糖尿病患者的口腔病徵及牙科醫療對策

Oral Manifestations and Dental Treatment in Diabetes Patients

許玲欣(Ling-Hsin Hsu)

《北市醫學雜誌》 2卷9期 (2005/09) Pp. 859-865

https://doi.org/10.6200/TCMJ.2005.2.9.12

摘要

本文回顧並討論糖尿病的口腔病徵。糖尿病的致病原因目前並非全然明瞭，只知糖尿病是一種慢性新陳代謝異常疾病，臨床上最重要的表現是血中葡萄糖濃度過高。高血糖所造成的直接效應是山梨醇(Sorbitol)濃度增加，導致糖尿性視網膜病變、神經病變、腎病變等；間接的效應則可能是因為生成不可逆糖化蛋白質(Advanced glycation end products; AGEs)所造成的傷害，這些衍生物的産生與血中葡萄糖濃度具有直接的關係。糖尿病的口腔併發症包括口乾，細菌、病毒、黴菌感染的機會增加，傷口癒合困難，齲齒、牙齦炎、牙周病等症狀更易出現，甚至於産生牙根尖膿腫。味覺改變、口腔黏膜灼燒感，這些合併症在病情未善加控制的患者可能更嚴重。為提供病患整體診療照護，牙科醫師應提高對糖尿病的警覺，並且提醒患者對自身健康的重視，與內科醫師充分合作，預防勝於治療，以期將併發症減少至最低。

關鍵字

糖尿病 ； 高血糖 ； 口腔併發症狀 ； 牙科醫療

並列摘要

The article reviews the biological basis of oral manifestations of diabetes mellitus (DM). The pathogenesis of diabetic complications is not fully understood. Hyperglycemia can have direct and indirect effects. A direct effect is the increased production of sorbitol, which may lead to the development of diabetic retinopathy, neuropathy and nephropathy. Indirect effects may be due to irreversible molecules called advanced glycation end-products (AGEs). These are glucose-derived compounds that are formed in direct relationship to blood glucose concentrations. The oral complications of diabetes mellitus, particularly when poorly controlled, are numerous and devastating. These complications include xerostomia (dry mouth), an increased susceptibility to bacterial, viral and fungal infections (oral candidiasis), poor wound healing, increased incidence and severity of caries, gingivitis and periodontal disease, periapical abscesses, taste impairment and burning mouth syndrome. The dental professional may be the first to notice early signs of DM, especially since many individuals are undiagnosed. Thorough documentation of medical treatment and glucose levels, including the type of diabetes, medications, frequency of testing and current symptoms, is imperative. Consultation with the treating physician can support the development of a comprehensive treatment plan that meets the patient's specific needs. As part of the health care team, the dentist's goal is to control the patient's diabetes through prevention. Accordingly, the dentist must motivate the patient to maintain glycemic (blood glucose) control in order to minimize the occurrence of oral complications.

並列關鍵字

diabetes mellitus ； hyperglycemia ； oral complication ； dental treatment