良い根の治療を受けよう

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根の治療は２種類あります。一つは抜髄という神経の生きている歯の神経を取る治療。もう一つは感染根幹治療という神経が既に死んでいたり、１度神経を取った歯の根の先で炎症が起きてしまった歯の治療です。

前者を抜髄、後者を感染根幹治療と呼びます。

抜髄は神経まで虫歯が到達してしまった歯の神経を取る治療です。

感染根幹治療は根の中で細菌が増殖してしまい、細菌が根の先から骨の方に出ていき炎症を引き起こしている歯の根の中を綺麗にする事で治癒する治療です。

抜髄で大切なポイントはしっかりと神経を取り除くこと、神経を取る段階では無菌状態であるため、新規の細菌の感染を防ぎ、治療後に年月が経過した時細菌が増殖しないような治療を行う事です。細菌が増殖すると感染根幹治療を行わなければならなくなります。

感染根幹治療の大切なポイントはしっかりと感染源を除去する事。更に、さらなる細菌の感染を防ぐ事です。

一般の方が良い歯科治療をしている歯科医院を見抜くポイント

①ラバーダムというゴムを使用し、根の中への唾液の流入を防いでいる

②マイクロスコープという歯科用顕微鏡を治療に使用している

③根の洗浄をする薬が次亜塩素酸とEDTAによる洗浄を行っている事をホームページ上で明記している

④パーフォレーションという過去の歯科医師の不手際で根の中に穴が開いた歯を抜歯にするのではなく、MTAセメントというセメントを使い処理する事ができる

⑤根の中の治療が上手くいかない際に、歯根端切除術や、歯牙再植立術という手術を行うという選択肢を提示してくれる。

①は最も大事な事で根の中に細菌が流入してしまうと、将来的にその細菌が増えてしまう可能性があるためいかに細菌の流入を防ぐかが根の治療のポイントとなります。

それを歯にゴムのバリアをする事で唾液の流入を防ぐのですが、そのゴムをラバーダムと呼びます。ただ、保険の治療でこれを行うのは採算が合わないため私は自費治療の根の治療にのみ使用しております。

②は感染根幹治療や複雑な根の治療において顕微鏡を使ってしっかりと根の中を見て治療をできると有利な事が多いです。

術者の技量を求められるため、顕微鏡の治療を行う事のできる歯科医師はレベルが高い事が多いと感じます。私は抜髄においては必ず顕微鏡が必要だとは思いませんが、少なくとも顕微鏡での根の治療をうたっている歯科医院が良い可能性が高いと考えております。

③に関してですが、現在根の中を洗浄・消毒するために使われる薬はこの２種類です。

少し前までは次亜塩素酸と過酸化水素水が使われておりましたが、今でもこの薬を使用している歯医者さんを多く見かけます。

しかしこれはデータ的にも意味を殆どなしていない事が証明されており、今でもこの薬を使って洗浄している歯科医院は勉強を一切していないという事を如実に表していると考えられます。

中々患者さんが何を使っているか知る事は難しいと思いますがホームページ等にこだわっている先生は書いてくれてある可能性がありますのでチェックしましょう。

④は歯に穴が開いたから抜歯と言う話を非常によく耳にします。現在では保存する事が可能なケースが増えてきました。

しかしその際にMTAセメントというものを使用するのですが非常に高価なため保険治療では難しいです。自費治療ではありますがこのような選択肢を提案してくれる歯科医院は保存の可能性を説明すらしてくれない歯科医院よりも良い歯科医院と言えると考えます。

MTAセメントの取り扱いは技術が必要ですので、予後に自信がないからやらないという先生も多いと思います。

⑤は、根の中からの治療で炎症が治まらなかった感染根幹治療において、外科的に病巣を取り除く手術となります。

根の中からのアプローチで上手くいかない時に抜歯するしかないとお話しする先生が非常に多いように感じます。

私はセカンドオピニオンで抜歯しなければいけないと言われた歯の治療を頻繁に行っているのですが、実際に抜歯と言われて本当に抜歯が必要なケースは半分以下であるのが実際の所です。

先生の技術不足により手術することができずに口腔外科に紹介するなどという歯科医師は基本的に名医の可能性は低いと考えております。

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