小児における腺扁桃肥大の口腔保健に及ぼす影響の比較評価

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children.

抄録

口呼吸に関連する腺扁桃肥大を有する患者を対象に、う蝕の有無、歯周健康状態、口臭、歯顎顔面変化の観点から小児の口腔衛生を調査し、鼻呼吸健常児および腺扁桃切除術施行児と比較することを目的とした。患者群は腺扁桃肥大と診断された口呼吸の子供40人、対照群は腺扁桃肥大のない鼻呼吸の子供40人で構成された。治療群には、研究の1年以上前に腺扁桃摘出術を受けた40人の小児が含まれた。全児童の口腔内診査を実施し，親に内科的・歯科的既往歴，人口統計学的パラメータ，歯磨きおよび栄養習慣，口腔保健関連 QOL（OHRQoL），児童の症状について質問した．人口統計学的パラメータ，歯磨き・栄養習慣，口腔内の悪習慣の有無に群間差はなかった（＞0.05）．腺扁桃摘出術は症状の顕著な改善と関連しているが、少数の小児ではいくつかの症状が残存している。唾液流量，dmft/s，DMFT/S index，歯垢，歯肉指標スコアに群間差はなかった（> 0.05）．治療群および対照群と比較すると，患者群では口臭の発生率が高かった ( < 0.001 )．腺扁桃肥大による口呼吸は，さまざまな歯顎顔面変化を引き起こし，II級1号不正咬合を増加させた（< 0.001）．腺扁桃肥大は OHRQoL に悪影響を及ぼさないこと，う蝕，歯周病，口臭の危険因子となりうるが，口腔ケアを十分に行うことで腺扁桃肥大児の口腔内の健康を維持できることが示された．また、矯正治療が必要な場合は、できるだけ早く治療を開始することが望ましいとされています。このように、耳鼻咽喉科医、小児歯科医、矯正歯科医がチームとなって、小児扁桃肥大症の治療に取り組むことが必要です。

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups ( > 0.05). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups ( > 0.05). The patient group showed higher rates of halitosis when compared with the treatment and control groups ( < 0.001). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion ( < 0.001). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.