虫歯になっている親知らずの治療
- 親知らずが虫歯になり、冷たいものを食べたりするとしみるようになってきたので治療を考えています。
ただ将来的に（1年後以降に）矯正を考えているので、抜歯したほうがいいのか、治療して残しておいたほうがいいのか悩んでいます。
矯正自体は他の地域で考えています。
こういう相談はこちらの歯科医院では行っておりますか？ - こんにちは！三木照久歯科、院長の三木照久です。
まず…歯やお口の健康に関することなら、どんなご相談でも全力で想い、考え、お答えさせていただきます。
そしてエリア•地域関係なく…歩いて3分のところからの方も、たとえ砂漠の果てから来て下さる方でも…、当院を頼ってきて下さる方のお口の問題には、全身全霊取り組みませていただきます。
さて本題ですが…お口を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、「近い将来の歯列矯正」を検討中で、しかも「虫歯になっている親知らず」の治療をお考えということであれば、その方程式の最適解となる治療は抜歯…である確率は高いと推測致します。
「親知らずに虫歯」ができていて、その症状を自覚しているとのご不安は、裏を返せば親知らず以外の歯にはそう大きな症状を感じていらっしゃらないということでは…と推察致します。
お若さから考えて、問題の親知らずはお口の中に生えてきてそう長期間経っていないものと思われます。そしてそれは、人体で(大腸と並んで)細菌の最も多いエリアの一つである口腔内＝お口の中に晒されてからの期間が最も短い歯である(他の歯は、概ね小学校〜中学校就学時前後で生え揃っている)はずです。
その「最も後に生えてきて、口腔内での存在期間が最も短い歯」が、冷たいものが沁みるほどの虫歯…その症状からおそらく、歯の表面の鎧兼断熱材に当たる部分、エナメル質はすで貫通している(う蝕＝虫歯4段階中2段階目、C2かそれ以上の)可能性が高いということは、う蝕の急速な進行が懸念される状態である事を意味します。
う蝕になる要素には、「宿主(ご本人)」「細菌」「環境」主にこの３つがあり、これに「時間」という要素が加わる、と言われています。このうちの時間因子…たとえ他の歯にも同程度のう蝕があったとしても、その進行速度は当該部で特異的にかなり速く進んでいるのではと危惧します。
そして親知らずは、もし仮に比較的まっすぐ生えているものであっても(そうでないものは尚更)、顎の骨の壁に近く、また大きくお口を開けたとしても最もスペースの狭いエリアに生えているため、歯磨きはとても難しい、またはほぼ不可能であることも多いです。
さらに歯列矯正の設計から考えても、大臼歯や、その他の複数の歯が虫歯で失われている場合等の例を除き、親知らずを「抜く側」の歯でなく敢えて「矯正して並べる側」の歯として選ぶケースは極めて少ないと言えます。
以上のことを踏まえ…当院は矯正専門歯科医院様との協力で、こちらでは一般歯科的治療と(必要な場合)抜歯という症例も頻繁にございますが、その膨大な症例の中で、(治療前か後かはケースによりますが)親知らずに関しては抜歯をご依頼いただくことが圧倒的に多いです。
是非一度拝見させていただければと思います。より詳し相談してさせていただき、お力になれればとても嬉しいです。
では、本当にお大事になさってくださいね。
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