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口腔乾燥症の診断には, 安静時唾液分泌量の測定が重要である｡一般的に吐唾法が用いられているが, 唾液を吐出する能力を必要とするため唾液の吐出が難しい患者への応用は困難である｡ワッテ法は, 術者がロールワッテを舌下部へ挿入し, 唾液を吸収させる方法であるため吐出が不要である｡また, 測定時間はわずか30秒間もしくは60秒間と比較的短く簡便である｡しかし, その有用性およびカットオフ値に関する検討はまだなされていないのが現状である｡そこで, ワッテ法のドライマウスの臨床における有用性を検討する目的で, ワッテ法と吐唾法との比較検討を行った｡被験者は, 口腔乾燥を自覚していない健常者26名と新潟大学医歯学総合病院くちのかわき外来受診者10名の計36名とした｡吐唾法による15分間の安静時唾液, 30秒間および60秒間のワッテ法による唾液分泌量を測定し分析した｡その結果, 吐唾法による安静時唾液分泌量とワッテ法30秒値, 60秒値との間にいずれも有意な正の相関が認められた｡従って, ワッテ法は唾液分泌測定法のひとつとして利用できることが示唆された｡さらに, ワッテ法における唾液分泌機能低下の目安としてカットオフ値を算出した結果, 30秒値は0.14g, 60秒値は0.25gとなった｡本研究の被験者のうち, 唾液分泌が実際に減少しているものは9名のみであった｡今後, 被験者を増やし, ワッテ法におけるカットオフ値を明確にする必要があると考えている｡, The measurement of unstimulated salivary volume is necessary for diagnosis of hyposalivation. There are many methods to evaluate the salivary volume. Although spitting method is generally used, it is difficult to apply to the patients who are unable to spit out their saliva. The cotton method, one of the absorbent methods, is not dependent to the subject's ability of spitting out and is accomplished in only 30 or 60 seconds. Therefore, this method may be a standard screening of hyposalivation. However, there is no data to discuss the relationship between spitting method and cotton method. The purpose of this study was to compare these two methods and to reveal the cut-off value of hyposalivation. Thirty six subjects have participated in this study. 26 subjects were healthy adults, 10 patients were the out patients of dry mouth clinic. Spitting method, 30 and 60 seconds cotton method were performed by well trained dentists, respectively. Strong positive correlations were found between spitting method and 30 seconds cotton methods (ρ= 0.480, p <0.05), spitting method and 60 seconds cotton methods (ρ= 0.514, p <0.01). The cut-off value of 30 and 60 seconds cotton method calculated with the regression lines were 0.14g and 0.25g, respectively. It is suggested that cotton method is useful for screening of hyposaivation. Further studies are necessary to clarify the cotton method.

Treatment of taste disorder patients was started at our department since gustatory outpatient clinic was opened in October 1999. For the purpose of grasping the clinical features of these patients, a clinical study was performed. Fifty-three patients (17 males and 36 females) who were examined and treated at our gustatory clinic from October 1999 to February 2002 were studied. Patient's age was distributed from 23 to 96 years, and the average age was 66.6 years. The most numerous group consisted in 15 female patients in their 70. The most frequent chief complaint was lack of taste (hypogeusia) and was reported by 18 patients. Among other complaints were bitter taste (pantogeusia) in 12 patients, tongue pain or dry mouth (intraoral conditions not related to taste) in 15 patients, heterogeusia in 3 patients. The diagnosis was drug-induced taste disorder in 10 patients, oral candidiasis in 7 patients, iron deficiency-induced taste disorder in 6 patients, idiopathic and peripheral conduction taste disorders each in 5 patients, and zinc deficiency-induced taste disorder in 3 patients. The treatment mainly consisted in dietary instructions, zinc prescription and oral care. The treatment outcome was investigated using the paper disk method by which a decrease of the psychogeusic threshold for all the tastes was found after treatment in the 14 patients whose chief complaint was a lack of taste. A tendency of quick recovery was observed in the patients who visited our clinic shortly after they have noticed taste-related symptoms. Moreover, since positive effects were obtained by zinc intake in many patients with normal serum zinc level, a latent zinc deficiency was suspected in these patients., 新潟大学歯学部附属病院加齢歯科では、平成11年10月に味覚外来を開設し、味覚障害患者の治療にあたってきた｡今回、味覚外来受診者の臨床的特徴を把握し、診療体制の充実を図るために臨床統計的検討を行った｡対象は平成11年10月から平成14年2月までに味覚外来を受診した53名(男性17名、女性36名)とした｡患者の年齢は23歳から96歳に分布し、平均年齢は66.6歳であった｡70歳代の女性患者が15名と最多であった｡主訴は、味がわからないなどの味覚減退が18名と最も多く、ロの中が苦いなどの自発性異常味覚12名、舌痛、口渇など口腔内症状15名、異味症3名などであった｡診断は、薬剤性味覚障害10名、口腔カンジダ症各7名、鉄欠乏性味覚障害6名、特発性、末梢伝導路性味覚障害各5名、亜鉛欠乏性味覚障害3名であった｡治療は、食事指導や亜鉛内服療法、口腔ケアなどを行った｡主訴に味がわからないと訴えた患者14名について、濾紙ディスク検査の結果を治療前後で比較したところ、全ての味質において、治療後に味覚閾値の低下がみられた｡症状が発現してから来院までの期間が短い方に治癒率が高い傾向にあった｡また、血清亜鉛値が正常値であっても、亜鉛内服により良好な効果が得られた患者が多く、潜在的な亜鉛欠乏が推察された｡

The present study was undertaken to determine the optimal thickness of palatal plates those are set to the patients suffering from swallowing disorders accompanied with tongue motion disorders. For the first stage, five normal subjects (26-40years) wore three kinds of thickness (1.5mm,3.0mm,4.5mm) of palatal plates and ingested water, gelatin jelly, food paste and rice crackers. The EMG activities in the anterior part of temporal muscle, orbicularis oris muscle, suprahyoid muscles and laryngeal muscles were recorded during swallowing. The following variables were analyzed: 1) the amplitude of integrated EMG activities, 2) the duration of EMG activities, 3) the timing of EMG activities. As a result, the patterns of EMG activities recorded from the subjects who wore 4.5mm thickness plates and those who wore nothing were relatively stable. To determine the optimal thickness of palatal plates, it was suggested that we should record EMGs in swallow-related muscles and gradually change the thickness of the plate by using plastic material. After that we can replace the plastic material with resinous material as the final one., 舌運動障害を伴う摂食･嚥下障害患者に対して口蓋床を装着する場合に、その厚径を客観的診断のもと決定することを目的とし、本研究に着手した。その第一段階として今回は、健常者5名(26歳-40歳)に対して、口蓋床未装着時および3種類の厚径(1.5mm,3.0mm,4.5mm)の口蓋床を装着させた時に、水、ゼラチンゼリー、ペースト食、せんべいを摂取させ、 嚥下時における側頭筋前部、口輪筋、舌骨上筋群、喉頭筋群の筋電図積分ピーク値、筋活動持続時間、筋活動タイミングを調べた｡4種の食品のうち、ゼラチンゼリーが最も筋の負荷の少ない状態で嚥下できた。また、いずれの食品嚥下時においても、筋負荷が少なく、かつ比鞍的安定した筋活動パターンが記録できたのは、4.5mm厚径の口蓋床装着時であった｡口蓋床の厚径を決定するにあたり、口蓋部分を可塑性の材質にし厚径を段階的に変え、筋電計により筋活動パターンを観察しながら、最終的材質に置換していく方法をとるべきことが示唆された｡

publisher, 東京, 学会講演要旨

publisher, 東京, 学会講演要旨

publisher, 東京, 学会講演要旨

publisher, 東京, 学会講演要旨

publisher, 東京, 学会講演要旨

publisher, 東京, 抄録