消化器がん患者で口腔疾患の集積を確認 ~むし歯経験は Oral-GI Axis の新たな手がかりとなるか~

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2026-07-01 北海道大学

北海道大学の研究グループは、2015~2025年に北海道大学病院で周術期口腔管理を受けた消化器がん患者218人を対象に、むし歯、歯周病、根尖性歯周炎を含む口腔疾患を後ろ向きに解析した。口腔内診査とパノラマX線画像を用いて、DMFT指数(むし歯・喪失歯・充填歯数)、歯周ポケット深さ、根尖性歯周炎を評価し、厚生労働省「歯科疾患実態調査」と比較した結果、25歳以上のほぼ全ての年齢層でDMFT指数が全国平均を有意に上回り、歯周病も高頻度で認められた。さらに、根尖性歯周炎は46.3%に認められ、消化器がん患者では複数の口腔疾患が集積していることが明らかとなった。特にDMFT指数は生涯のむし歯経験や口腔疾患負担を反映することから、口腔と消化器を結ぶOral-GI Axisでは、従来重視されてきた歯周病だけでなく、むし歯経験も重要な指標となる可能性が示された。ただし、本研究は探索的な後ろ向き研究であり、因果関係は示しておらず、今後は前向き研究や口腔・腸内細菌叢解析による検証が必要である。

消化器がん患者で口腔疾患の集積を確認 ~むし歯経験は Oral-GI Axis の新たな手がかりとなるか~
研究仮説の概要図

<関連情報>

消化器がん患者における口腔疾患の包括的評価:10年間の後ろ向き研究から得られた疫学的知見 Comprehensive Evaluation of Oral Diseases in Patients with Gastrointestinal Cancers: Epidemiological Evidence from a 10-Year Retrospective Study

Chiharu Kawamoto,Hirofumi Kaneko,Ryotaro Yago,Yudai Matsuo,Yuto Nakamura,Takuma Mirokuin,Shuhei Hoshika,Hidehiko Sano,Atsushi Tomokiyo andNaoya Sakamoto
Cancers  Published: 14 June 2026
DOI:https://doi.org/10.3390/cancers18121941

Abstract

Background: The association between oral health and gastrointestinal (GI) cancers has been primarily investigated within a periodontitis-centered framework. However, the potential contribution of cumulative oral disease burden, including dental caries and apical pathology, remains insufficiently explored. The Decayed, Missing, and Filled Teeth (DMFT) index reflects lifetime exposure to oral microbial dysbiosis and chronic inflammation.

Methods: This retrospective exploratory study included patients with GI cancers referred for perioperative oral screening and management at a tertiary care center between 2015 and 2025. Oral health was evaluated using the DMFT index, periodontal probing depth, and radiographically diagnosed apical periodontitis. Age-stratified DMFT and periodontal parameters were compared with national reference data, while apical periodontitis prevalence was descriptively assessed.

Results: Patients with GI cancers demonstrated higher DMFT values than national averages across most adult age groups. The prevalence of periodontal pockets (≥4 mm and ≥6 mm) was also elevated. Apical periodontitis was common, affecting 46.3% of patients, with some age groups exceeding 50%. Overall, these findings indicate oral disease clustering with coexisting chronic oral conditions.

Conclusions: Patients with GI cancers exhibit substantial oral disease burden, including increased caries experience, periodontal pathology, and apical lesions. These findings suggest that the oral–gastrointestinal cancer relationship may extend beyond a periodontitis-centered paradigm, and that cumulative oral disease burden—including cariogenic processes—may represent an underrecognized component of this axis. The DMFT index may serve as a surrogate marker of lifelong oral inflammatory exposure. While causal relationships cannot be established, this study provides a basis for future mechanistic and longitudinal investigations.

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