先天性甲狀腺機能低下症患者的牙科臨床考量－兩個病例報告

Dental Consideration for the Treatment of Patient with Congenital Hypothyroidism-Two Cases Report

陳韋翰(Wei-Han Chen) ； 謝春怡(Chun-Yi Hsieh) ； 施文宇(Wen-Yu Shih)

《臺灣兒童牙醫學雜誌》 21卷3期 (2021/09) Pp. 118-126

https://doi.org/10.6319/TJPD.202109_21(3).0004

摘要

先天性甲狀腺機能低下症（簡稱：先天低甲症）是一種內分泌異常疾病，疾病盛行率約1:3000至1:4000，主要影響患者的生長發育，並可能造成不可逆的智能障礙，顱顏面與口腔部分可能有巨舌、牙齒延遲萌發、前牙開咬、牙釉質生成不全、口呼吸⋯等症狀。本篇病例系列的目標是報告兩位分別是4歲與2歲的先天低甲症女童，因嚴重早發性齲齒前來求診，在擬定牙科整體治療計畫時考慮孩童生長發育、口腔狀況、合作程度與整體健康情形，量身打造個人化的牙科整體治療計畫。4歲女童因齲齒狀況嚴重，且合併有智能障礙，後續安排在全身麻醉下完成治療。2歲女童生長發育正常，且看診配合度佳，在門診以樹脂與不銹鋼牙冠復型齲齒。兩位女童完成療程後皆安排每三個月定期回診，除了追蹤治療成果與生長發育外，同時持續給予家長完善的口腔衛生指導與飲食控制建議，讓家屬能有效維持孩童口腔健康，避免後續再齲齒與齒源性感染的發生。

關鍵字

先天性甲狀腺機能低下症 ； 嚴重早發性兒童齲齒 ； 整體牙科治療計畫

並列摘要

Congenital hypothyroidism (CH) is defined as thyroid hormone deficiency present at birth. The overall incidence is approximately from 1:3000 to 1:4000. CH is linked with mental and growth retardation due to thyroid hormones are essential for growth and development. Macroglossia, delayed eruption, anterior open bite, enamel hypoplasia, mouth breathing etc. are the oral manifestations in CH patients. The aim of this paper is to report the dental treatments for two children with CH who are four and two years old, respectively. They both attended dental service for the first time at outpatient department. After they had been diagnosed with severe early childhood caries, comprehensive dental treatment plans considering four principal aspects (growth and development, patient cooperation, oral conditions, general health status) of oral health care were made. Dental treatment under general anesthesia was arranged for the 4-year-old girl due to her mental retardation and complicated oral conditions. On the other hand, the 2-year-old girl was able to comply with dentists. She received treatment included tooth restoration with composite resin and stainless-steel crown in outpatient department. These two girls had been arranged for dental follow-up every three months after completing the treatment. Aside from tracking the treatment outcomes and their growth and development, oral hygiene reinforcement and diet counseling were consistently provided for their parents. Therefore, they could maintain their children's oral health to prevent caries to occur.

並列關鍵字

Congenital hypothyroidism ； severe early childhood caries ； comprehensive dental treatment planning