as soon as possible beforehand, to remove any potential sources of oral infection. Educating physicians, as well as their patients, about the importance of early dental screening and pre-transplant dental treatment is essential.