身体障害者の口腔ケア

Current treatments for oral and maxillo-facial diseases. Oral healthcare for the persons with special needs.

　歯科保健・診療においては，医科にはないような「障害者歯科」という分野がある。それは歯科治療のほとんどは小規模医院で行われているが，歯の切削や摘出，歯内療法など組織傷害リスクを伴い，かつ細かい処置を障害児・者の狭い口腔内で行うのは困難なことが多いためである。さらに障害児・者では処置時の心身反応が大きく，体動や不安・恐怖のコントロールには特別な対応を要するため，このようなスペシャルニーズに対し，歯科臨床の領域として障害者歯科（special care dentistry）が設けられている。 　ここでは心身障害児・者を対象とする口腔ケア，歯科保健と治療の現状を概説する。

　The field of special care dentistry is rapidly gaining recognition as a service that should be provided to the persons with physical, mental or intellectual disabilities by general practitioner, pediatric or geriatric dentists as well as dental hygienists. Because the oral healthcare and dental treatments are given in the narrow space of oral cavity and also accompanying technical difficulties with high risk of injury, the special needs patients are treated under being controlled their behavior or body motion by applying psychological, physical or pharmacological techniques. Those persons also manifest specific oral signs and symptoms such as dental caries, periodontal diseases as well as high incidence of dental hypoplasia, oro-facial trauma or drug-induced gingival overgrowth. The children with developmental disorders especially such as autism spectrum disorder（ASD）, attention-deficit/hyperactivity disorder（AD/HD）, or specific learning disorder（LD）, and those with medical care needs at all times are also increasing relatively in Japan with declining birthrate. Those children have specific dental problems and require the special oral healthcare. This article presents the current status of oral healthcare for the persons with special needs.