嚼檳榔對口腔及口腔細菌的影響

Abstract

本論文包括三大部份，一??述有關檳榔的種種，二?嚼檳榔對口腔的影響，三?嚼檳榔對口腔唾液中細菌的影響。第一部份的資料大都?參考文獻所得，也有部份?作者以詢問的方式得到。嚼檳榔的習慣至少已有二千多年的歷史，在東方有此嗜好的人，據估計約有四億。分佈非常廣泛，由非洲東岸經印度洋沿岸至大洋洲等地區的居民大部份都有此嗜好。食用檳榔所包含的組成物雖然隨地方而有差異，然其主要組成物檳榔、石灰、兒茶及老藤等則大致相同。台灣嚼檳榔的習慣，據推測可能在一千多年前由南洋傳過來的。 第二部份的資料?請牙醫師黃芳來先生代?檢查所得結果，作者加以整理，並與二十幾年前陳增全教授所得結果相對照，其中可得到下列幾點的結論： (一) 嚼檳榔者的蛀牙患率確實較低。如陳教授的結果，檢查313名檳榔嗜食者總齒數8681齒，平均每人齲齒數?0.47％，而非嗜食者388名，總齒數8352齒，每人平均齒數2.97％，比嗜食者的齲齒數大六至七倍。而作者的結果，檳榔嗜食者280名，總齒數8246齒，每人平均CMF齒?5.33，而非嗜食者306名，總齒數9109齒，每人平均CMF齒?6.06。二者都顯示出檳榔嗜食者之齲齒數較少。 (二) 由作者之結果與陳教授的對照可看出一事實，就是在六十幾以前，檳榔嗜食者及非嗜食者的齲齒或CMF狀態相差不多，而是在六十幾以後，二者間之差異才漸漸明顯。也就是?一般非嗜食者的牙齒蛀蝕及脫落所發生的時間要比檳榔嗜食者要早。 (三) 檳榔嗜食者牙齒磨耗的情形比非嗜食者?嚴重的多。並且與每日食量及食用年數之間成正比的關係。 (四) 檳榔嗜食者的齒齦發炎情形較?嚴重，其齒齦炎罹患率比非嗜食者大五倍左右。 (五) 檳榔嗜食者的牙垢及牙齒染黑情形非常明顯，並與食用年數及每日食量成正比的關係。 (六) 嚼檳榔與口腔病有關係，此點已由動物實驗得到確實證明。 第三部份所得結果顯示： (一) 嚼檳榔對口腔中乳酸菌的數目及種類並沒有顯著的影響。在Rogosa氏選擇性培養基上計數平板培養的結果，嚼檳榔者每毫升唾液中乳酸菌數大於103所佔的百分比?27.59，其每人平均每毫升唾液中所含乳酸菌數?77.70×103，而不嚼檳榔者佔35.90％，其平均每毫升唾液中所含的乳酸菌數?84.58×103。依據Davis的分類標準唾液中的乳酸菌可分五大類，在檳榔嗜食者及非嗜食者的口腔唾液中都有，並且每類乳酸菌的量相差不多。不過在唾液樣品中的分佈情形則有所差異。此外乳酸菌數目的?定性，在檳榔嗜食者的口腔中也存在著，並不因嚼檳榔而有所變動。 (二) 在含血培養基上所得結果也顯示嚼檳榔對口腔唾液中細菌的數目影響並不大。檳榔嗜食者在含血培養基上所得菌數的平均??159×108，而非嗜食者?233×108，二者之間沒有什?差別。 (三) 在試管中試驗以食用檳榔各組成物的水溶液之殺菌作用，其結果顯示，不論以圓板法或液態培養基法，檳榔各組成物的水溶液對口腔中的乳酸菌、鏈球狀菌、葡萄狀球菌、桿狀菌及酵母菌都沒有殺菌力。 (四) 由直接染色觀察比較檳榔嗜食者與非嗜食者口腔唾液中的細菌，其中桿狀菌類及球狀菌類的分佈情形大致相同，而螺旋狀菌及梭菌則在嚼檳榔者的唾液中存在者較少。 (五) 對檳榔嗜食者蛀牙患率較低的事實與唾液中?酸菌的關係加以討論。

There are three parts to this thesis, the first part describes the general characters of betel nuts and it's quid components, the second part investigates the effects of chewing betel nut on the mouth, and the third part reports on the effects of chewing betel nut on the oral bacteria which were found in the saliva. Most of the information contained in the first part is derived from literatures, and some from interogating those who used betel nut. The chewing of betel nuts is the widest spread masticatory hobby in the world. It has a history of at least 2000 years, for people have been chewing betel nuts as a masticatory since very ancient times. And in the Orient, the numbers of people having this hobby is estimated at over 400 millions. Most of the residents from East coast of Africa along Indian Ocean to some of the remotest of the Pacific Ocean, chew betel nuts as a hobby. The components of the betel nut quid may be different in different localities, but the essential components, i.e. the betel nuts, gambir or catechu, Piper betle and lime-are always the same. In Taiwan the habit of chewing betel nuts very probably came from Malaysia a thousand years ago. The results of second part were obtained by a dentist (Dr. F. L. Huang). His investigations and data were analysed by the auth r and compared with the results of professor Chen Cheng-Chian which were reported 25 years ago. This part contains several conclusions: 1. The rate of occurrence of dental caries is lower in betel nut chewers than in non-chewers. Chen reported on 313 persons who chewed betel nut, and examined a total of 8681 teeth. The average rate of dental caries per person was 2.97, the caries rate for non-chewers was greater than betel nut chewers being 6-7 times as many. The author's results were based on 280 persons who chewed betel nut, and a total teeth of 8246 were examined. The average CMF teeth per person was 5.33, 306 non-chewers were examined and total numbers of teeth investigated was 9019, the average CMF teeth numbers per person were 6.06. Both of these investigation showed that the dental caries of betel nut chewers were le. than non-chewers. 2. From a comparisons of Chen's results with that of the author's, we can see that before the age of 60, the caries of both betel nut chewers and non-chewers is almost the same. The differences between these groups shows up most obviously after 60 years of age. It appears that the occurrence of caries and missing of teeth in non-chewers occurs earlier than in betel nut chewers. 3. The attrition of the teeth of betel nut chewers is very serious. 4. Gingivitis is much commoner and severer in betel nut chewers than non-chewers. The occurrences of gingivitis in betel nut chewers is 5 times greater than in non-chewers. 5. The calculus and stained teeth of betel nut chewers is very heavy, and is correlated with the number of years of betel nut chewing and also the number of betel nuts consumed per day. 6. From recent studies, it is evident that betel nut chewing can induce oral cancer. In third part of my thesis the following results are presented: 1. The quantity of oral lactobacilli and kinds of species present in the mouth of betel nut chewers is not markedly different from that of non-chewers. The results of the plate counts of lactobacilli on Rogosa's selective medium are as follows; the percentage of lactobacilli numbers which are greater than 103 per ml. in the saliva of betel nut chewers is 27.59, and the average number per person of lactobacilli numbers are 77.70X103 per ml.. And for non-chewers the lactobacilli numbers are greater than 103 per ml. and the percentage is 35.90, and the average number of lactobacilli per person is 84.58 X 103. Based on Davi's classification we can classify the lactobacilli in saliva into 5 groups. The quantity of each group for both betel nut chewers and non-chewers is not much different; neverthless the frequency of distribution of the groups of the lactobacilli in saliva is different. We confirm the results of previous investigators in finding that there is a constancy in the lactobacilli numbers in mouth of non-betel nut chewers and we have found that there is also a constancy in the number of of lactobacilli in the mouth of the betel nut chewers. 2. Plate counts of saliva on blood agar shows that the quartity of bacteria in the saliva is not affected by the chewing of betel nuts. The average bacteria number for betel nut chewers of blood agar is 233 X 108, there is no great difference. 3. Using water extracts of the quids betel nuts, we tested for their bacteriocidal effect on Lactobacillus sp., Streptococcus sp. , Staphylococcus sp., bacilli and yeast both by the disk method and by inserting the extracts into broth cultures and found no inhibitory effect on any of the above organisms. 4. We compared the kinds of bacteria from the saliva of both betel nut chewers and non-chewers by various staining methods; and found the distribution of the bacilli and cocci were almost the same in both, however, the □sence of spirochetes and fusiform bacteria in the saliva of betel nut chewers was less than non-chewers. Finally, the relationship of dental caries in betel nut chewers and the acidogenic bacteria present in their saliva is dicussed.