歯肉炎および歯周炎患者における揮発性硫黄化合物レベルと口臭の調査

Investigation of volatile sulfur compound level and halitosis in patients with gingivitis and periodontitis.

抄録

本研究の目的は、歯肉炎および歯周炎患者における揮発性硫黄化合物レベルの測定と口臭の発生状況を調査することである。さらに、口臭を有する患者における歯肉炎および歯周炎の罹患率を調査した。さまざまな統計分析により、歯周病と口臭の関係を明らかにした。本断面調査には，健常対照者33名，歯肉炎患者43名，歯周炎患者28名の計144名（女性52名，男性52名，平均年齢46.49±16.03歳）が登録された．代表的なVSCである硫化水素（HS）とメチルメルカプタン（CHSH）の測定にはガスクロマトグラフィーを用いた。口臭診断のためのVSCカットオフ値は女性65.79ppb、男性79.94ppbであった。VSC総量は歯肉炎群が健常対照群より有意に高かった（186.72±374.83ppb vs. 19.80±40.19ppb、p=0.035）。歯肉炎群と歯周炎群（153.79±278.51ppb）では有意差はなかった。HS値は歯肉炎群（100.51±183.69ppb）および歯周炎群（91.57±132.06ppb）で健常対照群（14.97±31.22ppb）より有意に高く、CHSH値は歯肉炎群（29.31±59.16ppb）で健常対照群（5.73±14.10ppb）より有意に高かった（いずれもp＜0.05）。口臭は健常対照群では3％、歯肉炎患者群では39.5％、歯周炎患者群では42.9％に認められ、歯肉炎群および歯周炎群では健常対照群に比べて有意に高かった（p=0.005）。逆に口臭のある患者では、53.1％が歯肉炎、37.5％が歯周炎、90.6％が歯周病であった。口臭の有無を予測するための多変量ロジスティック回帰分析の結果、歯周病は口臭の有意な予測因子であった（OR=3.607, 95% CI 1.023-12.718, p=0.046）。口臭の曲線下面積値を考慮すると、健常対照（HS:61.5ppb、CHSH:3.5ppb）、歯肉炎（HS:50.0ppb、CHSH:6ppb）、歯周炎（HS:62.0ppb、CHSH:3.5ppb）がカットオフ値であった（いずれもp<0.05）。この結果は、歯周病と口臭が密接かつ強い関係にあることを、相互疾患の高い併発率に基づくヒト臨床的エビデンスによって強調するものである。また、歯周病の有無は口臭の発生確率を3.607倍に増加させた。これらの結果は、HSが歯周病患者の口臭のバイオマーカーとして使用できることを示唆している。

This study aimed to measure the levels of volatile sulfur compounds and investigate the occurrence of halitosis in patients with gingivitis and periodontitis. Additionally, the incidence rates of gingivitis and periodontitis in patients with halitosis were investigated. Through various statistical analyses, we attempted to determine the relationship between periodontal disease and halitosis. One-hundred-and-four participants (52 females and 52 males, mean age: 46.49 ± 16.03 years) were enrolled in this cross-sectional study, comprising 33 healthy controls, 43 patients with gingivitis, and 28 patients with periodontitis. Gas chromatography was used to measure hydrogen sulfide (HS) and methyl mercaptan (CHSH), which are representative VSCs. The VSC cut-off values for diagnosing halitosis were 65.79 ppb for women and 79.94 ppb for men. Total VSC level was significantly higher in the gingivitis than the healthy control group (186.72 ± 374.83 ppb vs. 19.80 ± 40.19 ppb, p = 0.035). There was no significant difference between the gingivitis and periodontitis (153.79 ± 278.51 ppb) groups. HS level was significantly higher in the gingivitis (100.51 ± 183.69 ppb) and periodontitis (91.57 ± 132.06 ppb) groups than in healthy controls (14.97 ± 31.22 ppb), and CHSH level was significantly higher in gingivitis group (29.31 ± 59.16 ppb) than in the healthy control (5.73 ± 14.10 ppb) (all p < 0.05). Halitosis was found in 3% of healthy controls and 39.5% and 42.9% of patients with gingivitis and periodontitis patients, respectively, making it significantly higher in the gingivitis and periodontitis groups than the healthy controls (p = 0.005). Conversely, among participants with halitosis, 53.1% had gingivitis, 37.5% had periodontitis, and 90.6 incidence had periodontal disease. Multivariate logistic regression analysis to predict the presence of halitosis, found periodontal disease was a significant predictor of halitosis (OR = 3.607, 95% CI 1.023-12.718, p = 0.046). Considering area under curve value for halitosis, the cut-off value of healthy control (HS:61.5 ppb, CHSH:3.5 ppb), gingivitis (HS:50.0 ppb, CHSH:6 ppb), and periodontitis (HS:62.0 ppb, CHSH:3.5 ppb) were (all p < 0.05). Our results emphasize the close and strong relationship between periodontal disease and halitosis through human clinical evidence based on the high co-occurrence rate of mutual diseases. Additionally, the presence of periodontal disease increased the probability of halitosis by 3.607 times. These results suggest that HS can be used as a biomarker of halitosis in patients with periodontal disease.