食事性酸の摂取時期と侵食性歯牙摩耗：症例対照研究

Timing of dietary acid intake and erosive tooth wear: A case-control study.

抄録

目的:

侵食性歯牙摩耗の進行を抑制しようとする場合、食事性酸摂取のタイミングと歯ブラシ磨耗の影響に関する臨床データは不足している。本研究の目的は、理論的な原因因子と糜爛性歯牙摩耗との関連を推定し、エビデンスに基づくガイドラインに役立てることである。

OBJECTIVES: There is a lack of clinical data on the impact of timing of dietary acid intake and toothbrush abrasion when attempting to control erosive tooth wear progression. The aim of this study was to estimate the association of theoretical causative factors with erosive tooth wear to inform evidence-based guidelines.

方法:

症例対照研究デザインを用い、King's College London Dental Instituteの修復クリニックから、食事性糜爛性歯摩耗を有する300名と、年齢をマッチさせた300名の対照者を募集した。以前に検証された質問票を面接者主導型に変更し、嚥下前の代替飲酒習慣に加え、食事性酸の摂取頻度、タイミング、期間を評価した。食事と食事性酸摂取量に関連した歯磨きのタイミングが調査された。侵食性歯牙摩耗との関連を粗および調整ロジスティック回帰モデルで評価した。

METHODS: Using case-control study design, 300 participants with dietary erosive tooth wear and 300 age-matched controls were recruited from the restorative clinics of King's College London Dental Institute. A previously validated questionnaire was adapted to be interviewer-led and to assess frequency, timing and duration of dietary acid intake in addition to alternate drinking habits prior to swallowing. Timing of toothbrushing in relation to meals and dietary acid intake was investigated. Associations with erosive tooth wear were assessed in crude and adjusted logistic regression models.

結果:

食間の果物摂取（p＜0.001）は、食事と一緒には摂取せず（p＝0.206）、侵食性歯牙摩耗と関連しており、摂取のタイミングにかかわらず強い関連を維持した酸性飲料とは対照的であった（ORは最大11.84［95％CI：5.42-25.89］、p＜0.001）。長時間の果物摂取および嚥下前の交互飲酒習慣（それぞれOR 12.82［95％CI：5.85-28.08］および10.34［95％CI：4.85-22.06］）は、1日3回以上の酸摂取（OR 10.92［95％CI：4.40-27.10］）と同様に、侵食性歯牙摩耗と強く関連していた。酸摂取後10分以内の歯磨きは、食事要因を調整した後では、侵食性歯牙摩耗とは関連しなかった（OR 1.41 [95% CI: 0.82-2.42], p=0.215）。

RESULTS: Fruit intake between meals (p<0.001), but not with meals (p=0.206), was associated with erosive tooth wear and contrasted with acidic drinks which maintained a strong association regardless of timing of intake (OR up to 11.84 [95% CI: 5.42-25.89], p<0.001). Prolonged fruit eating and alternate drinking habits prior to swallowing (OR 12.82 [95% CI: 5.85-28.08] and 10.34 [95% CI: 4.85-22.06] respectively) were as strongly associated with erosive tooth wear as three or greater daily acid intakes (OR 10.92 [95% CI: 4.40-27.10]). Toothbrushing within 10min of acid intake was not associated with erosive tooth wear following adjustments for dietary factors (OR 1.41 [95% CI: 0.82-2.42], p=0.215]).

結論:

このコホートの患者において、食間に酸を摂取した場合、有意なオッズ比の増加が観察された。食後のブラッシングを遅らせるという普遍的な助言は、立証されない可能性がある。

CONCLUSION: Significantly increased odds ratios were observed when acids were consumed between meals in this cohort of patients. Universal advice to delay brushing after meals may not be substantiated.

臨床的意義:

予防は、食間の酸を避けること、酸との接触時間を長くする習慣をなくすこと、酸性飲料の1日の摂取量を減らすことに重点を置くべきである。食後の歯磨きは糜爛性摩耗とは関連しなかった。酸チャレンジ直後の歯磨きは、さらなる調査が必要である。

CLINICAL SIGNIFICANCE: Prevention should be focused on avoiding dietary acids between meals, eliminating habits which increase contact time with the acid and reducing daily intake of acidic drinks. Toothbrushing after meals was not associated with erosive wear. Toothbrushing immediately after an acid challenge requires further investigation.