国际口腔医学杂志 ›› 2018, Vol. 45 ›› Issue (5): 501-508.doi: 10.7518/gjkq.2018.05.002

• 中青年专家笔谈 • 上一篇    下一篇

妊娠期牙周疾病的防治策略

叶畅畅1(),赵蕾1,王冬青2,王晓丽3,王海燕4,游梦5,黄萍1,吴亚菲1   

  1. 1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院牙周科 成都 610041
    2. 首都医科大学附属北京口腔医院牙周科 北京 100050
    3. 四川大学华西妇女儿童医院妇产科 成都 610041
    4. 上海交通大学医学院附属第九人民医院口腔黏膜科 上海 200011
    5. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院放射科 成都 610041
  • 收稿日期:2018-01-22 修回日期:2018-06-07 出版日期:2018-09-01 发布日期:2018-09-20
  • 通讯作者: 叶畅畅 E-mail:yechang111@163.com
  • 作者简介:·专家简介·
    叶畅畅,讲师,博士,Email:yechang111@163.com
    叶畅畅,主治医生,口腔医学博士。2014年毕业于日本东京医科齿科大学牙周病学专业,现就职于四川大学华西口腔医院,美国加州大学旧金山分校访问学者,中华口腔医学会牙周病专业委员会青年委员。长期从事孕期口腔疾病的诊疗工作和牙周病与不良妊娠结局的相关研究工作,主持国家自然科学基金青年科学基金1项,成都市科技局基金1项。
  • 基金资助:
    国家自然科学基金(81600875);成都市科技局惠民研发项目(2015-HM01-00088-SF);国家卫生和计划生育委员会牙周病科国家临床重点专科建设项目(2010)

The treatment strategy of periodontal disease during pregnancy

Changchang Ye1(),Lei Zhao1,Dongqing Wang2,Xiaoli Wang3,Haiyan Wang4,Meng You5,Ping Huang1,Yafei Wu1   

  1. 1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2. Dept. of Periodontology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
    3. Dept. of Gynaecology and Obstetrics, West China Women’s and Children’s Hospital, Sichuan University, Chengdu 610041, China
    4. Dept. of Oral Medicine, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
    5. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-01-22 Revised:2018-06-07 Online:2018-09-01 Published:2018-09-20
  • Contact: Changchang Ye E-mail:yechang111@163.com
  • Supported by:
    This study was supported by National Natural and Science Foundation of China(81600875);Chengdu Science and Technology Bureau(2015-HM01-00088-SF);National key clinical specialist construction programs of China (2010)

摘要:

妊娠期女性的牙周疾病被证实是不良妊娠结局的危险因素之一,口腔医生对妊娠期女性进行有效的牙周疾病防治,对控制牙周局部及全身炎症,维护妊娠期妇女的口腔健康,预防不良妊娠结局的发生具有重要的临床意义。本文就妊娠期女性牙周疾病的好发原因、治疗原则与方法以及注意事项等作一综述,希望能为妊娠期牙周疾病的临床诊疗提供一些新的思路。

关键词: 牙周病, 不良妊娠结局, 妊娠期药物使用, 牙周治疗

Abstract:

Periodontal disease was a risk factor for adverse pregnancy outcomes. Periodontal treatment during pregnancy will benefit for controlling local and systemic inflammation, even prevent the incidence of adverse pregnancy outcomes. This article reviews the causes, treatment principles and precautions of periodontal disease during pregnancy, hoping to provide some new clinical ideas for the diagnosis and treatment of periodontal diseases during pregnancy.

Key words: periodontal disease, adverse pregnancy outcomes, drugs in pregnancy, periodontal treatment

中图分类号: 

  • R781.4

图 1

牙周炎影响分娩结局的可能机制"

图 2

妊娠期龈炎的治疗1例A:初诊时;B:口腔卫生宣教后1周复诊;C:牙周基础治疗后1周复诊。"

图 3

牙龈瘤导致牙齿松动移位,Nd-YAG激光切除妊娠期牙龈瘤1例A:术前;B:激光切除术中;C:激光切除后1周。"

表 1

口腔治疗中可能涉及的药物及其美国FDA分类"

药物 分级 使用提示
维生素类、枸橼酸类 A:动物实验和临床观察未见对胎儿有损害,是最安全的一类。 可安全使用
青霉素类、部分头孢类、对乙酰氨基酚、甲硝唑、利多卡因 B:动物实验中显示对胎仔有危害,但临床研究未能证实,或动物实验未发现有致畸作用,但无临床验证资料。 有明确指征时慎用
氧氟沙星、阿司匹林、阿替卡因 C:仅在动物研究中证实对胎仔有致畸作用或者杀胚胎作用,但人类研究缺乏资料证实。 在确有应用指征时,充分权衡利弊后决定是否选用
米诺环素、卡马西平、碘制剂 D:临床有一定资料表明对胎儿有危害的迹象,但治疗孕妇疾病的疗效肯定,又无代替之药物,其效益明显超过其危害时,再考虑使用。 避免使用,但在确有应用指征,且患者受益大于风险时选用
利巴韦林 X:动物或人的研究中已证实对胎儿有危害,为妊娠期禁用的药物。 禁用

图 4

孕期口腔问题的理想就诊路径"

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