Ibrahim, Hardjo Sukaeni

Okayama University Digital Information Repository

本人小児におけるカリエスリスク、齲蝕と生活習慣ならびに細菌学的スクリーニングの関連

Okayama University Scientific Achievement Repository

論 文 要 旨 等 報 告 書氏 HardjoSukaeni授 与 した 学 位 博専攻分野の名称 歯学位授与の番号 博 甲 50号学位授与の 日付 平 成 '2 1 年 3 月 2 5 日学位授与の要件 医歯薬学嘩合研究科社会環境生命科学専攻(学位規則第4条第1項該当)学 位 論 文 題＼名 CARIES,CARIESRISK,LIFESTYLEANDTHEIRRELATIONW汀HMICROBIALSCREENINGINJAPANESEC川LDREN (日本人小児におけるカリエスリスク､瀦蝕と生活習慣ならびに細菌学的スクリー ニングの関連)論 文 審 査 委 員 教授 森田 学 教授 鳥井 康弘 教授 下野 勉学 位 論 文 内 容 の 要 旨(INTRODUCTION)AkeycomponentofanyLPreVentiveprogr8mi8tOaS8e88aper80n'Sri8kofdevelopingadi8eaSe.Childrenareimportantsubjectsfordentalhealtheducationbecauseinthisperiod,theprimaryteetherupt,theyareathigherri8kforearlybacterialcolonization,andtheybegintoformtheirlifelongdentalbehaviors.Achild'8motherplaysavitalroleinraisingandtransferringhealth･relatedhabitstOherchildren.AsSe88ingachild'8riskofdevelopingcariesiB-avitalpartofcariesmanagement.AcomprehensivecariesaSSeSSmentShouldconsiderfactorsSucha8Pastandcurrentcariesexperience,presenceOfcariogemicbacteria,andlife8tyleS.Childrenwhoexperiencedinfectionbymutan8StreptococciearlyintheirliveshadgreaterriskofdevelopingcariesthanthoSeWhowereinfectedlater.Thesebacteriaareacidogenic,㌔aciduricandproduce8PeCifCintraandextrapoly8aCCharide8thatfacilitatemicrobialadherenceontheteeth.Theiramountandvirulence,to官etherwithpatient'8ageatwhichthesebacteriawerecontracted,areimportantfactorsindeterminingthecour8eOfdentalcaries.Thegeneticdiversityofthesecariogemicbacteriaisstilcontroversial;S.LZutaBShasbeenShowntobemoreprevalentwhileS.sobm'nusi8moreCloselyrelatedwithhighcariesactivtyandseldomfoundwithoutS.mzLtaDS.Howeyer,itisdifRculttoidentifycariesri8kofchildrenontheba8i80foral･examinationonly.Manybacteriologicalcarie8activtytesthavebeendevelope,dtoavertthi革difGculty.Theoreticaly,dentalplaqueseemstobeaparticularlyappropriatemethodbedauSethetooth surfaceconStitutesthenatwalhabitatofS.RZutaL28.TheCar～io8tattestiSaCariesriskaSSe88menttOOlthatcouldpredictchildren'SCarieSriSk.TheCariOstatmediun contains20%ofsucroseandtwokindsofpHindicatortoshowviSuallythep,HdecreaseCausedbymicroorganismsinthepatient'8plaqueSample.Moreover,alongitudinalstudyi8moreappropriateforfouowingthechange80fdentalprogre8Sion,oralhygieneofchildren,andlookingforpredictor80fcaries.(MATERIALSANDMETHODs)Atotalof283childrenwereSelectedbasedontheseCriteria:theyhaddentalexam血ation,hadfiledoutthequestionnaireandhadparticipatedinCariostatmicrobial8amPling･Thedentalexaminationswerecamiedo叶bytheSamedentistWithadentalmirrorandexplorel･undernaturallight.TheSamedentistalsoCOlectedplaque8amPleSfrom themaxillarybuccaLcervical surfaceSusingSterilecoton･tippedapplicators.Adental hygienistthenincubatedtheCarioBtatmediumat37oCfor48hours.InthepresentStudy,theCariOStatresultweregroupedaccordingtolowri8kgroup(CAT0,0.5,1.0andl･5)andhighriskgroup(CAT2.0,2.5and3.0).A8truCturedquestionnairewasCOmPletedbythemotherofthechildrenateach8Creeningtoevaluatewhichfactorsregardingthechildren'SlifeStylemadethemSuSCePtibletocarieS･Thechi･Squareand8tudent七･teStWereusedtoanalyzeSignifcantrankingofchildren･Slife8tyleSandhowchildren'life8tyle8andcariesriskatthel･5･year･oldperiodwouldinfluencechildren'8averageCariesatthe2･5･,and3･5･yearperiod.ⅠnadiuerentStudyof499children,onehundredchildrenwere-randomlySelectedfromlowandhighcarieBri8kchildren.Totaly,200childrenwereselectedformicrobia18Creening･Simplerandom sampling was performe<:l using three-colored dices thrown at the same time.Microbial screening of their Cariostat-inoculated plaque sample was done for detecting thepresence of S.m utans and S.sohrinus on the basis of caries activity. DNA extraction was donefollowing a protocol for Gram positive bacteria. Bacterial DNA detection was initially donethrough a PCR technique 'using universal primers to check for the presence of bacteria. ThePCR reaction mixture. (20 11]) contained of 2.0~III of lOX PCR buffer, 1.6 III of dNTP mixture,and 0.1111 of Taq DNA polymerase (Takara TaqTM) , 5.9 III of distilled Water (GIBCOTM), 10 J.lltemplate solutions and 2 III each of the primer pairs. Besides the samples, purified genomicDNA from S. mutans ATCC 25175 and S. sohrinus ATCC 33478 were used as positivecontrols in each experiment. The PCR amplification was performed under thermal conditionsspecific for both bacteria. The PCR products were analyzed by electrophoresis on a 1%agarose' gel in Tris-acetate-EDTA running buffer (pH 8.0). To estimate the size of the PCRproducts, a 100-bp DNA ladder and 0 X174 RF DNAlHae III fragment were included in eachgel as markers. After staIning with 2%ethidium -bromide, the newly synthesized DNAfragment was visualized under ultraviolet light. PCR products were verified at least twotimes under the same conditions, in accordance to the presence or absence of DNA bands.(RESULTS)a. Cariostat score during the early childhood period showed the current oral condition andsucceeded in predicting oral condition at a later age.' .b. Childrep.'slife styles af~ect caries risk.c. Cariostat test is useful ina'ssessing caries increment.d. The presence of S. sohrin us was more closely related with high caries activity and high dfnumbers.(DISCUSSION)Knowledge about all of the risk factors in children is important for determining the optimalperiod for prevention and interceptive treatment. Caries experience and caries activity inchildren tend to increase as their age increases. Before a carious lesion actually develops,caries risk assessment is recommended. For life style at the 1.5-year-old period, a strongdifference of the mean number'of carious teeth was found between children with and withoutpre ,chewing habit. This negative parental behavior plays a role in early vertical transmissionby salivary contact. The effect of breastfeeding to children's caries occurrence is stillcontroversial. A few specific case studies have linked prolonged ad libitum and nocturnalbreastfeeding to early childhood caries. For life style at the 2.5-year-old period, children withhigh sugar intake were clearly associated with an increase in caJ,'ies at the 3.5-year-oldperiod. Children with irregular snacking had a significant influence on children's decay rate.Initial PCR using universal primers showed a band indicating the existence of some bacteriathroughout the whole plaque samples. It has been suggested that these bacteria aregenerally established in the oral cavity of children before 3 years old. Our PCR results showthat·these cariogenic.bacteria are more prevalent in,a child who has high caries risk thanlow caries risk, and agrees with several previous studies' This finding also associated thepresence of cariogenic bacteria in children with high number of decay. S. sohriIius and thepresence of both S. muta.ns and S. sobrinuswere more likely detected in children in the.highcaries risk group and had high number of df. S. m utans is undoubtedly one of the mostacidogenic of the species found within the dental plaque, being capable of producing acidfrom fermentable carbohydrates at a higher rate and over a much greater pH range thanmost other streptococci.'Moreover, the presence of S. sobrinus was more closely related withhigh caries risk activity and high df numbers. Based on' these studies, we summarize that;Carisotat score at early childhood not only show the present oral condition but also couldpredict their oral condition at a later age. Children's ).ife styles change according their ageand can potentially affect children caries status. The Cariostat test is useful in assessmentand predicts children caries risk. OUf microbial screening result show that the presence ofStreptococcus sobrinus is more closely related with high caries activity and high df numberof children.歯蝕篠息の危険性を嚇蝕羅患または進行拡大する前に分析し予防することは､とくにその変化め著しい小児においては重要なことである｡嚇蝕は､養育環境に大きく左右される疾患であり､小児の口腔内の状態､歯蝕羅患甲危険性ならびに生活スタイルにまで言及して予防を行う必要がある｡本研究は1.5歳,2.5歳,3.5歳児健診時に保健センターで行われた口腔内健診､麟蝕活動性試験カリオスタシトならびにアンケー ト調査の縛果から小児期の癖蝕予防の要点を解析し､さらに2.5歳児の口腔内から分離されるS.mutaDS､S.sobrl'DuSの存在と口腔内の状態の関係をdf歯数と嚇蝕活性度によって評価したものであり､次のような結論を得たo1)1.5歳時の(Lowrisk:カリオスタットスコア一､Ⅰ.5以下とHighrisk:カリオスタットスコア一､2.0)スコア-をもとに被験者が2.5歳ならびに3.5歳児になった時のdf歯数と比較したところ両年齢時の平均df歯数は有意にHighrisk児のそれが多かった.さらに畠.5歳時のカリオスタットスコア-をもとに分析すると3.5歳時におけるdf歯数で同様の結果を得た｡2)嚇蝕活性度に有意に関与するライフスタイルは､噛み与え､養育者,授乳の継続､仕上げ磨き､間食の回数と遊びながら間食を食べる､近所からお菓子をもらうなどであった｡3)1.5歳時と2歳時の生活スタイルは､それ以降の年齢の嚇蝕活動性にも影響を与えた｡4)Lowriskに比べHighriskgroupでは､S.sobFl'DuSあるいはS.mutaDSとS.sobTl'nusが同時に高い確率で検出され､df歯数も大であった｡これらの知見は､小児の嚇蝕予防に役立ち歯科保健指導にエビデンスを与えるものである｡よって本論文は博士(歯学)の学位授与に値すると判定した｡

本人小児におけるカリエスリスク、齲蝕と生活習慣ならびに細菌学的スクリーニングの関連

Abstract

Similar works

Full text

Available Versions

Okayama University Digital Information Repository

Okayama University Scientific Achievement Repository