5歳の息子の乳歯について

初めまして。
5歳の息子の乳歯についての相談です。
上の歯が虫歯になり治療をしたのですが、その3ヶ月に片方の顔がパンパンに腫れ歯茎も腫れ歯医者さんにかかったところ以前治療した虫歯が再び虫歯になり?根っこまで菌が広がり神経までもが死んでいました。
その治療も完了したと思ったら今度は下の歯にフィステルと思われるデキモノができました。
こちらも以前に虫歯の治療をしています。
かかりつけ医からは乳歯は治療していても虫歯が再びできやすい。
息子の場合は早い年齢で虫歯になったためより一層そういうことが起こりやすいとの説明を受けましたが本当なのでしょうか?
以前虫歯の治療した時に適切に処置がされていなかったのではないか、虫歯が残っていたからこうなったのではないかと不安です…
虫歯治療が適切に行われていたとしてもこういったトラブルが起こることはありますか?
ご意見いただけたら幸いです。
こんにちは!三木照久歯科、院長の三木照久です。
さて、大切なお子様のお口の健康…さぞかしご心配なことと存じます。
個人•個別の歯の状態は、直接拝見しておりませんので断定的なことは申し上げかねますが…診て下さってる先生のおっしゃる「子供の虫歯は再発し易い、早期に進行した虫歯はその傾向がさらに高い」というお話は、確かにその通りです。
まず、乳歯は子供達の小さなお口の中に生えている歯なので、同じ機能の歯牙(乳切歯と永久切歯、乳臼歯と大臼歯)同士で比べると永久歯より小さいです。さらにその表層の鎧にあたる部分=エナメル質も薄く…相対的に、神経の入っている内部の空洞=歯髄腔の容積比は大きいです。
これらのことから、乳歯の虫歯(う蝕)は容易にエナメル質を通過し、神経にも早期に到達します。仮に永久歯と同じ深さに進行したら、その2倍、3倍の深さに達した虫歯と同じ深刻さととらえられます。
また、永久歯はその名の通り、健康を維持できれば一生物の歯ですが…一方乳歯は、約6〜7年間で役目を終えます。大体生後8ヶ月〜3歳で生え揃います。
永久歯の根は、張ってしまったあとは変化しませんが、乳歯の根は張りきった後、後に続く永久歯との生え替わりのため吸収(根がなくなり、歯の頭だけが残ること)を始めます。乳歯は、生えてきてから生え変わるまで変化し続ける、代謝の旺盛な歯と言えるでしょう。
乳歯、永久歯に共通するのは、「生えたての歯は脆弱である」という点です。どちらも生えてしまえば見た目は変化があまりない様に見えても、石灰化度…イメージ的にいうと硬さ•頑丈さが違うと思ってください。
いわば、抵抗力が低く一方で代謝は旺盛…人間の成長過程に例えれば、同じ風邪をひいてもちびっこは大人より高熱が出たり、くしゃみや咳といった症状がより強く出ることが有りますね。歯も同じで、生えてすぐは弱くなおかつ反応しやすく、お口の中で少しずつ強くなっていきます。
お子さんは5歳ということですので…そのご年齢で虫歯の治療を受けたということは、生えてきて比較的早期に虫歯になり始めていたと推測されます。
エナメル質が薄く、神経が近く、幼若な乳歯が虫歯に罹った場合…それだけ急速に進行している可能性が高く、一度治療しても難治性…経過がよくなかったり、繰り返したりは確率として高いと言わざるを得ません。
原因は様々です。歯磨きはもちろんですが、遺伝的な因子や、生活習慣的な因子もありますが、虫歯(に限らず病気全般)は、色々な要素が複雑に絡み合って起こります。
余談ですが、永久歯との交換間近の乳歯の虫歯も、歯冠の下に歯根が吸収した状態の骨の空洞があるため、そこに細菌が侵入して歯茎が腫れることも有ります。
ご心配はよく分かりますが、どうか落ち込みすぎず、いまはかかりつけの先生と力を合わせて、治療とアドバイスを受けていただき、現時点ででき得る限りのお子様のお口の健康管理を実践していってあげてください。前向きに考えていただいて、お口の健康が早く確立できれば、全身の健康にもたくさん良い影響があります。それを学ばれるチャンス…と言えるかも知れません。
ある意味で乳歯は、ものすごくざっくり言ってしまえば練習問題や模試みたいなもの…という側面もあるかも知れません(大事にしなくていいという意味では決して有りません。練習問題や模試に真剣に取り組むことが、本番の結果に繋がるのと同じです)。
先に述べました様に、永久歯は一生物です。永久歯に生え変わってからが、本当のお口の、そして全身の健康管理です。
では、本当にお大事になさってくださいね。

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