くろの考える大まかな良い歯医者の特徴

歯科治療というのは、歯周病のコントロール、う蝕リスクのコントロール、う蝕の治療、歯並び、歯にかかる力のコントロール、根の治療の精度、被せ物の精度と言った様々な要素の掛け算で点数が決まります

いかに良い虫歯の治療をしても歯周病の治療を理解しておらず最終的に抜けてしまったらその治療の点数は限りなく低くなってしまいます。

しかしこれでは一体全体どういった歯医者が優れているかわからないじゃないかとお考えになると思います。

ここからは完全に私の考えなので賛否両論あると思いますが、良い歯医者である可能性の高い大まかな着眼点をご紹介させて頂き、より細かく知りたい方はご自身に当てはまる症例別に良い歯科医師の条件を別途紹介させて頂きます。

あくまで大まかに知りたい方向けの情報ですがこれだけでも大分医院選びで失敗しにくくなるように思います。


では、良い歯医者である可能性はホームページのどの部分に注目すべきか。

・EBM( evidence-based medicine )を治療の根幹に置いている。

EBMとは日本語にすると根拠のある治療です。

医療の世界、特に古い世代の先生は自分の今まで行ってきた治療で成功体験をもとに治療を行っている先生が非常に多く、現在ではそうではなく論文ベースで評価され統計学的に有利な治療を選択することが良い医療だとされています。

例えば、ある症状に対してこの薬を今まで出してきたからこれで治ると思うという考えで処方するのが根拠のない治療。

ある症状に対して過去に同じ症状の人を被験者とした論文がありその中の様々な対処方法の中でこの薬を出した時に治癒する確率が最も高く、またその治療の弱点は統計学的にどの程度出現しその後どのような治療を行っていくのが治癒の可能性が高いかまでわかって薬を処方するのがEBMに基づいた治療となります。


私の出身大学では、ついこの間まで根の治療の消毒に今では効果が期待できなく、その後の疼痛が消失しにくいということがわかっている薬を使っていたりしました。

なぜなら今までの経験だけを頼りに治療を行っている向上心のない先生だらけだからです。ようやく最近になりEBMにのっとり適切な薬を使用するようになりましたが、日々情報が出てくる統計学的根拠を日々研究し治療に活用できる先生を選ぶ事が最低限のボーダーラインないかと私は考えております。

ホームページに根拠に基づく治療を意識している記述があると少し安心できるかもしれません。これは最低限のラインです。これにプラスして下の要素が見受けられるかどうかで判断して下さい。


・マイクロスコープという顕微鏡による治療を導入している歯科医院

私もマイクロスコープを導入しておりますがマイクロスコープによる虫歯や根の治療は技術的に非常に難しくマイクロスコープでの治療が可能な先生はある一定水準以上の技術を持っている可能性が高いと考えます。治療時間もかかるため割にあわない治療も多く自己満足でマイクロスコープの治療を行っている先生が非常に多いように感じます。患者さんの歯をできるだけ救いたいという意思の強い先生だと思います。

・歯周病の原因が歯茎の慢性的な炎症が原因だという事が明記してあり、重度なケースの場合、歯周外科治療という歯周病に対する手術まで行っている歯科医院

歯周病の原因は歯周病菌の出す毒素に対する歯茎の炎症が慢性的に起こることが原因だと考えられています。

私の所にやってくる患者さんで非常に多いのが、定期的に歯科医院に通っていて歯周病のケアをしていたにも関わらず、当院で歯茎の検査をすると炎症だらけという患者さんです。

若手の先生が当院にも在籍しておりますが、歯周病の起こる病態を生理学という学問レベルで理解できている先生は驚くことに殆どおりません。

まして衛生士の方で歯周病がどのように進行していくかを真の意味で理解できている方は非常に珍しいと思っています。その位日本の歯科医療はレベルは絶望的に低いという事です。

歯茎の慢性的な炎症が原因で歯周病が進行していくのに、炎症が起こっているのは患者さんの歯磨きのせいだという説明をし、患者さんが歯磨きを頑張っても結果がでない状態で表面上のクリーニングを繰り返しているケースが非常に多いように思います。

その点、歯周外科手術をしてまで炎症のコントロールを図りたいと考えている歯科医師は真の意味で歯周病を理解している可能性が高いと考えております。





・インプラントを行っている歯科医院で、かつその中でもサイナスリフトという手術を行える歯科医院

個人的にインプラント治療は非常に素晴らしい治療だと考えており、インプラント治療をダメだいう先生のお話しを聞いたりしますが、(確かに老後に痴呆により歯磨きができない状態となり困るというケース等あったりするが対応可能である)、先ほどお話ししたエビデンス的にみてインプラントが悪いものだという事実はないため、インプラント治療のリスクは説明した上で行っていけば患者さんによっては非常に有効な手段です。(あくまで適応の人にとって有効な手段になりうるというお話し)

ですから個人的にはインプラント治療を行っていない歯科医院は単純に技術的な向上心のない医院と考えてしまいますし、否定する先生は先ほどお話ししたEBMエビデンスベースドメディシンを遂行していない先生の可能性が非常に高いように思います。

更にお話しすると、インプラントを埋め込むだけの骨のない患者さんへの骨造成手術であるサイナスリフトという術式があるのですが、一般的には難しいとされている手術となり行うことのできる先生は少ないのが実際です。(私的には何を先生方が難しいと言っているかさっぱり理解できないのですがそれは置いておいて、みんな難しい手術と捉えています)ですからこの手術を行える先生は外科治療の関して自信のある先生と考える事ができます。





・根の治療を行う際にラバーダムというゴムで歯を唾液から守った状態治療を行っている医院

ラバーダムとは、根の治療をする際に、ゴムで唾液(=細菌)が根の中に入りこまないようにするゴム製の防御膜の事です。

非常に手間がかかり、保険の治療でこれを行うことは私の医院でもできていないのですが、仮にすべての根の治療でこれを行う先生がいらっしゃるとしたら完全に赤字となるので、ただ単純に良い治療がしたいという思いで行っています。

そのような先生は研究熱心で熱い気持ちで医療に接しているのは想像に難しくありません。保険治療でなく、自費治療だけだとしてもラバーダムによる治療を行っている先生はやはり意識が高いように思います。



・出身大学(研修医の時点ではどの大学にも所属できますし、大学院もどの大学でも入学できるのであくまで出身大学のお話しです

私の口からピンポイントでどこの大学が良いとか悪いとかはお話しすることはできませんが、歯科の診断は非常に冷静さと頭の良さ豊富な知識が求められケースが多く、現実に他院の誤診等も多く出会う事がある分野です。

治療をしたから治ったのではなく、そのような治療をしなくても治ったり、本来適切な治療をしていれば救える歯があったりという症例も非常に多く見かけます。一概に頭の良さだけで診断力があるとは判断できませんが、通いたいと思っている歯科医院の先生がどこの大学出身であり、その大学の偏差値はしっておいて損はないと私は考えております。

もちろん偏差値の低い大学でも優秀な先生は沢山いらっしゃいますがあくまで確率論の話として捉えて下さい。

私立の先生の方が圧倒的に人数としては多く、偏差値だけを見ると歯科医師の偏差値の平均はおよそ50前後位だということがわかると思います。

何度も書かせて頂きますが、偏差値が高い大学出身でも良い歯医者とは限らないし、低い大学出身でも良い先生はいらっしゃいます。

https://momotaro.website/sigakubu.html 参照




・院長に必ず診療してもらいましょう

例外もいくらか見たことはありますが、普通であれば院長の技量や知識を超えた勤務医であれば開業するか他の医院で修行をするはずです。

ですからその医院の最も優れた歯科医師は院長である可能性が非常に高いと考えられます。



複数の歯科医院を経営しておらず一つの医院のみで診療を行っている事

複数の病院をハイレベルに保つのは私は困難な事が多いように思います。例え話をさせて頂くとミシュランの三ツ星を取ったシェフがもう1店舗出店し再び三ツ星のレストランに簡単にできるか想像してみて下さい。



如何でしたでしょうか?あなたの通っていた病院は当てはまっているでしょうか?最初の導入として大まかな基準のお話しをさせて頂きました。これを参考にホームページを検索すればいくつかの条件に当てはまる歯科医院がきっと見つかると思います。

また、私の症状の場合どういう治療が素晴らしい治療なの?この間受けた治療はどうだったの?と気になる方がいらっしゃると思います。そういう方向けにより細かく治療の内容毎に場合分けして再度別の機会にご説明させて頂きます。

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