干燥综合征口腔疾病的治疗特点

doi:10.19723/j.issn.1671-167X.2023.05.023

摘要/Abstract

摘要：

目的: 深入了解(Sjögren’s syndrome, SS)干燥综合征相关口腔疾病治疗的临床特点, 为临床工作提供指导。方法: 回顾2015年1月至2021年9月于北京大学口腔医学院综合科进行口腔诊疗的部分SS患者, 分析其口腔疾病的诊断和治疗情况。对本研究纳入的SS患者, 进行全面的口腔检查, 包括腮腺区检查、口腔黏膜检查、牙列检查、牙体检查、牙周检查、静态唾液流率、念珠菌感染情况及影像学检查。根据检查结果, 按顺序给予患者氟化物治疗、抗真菌治疗、根管治疗、直接充填修复、间接修复治疗, 并记录治疗情况。结果: 共纳入9例SS患者, 其中4例原发性SS患者(primary SS, pSS), 5例继发性SS患者(secondary SS, sSS), 平均年龄(49.2±16.2)岁, 平均口干病程5年, 静态唾液流率均 < 1 mL/10 min。8例患者唾液念珠菌培养阳性(>200个/mL), 1例患者唾液念珠菌培养阴性。治疗前9例患者平均龋失补牙数(decay, missing, filling teeth, DMFT) (24.8±4.2)个, 平均龋失补牙面数(decay, missing, filling tooth surfaces, DMFS) (59.2±21.9)个, 平均切端龋(2.5±1.3)个, 平均冠修复体(4.5±3.6)个。9例SS患者均局部应用了氟化物治疗, 其中8例念珠菌感染者进行了抗真菌治疗。9例SS患者中6例患者人均3.2个全冠修复体由于继发龋而拆除。修复治疗阶段, 1例SS患者仅充填修复治疗, 1例SS患者进行了全口咬合重建治疗, 其余7例患者均进行直接充填联合固定修复治疗。9例SS患者中3例患者进行了种植义齿修复。结论: SS口腔疾病的治疗需要序列进行, 应先进行全面检查和诊断, 再控制感染, 然后进行口腔功能的恢复。

关键词: 干燥综合征, 口腔疾病, 龋病, 念珠菌

Abstract:

Objective: To understand the clinical characteristics about sequence diagnosis and treatment of oral complications in patients with Sjögren's syndrome (SS) through retrospective analysis, and to provide some guidance for clinical work. Methods: Some SS patients who underwent oral sequence management in the Department of General Dentistry, Peking University School and Hospital of Stomatology from January 2015 to September 2021 were enrolled. For the SS patients included in this study, a comprehensive oral examination was performed, including parotid region examination, oral mucosal exa-mination, dentition examination, dental examination, periodontal examination, unstimulated salivary flow rate, Candida infection and radiological imaging examination. According to the examination results, the patients were given fluoride application, antifungal treatment, root canal therapy, direct filling repair, and indirect repair treatment in sequence and the results recorded. Results: A total of 9 patients with SS, with 4 primary SS patients (pSS) and 5 secondary SS patients (sSS) were enrolled in the study. For all the 9 patients, the average age was (49.2±16.2) years and the median xerostomia duration 5 years. The unstimulated salivary flow rate of the 9 patients was all less than 1 mL/10 min. Eight of the 9 cases was diagnosed as oral Candidiasis, with positive salivary Candida culture result (>200 cfu/mL), and 1 of the 9 cases was not. The average decay, missing, filling teeth (DMFT) was 24.8±4.2; the average decay, missing, filling tooth surfaces (DMFS) was 59.2±21.9, the average incisal caries was 2.5±1.3, and the average number of crown restorations at baseline was 4.5±3.6. All the 9 SS patients were applied with topical fluoride usage, and 8 were prescribed with antifungal treatment. One sSS patient was conducted with filling restoration treatment, one pSS patient was conducted with full mouth rehabilitation, and the remaining 7 patients were conducted with direct filling combined with fixed repair treatment. The average 3.2 full crown restorations in 6 patients had to be removed and restored because of secondary caries, and 3 of the 9 patients underwent implant denture restorations finally. Conclusion: Management of oral complications in SS patients needs to be carried out in sequence. A comprehensive examination and diagnosis should be carried out first, followed by infection control, and then restoration of oral function at last.

Key words: Sjögren's syndrome, Oral complication, Caries, Candida

中图分类号:

R781.6

邢海霞,王琳,乔迪,刘畅,潘洁. 干燥综合征口腔疾病的治疗特点[J]. 北京大学学报（医学版）, 2023, 55(5): 929-933.

Hai-xia XING,Lin WANG,Di QIAO,Chang LIU,Jie PAN. Clinical features of oral management to oral complications of Sjögren's syndrome[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 929-933.

图/表 2

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Case No.	Systemic medication	Filling surfaces, n	Remove crowns, n	Root canal treatment, n	Crowns restoration, n	Other restoration	Follow up/ months
1	Nifedipine	10	2	2	4	RPD	12
2	Glucocorticoid	22	1	1	2	Fixed bridge	72
3	Glucocorticoid	39	4	4	4	None	66
4	None	49	0	5	5	RPD	6
5	Glucocorticoid	24	0	3	3	None	24
6	None	18	2	2	3	2 implants	15
7	Hydroxychloroquine	0	8	1	24	Full mouth rehabilitation with 2 implants	12
8	Glucocorticoid	38	0	1	0	None	10
9	Hydroxychloroquine, leflunomide	26	2	6	3	4 implants, 2 fixed bridges	6