適切な義歯治療で栄養状態改善

部分的に歯のある高齢者の栄養状態に対する歯の置換戦略の影響に関する研究を紹介します。

McKenna G, Allen PF, Flynn A, O'Mahony D, Damata C, Cronin M, Woods N. Impact of tooth replacement strategies on the nutritional status of partially-dentate elders. Gerodontology. 2011 Nov 28. doi: 10.1111/j.1741-2358.2011.00579.x. [Epub ahead of print]

部分的に歯のある高齢者を対象に、従来型の取り外し可能な部分義歯を使用する対照群と、歯列弓の短縮に基づいた機能的治療（functionally orientated treatment based on the shortened dental archの意味がわかっていません。すみません…）を行う介入群で、栄養状態の変化を評価しました。栄養状態はMNAと検査値で評価しています。

結果ですが、咬合接触している歯の数と栄養状態に関連を認めました。咬合接触している歯の数が増えると、MNA、ビタミンB12、葉酸、総リンパ球数が増加しました。治療介入後は両群ともMNAのみ有意に改善しました。検査値に両群間で有意な差を認めませんでした。対照群、介入群とも義歯を用いたリハによって栄養状態が改善したという結論です。

介入方法に関わらず、適切な義歯治療で咀嚼機能を改善させると栄養状態が改善するという結論は理解できます。ただ、歯科の専門用語を日本語でさえよく知らないため、おかしな日本語になっていると思います。もっと臨床歯科栄養に関する論文を読みこまなければと感じました…。

Abstract
Objective:  To investigate the impact of tooth replacement on the nutritional status of partially dentate older patients, and, to compare two different tooth replacement strategies; conventional treatment using removable partial dentures and functionally orientated treatment based on the shortened dental arch.

Background:  Amongst older patients, diet plays a key role in disease prevention, as poor diets have been linked to numerous illnesses. Poor oral health and loss of teeth can have very significant negative effects on dietary intake and nutritional status for elderly patients. There is evidence that good oral health generally, has positive effects on the nutritional intake of older adults.

Materials and methods:  A randomised, controlled clinical trial was designed to investigate the impact of tooth replacement on the nutritional status of partially dentate elders. Forty-four patients aged over 65 years completed the trial, with 21 allocated to conventional treatment and 23 allocated to functionally orientated treatment. Nutritional status was accessed at baseline and after treatment using the Mini Nutritional Assessment (MNA) and a range of haematological markers.

Results:  At baseline, relationships were observed between the number of occluding tooth contacts and some measures of nutritional status. As the number of contacts increased, MNA scores (R = 0.16), in addition to vitamin B12 (R = 0.21), serum folate (R = 0.32) and total lymphocyte count (R = 0.35), also increased. After treatment intervention, the only measure of nutritional status that showed a statistically significant improvement for both treatment groups was MNA score (p = 0.03). No significant between group differences were observed from analysis of the haematological data.

Conclusion:  In this study, prosthodontic rehabilitation with both conventional treatment and functionally orientated treatment resulted in an improvement in MNA score. Haematological markers did not illustrate a clear picture of improvement in nutritional status for either treatment group.