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論文(リポジトリ) |
論文(リポジトリ)
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高木, 純一郎 ; 佐野, 富子 ; 田口, 洋 ; 三富, 智恵
概要:
下顎第二小臼歯は様々な局所的要因により萌出が障害されるが，本研究では特発的な歯胚の方向異常により下顎第二小臼歯の萌出が障害された症例について検討を行い，臨床的対応法についてフローチャートを考案した。調査対象は1979年から2008年までに新
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潟大学医歯学総合病院小児歯科診療室で処置した，歯胚の方向異常に起因する下顎第二小臼歯萌出障害の11症例15歯で，診断時年齢は8歳Oか月～13歳11か月，片側性7例，両側性4例であった。15歯中14歯が遠心に傾斜しており，歯胚形成度が低いものほど遠心傾斜度が大きい傾向にあった(R>0.70)。また，片側怪と両側怪の2群に分けて傾斜度を比較すると，遠心傾斜度は片側性で有意に大きい値を示した(P<0.01)。診断後に全症例で先行乳歯を抜去していたが，傾斜度の大きい場合には，その後歯胚形成がすすんでも傾斜度はわずかに改善するのみで，初期歯根形成期から歯根長1/4形成期頃にかけて骨開窓や牽引，誘導等の複雑な対応を必要とする場合が多かった。したがって，形成遅延が顕著に認められる場合には，早期に先行乳歯を抜去すると保隙期間が長くなるため，下顎第二小臼歯の歯根形成開始を待って対応した方が良いと考えられた。<br />The aims of this retrospective study were to examine the eruption disturbances of the mandibular second premolar caused by abnormal inclination of the tooth germs and to discuss and demonstrate the recommended treatment for these cases. The subjects comprised of 11 patients (eight girls and three boys) in whom the eruption of 15 mandibular second premolars was disturbed by aberrant direction of the tooth germs. The patients were treated at the Pediatric Dental Clinic of Niigata University Medical and Dental Hospital during 28 years from September 1979 to January 2008. The ages of the patients at the time of diagnosis ranged from 8 years exactly to 13 years and 11 months. The eruption disturbance occurred unilaterally in seven cases (five on the right side and two on the left) and bilaterally in four cases. In 14 of 15 affected premolars, the tooth germs exhibited distal inclinations. A strong correlation between the degree of distal inclination and the delay in formation of the tooth germ was observed (correlation coefficient: R>0.70); the more significant the delay in formation of the tooth germ, the higher the degree of distal inclination. In unilateral cases, the tilting degree was very high, and the formation of the tooth germ was significantly delayed. In bilateral cases, however, both the tilting degree and delay in formation were not severe, and were almost the same on both sides. A comparison between the unilateral group and the bilateral one revealed that the degree of distal inclination was considerably higher in the unilateral group (P<0.01). In the cases of 14 teeth among 10 patients (all but one unilateral case, in which血e patient was very young), the primary second molars were removed soon after diagnosis. The cases that had serious tilting, however, showed only slight improvement of the aberrant tilting even after their predecessors were extracted early, and additional complex treatments such as bone fenestration or traction of the affected tooth were required at the developing stage of initiation or one-fourth of the tooth root formation. If a predecessor is extracted at an early stage of tooth germ formation, long-term space maintenance is required. It was concluded that in cases with a markedly severe distal inclination, eruption disturbance of the mandibular second premolar should be treated after the root formation of its tooth germ is initiated.
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| 2.
論文(リポジトリ) |
論文(リポジトリ)
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杉林, 篤徳 ; 木下, 承子 ; 田口, 洋 ; 野田, 忠
概要:
サッカーは，野球とバスケットに次いで顎口腔領域の受傷件数が多い。本研究では，歯の外傷やマウスガードへの一般の認知度と関心度を把握する目的で，サッカーチームに所属する小児の保護者86名と指導者19名を対象に，1）歯の外傷についての一般的事項，
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2）完全脱臼歯の再植に関する事項，3）マウスガードに関する事項についてアンケート調査を行った。その結果，保護者と指導者の間に，歯の外傷に関する認知度と関心度には違いが認められず，歯の再植に関連する項目では，指導者の方が認知度は低い傾向にあった。歯の外傷に関するアドバイスを受けたことがあったのは，保護者で9.3%，指導者ではいなかった。一方，歯の外傷についての講習会参加希望者は保護者で65.1%，指導者で84.2%であった。脱落歯が再植可能であることを保護者の74.4%と指導者の85.2%が，脱落歯の牛乳保存については保護者の75.6%と指導者の94.7%が知らなかった。今後小児のマウスガード使用を考えた保護者は35.7%，指導者は41.2%と半数以下であった。以上の結果から，特に指導者に対して，講習会への参加希望が多いことを利用して，脱落歯が再植可能であること，脱落歯の牛乳保存，そしてマウスガード、の利用等について，科学的根拠に基づき啓蒙する必要のあることが示唆された。<br />Children often suffer dental injuries when playing soccer. The purpose of this study was to investigate the lay people knowledge and attitudes of parents and coaches regarding the emergency treatment of traumatized teeth, in particularly avulsed teeth, and the use of mouthguards. A questionnaire regarding common dental injuries, the replantation of avulsed teeth due to trauma, and mouthguards was submitted to 86 parents whose children were members of soccer teams and to 19 coaches. The following results were obtained. Although a statistically significant difference between the parents and the coaches was not recognized in the reply ratios for all the questionnaire, the ratio of positive answer of the coaches showed a lower tendency than the ratio of the parents regarding items relevant to tooth replantation. Only 9.3% of the parents and none of the coaches had ever been given advice concerning sports-induced dental injuries. On the other hand, 65.1% of the parents and 84.2% of the coaches expressed a desire to attend courses regarding dental injuries. As to the replantation of an avulsed tooth, 74.4% of the parents and 85.2% of the coaches did not know that avulsed teeth could be replanted, and 75.6% of the parents and 94.7% of the coaches did not know that milk is a better transportation medium for an avulsed tooth. Fewer than 10.5% of the respondents knew that it is best to return an avulsed tooth into the alveolar socket by themselves as soon as possible. As to mouthguards, although 81.4% of the parents and 89.5% of the coaches were aware of the existence of mouthgurards, only 35.7% of the parents and 41.2% of the coaches were prepered to require the use of mouthguards for their children while participationg in sports. The above results suggest that it is essential to emphasize, especially to coaches, as well as to parents, the possibility of the replantation of an avulsed tooth due to trauma, the use of milk to preserve an avulsed tooth, and the use of a mouthguards, as part of their concern for dental injuries suffered while engaged in sports.
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| 3.
論文(リポジトリ) |
論文(リポジトリ)
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富沢, 美惠子 ; 野田, 忠 ; 鈴木, 誠
概要:
1979年から1998年の19年間に,新潟大学歯学部附属病院小児歯科において治療した口腔軟組織の良性限局性線維性組織病変22症例について,臨床病理学的に検討し次の結果を得た。1.性別症例数は,男児9例,女児13例で,年齢は8か月から11歳4
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か月に分布し,1歳以下の乳児の症例が3例あった。2.発生部位は,歯肉が16例と多く,次いで口蓋4例,頰粘膜2例で,病理診断は,歯肉症例は線維性エプーリス,口蓋と頰粘膜症例は線維性過形成あるいは線維上皮性過形成であった。3.線維性エプーリス16症例は,上顎10例,下顎6例で,16例中15例が前歯部にみられた。病理組織像は,粘膜下の結合組織に膠原線維の密な増生がみられた。4.口蓋症例の4例中3例は,切歯乳頭に接して,ほぼ同部位にみられたが,切歯管との連続性はなかった。5.治療は,全例摘出術が行われ,再発症例はなかった。6.小児の口腔軟組織における線維性病変では,線維性エプーリスの頻度が高いと思われた。7.頰粘膜症例は,粘液囊胞と臨床的に診断されており,摘出物の病理組織検査は,確定診断を得るために重要である。<br />Fibrous lesions such as fibroma, fibrous hyperplasia, fibrous epulis, denture fibroma are not so rare in the oral cavity. There are, however, few reports about them in children. We experienced 22 cases of oral fibrous lesions at the Pedodontic Clinic of Niigata University Dental Hospital during a period of 19 years from 1979 to 1998 and investigated them clinically and histopathologically. The results were as follows: 1. The patients consisted of 9 males and 13 females. Their ages ranged from 8 months to 11 years and 4 months. Three patients were under 1 year old. 2. Sixteen cases were located on the gingiva, 4 on the palate and 2 on the buccal mucosa. They were pathologically diagnosed as fibrous epulides in 16 cases and fibrous hyperplasia or fibroepithelial hyperplasia in 6 cases. 3. As for the 16 cases of fibrous epulides, 10 cases occurred in the maxilla and 6 in the mandible. Fifteen cases were in the incisor region. All of the epulides were smaller than 1 cm in diameter. Microscopically, they were shown to be composed of numerous fibroblasts and proliferating collagen fibers. 4. As for the 6 cases of fibrous hyperplasia, four cases occurred on the palate and two on the buccal mucosa. Three of the four cases of palatal fibrous hyperplasia were similarly located near the incisor foramen. They were hemispherical or elliptical in shape, 3-7 mm in diameter, and pedunculated or sessile and elastic-hard. Buccal lesions were clinically well-defined masses with smooth, normalcolored surfaces and broad bases. They were clinically suspected of mucocele. Microscopically, the lesions were shown to be composed of proliferating collagen fibers. 5. All of the fibrous lesions were excised surgically and no recurrence was found. 6. Most of the oral fibrous lesions in children may be fibrous epulides. Histological examination of the excised specimens is needed to confirm the diagnosis.
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| 4.
論文(リポジトリ) |
論文(リポジトリ)
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竹内, 優美子 ; 松山, 順子 ; 川﨑, 勝盛 ; 三富, 智恵 ; 佐野, 富子 ; 田口, 洋
概要:
食物摂取時の一口量は，幼児では一口ごとのばらつきが大きく一定していないものの，11歳頃には成人と同程度に一口量が一定すると報告されている。一口量が一定してくる11歳頃までは，乳歯から永久歯への歯の交換期に相当するが，特に，食物の取り込みに関
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連している前歯部の交換が一口量に及ぼす影響はきわめて興味深い。そこで，本研究では上顎永久中切歯萌出前後における一口量の変化を分析した。上顎永久中切歯萌出期の個性正常咬合を有する８名（男児３名，女児５名）を被験児とし，上顎永久中切歯萌出前および萌出完了後の一口量の変化を分析した。パン，ソーセージ，りんごを被験食品とした。萌出前の年齢は平均６歳６か月，萌出完了後の年齢は平均７歳３か月で，平均一口量は，すべての被験食品において，萌出前と完了後で差が認められなかった。一方，一口量のばらつきは，りんごでは，上顎永久中切歯萌出前に比較して，萌出完了後でばらつきが小さくなったのに対して，パン，ソーセージでは萌出前後において，ばらつきに差が認められなかった。以上のことから，小児の成長過程におこる前歯部の乳歯から永久歯列への交換が一口量に及ぼす影響は少ないことが示唆された。<br />It is well known that children take different-sized bites as they eat, depending partly on the food, while adults take uniformed-sized bites. It has been reported that the bite size variability of children decreases with age, with bite size becoming as uniform as that of adults at the age of nearly 11 years. At around 7 years of age, the upper primary central incisors are replaced with their successors. The purpose of the present study was to investigate the influence of tooth replacement on bite size of foods. Three boys and five girls with functionally normal occlusion participated in this study. The experiments were performed twice for the same subjects at the following stages. In the first stage, both upper primary central incisors of the participants (mean age, 6.5 years; range, 5.9-7.4 years) were exfoliated, but the successors had not erupted yet. In the second stage, the permanent central incisors had fully erupted (mean age, 7.3 years; range, 6.3-7.9 years). The test foods were bread, fish sausage and peeled apple. Each participant was provided with the same portions (by weight) of the test foods. In all the test foods, the average bite size did not differ significantly before and after the eruption of the upper central incisors (Wilcoxon signed-rank test). The coefficient variation in the bite size of the apple after eruption of the upper central incisors was significantly smaller than that before eruption. On the other hand, the fluctuations in bite size in bread and sausage did not differ significantly between the two stages. The findings of the present study suggest that there is little influence on bite size by the replacement of upper central incisors from primary to permanent dentition.
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| 5.
論文(リポジトリ) |
論文(リポジトリ)
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武田, 正之 ; 高田, 恒郎 ; 柳原, 敏雄 ; 関根, 昭一 ; 桜井, 叢人
概要:
Eleven patients underwent living-related renal transplantation (Tx) in Yoshida Prefectural Hospital from 1985 to 1991. Patients were 10 males and 1 female, ranging from 4 to 27 years old at Tx, and the duration of dialysis before Tx
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were between 22 and 122 months. Causes of end stage renal failure were congenital renal hypoplasia 4, familial juvenile nephronophtisis 2, chronic glomerulonephritis 2, Alport syndrome 1, congenital nephrotic syndrome 1, and acquired nephrotic syndrome 1. Types of dialysis were Hemodialysis 9 and continuous ambulatory peritoneal dialysis 2. Immunosuppression therapies were conventional method without Ciclosporin in the initial 2 patients and Ciclopsporin method in the other 9 patients. The number of acute rejection were 4 in 1, 2 in 1, 1 in 2, and zero in 4patients. Treatment of acute rejection was performed using Methylpredonisolone pulse therapy alone and was successful in every patients. Serum creatinin level ranged from 0.4 to 1.2 mg/dl in the follow up period of 2 to 76 months in every patients. Problems in pediatric renal transplantation were discussed.
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