国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (2): 177-185.doi: 10.7518/gjkq.2019003

• 牙周专栏 • 上一篇    下一篇

非牙周病性龈病损

闫凯娴,李纾()   

  1. 山东省口腔组织再生重点实验室 山东大学口腔医院牙周病科 济南 250012
  • 收稿日期:2018-05-17 修回日期:2018-11-20 出版日期:2019-03-01 发布日期:2019-03-15
  • 通讯作者: 李纾
  • 作者简介:闫凯娴,硕士,Email： 2281780725@qq.com
  • 基金资助:
    国家自然科学基金(81271138)

Non-periodontal gingival lesions

Kaixian Yan,Shu Li()   

  1. Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Dept. of Periodontics, Hospital of Stomatology, Shandong University, Jinan 250012, China
  • Received:2018-05-17 Revised:2018-11-20 Online:2019-03-01 Published:2019-03-15
  • Contact: Shu Li
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81271138)

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摘要：

牙龈是众多全身系统性疾病的首发及好发部位,多数患者因牙周病损就诊,却忽略了全身系统性疾病的诊断和治疗。作为牙周病学专科医生应有全局观念,针对患者出现的牙周病损,既要做到对症治疗,也要做到对因治疗,纠正引起牙周病损的全身系统性因素,使牙周病损得以彻底解决。本文将全身系统性疾病所伴发的非牙周病性龈病损,按照常见的“增生、出血、溃疡/糜烂”三大临床表征作一综述。

关键词: 非牙周病性龈病损, 全身系统性疾病, 牙龈增生, 牙龈出血, 溃疡/糜烂

Abstract:

Gingiva is the first predilection site in many systemic diseases. A large number of patients whose chief complaint was periodontal lesions visit periodontists initially, thereby neglecting the diagnosis and treatment of systemic diseases. Periodontists must have comprehensive views for patients with periodontal lesions. It is necessary to achieve both symptomatic and etiological treatments to correct the periodontal lesions caused by systemic factors. Some systemic diseases associated with non-periodontal gingival lesions are reviewed in accordance with the common three clinical features “hyperplasia, bleeding, and ulceration/erosion”.

Key words: non-periodontal gingival lesions, systemic diseases, gingival hyperplasia, gingival bleeding, ulceration/erosion

中图分类号: 

  • R781

表 1

肉芽肿性疾病的临床和组织病理学鉴别要点"

病名 临床特点 病理特点
牙龈 其他部位
化脓性肉芽肿 瘤样增生 唇、颊、舌、腭以及前庭部分增生病变 血管增生性肉芽肿,有时形成溃疡
CD 增生,颜色明显发红,表面呈颗粒状 口腔黏膜线状溃疡、回肠末端局限性肠炎、X线检查肠管狭窄 非干酪化上皮样细胞肉芽肿
结节病 类瘤反应-增生肿胀 唇组织增厚、肿胀,唇颊部可触及结节样肿物;腮腺区肿胀;颈部淋巴结慢性肿大 上皮样细胞结节,中心无干酪化;网状纤维染色可见大量嗜银的网状纤维网架;可见舒曼体
PCG 增生肿大,呈红色,易出血 偶有多发性病变 浆细胞浸润的肉芽肿性病变,可见Russell小体
嗜酸性肉芽肿 似坏死性龈口炎,龈缘坏死并形成肉芽组织 好发于舌,主要表现为边缘不整的黏膜溃疡,可自愈可复发;病损不侵犯骨 嗜酸性粒细胞肉芽肿和泡沫细胞
WG 增生性改变,或者为坏死性肉芽肿性溃疡 坏死性肉芽肿性溃疡好发于软腭及咽部,破坏牙槽骨;早期的呼吸系统症状和晚期肾功能改变;全身发热、消瘦等症状 坏死性血管炎和肉芽肿性炎症
外周性巨细胞肉芽肿 反应性增生病变,为暗紫色肿块 发生于牙槽骨黏膜,暗紫色肿块 肉芽组织内有大量多核巨细胞,毛细血管居多,常见出血灶

表 2

剥脱性龈病损的临床和组织病理学鉴别要点"

病名 临床特点 病理特点
牙龈 其他部位
良性黏膜类天疱疮 水疱、糜烂、溃疡、剥脱 唇颊多见,糜烂、溃疡,全身水疱 基层下疱,浆细胞广泛浸润,卢梭小体,基膜有免疫复合物沉积,呈薄而连续的带
扁平苔藓 剥脱伴白色线网条纹 颊部多见,呈白色网状条纹,其次舌部,浅白斑 基底细胞液化,基膜不清,T细胞呈带状浸润,腺样小体
寻常性天疱疮 水疱不易见,尼氏征阳性 多处黏膜损害,肿胀糜烂 棘层松解,基层上疱,上皮细胞间有免疫复合物沉积
慢性盘状红斑狼疮 糜烂、溃疡伴白色条纹 舌背白色斑块 角化层可有剥脱,固有层血管周围有密集淋巴细胞呈环状浸润,基底膜区有“狼疮带”
龈变性 水肿、肿胀 无 上皮水样变性结缔组织水肿,胶原纤维减少,玻璃样变
剥脱性龈炎 鲜红、剥脱 无 上皮缺乏角化,棘层薄,水样变性,结缔组织水肿,炎症细胞弥漫浸润
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