Lucas Victoria S, Roberts Graham J
Unit of Paediatric Dentistry, Division of Microbial Diseases, Eastman Dental Institute For Oral Health Care Sciences, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK.
Pediatr Nephrol. 2005 Oct;20(10):1388-94. doi: 10.1007/s00467-005-1929-2. Epub 2005 Jun 10.
As a consequence of chronic renal failure (CRF) and its treatment, a number of oro-dental changes occur that persist after the end-stage is reached. An early effect is enamel hypoplasia due to a defect of enamel development and mineralisation. This is usually reparable to a high aesthetic standard using dental composite filling material. Children with CRF have significantly less dental caries than healthy children due to the inhibitory effect of increased salivary urea levels. Grafted patients frequently develop gingival enlargement as a result of immunosuppression with cyclosporine A, which is further exacerbated by the additional use of antihypertensive calcium-blocking agents. Surgical reduction of gingival hyperplasia is effective and is required in approximately one third of adolescents. A very high standard of home care should be encouraged for all children with CRF in the form of thorough mechanical tooth cleaning and plaque inhibition through the use of an antibacterial mouthwash. In transplanted children presenting an increased risk of infection, antibiotic prophylaxis may be indicated for dental treatment procedures. The drug dosage should be adapted to the reduced renal function. Pediatric nephrologists should be aware that dental surgeons can make a considerable contribution to the general health and well-being of children with CRF. Thus, only oro-dental problems that are mainly encountered and treated by dental surgeons are reviewed.
作为慢性肾衰竭（CRF）及其治疗的结果，会出现一些口腔牙齿变化，这些变化在进入终末期后依然存在。早期影响是由于牙釉质发育和矿化缺陷导致的牙釉质发育不全。使用牙科复合填充材料通常可以将其修复至较高的美学标准。由于唾液尿素水平升高的抑制作用，CRF患儿的龋齿明显少于健康儿童。移植患者经常因使用环孢素A进行免疫抑制而出现牙龈增生，额外使用抗高血压钙阻滞剂会使这种情况进一步恶化。约三分之一的青少年需要进行手术来减少牙龈增生，这种手术是有效的。对于所有CRF患儿，都应鼓励以彻底的机械性牙齿清洁和使用抗菌漱口水抑制牙菌斑的形式进行高标准的家庭护理。对于存在感染风险增加的移植儿童，牙科治疗程序可能需要使用抗生素预防。药物剂量应根据肾功能减退情况进行调整。儿科肾病学家应意识到，牙科医生可为CRF患儿的总体健康和福祉做出重要贡献。因此，本文仅回顾主要由牙科医生遇到和治疗的口腔牙齿问题。
