药物性牙龈增生的临床治疗效果观察

发布时间：2018-04-30 19:32

本文选题：药物性牙龈增生 + 胶原　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:药物性牙龈增生是一种药物不良反应,指服用药物引起的牙龈增生和体积增大,主要见于三类常用药物即钙通道阻滞剂(硝苯地平),癫痫药物(苯妥英钠)和免疫抑制剂(环孢素)。药物性牙龈增生发病机制尚无定论,影响因素主要包括药物的作用、炎症和基因方面影响牙龈的增生程度。药物性牙龈增生的治疗主要包括菌斑控制、去除局部刺激因素、更换或停用能引起牙龈增生的系统用药及牙周手术治疗。本研究目的在于分析牙龈增生的病因,评价规范化牙周系统治疗对药物性牙龈增生的治疗效果,为药物性牙龈增生的治疗提供依据。研究方法:收集2014年至2016年青岛大学附属医院就诊的药物性牙龈增生的6例病例。服用可引起药物性牙龈增生的药物持续时间1月以上。近1年内未予牙周科就诊治疗且3个月内未服用过任何抗生素。所有患者经同一牙周医生实施牙周评定。患者在知情同意的情况下参加本研究。本研究针对患有药物性牙龈增生的6例患者行病史记录,牙周各项指标检查,在暂时不更换口服药物的情况下,行牙周基础治疗、必要的牙周手术和牙周支持治疗。牙周系统性治疗后进行效果观察及病因分析。评价牙龈增生在治疗前与治疗后3个月、6个月的探诊深度(PD)、出血指数(BI)、菌斑指数(PLI)和牙龈增生指数(GHI)的变化。牙周治疗后随访观察病变进展情况。结果:患者治疗前与经过牙周序列治疗3个月和6个月的PLI、PBI、PD和GHI等指数较基线水平有显著差异。130个增生位点中有115个位点牙龈增生完全消失。随访6月-2年均无明显复发。部分菌斑控制差的患者有牙龈炎症复发的倾向,但菌斑控制后好转,无牙龈增生复发。结论:药物性牙龈增生通过牙周基础治疗有效菌斑控制联合切除性手术可以得到理想的治疗效果。牙龈增生中由炎症引起的增生大部分为可逆且能在菌斑控制后短时间内消退,再通过牙周手术去除牙龈中堆积的胶原成分,恢复牙龈的外观和功能。因此以菌斑控制为主的牙周基础治疗是牙龈增生治疗的首要程序。基于目前观察的病例及观察时间,本实验中的所有病例均未更换治疗药物,观察期内均取得较好的临床疗效。本研究针对药物性牙龈增生的发病机制及临床治疗,对指导医疗专业人员有效的防止药物性牙龈增生的发生有一定的意义。本研究尚需增加补充病例和延长观察时间,以期对临床治疗起到更进一步的指导作用。
[Abstract]:Objective: drug induced gingival hyperplasia is a kind of adverse drug reaction. It is mainly found in three kinds of common drugs: calcium channel blockers (nifedipine), epileptic drugs (phenytoin sodium) and immunosuppressants (cyclosporine). The pathogenesis of drug-induced gingival hyperplasia is still unknown. The main influencing factors include drug action, inflammation and gene influence on the degree of gingival hyperplasia. The treatment of drug-induced gingival hyperplasia mainly includes plaque control, removal of local stimuli, replacement or discontinuation of systemic medication and periodontal surgery. The purpose of this study was to analyze the etiology of gingival hyperplasia, to evaluate the therapeutic effect of standardized periodontal system therapy on drug induced gingival hyperplasia, and to provide evidence for the treatment of drug induced gingival hyperplasia. Methods: six cases of drug-induced gingival hyperplasia were collected from 2014 to 2016 in Qingdao University affiliated Hospital. Medication that can cause drug-induced gingival hyperplasia lasts for more than one month. No periodontal treatment was given within 1 year and no antibiotics were taken within 3 months. All patients were assessed by the same periodontists. The patient participated in the study with informed consent. In this study, 6 patients with drug-induced gingival hyperplasia were treated with medical history, periodontal indexes, periodontal basic treatment, periodontal surgery and periodontal support therapy. The effect and etiology were observed and analyzed after systemic periodontal treatment. To evaluate the changes of probing depth, bleeding index (BI), plaque index (PLI) and gingival hyperplasia index (GHI) of gingival hyperplasia before treatment and 3 months and 6 months after treatment. The progress of the disease was observed after periodontal treatment. Results: there were significant differences in PD and GHI indexes between the patients before treatment and after periodontal sequence therapy for 3 months and 6 months, and 115 of 130 proliferative sites disappeared completely. There was no significant recurrence in 6 months after follow-up. Some patients with poor plaque control tended to recur of gingival inflammation, but no recurrence of gingival hyperplasia occurred after plaque control. Conclusion: drug-induced gingival hyperplasia can be effectively treated by plaque control combined with excision surgery. Most of the hyperplasia caused by inflammation in gingival hyperplasia is reversible and can recede in a short time after plaque control. Then the collagen accumulated in the gingiva is removed by periodontal surgery to restore the appearance and function of the gingival. Therefore, the primary procedure of gingival hyperplasia treatment is the periodontal basic therapy based on plaque control. Based on the present observed cases and the observation time, all the cases in this experiment did not change the therapeutic drugs, and good clinical effect was obtained during the observation period. This study aims at the pathogenesis and clinical treatment of drug-induced gingival hyperplasia, which has a certain significance for guiding medical professionals to prevent the occurrence of drug-induced gingival hyperplasia. This study needs to increase the number of supplementary cases and prolong the observation time in order to provide further guidance for clinical treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.4

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