口腔乾燥症におけるCasein Phosphopeptide-Amorphous Calcium Phosphateとフッ素入りワニスによる根面う蝕の回復．

Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia.

抄録

根面う蝕の管理には，さまざまな処方のフッ化物外用剤が使用されてきた．本臨床試験は，カゼインホスホペプチド-非晶質リン酸カルシウム（CPP-ACP）およびフッ化物配合ワニスが，口腔乾燥患者の根面う蝕の回復・停留に対して，フッ化物単独と比較して 1 年間有効であるかを検討することを目的としたものである．無刺激唾液流量が 0.2 mL/min 未満の原発性根面う蝕患者 80 名（年齢層 45-92 歳）に対し，CPP-ACP と 5％フッ化物配合歯科用ワニス（第1 群 MI ワニス，GC，日本）（n = 41，83 病巣），または 5％フッ化物単体のワニス（第2 群 NUPRO White，Dentsply，アメリカ）（n = 39，101病 巣）にランダムに割り付け，1 年間の臨床評価を行った．ベースライン時，3，6，12ヵ月後に，根面う蝕のSeverity Index（SI）による臨床評価，DIAGNOdentによる測定，ワニスの塗布を実施した．両群とも 1,450ppm のフッ化物配合歯磨剤による標準的な口腔衛生指導を行った．3 ヵ月後，根面う蝕の硬度（SI：0）は，1 群 63.9%（n = 46）に対し，2 群 39.3%（n = 35）であった（p < 0.01）．6ヵ月後および12ヵ月後のSIの差は，それぞれ（1群，n=60，83.3%）（2群，n=66，74.2%）（p=0.36），（1群，n=60，89.6%）（2群，n=67，81.7%）（n=1 soft, 1.2%）（p=0.29 ）と有意ではなかった．両群とも，虫歯のないレザー状病変は，虫歯のある根面カリエスに比べて硬くなりやすいことがわかった．歯垢指数，表面粗さ，病巣寸法，DIAGNOdent 読み取り値は両群とも有意に減少し，歯肉縁からの病巣距離は有意に増加した（p < 0.05）．本研究は，カルシウムとリン酸を含むフッ素系歯科用ワニスが口腔乾燥患者の根面う蝕，特に非う蝕病巣を阻止・回復する可能性を示す証拠である．

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45-92 years) with primary root caries (n = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (n = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (n = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (n = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (n = 35) in group 2 (p < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, n = 60, 83.3%) (group 2, n = 66, 74.2%) (p = 0.36), and (group 1, n = 60, 89.6%) (group 2, n = 67, 81.7%, n = 1 soft, 1.2%) (p = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (p < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.