臨牀透析 Vol.27 No.6(1-1)


特集名 透析患者の歯科領域疾患
題名 [序論]透析患者における口腔疾患の多発と重症化
発刊年月 2011年 06月
著者 永田 俊彦 徳島大学大学院ヘルスバイオサイエンス研究部歯周歯内治療学分野
【 要旨 】 透析患者は歯周病や口腔乾燥など多くの口腔疾患を抱えている.これらの口腔疾患は歯の喪失および咀嚼障害を招き,生活の質(QOL)を低下させるだけでなく全身状態を悪化させる原因となる.とくに糖尿病を合併している場合には,歯周病の炎症因子がインスリン抵抗性を亢進することがある.透析患者は一般に高齢であり服用薬剤も多いため,加齢や薬剤に関連した口腔疾患が発現しやすく,重症化しやすい.ニフェジピンやシクロスポリン誘発性歯肉増殖症やビスフォスフォネート製剤関連顎骨壊死は,いずれも薬剤副作用によって発現する重篤な口腔疾患である.口腔疾患と全身疾患を予防するために,透析患者では口腔ケアがとくに重要である.
Theme Oral Diseases and Oral Care in Dialysis Patients
Title Occurrence and progression of oral diseases in dialysis patients
Author Toshihiko Nagata Department of Periodontology and Endodontology, Institute of Health Biosciences, The University of Tokushima Graduate School of Oral Sciences
[ Summary ] Dialysis patients have many dental complications such as periodontal disease, xerostomia, and taste disorders. These complications induce tooth loss and mastication disorders, resulting in reduced quality of life and aggravation of systemic conditions. Periodontal diseases affect systemic conditions. In diabetes patients with periodontitis, inflammatory factors such as TNF-α and IL-1β may be a cause of increased insulin resistance. It is reported that periodontal therapy may actually decrease HbA1c levels in diabetes patients. Since dialysis patients are likely to be elderly and receiving ongoing medications due to complications, age-related and drug-associated oral diseases frequently occur. In general, the number of dental caries and frequency of periodontal disease increase with age and are more severe in dialysis patients. It is possible that drug induced gingival overgrowth, a side effect of nifedipine and cyclosporine-A treatment, may occur in dialysis patients with hypertension and/or immune diseases. Bisphosphonate related osteonecrosis of the jaw (BRONJ) is also a serious disease observed in oral tissues. Oral care is very important for dialysis patients to prevent oral and systemic diseases.
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