周術期患者のオーラルマネジメント

Current treatments for oral and maxillo-facial diseases. Oral management for perioperative patients.

　周術期においては術後肺炎や創部感染だけでなく，歯の損傷も含めさまざまな口腔に関連する合併症が起こり得る。また，人工弁や人工関節など，異物を留置する手術では，遠隔部位感染として，口腔の歯周炎などに由来する菌血症によって将来的に感染を生じるリスクがある。 　狭義の口腔ケアとされる口腔清掃のみでは，口腔の潜在的な問題までは評価されず，周術期に本来必要な治療が行われない可能性がある。口腔の適切な評価に基づいて，必要な歯科治療や摂食・嚥下リハビリテーションの実践と，患者や医療従事者への教育までを行うオーラルマネジメントを実施することにより，口腔に関連して発生する合併症を予防または軽減することができる。

　During perioperative period, several oral-related complications happen to occur, including not only postoperative pneumonia and surgical site infection, but also damage to teeth. Furthermore, in case of surgeries where the materials such as prosthetic valves and artificial joints are installed inside the body, there is a potential risk of developing foreign material infections due to bacteremia from the oral cavity as the periodontitis remains there. There is a possibility that a necessary treatment during perioperative period is not performed with only the oral cleaning which is narrowly defined as oral care, without an assessment of potential problems for oral. The oral-related perioperative complications can be prevented by putting the oral management into practice, which include a necessary dental treatment, rehabilitation for mastication and swallowing, and education of patients and medical staff, based on accurate oral assessment.