口腔黏膜寻常型天疱疮的口服糖皮质激素治疗：不良反应与对策

糖皮质激素是治疗寻常型天疱疮的首选药物。但糖皮质激素治疗可能引起血糖升高、血压升高、脂质代谢异常、钙的吸收代谢及骨形成异常、感染、肾上腺皮质功能减退、心血管问题,及糖尿病、高血压、骨质疏松、骨坏死等不良反应。因此,了解糖皮质激素的不良反应并掌握相应的应对手段对临床治疗口腔寻常型天疱疮十分必要。本文将综述口服糖皮质激素治疗口腔寻常型天疱疮过程中可能出现的不良反应及其应对策略。     

平阳霉素及糖皮质激素与微波联合治疗口腔颌面部血管瘤72例报告

目的：总结平阳霉素、糖皮质激素与微波联合治疗口腔颌面部血管瘤的疗效。方法：采用平阳霉素、糖皮质激素与微波联合治疗口腔颌面部血管瘤72例,瘤体0.6cm×0.9cm～9.0cm×15.0cm大小。7～10d注射一次平阳霉素,3～5次一个疗程,一个疗程的总量不超过40mg;小于6岁患儿口服强地松;根据病情联合微波治疗。结果：治疗后经6～30个月的随访,治愈率91.67%,有效率100%。结论：平阳霉素、糖皮质激素与微波联合应用治疗口腔颌面部血管瘤是一种安全、经济、有效的治疗方法。     

口服糖皮质激素患者骨代谢与下颌骨密度变化及相关性的研究

目的初步探讨长期口服糖皮质激素(glucocorticoid,GC)患者血、尿骨代谢指标、全身骨密度(bone mineral density,BMD)、颌骨BMD的变化及其之间的相关性。方法采用自身对照法检测30例患者口服GC前后血碱性磷酸酶(alkalinephosphate enzyme,ALP)、血骨钙素(bone gla protein,BGP)、血钙(calcium,Ca)、尿钙(urine calcium,UCa)及尿肌酐(urine creat-inine,UCr)值的变化;使用双能X线骨密度仪测定全身BMD的变化;应用图像处理软件分析头面部曲面体层片,测定颏孔区下缘皮质骨厚度(cortical width,CW)、下颌骨平均灰度值(mean grey values,MGVs)。用SPSS17.0软件包对检测结果进行统计学分析。结果血Ca与全身BMD、颏孔区下缘CW、下颌骨MGVs显著正相关。全身BMD、颏孔区下缘CW、下颌骨MGVs两两显著正相关。血、尿骨代谢指标、全身BMD、颏孔区下缘CW、下颌骨MGVs在服用GC前后未见明显变化。结论口腔曲面体层片的计算机灰度法可作为检测颌骨BMD的有效方法。本研究中口服GC患者未发生糖皮质激素性骨质疏松(glucocor-ticoid induced osteoporosis,GIO),颌骨骨质疏松得到了预防。     

美洛西林钠致口腔多发性血疱1例

四川大学华西口腔医院黏膜科对1例药物性血小板减少性症(美洛西林钠相关性)患者给予糖皮质激素、成分输血治疗,使其病愈出院.本文还就药物性血小板减少症的诊断、易引起血小板减少的常见药物以及口腔血疱相关疾病的鉴别诊断进行了讨论.     

骨质疏松对口腔种植修复影响的研究进展

骨质疏松症是一种全身性骨代谢疾病,好发于中老年人群。随着老年人口的增多,发病率也逐年上升。同时,伴随着口腔种植技术的发展和成熟,有越来越多的老年人选择进行种植修复。骨质疏松曾被认为是口腔种植修复的危险因素之一,对种植体的初期稳定性、生存率可能存在影响,且骨质疏松治疗药物不可避免地对种植体骨结合产生影响。本文就骨质疏松对口腔种植修复影响的研究进展进行综述。     

卵泡刺激素在女性绝经后骨质疏松及口腔骨吸收疾病中的研究

卵泡刺激素是(Follicle stimulating hormone,FSH)是由动物脑垂体前叶嗜碱性细胞合成与分泌的一种糖蛋白类促性腺激素。近年来,研究发现FSH可独立于雌激素调节骨量,影响绝经后骨质疏松。绝经后骨质疏松可影响牙槽骨骨量,在口腔骨吸收疾病中,起到一定作用。本文就FSH的研究背景及其对骨质疏松和口腔骨吸收疾病的影响作一综述。     

骨质疏松症对口腔颌面部骨骼影响的研究进展

骨质疏松 (ｏｓｔｅｏｐｏｒｏｓｉｓ ,ＯＰ)是一种以骨量减少 ,骨的微结构破坏为特征的全身性骨骼疾病 ,伴有脆性增加 ,容易发生骨折[1] 。它的发生主要与性激素、细胞因子、遗传、环境、营养等因素有关。本文拟对由口腔颌面骨骨质疏松引起的牙槽骨吸收、牙周病、种植体愈合 ,颞颌关节病变与全身性骨质疏松的关系研究进展作一综述。一、ＯＰ与牙槽骨吸收全身性ＯＰ与牙槽骨骨质疏松的一致性尚无定论 ,但大多数学者认为口腔颌骨为全身骨骼的一部分 ,影响全身骨疏松的因素同样影响着颌骨。Ｓｔｒｅｃｋｆｕｓ通过研究证实全身性ＯＰ患者 ,其…     

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提要：骨质疏松患者是否适合进行种植修复，是否会造成种植修复失败，一直以来都是种植临床医生关注的热点。本文对近年来国外围绕种植体成功率与骨质疏松关系的研究进行综述，并对利用口腔曲面断层片进行骨质疏松病情判断进行讨论，为临床和科研工作提供帮助。     

绝经期女性骨质疏松与牙周重度附着丧失的相关性研究

目的研究绝经期女性骨质疏松与牙周重度附着丧失的相关性。方法纳入2017年3月至2018年8月在北京大学国际医院就诊,以及在此期间通过网络招募的50至65岁绝经期女性195例,进行牙周检查、填写调查问卷并接受骨密度检查。牙周检查指标包括:临床附着丧失(clinical attachment loss,CAL)、简化口腔卫生指数(oral hygiene index simplified,OHI-S)、探诊出血阳性位点(bleeding on probing,BOP)百分比[BOP(+)%]。受试者口内牙齿存在CAL≥5 mm的位点不少于3处且位于不同象限时,计为重度CAL。受试者填写调查问卷,内容包括一般身体状况、生活习惯、社会经济背景、婚姻情况、口腔就诊情况和口腔卫生维护情况等。使用双能X线骨密度测量仪检查受试者左侧髋部以及腰椎的骨密度。按照世界卫生组织的标准,当骨密度与年轻白人健康女性骨密度峰值标准差的倍数(T值)≤-2.5时,诊断为骨质疏松。采用卡方检验,对年龄、绝经时间、体重指数、锻炼习惯、家庭收入、婚姻状况、教育程度、口腔就诊习惯、刷牙习惯、牙齿邻面清洁工具的使用、OHI-S、BOP(+)%、髋部骨质疏松、腰椎骨质疏松等14个因素进行初筛,选取P<0.05的因素进行多因素Logistic分析。采用Logistic回归分析评价骨质疏松与牙周重度CAL发生的相关性。结果195例绝经期女性年龄(57.8±4.3)岁,其中有重度牙周CAL者111例(56.9%),骨质疏松者89例(45.6%)。对年龄、家庭收入、口腔就诊习惯、OHI-S、BOP(+)%和髋部骨质疏松6个风险因素的回归分析结果显示,差异有统计学意义的3个因素OR值分别为:髋部骨质疏松(OR=2.466)、OHI-S(OR=2.262)、BOP(+)%(OR=7.274),这3个因素是绝经期女性发生重度CAL的危险因素。髋部骨质疏松的绝经期女性发生牙周重度CAL的风险是无骨质疏松者的2.466倍(P=0.017)。结论髋部骨质疏松的绝经期女性发生牙周重度附着丧失的风险增加。     

口腔黏膜病

RAU病变期外周血细胞免疫功能检测及临床意义,白斑及鳞癌9p微卫星位点改变及与病理的关系,EMS1基因扩增与口腔黏膜癌变的相关研究,糖皮质激素对口腔扁平苔藓辅助性T细胞平衡的影响,口腔白斑和鳞癌中p16基因甲基化的研究[编者按]     

Bisphosphonate-associated osteonecrosis of the jaws 1

Bisphosphonates are generally administered either orally or intravenously. Orally administered bisphosphonates are primarilly used in the treatment of postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and Paget's disease. When orally administered, only about 1% is absorbed from the tractus from the tractus digestivus. With intravenous administration, higher blood levels levels are reached. Intravenously administered bisphosphonates are used in the treatment of hypercalcaemia, Kahler's disease, and bone metastases of other malignancies. A few cases of osteonecrosis of the jaw(s) are seen especially when more powerful bisphosphonates are administered intravenously. This osteonecrosis is most often provoked by means of an invasive oral treatment. Bisphosphonate-associated osteonecrosis is very difficult to treat. Therefore, dental preventive measures and treatment of dental foci and other inflammations are recommended before starting bisphosphonate therapy.     

Role of the oral and maxillofacial surgeon in the diagnosis and treatment of patients with osteoporosis

Because of the increasing prevalence of osteoporosis in the aging population, it is important for oral surgeons to be aware of this condition. Oral health frequently reflects systemic diseases, and calcium loss in the teeth may mirror systemic mineral losses in the skeleton. Chronic health conditions, such as osteoporosis, also may affect surgical outcomes. In the past, therapies of osteoporosis were limited to hormonal replacement therapy and fluoride. Recently, there has been a proliferation of new therapies for osteoporosis that may affect dental health. The association between bisphosphonate use and osteonecrosis of the jaw is of concern. It is important that oral surgeons be aware of the medications a patient is using for the treatment of osteoporosis before initiating any procedure.     

Identification of postmenopausal women at risk of osteoporosis using panoramic and intraoral radiographs ‑ A review

Osteoporosis is one of the most common human bone diseases affecting millions of people, including over one-third of females above the age of 65. Osteoporosis is characterized by decreased bone density and weakened bones. There is evidence that osteoporosis affects the craniofacial and oral structures, although the contribution of osteoporosis in the loss of periodontal attachments, teeth, and height of the residual ridge has not been clearly elucidated. Therefore, the relationship between systemic osteoporosis and oral health is still a complex problem of great interest to a large number of researchers and clinicians. In addition, the dentist could screen patients with unrecognized osteoporosis using information already available in the dental office. The purpose of screening is to identify individuals who are likely to benefit from treatment. The fact that dental radiographs are regularly made on a large fraction of the adult population makes their potential use as a marker of skeletal health an exciting avenue of research. The purpose of this article was to review the use of various intraoral as well as panoramic radiographs to promote early identification of patients at risk for osteoporosis.     

Patients' knowledge and opinions regarding osteoporosis,osteoporosis treatment,and oral health care

BackgroundIn this study, the authors assessed the knowledge and opinions of patients regarding osteoporosis and the associations among osteoporosis, osteoporosis treatments, and oral health care use.MethodsOutpatients with osteopenia or osteoporosis completed a questionnaire, including sociodemographic data, internet use, osteoporosis status, oral health care use status, and knowledge regarding the effect of osteoporosis pharmacotherapy on dental procedures.ResultsAmong 258 patients (mean [standard deviation] age, 68.5 [9.3] years; 93% female), 83.9% had osteoporosis, one-third had previous osteoporotic fracture, and 74.4% took osteoporosis medication, mostly antiresorptive agents. In addition, 66.3% had more than 12 years of education, and 53.9% used the internet daily. A total of 79.9% visited a dentist during the past year, and 29.0% had undergone an invasive procedure. Yet 46.5% estimated that their dentist did not know that they had osteoporosis. Approximately one-half of the participants responded that they did not know the answers to knowledge questions regarding associations between osteoporosis, its pharmacotherapy, and oral health care. Of the patients who answered questions about associations between osteoporosis and oral health care, 70% incorrectly believed osteoporosis increased gingival disease, and 30% incorrectly thought medications should be discontinued before caries restoration.ConclusionsOutpatients with osteoporosis or osteopenia who responded to a questionnaire had limited knowledge about associations among osteoporosis, osteoporotic treatment, and oral health care.Practice ImplicationsDentists should review previous and current medical treatments with their patients, including osteoporosis diagnoses. The medical community should make more efforts to provide balanced, accurate information to help patients prioritize health care treatment and avoid unnecessary interruptions in osteoporosis treatment.     

Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients

Aim: Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. We investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture. Materials and methods: We conducted a cross-sectional study to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019. Results: Of 461 dentists who were sent the questionnaires at their dental clinics, 307 (67%) responded via fax. Of 846 physicians who were sent the questionnaire at their clinics, 378 (45%) responded via fax. Of these, 268 (32%) were finally analysed because 110 (13%) physicians had never treated patients with osteoporosis; 50% dentists and 24% physicians were familiar with the MRONJ position paper in Japan, and 39% dentists and 9% physicians had encountered MRONJ in their clinical practice. A total of 30% physicians had requested oral health care by a dentist before administering bone-modifying agents (BMA) therapy. The knowledge and experience of MRONJ differed between physicians and dentists. Conclusion: The behaviour of physicians and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment in the Shiga prefecture in Japan is documented in this study.     

Osteonecrosis of the jaw: balancing the benefits and risks of oral bisphosphonate treatment for osteoporosis

Osteoporosis is a major public health problem. Oral bisphosphonates are effective for reducing the risk of osteoporotic fractures and are an important treatment option for patients at risk for this condition. Osteonecrosis of the jaw (ONJ) is uncommon among cancer patients who are receiving high-dose intravenous bisphosphonates and rarely is seen among patients who are taking oral bisphosphonates for osteoporosis. Dentists play an important role in discussing the implications of the overall dental and medical treatment plans with both patients and physicians. The low risk of ONJ with oral bisphosphonates should be balanced against the benefits of osteoporosis therapy.     

Osteonecrosis of the jaw and oral bisphosphonate treatment

BACKGROUND: Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. CASE DESCRIPTION: A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic débridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. CLINICAL IMPLICATIONS: Dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.     

Osteoporosis and osteopenia: implications for periodontal and implant therapy

How does low bone mineral density alter treatment decisions? Osteoporosis and osteopenia are major health care issues that may impact on periodontal and implant therapy. Because of the prevalence of osteoporosis, understanding its etiology and the current treatment regimens for patients with low bone mineral density is essential for dental professionals. Millions of patients are now taking medications for the treatment of osteoporosis, and periodontists should be aware of the many medication options that are prescribed. The most frequently prescribed drugs are the bisphosphonates. It is important to be aware that bisphosphonates are not all the same, and patient responses to treatment may vary depending on which bisphosphonates they are taking. Due to recent concerns about bisphosphonate‐induced osteonecrosis of the jaw, this paper provides guidance to help the clinician regarding decision‐making about preventive and interventional dental treatment when their patient has been prescribed a bisphosphonate. An understanding of current bisphosphonates, their uses, their structural differences and their intended actions helps to improve clinical decision‐making. Current knowledge regarding the effects of osteoporosis/osteopenia on periodontal diseases and alveolar bone loss is inconclusive. It is certainly clear that bisphosphonates are not indicated as an adjunctive treatment as part of periodontal therapy because of the risk of osteonecrosis. Regarding implant placement, there are no convincing data that dental implant placement is contraindicated in the osteoporotic patient. However, patients should understand the small risk of compromised bone healing following implant placement if the patient has been taking bisphosphonates. Due to the risks of osteonecrosis, dental clinicians should work closely with their medical colleagues prior to the physician prescribing oral bisphosphonates. Ideally, optimal periodontal and dental health should be established before the patient commences bisphosphonate therapy.