Prevention of systemic diseases caused by oral microbes in dependent elderly

近年来，口腔微生物对各种全身性疾病的影响已被阐明，提示口腔保健的重要性。在受赡养的老年人中，由于使用传统牙刷有误吸的危险，一般采用纱布清洁，但效果不理想。目前，在引进的护理保险制度下，迫切需要开发有效的口腔保健方法，使日常护理提供者能够安全、方便地进行口腔保健。然而，老年人的独立程度和口腔状况与年轻人明显不同，因此，应根据这些状态建立有效的口腔保健方法。我们将口腔保健按照独立程度（独立、部分依赖、完全依赖）和口腔状况（现牙数、有无假牙）分为9类，制作了老年人口腔保健需求分类表。根据不同的口腔保健类别制定了订制的口腔保健方法，并主要采用微生物学方法对其效果进行了评价。为了安全有效地为受供养的长者提供口腔保健，即使是由牙科工作人员以外的护理提供者，我们开发了一种结合自动液体供应/吸吸系统的电动口腔刷(Dent。Erac910，狮子牙科产品)。在本研究中，口腔保健员和护士将该刷系统应用于依赖牙齿的老年人，并根据漱口水中厌氧菌计数的变化来评估其效果。牙科保健员和护士使用该牙刷系统后，口腔微生物明显减少。在口腔保健实践中未观察到误吸症状。

In recent years, the influences of oral Microbes on various systemic diseases have been clarified, suggesting the importance of oral health care. In dependent elderly people, since the use of conventional tooth brushes has the risk of aspiration, cleaning with gauze is generally performed, but its effects are inadequate. At present, under the introduced care insurance system, it is urgently needed to develop effective oral health care methods that can be safely and readily performed by daily care providers. However, the degree of independence and the oral condition in the elderly markedly differ from those in younger adults, and therefore, effective oral health care methods according to these states should be established.We classified oral health care according to the degree of independence (independent, partially dependent, totally dependent) and the oral condition (number of present teeth and with or without denture) into 9 categories and produced a categorical table of oral health care needs for the elderly. Order-made oral health care methods according to each category were developed, and their effects have been evaluated mainly by microbiological methods.For safe and effective oral health care in the dependent elderly even by care providers other than dental staff, we developed an electrical oral brush combined with automatic liquid supply/suction system (Dent. ERAC910, LION DENTAL PRODUCTS). In this study, this brush system was applied to the dentate dependent elderly by dental hygienists and nurses, and its effects were evaluated based on changes in anaerobe counts in gargling water. Oral microbes markedly decreased after the use of this brush system by dental hygienists and nurses. No symptoms suggesting aspiration were observed in oral health care practice.