歯科衛生士として出来る
技術移転

カワムラ歯科医院・南太平洋医療隊
鈴木千鶴

南太平洋医療隊のトンガ王国における主な活動は・・・• 学校歯科保健指導• 乳幼児歯科保健活動（歯科スタッフ、教師、保護者）• 小学校巡回 フッ化物洗口（週１回）• オーラルフェステバルの開催• ワークショップの開催• スタッフ教育• 器機材の支援
・2013年より新プロジェクト開始• 救急車、指令車の寄贈など・・・

歯周病治療の現状• 歯周病・・・痛みや動揺歯への対応
抜歯 or 投薬・抜歯後の対応・・・義歯装着（有料）
多くの場合放置トンガ王国における口腔保健のアプローチから
生活習慣を改善するプロジェクト
プロジェクトの成果
1) 歯科・医科スタッフが生活習慣改善の指導できるよ
うになり、トンガ国民は生活習慣が改善する
2)中高生対象の口腔保健啓発活動
3) 妊産婦の口腔保健啓発活動

4) 普及啓発の担い手（教師、政府職員、トンガTV職員）を育成
5)普及啓発活動が国内で定着

VAIOLA病院にて
口腔内写真
歯周病検査
歯磨き指導
クリーニング（SC,SRP,PMTC)

指導用マニュアル・歯周病とは・歯周病治療の流れ
・器材の紹介・検査、測定方法
・スケーラーの種類、使い方、使い分け
・チェアポジション
・口腔内写真の取り方
・歯磨き方法・歯間ブラシの使い方

Periodontal Disease

What is periodontal disease ?

• Periodontal disease is a chronic bacterial infection that affects the gums and the bone
supporting the teeth.
normalnormal gum

periodontal
disease*plaque (calculus)

normal bone

gum being swollen and red
Bone has melted＊plaque : a harmful substance which forms on your teeth, which BACTERIA can grow and breed in＊calculus : a hard substance that forms on your teeth and can cause them to dental diseases• Left untreated, dental plaques spread and grow between the gum and tooth. It produces
poisons or toxins that cause the gums to separate from the teeth and form pockets .
When this happens, these pockets deepen and eventually the bone holding the tooth in
the jaw is destroyed. Teeth then become loose and may have to be removed.

Scaling and root planing・Current treatment for periodontitis involves scraping dental plaque,the polymicrobial biofilm, off the tooth, a procedure called scaling.
Root planing involves scaling the tooth’s root. Scaling and root
planing are often referred to as deep cleaning.
・The objective for periodontal scaling and root planing is to remove
dental plaque and calculus (tartar), which house bacteria that
release toxins which cause inflammation to the gum tissue andsurrounding bone.

The flow chart of Periodontitis treatment
Ｐｌａｑｕｅ Ｃｏｎｔｒｏｌ is Important!

＊1st Ｔｉｍｅ・Ｏｒａｌ Ｅｘａｍｉｎａｔｉｏｎ
・Ｔａｋｅ Ｐｈｏｔｏ・Ｐｒｏｂｉｎｇ
・Porphyromonaｓ
Ｇｉｎｇｉｖａｒｉｓ (Ｂａｃｔｅｒｉａ）with the microscopeis shown.
・Tooth Ｂｒｕｓｈｉｎｇ・Ｍｏｔｉｖａｔｉｏｎ＊Home care

<Ｅａｒｌｙ Ｐｅｒｉｏｄｏｎｔｉｔｉｓ>＊2nd Timeｓ
Tooth Ｂｒｕｓｈｉｎｇ
Ｐｒｏｆｅｓｓｉｏｎａｌ Ｔｏｏｔｈ Ｃｌｅａｎｉｎｇ<Ｍｏｄｅｒａｔｅ Ｐｅｒｉｏｄｏｎｔｉｔｓ>＊2nd Timeｓ～3th times
Recheck after 1 Month (4th ｔimeｓ)
Tooth Ｂｒｕｓｈｉｎｇ
0,1~0,2%Chlorhexidine
Ｐｒｏｆｅｓｓｉｏｎａｌ Ｔｏｏｔｈ Ｃｌｅａｎｉｎｇ
Root Plaining (The recheck will berecommended / required to the patient
according to the risk.）<Ａｄｖａｎｃｅｄ Ｐｅｒｉｏｄｏｎｔｉｔｓ>(Pocket Depth : over 7mm or FurcationⅡ)
Flap operation ：Modified Widsman’s Flap

a periodic medical
check-up

Treatment

Recall• Pocket Probing(EPP)• Oral Hygiene Instruction(OHI)• Tooth Brushing
Instruction(TBI)• Scaling(SC)• Root Planing(SRP)• Professional MechanicalTooth Cleaning(PMTC)• Normal:4～6Month• Moderately :2～3Month• Severe: 1Month

Diabetes and Oral Care
Could diabetes put your smile
at risk?
Extra care is needed to avoid
oral care complications fromdiabetes.

・Periodontal Treatments' Instruments

・Pocket Probe

・Probe for Furcation

・Ultrasonic scaler

・Hand scaler

・Prophy brush

・Prophy paste
・Prophy cup

B・Pocket depth
Probing pressure:15～ 20g
1～3mm: Normal
4～6mm: Moderately
7～ mm: Severe

M

D
L・Bleeding on Probing: （＋）
after 30sec check

・Furcation involvement
1/3: F1
1/3～not Through: F2
Through: F3

・Mobility
Front and back:(+)
Four quarters:(++)
Up and down:(+++)

lower

F1

F2

F3

upper

・supragingival scaling
place the 1st shank pararell to tooth surface①A scaler is operated in the directionof dentes axial direction within agingival pocket.
② The blade is always operated at thefitness angle along dental curved
surface.
③The scaler carry out operation towhich the starting point and theend point are always decided.
④It certainly fixes and operates
a scaler.

EnamelGum
Calculus
Sickle Scaler

・Pull Stroke
Face
Cutting edge
Lateral surface
Back

Lateral surface
Cutting edge
Back

Face

Toe

・subgingival scaling
place the curette below the gingival marginand move 1~5mm stroke and place the curetteparallel to tooth surfaces
・Pull or Push Stroke

Face
Cutting edge

Face

Heel
Lateralsurface

Toe

Lateral surface

Cutting edge

Back

Lateral surface

Teeth

Back
Cutting edge

lower shank(1stshank)#5/6#7/8 #11/12 #13/14

Upper shank(2ndshank)#5/6 #7/8#11/12 #13/14

Basic of Scaling technique

Support with your ring finger and don’t stroke up anddown but gently move your arm right and left
middle finger
forefinger
Ringfinger・Sickle#5/6

#13/14 Distal#7/8 Buccal&Lingual(P)#11/12 Medial

Basic of Sharpening technique45°
20°stone

Face＊Down stroke-strong
Up stroke-weak＊Once every
ten times＊A Face should become a floor and parallel.
＊As for a ceramic stone, oil is unnecessary.

60％

30％

10％

Test stickProfessional
Mechanical
Tooth
Cleaning・Feather touch・Removal of big dental calculus
・ It finishes it up by the curette.
・On a gingival margin
・The patient who is using Pacemakers
is absolutely taboo.

・Secondary polishing・Primary Polishing・Removal of coloringand Strong dirt

・10:00 to 11:00 position

・8:00 (front) position

・9:00 (side) position

・12:00 position (behind the Patient)・Areas1 and 2

・Aereas3 and 4

・Patient position:
Area1-head straight ahead
Area2-head turned slightly away from operator
Area1&2-chin down

・Patient position:
head turned toward operator,chin down・Operator position: 9:00

・Operator position: 9:00
・Operator position:
10:00 to 11:00

・Areas5
・Patient position: head straight ahead,chindown・Operator position: 8:00

・Operator position: 11:00 to 12:00

・Areas6
・Patient position: head straight ahead,chin down・Operator position: 8:00

・Operator position: 11:00 to 12:00

・Aereas7 and 8
・Patient position:
Area 7-head straight ahead
Area 8-head turned slightly away;chin up

・Aereas 9 and 10

・Patient position:
head turned toward operator,chin up

・Operator position: 9:00
・Operator position: 9:00
・Operator position:
10:00 to 11:00

・Areas11
・Patient position: head straight ahead, chin up

・Operator position: 8:00

・Operator position:11:00 to 12:00

・Areas12
・Patient position: head straight ahead, chin up

・Operator position: 8:00

・Operator position:11:00 to 12:00

Take photo：focusThe Angle of Tooth Brush

Bass method

Scrubbing method

Interdental Brush

Size SSS→L歯周病の説明

クリーニング

P検の説明

スタッフからスタッフへ歯磨き指導Before

After

43歳
男性
糖尿病患者

砂糖を控えて来年はワンサイズ小さいＴシャツに！