歯科初診患者の歯周病重症度と口腔関連QOLの関連性

従来，歯周病重症度の診断や治療のアウトカムは，プロービングデプスなどの生物医学的データにより客観評価されてきたが，近年，医療において生活の質に焦点を当てた臨床・研究の重要性が高まりつつある。そのため，本研究では歯周病の重症度と初診患者の口腔関連QOL との関連性を明確にすることを目的とした。2014 年11 月～2017 年7 月までのなかい歯科の初診患者のうち，30～64 歳の者を対象として，カルテおよびサブカルテから基本情報を抽出した。歯周病の重症度は初診時の歯周基本検査の結果をCPI に変換し，4 群（C，P1，P2，P3）に分類した。同じく初診時に調査したOral Health Impact Profile Short Version（以後，OHIP-14）を用いて口腔関連QOL を評価した。OHIP-14 の合計スコアおよび7 つのサブドメインスコアを算出し，歯周病重症度の異なる4 群を比較した。OHIP-14 の合計スコアと「機能的問題」にはP1-P3 間とP2-P3 間に有意差が認められ，「不快感」についてP1-P3 間に有意差が認められ，P3 群が有意に高かった。本研究より，今回検討した歯科医院の初診患者において，歯周病の重症度と口腔関連QOL には関連性が認められ，歯周病が重症の患者ほど主観的に口腔機能が低下し，不快感が増加し，QOL が低くなることが示唆された。

Diagnosis and treatment outcomes of periodontal disease have typically been evaluated using biomedical data such as probing depth. Recently, however, there is greater research focus on quality of life (QOL) in medical treatment. This study therefore aimed to clarify the relationship between periodontal disease severity and oral health-related QOL. Information was extracted from medical records of patients aged 30-64 years and who visited Nakai Dental Office for the first time between November 2014 to July 2017. Severity of periodontal disease was diagnosed by results of a baseline periodontal examination, and then scored in accordance with the Community Periodontal Index and classified into four groups: (C, P1, P2, P3). QOL was assessed using the total score and seven subdomain scores from the Oral Health Impact Profile Short Version (OHIP-14). The Kruskal-Wallis test was then used to compare among the four groups of the total score of OHIP-14 and the seven subdomain scores. Comparison of the groups’ total OHIP-14 scores showed significant differences between P1 and P3 and between P2 and P3, while P3 had a significantly higher score than other groups. Comparison of the groups’ OHIP-14 subdomain scores showed significant differences between P1 and P3 and between P2 and P3 for “functional limitation,” and between P1 and P3 for “psychological discomfort,” while P3 had a significantly higher total score than other groups. There were no significant between-groups differences for the other five subdomain scores. Functional limitations was assessed subjectively as difficulty in chewing and food getting caught between teeth. Anxiousness and negativity regarding the dental problem were reported among psychological discomfort. Oral function appeared to subjectively decrease, while discomfort increased with worsening of periodontal disease. In general, QOL worsened. Among the subjects, severity of periodontal disease was associated with oral-health-related QOL. It was suggested that patients with more severe periodontal disease had subjectively more impaired oral function, more discomfort, and lower QOL.