Perioperative Oral Management Research Articles

The prospect of perioperative oral management of cancer patients: The role of dentists in state cancer center hospitals

独立行政法人国立病院機構に属する北海道がんセンターは北海道の都道府県がん診療連携拠点病院（以下 都道府県がん拠点病院）に指定されており全道各地よりがん患者が治療に訪れる。がん治療中の口腔内のトラブルに迅速かつ適切に対応することを目的として2012年に歯科口腔外科は開設され，2016年からは常勤体制となった。同年からは新たに口腔腫瘍外科も加わり，口腔癌診療を精力的に行っている。大学病院を除く都道府県がん拠点病院において，口腔がん治療と周術期口腔機能管理（がん支持療法）が分業できている施設は他になく，当院の特徴である。質の高い周術期口腔機能管理を実践するためには，病院内の他職種と連携が必須である。また，周術期口腔機能管理の継続性を担保するためには地域歯科医院との病診連携も重要になってくる。本稿では都道府県がん拠点病院の歯科としての役割をがん専門病院の立場から述べるとともに，当院で行っている医科歯科連携システムについて紹介する。

A Retrospective Study of the Efficacy of Perioperative Oral Management on Prevention of Postoperative Pneumonia Associated with Lung Cancer Surgery

A Retrospective Study of the Efficacy of Perioperative Oral Management on Prevention of Postoperative Pneumonia Associated with Lung Cancer Surgery

Effectiveness of an Interdisciplinary Medical Hospital Admission Center: The Role of the Dental Section in the Interdisciplinary System for Perioperative Management of Patients Awaiting Surgery.

Perioperative oral functional management (POFM) involves total oral management of a patient before surgery. Considerable benefits have been reported, but POFM remains scarce in medical settings. An interdisciplinary Medical Hospital Admission Center (MHAC) opened in our hospital in December 2014, and has since provided unified perioperative management for patients. This study reports on the clinical system and contributions of the systematized, standardized POFM applied through the MHAC. Patients awaiting surgery undergo oral screening before admission, with patients classified into three groups: red, needing surgical oral management (tooth extraction or other oral surgery) before surgery; yellow, needing non-surgical oral management before surgery, due to the planned surgery or the risk of tooth injury in connection with general anesthesia; or green, patients with good oral hygiene considered capable of suitable oral self-management. Patients categorized as red or yellow undergo POFM in the dental section of the MHAC before surgery. Almost all patients (88.8%) awaiting surgery now undergo preoperative oral screening, excluding emergent surgeries. In addition, oral screening is important for preventing tooth injury during endotracheal intubation for general anesthesia, and a need for preventive measures was identified in 6.1% of patients. No traumatic injuries of the teeth in connection with general anesthesia have occurred since the opening of the MHAC. Standardized POFM through an interdisciplinary MHAC thus seems extremely useful.

Perioperative Oral Management in University Hospital: The Role and Future Prospects of Preventive Dentistry

Perioperative Oral Management in University Hospital: The Role and Future Prospects of Preventive Dentistry

肺癌手術における周術期口腔機能管理の術後肺炎予防効果

【目的】肺癌手術における周術期口腔機能管理の肺炎予防効果を検討した．【対象】2013年4月～2015年3月に原発性肺癌に対して胸腔鏡下肺葉切除術を行った連続100例を対象とした．周術期口腔機能管理導入前後で介入群50例，非介入群50例に分類し検討した．【結果】患者背景，腫瘍因子，手術因子には有意差を認めなかった．術後合併症は，介入群で5例（10.0%），非介入群で16例（32.0%）と介入群で有意に少なく，術後肺炎は，非介入群では6例（12.0%）にみられたが，介入群では1例もみられなかった．術後に発熱を認めた症例は，介入群で有意に少なく，術後CRP値は，介入群で低い傾向にあった．術後在院日数は，介入群で有意に短かった．【結語】周術期口腔機能管理には肺癌の術後肺炎を予防する効果がある可能性がある．今後，医科歯科の連携を強め，広く行われるべきであると考える．

周術期オーラルマネジメントの実際

With the revision in fiscal year 2012 of the healthcare insurance, “the perioperative oral management fee” has been newly established, which is expected to reduce the complications after cancer, cardiac and other surgeries. Possible oral-related complications during perioperative period include 1) damage to teeth during endotracheal intubation, 2) pressure ulcer due to compression of orally-intubated endotracheal tube, 3) postoperative pneumonia, 4) surgical site infection of oropharynx, and others. Also, there is a potential risk of developing foreign material infections due to bacteremia from the oral cavity as the periodontitis remains there. Such risks are found in surgeries where the materials such as prosthetic valves and artificial joints are installed inside the body.

造血幹細胞移植患者に対する周術期口腔機能管理

造血幹細胞移植は，患者の最大耐容量を超える大量の抗癌剤投与や全身放射線照射（total body irradiation ; TBI）を行ない，患者の骨髄とともに悪性腫瘍の殺滅を達成した後に造血幹細胞を輸注することで，失われた造血能を補う治療法である。放射線，抗癌剤および免疫抑制剤を用いるため，口腔の有害事象として，粘膜炎，出血，易感染性，さらには移植片対宿主病（graft versus host disease ; GVHD）が問題となる。我々は造血幹細胞移植を行なう患者に対して，血液・腫瘍内科と歯科口腔外科が連携して周術期口腔機能管理を実施しているので報告する。対象は2008年から2015年までに自家移植52例，同種移植139例，合計191例の造血幹細胞移植患者である。移植前処置開始までにセルフケアによるブラッシング，含嗽，保湿などの口腔ケア指導に加え，専門的口腔ケアとして歯科衛生士による歯面清掃，機械的歯面清掃および3DS（dental drug delivery system）を完了させる。周術期口腔機能管理によって，咽頭粘膜の細菌検査ではカンジダ菌の頻度が19.3％から4.3％に減少した。造血幹細胞移植に伴う口腔有害事象に対して，移植前処置までに支持療法として口腔ケアプログラムの標準化を立案することは，患者のQOL向上に効果的であると考えられた。

当科における口腔癌に対する周術期口腔機能管理の取り組み：根拠に基づく口腔機能管理を目指して

口腔癌の治療は，手術，放射線，薬物療法の三大療法に，欠くことのできない支持療法や緩和ケア等を組み入れた集学的治療（チーム医療）により行われている。周術期口腔機能管理は支持療法のひとつであり，がん患者の口腔機能の維持・改善，口腔内の保清，慢性感染巣のコントロール等を行う事により，がん治療時の有害事象の予防・軽減，がん治療成績の向上，生活の質（QOL）の維持・改善等をはかるものである。本稿では，当科で行っている口腔癌治療における周術期口腔機能管理の内容，理論および根拠を概説した。管理方法の標準化とその効果の検証が，今後の課題である。

The action of perioperative oral management in an acute care hospital without dentistry

The action of perioperative oral management in an acute care hospital without dentistry

The effect of perioperative oral management on prevention of postoperative pneumonia in patients undergoing esophageal resection

The effect of perioperative oral management on prevention of postoperative pneumonia in patients undergoing esophageal resection

P1-6-14 - Oral supportive care for cancer patients receiving chemotherapy

Background: Perioperative oral management received medical insurance coverage in 2012 in Japan. Management includes not only prevention of wound infection and perioperative pneumonia but also management of oral complications during chemotherapy and radiotherapy in cancer patients. Methods: Clinical records for 293 patients treated with chemotherapy from April 2013 to December 2014 were analyzed. Result: Patients were 168 males and 125 females aged 23-92 years (median 66). Primary site of cancer was esophagus in 62, lung in 50, head and neck in 36, colon in 28, pancreas in 22, breast in 11, hematological cancer in 38, and others in 46. Treatment was chemotherapy in 158, and concurrent chemoradiotherapy in 135. Before beginning chemotherapy, most patients received a dental check and acquired tooth brushing techniques. Oral supportive care was continued to maintain good oral hygiene, detect oral complications early and manage them with mouthwash and topical ointment. Oral complications of ≥G3 (NCI-CTC AE) were medication-related osteonecrosis of the jaw, teeth infections, and oral mucositis occurred during treatment. All agents could be continued as scheduled without dose reduction for oral complications, apart from interruption of denosumab due to osteonecrosis in one patient. With regard to 12 infected teeth extracted during the treatment, treatment with bevacizumab was rested to prevent bleeding during extraction in one patient, but this did not result in a delay in treatment. The oral mucositis induced by molecular targeted therapy seemed to be due to physical damage to the oral mucosa, indicating the need for shaping of sharp teeth and adjustment of dentures. Conclusions: Oral supportive care for cancer patients receiving chemotherapy begins before the start of treatment and continues until the successful completion of treatment without the withdrawal of drugs.

Change in the prevalence of oral bacteria detected in blood cultures before and after the introduction of insurance coverage for perioperative oral management

Change in the prevalence of oral bacteria detected in blood cultures before and after the introduction of insurance coverage for perioperative oral management

A Clinical Study on the Condition of Inpatients with a History of Implant Therapy in Patients Receiving Perioperative Oral Management

A Clinical Study on the Condition of Inpatients with a History of Implant Therapy in Patients Receiving Perioperative Oral Management

Perioperative oral management of cancer patients：Collaboration of medicine, dentistry and the regional dental clinic

Perioperative oral management of cancer patients：Collaboration of medicine, dentistry and the regional dental clinic

About a characteristic and problems of the perioperative oral management of the University of Occupational and Environmental Health Hospital

About a characteristic and problems of the perioperative oral management of the University of Occupational and Environmental Health Hospital