中心結節を削合してもらったことに関して
- 現在通院している歯科医院にて、中心結節について相談すると、「レジンなどの補強は子供のうちにしないと噛み合わせがおかしくなるので出来ない」と拒否され、代わりに「半年くらいかけてちょっとずつ削ると神経が少しずつへっこんでいく」などと言われ、全ての中心結節を研磨されてしまいました。
そのせいで噛み合わせの違和感や痛みなどが出てしまい…(多分もう露髄してる？)ネットで調べても「中心結節を削ると神経がへっこむ」などという情報は見つかりませんでした。
この歯医者を信頼していいのでしょうか？
研磨されてしまった歯は露髄と歯髄炎のリスクが高まっただけなのでは？と不安です。
どういった対処を受ければよいでしょうか。 - こんにちは！三木照久歯科、院長の三木照久です。
さて、早速ご相談の件ですが…
まず、中心結節を削合してもらったことに関しては…噛み合わせがどうなっているかは、直接拝見してみないと分かりかねます(削合すること自体は、歯科医学的妥当性が有れば行うことはあります)。バランスの取れた状態に噛み合わせが調整されていても、自然に歯がすり減る(「咬耗」と言います)のより遥かに速く噛み合わせが変化したわけですから、脳がまだその急速な変化を受け入れられず「噛み合わせの違和感」になっている可能性はあると思われます。
「少しずつ削ると神経が引っこむ」というのは、専門用語で申し上げると「第二象牙質の形成」と言う現象を引き出すことを狙ったものと考えられます。「引っこむ」と言うのは診て下さってる先生が分かりやすく説明してくれたもので、正確には歯の神経(歯髄)の入っている歯の内部の空洞(歯髄腔)から、新たに象牙質(歯の表面にある鎧＝エナメル質と歯髄の中間に位置する硬組織)が少しずつ添加されていく現象の事です。
第二象牙質はゆっくり進行するタイプの虫歯にかかった時等に形成され、歯髄への細菌の侵入を遅らせてくれたり、また加齢によっても少しずつ添加されてくると言われています。
おっしゃられる痛みの症状は…まだ十分な第二象牙質の形成がなされていないせいかも知れません。中心結節の削合による露髄…は、可能性はないとは言えませんが、よほど削らないと露髄までは至らないと思われます。が…「エナメル象牙境(文字通り、エナメル質と象牙質の境界線)」に近いところまでは削合していることが考えられます。中心結節をフラットになるまで削っているのであれば、その可能性は高いと思われます。治療ではなく虫歯や外傷でエナメル質が破壊された場合も、「人体の防犯ブザー」として、まずエナメル象牙境で痛みが出ることが多いとされています。
もちろん先に述べたように、「歯科医学的妥当性があれば」中心結節を削ることも有りますし、その場合第二象牙質の形成に時間がかかることも、ケースによっては起こり得ることと考えられます。また、痛みやその他何らかの症状が出た場合、その強弱には個人差があり、また落ち着くのに時間のかかる方、稀に症状が続く方や、ごく稀に増強する方もいらっしゃいます。
現時点で診て下さってる先生に対応してもらうとすれば、ある意味で「治療による不可抗力で起こった、一種の知覚過敏」のような状態とも言えますので、その症状への対策をしていただくと、お気持ち穏やかになるのでは…と思います。なお、知覚過敏的な症状への治療は様々有り、先生によって持っていらっしゃるカードも違うかと思いますので、かかりつけの先生に直接、どんな形で対応してもらえるのかをご相談されてみてはいかがでしょうか。
これは私自身も、もう一度肝に銘じて確認しておかなくてはと身が引き締まったご質問でした。と言いますのは、ご納得されぬまま受けられた治療は、…たとえどんなにいい治療でも…誰よりご自身が幸せになれません(私は、歯科医師の仕事は「歯を治すこと」ではなく「歯の健康を患者さんと一緒に回復•維持することを通して、その方が幸せになるお手伝いをすること」だと思っています)。
どうぞご納得いくまで、何でも先生にお気持ちをぶつけてみてはいかがかと思います。
その上で、もしどうしてもご納得がいかなければ、お通いになれるところにお住まいでしたら、私達が全員全身全霊でお力にならせていただきます
では、本当にお大事になさってくださいね。
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