Japanese

Title	口腔用保湿ジェルを使用し超音波スケーラーにて注水せずにベッド上で歯石除去を実施した1症例
Subtitle	症例報告
Authors	波多野真智子1), 大野友久2), 橋詰桃代1), 野本亜希子2), 藤島一郎3)
Authors (kana)
Organization	1)浜松市リハビリテーション病院リハビリテーション部, 2)浜松市リハビリテーション病院歯科, 3)浜松市リハビリテーション病院リハビリテーション科
Journal	日本摂食嚥下リハビリテーション学会雑誌
Volume	27
Number	2
Page	136-142
Year/Month	2023 / 8
Article	報告
Publisher	日本摂食嚥下リハビリテーション学会
Abstract	「要旨」【緒言】摂食嚥下障害患者では, 口腔機能の低下・自浄作用の減退などにより口腔内環境が悪化しやすく, 口腔衛生管理が重要となる. そして, 摂食嚥下障害患者における歯石除去を含む口腔衛生管理には, 誤嚥リスクを回避した安全な方法で行うことが大切である. 今回, 誤嚥や血圧低下を回避する目的で, 注水の代替に口腔用保湿ジェルを用いた超音波スケーラーでの歯石除去を実施した起立性低血圧がある嚥下障害患者症例を報告する. 【症例】55歳男性. 脳腫瘍摘出術後の小脳出血, 術後性球麻痺を呈し摂食嚥下障害と起立性低血圧が残存していた. 意識清明で経口摂取再開の希望が強く, 嚥下機能改善手術目的で当院に入院した. 長期間にわたる非経口摂取により多量な歯石沈着を認めた. 【経過】超音波スケーラーは効率よく歯石除去可能だが, 注水を伴うため水分の咽頭流入による誤嚥のリスクが懸念される. そのため, 座位での歯石除去を試みたが, 起立性低血圧の影響と考えられる短時間の著明な血圧低下を認めた. 摂食嚥下障害には座位が, 起立性低血圧には臥位が望ましく相反する体位が必要とされた. そこで, 口腔用保湿ジェルを用いた非注水下での超音波スケーラーによる歯石除去をベッド上にて試みた. 処置中はバイタルサイン測定および痛みの評価を実施した. すべての処置においてバイタルサインの異常は認められず, 処置中・後の疼痛の訴えもみられなかった. そして, 歯石の除去効果は注水下での超音波スケーラー使用時と同等であり, 手術前に口腔内環境を整えることが可能となった. 【考察】口腔用保湿ジェルを用いた非注水下における歯石除去により, 水分誤嚥や血圧低下を回避しながらベッド上での歯石除去が可能であったと考える. 今後も, 誤嚥リスクの高い患者や離床困難な患者において, 口腔用保湿ジェルを用いた超音波スケーラーにより安全な歯石除去が可能となることが示唆された.
Practice	医療技術
Keywords	口腔衛生管理, 口腔用保湿ジェル, 歯石除去, 摂食嚥下障害, 超音波スケーラー, oral health care, oral care gel, scaling, dysphagia, ultrasonic scaler

English

Title	A Case Report of Ultrasonic Scaling in a Hospital Ward Bed with Oral Care Gel instead of Water Irrigation
Subtitle
Authors	Machiko HATANO1), Tomohisa OHNO2), Momoyo HASHIDUME1), Akiko NOMOTO2), Ichiro FUJISHIMA3)
Authors (kana)
Organization	1)Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, 2)Department of Dentistry, Hamamatsu City Rehabilitation Hospital, 3)Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital
Journal	The Japanese Journal of Dysphagia Rehabilitation
Volume	27
Number	2
Page	136-142
Year/Month	2023 / 8
Article	Report
Publisher	The Japanese Society of Dysphagia Rehabilitation
Abstract	[Abstract] Introduction: In patients with dysphagia, oral hygiene management is important because the oral environment tends to deteriorate by oral hypofunction and less self-cleaning. Oral hygiene management, including scaling (dental tartar removal) in patients with dysphagia, should be performed by a safe method while preventing the risk of aspiration. In this case report, we describe a patient with dysphagia and orthostatic hypotension who underwent tartar removal using an ultrasonic scaler with oral moisturizing gel as an alternative to water injection to prevent aspiration and hypotension. Case: A 55-year-old male. He had cerebellar hemorrhage after brain tumor resection and postoperative bulbar palsy, which caused dysphagia and orthostatic hypotension. He was admitted to our hospital for surgery to improve swallowing function. Evaluation of the oral cavity revealed significant accumulation of dental tartar. Course: Although ultrasonic scalers can efficiently remove tartar, there is concern about the risk of aspiration due to the influx of water into the pharynx. Therefore, we attempted to remove tartar in a sitting position, but a marked decrease in blood pressure was observed for a short period of time, which was thought to be due to orthostatic hypotension. The sitting position is desirable for dysphagia, while the supine position is desirable for orthostatic hypotension: the two positions are contradictory. We attempted to remove tartar using an ultrasonic scaler while the patient was in bed, without water injection, using an oral moisturizing gel. Vital signs were monitored and pain was assessed during the procedure. No abnormalities in vital signs were observed during all procedures, and there were no complaints of pain during or after the procedures. The removal of tartar was as effective as when the ultrasonic scaler was used under water injection, and it was possible to prepare the oral environment before surgery. Discussion: Tartar removal using oral moisturizing gel instead of water made it possible to remove tartar while the patient was in bed, while preventing aspiration and hypotension. Oral care gel may be useful for tartar removal to avoid aspiration and hypotension.
Practice	Medical technology
Keywords	oral health care, oral care gel, scaling, dysphagia, ultrasonic scaler

• 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。

参考文献