A Study on Pediatric Dentistry in Web-based Child care Support Project

本論文の要旨の一部は第43回日本小児歯科学会大会(2005年5月26,27日)において発表した

Oral Appliances Improve Dysphagia following Intracranial Epidermoid Tumor Removal in a Developmentally Disabled Child : A Case Report

頭蓋内類表皮腫摘出後に嚥下障害を生じた発達障害児(初診時8歳5カ月,女児)に対し,耳鼻咽喉科医師と連携し,Videofluorography(以下VF)による診断に基づき口腔内に装置を適用し,舌の訓練と嚥下動作の改善を行い,以下の治療効果を得た. 1.舌挙上訓練のため,接歯唇側線およびビーズアタッチメントを取り付けた可撤式の装置による治療を開始した.装置適用6カ月後,開咬の改善とoverjetの減少および嚥下機能の改善がみられた. 2.初診から1年後,開咬の再発はなかったが,VF検査にて再び嚥下動作に異常がみられたため,食事時にも舌挙上を補助できる固定式の舌挙上装置に変更して治療を継続した. 3.初診2年後のVF検査にて,嚥下機能の改善が確認できた.さらに1年後のVF所見でも嚥下機能が改善した状態が維持されていた. 4.治療により最長で2時間かかっていた食事時間が30分に短縮された. なお,この患児の嚥下障害の原因が判明していないため,装置の必要性、あるいは撤去時期については,注意深く経過観察をしたうえで決定する必要がある.We treated dysphagia that presented after intracranial epidermoid tumor removal in a developmentally disabled child (female, aged 8 years 5 months at the time of initiale xamination).An intraoral appliance followed by a tongue-lifting device were used to improve swallowing based on videofluorographic(VF) diagnosis in collaboration with an otorhinolaryngologist. We observed the following therapeutic results. 1. The treatment was initiated using a removable oral appliance with a labial arch and a bead attachment (palatal training appliance).A fter using this appliance for 6 months, the patient showed improved apertognathia and reduced overjet. VF analysis also demonstrated improved swallowing. 2.Although there was no recurrence of apertognathia, VF showed the recurrence of abnormal swallowing movements 1 year after the initiale xamination. Thus, we altered treatment by switching to a fixedt ongue-1ifting appliance that can supplement tongue-lifting during eating. One year later, VF analysis showed improved swallowing that was maintained for the following year. 3.The time spent eating for the patient, which upon admission was up to 2 h, had reduced to 30 min because of this treatment. As the cause of dysphagia in this child remains unclear, the need for these oral appliances and the timing of their removal must be carefully monitored during follow-up

Overview of community-based oral health support activities at the shelter care facilities and dental caries prevalence of children during temporary custody

Child abuse is a serious social issue, with the number of consultations having rapidly increased in recent years. Major incidents that threaten children's lives occur constantly; thus, child abuse is a crucial problem that must be solved as quickly as possible. When children undergo dental examinations or emergency medical treatment, an understanding of their words, their actions, and their oral health statuses may yield clues that lead to early detection and reporting of child abuse. Therefore, dental health professionals are anticipated to play a role in preventing child abuse. We conducted a survey study of children sheltered at three temporary shelter care facilities in Hiroshima Prefecture, Japan. We investigated dental examinations, oral health instruction, and other support activities provided for these children. The survey results yielded the following findings. 1) The number of children sheltered due to child abuse was comparable to the number of children sheltered for other reasons. 2) Among the abused children, the most prevalent age group was elementary school children (ages 6-11years; 48.4%). followed by preschool children (ages 0-5 years; 29.9%). and junior high school/high school children (ages 12-18 years; 21. 7%). 3) Compared with average children, children in shelter care were more likely to have experienced dental caries and to have untreated teeth; these children demonstrated a high average number of teeth that had experienced dental caries, as well as a high average number of untreated teeth. 4) In contrast, no difference in the morbidity of dental caries was observed between children sheltered due to abuse and children sheltered for other reasons. These results indicate that proactive support is necessary for children who demonstrate oral health problems, such as a high prevalence of dental caries, regardless of whether they have been abused, since such manifestations can be interpreted as signs of maltreatment

学校歯科健康診断の結果は児童虐待の早期発見のためのスクリーニング指標となるか

現在，小学校には児童虐待の早期発見努力義務が課され，関係機関と連携し虐待防止に取組むことが求められている。また，歯科医療関係者の児童虐待防止への関与が期待されている。 そこで，学校歯科健康診断の結果が児童虐待の早期発見のためのスクリーニング指標となりうるかどうかについて検討し，以下の結論を得た。 1. 学校歯科健康診断を受けた小学生総計3,569名（男児1,843名，女児1,726名）のうち，虐待を受けた児童（「虐待あり」群）は89名（男児43名，女児46名）であった。 2. 「虐待なし」群および「虐待あり」群のそれぞれ約90%が，乳歯の未処置歯数が2本以下であった。 3. 「虐待なし」群の95.00%, 「虐待あり」群の93.26%が，永久歯の未処置歯数が0本であった。 4. 「虐待なし」群の84.94%, 「虐待あり」群の87.64%が，歯垢状態のスコアが0であった。 5. 「虐待なし」群の87.04%, 「虐待あり」群の91.01%が，歯肉状態のスコアが0であった。 以上より，「虐待あり」群と「虐待なし」群との間で口腔内の状態に違いが認められないことから，学校歯科健康診断の結果だけで児童虐待のスクリーニング指標とすることは困難であることが示唆された。したがって，歯科医療関係者が児童虐待の早期発見・防止に貢献するためには，診療室での診察のようにある程度時間をかけて児童の口腔内や言動，保護者の様子などを観察できる状況が必要であると考えられた。Elementary schools in Japan are committed to early discovery of child abuse and required to cooperate with other institutions such as dental services to prevent such abuse. However, the extent to which dental practitioners cooperate with schools remains limited. In the present study, we investigated the use of school dental examination data for early discovery of child abuse. I) We examined the records of a total of 3569 elementary school students who underwent dental health examinations, of whom 89 were found to have been abused ( abuse group). 2) Approximately 90% of all children had 2 or less deciduous teeth with untreated cavities. 3) A total of 95% of the children in the non-abuse group and 93.26% of those in the abuse group had no untreated cavities in permanent teeth. 4) A plaque score of zero was noted in 87.64% of the abuse group and 84.94% of the non-abuse group. 5) As for gingival inflammation score, that was zero in 87.04% of children in the non-abuse group and 91.01 % of those in the abuse group. No differences were found between abused and non-abused children in terms of the condition of their oral cavity. Our findings suggest that data collected from school dental health examinations are not useful to screen for possible child abuse. An environment in which dental practitioners spend time not only observing the oral cavity, but also the behavior of children and attitudes of their guardians is needed for early discovery and prevention of child abuse

A preliminary study for analysis of three dimensional change of children's palates and alveolar ridges in pre-dentition period

無歯期小児における口蓋および歯槽部の経時的な形態変化を縦断採得した模型資料により立体的に分析するための基礎研究として、三次元形状計測装置を用いて、成長に伴う口蓋および歯槽部の形態変化について検討を行い、以下の結論を得た。 1)口蓋の側方および垂直方向への成長変化は生後6か月までは大きいが、その後はゆるやかであった。 2)生後7日から3か月までは側方への成長が大きく、特に生後7日から1か月にかけての成長変化が最大となった。 3)生後6か月以降は口蓋前方部の前方向への成長が大きかった。 口腔内模型を三次元形状データに変換することにより、面積や体積の計測が可能になり、数値のみならず形態変化を視覚化することが可能となった。The purpose of this study was to analyze the growth of palates and alveolar ridges in pre-dental period longitudinally and 3-dimmensionally. The study models obtained from a few volunteers during pre-dentition stage at appropriate intervals were scanned to create the corresponding 3D surface models by the use of a non-contact 3D surface scanner, and the morphological changes during growth and development periods of each individual were analyzed. 1) The palates considerably increased laterally and vertically during the first six months, and leveled off. 2) The palates increased, to a large extent, in lateral direction during first one months, and then gradually increased within 3months. 3) The size of anterior palates increased in a sagittally within the first six month. At last, the three-dimensional measuring system was useful aid to analyze the development of jaws of the nepionic children

Oral findings in Noonan syndrome : Report of a case

Oral findings in a case of Noonan syndrome in an 8-year-old Japanese male are reported. Examination of the patient revealed a narrow, higharched palate and an anterior open bite. Cephalometric measurements showed a wide gonial angle, a large mandibular plane angle, a large Y-axis and long facial height. It is suggested that the patient had a skeletal open-bite malocclusion, which included an abnormal swallowing habit

Preliminary Survey to Establish Indicator for Screening of Primary School-age Children Who Require Welfare Assistance

小学校において被虐待児にみられる行動特徴から要保護児童をスクリーニングできる質問紙を作成するために，教職員にとって判断が容易で信頼性の高い回答が得られる項目を厳選するための基礎調査を行った。64名の小学校の教職員に，35項目からなる同じ内容の質問紙に2週間の間隔をあけ， 2回回答してもらった結果を照合し，質問内容の判断の容易さ回答の再現性，および文章表現について検討した。 1. 学校現場で教職員が判断するのが難しい質問項目は，「トイレの後に手を洗わない」，「行事の時の弁当が手作り弁当ではない」，「保護者と目を合わさず，おどおどする」，「家族関係に変化があった」，「年齢にそぐわない性的な言動がみられる」，「病気になっても病院に行かない」，および「過度な警戒心を持つ」であった。 2. 回答の信頼性の低い質問項目は「やせすぎている」，「行事の時の弁当が手作り弁当ではない」，「よく教室から離れる」，および「保護者と目を合わさず，おどおどする」であった。 3. 表現が不適切であると指摘された質間項目は「時々嘘をつく」，「友達をいじめる」，および「集団になじめないところがある」であった。 今後は，上記の質問項目を除いた質問項目からなる質問紙を作成し，実際に児童を対象とした調査を行い，要保護児童のスクリーニング指標としての有効性について検証する必要があると考えられる。We conducted a survey to select questions that teachers could easily and reliably answer as part of a basic research project to create a questionnaire based on characteristic behaviors exhibited by abused children at primary school for screening of those who may need welfare assistance. Questionnaires comprised of 35 items were sent to 64 primary school teachers, with the same questionnaire sent again 2 weeks later. Responses to both were compared to examine ease of assessing the contents of the questions, reproducibility of the responses, and written expressions. 1) Items that teachers found difficult to assess at school were "Does not wash hands after using the toilet," "Does not bring homemade lunch to events," "Does not meet guardian's eyes; appears apprehensive," "Has experienced a change in familial relations," "Uses sexual speech and behavior that is not age appropriate," "Does not see a doctor despite being sick," and "Is excessively wary." 2) Items that showed responses with low reliability were "ls too thin," "Does not bring homemade lunch to events," "Is often absent from the classroom," and "Does not meet guardian's eyes; appears apprehensive." 3) Items indicated to use inappropriate expressions were "Sometimes tells lies," "ls bullied by friends," and "Does not fit in with group in some ways." Next, use of a questionnaire that does not include the above items should be done with actual children to examine its effectiveness as an indicator for screening children who require welfare assistance

A Study on the Development Process of Dentition and Occlusion in the Japanese Children with the Three Dimensional Measurement System of Dental Casts

本論文の要旨は平成5年5月の第31回日本小児歯科学会大会,平成5年6月の第26回広島大学歯学学会総会におて発表した

A Study on the Development Process ofDentition and Occlusion in the Japanese Children with the Three Dimensional Measuren-ent System of Dental Casts

広島大学(Hiroshima University)博士(歯学)Dentistrydoctora