Shibukawa Yoshihiro, Fujinami Koushu, Yamashita Shuichiro
Division of Conservative Dentistry, Department of Clinical Oral Health Science, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan.
Bull Tokyo Dent Coll. 2012;53(2):91-9. doi: 10.2209/tdcpublication.53.91.
In this case report, we describe the clinical course over a 14-year follow-up in a 47-year-old diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth. The patient had a history of hypertension for over 5 years and uncontrolled type 2 diabetes. Overgrown gingiva was observed in most of the teeth and was marked in the upper and lower anterior teeth. A probing pocket depth of ≥ 4 mm and bleeding on probing (BOP) were observed in 94 and 90% of sites examined, respectively. At baseline, his hemoglobin A1c (HbA1c) was 8.5%. The patient received periodontal and diabetic treatment simultaneously. Medication was changed from nifedipine chloride to an angiotensin-converting enzyme inhibitor. After initial therapy and subsequent periodontal surgery, gingival overgrowth disappeared and probing depth and BOP showed a significant improvement. No recurrence was observed during supportive periodontal therapy (SPT). The HbA1c level improved from 8.5 to 6.3% after periodontal treatment, subsequently remaining at a good level during SPT over 10 years. This study demonstrated that periodontal treatment, withdrawal of medication and control of diabetes can result in remarkable improvements in type 2 diabetes patients with chronic periodontitis and nifedipine-induced gingival overgrowth. These results suggest that comprehensive periodontal treatment in combination with treatment for diabetes mellitus can exert a positive influence on blood glucose levels and periodontal condition in diabetic patients.
在本病例报告中，我们描述了一名47岁患有重度慢性牙周炎和硝苯地平引起的牙龈增生的糖尿病患者14年随访期间的临床病程。该患者有5年以上的高血压病史且2型糖尿病控制不佳。在大多数牙齿上观察到牙龈增生，在上、下前牙处尤为明显。在检查的部位中，分别有94%和90%观察到探诊深度≥4mm和探诊出血（BOP）。基线时，他的糖化血红蛋白（HbA1c）为8.5%。该患者同时接受了牙周治疗和糖尿病治疗。药物从硝苯地平改为血管紧张素转换酶抑制剂。经过初始治疗和随后的牙周手术，牙龈增生消失，探诊深度和BOP有显著改善。在支持性牙周治疗（SPT）期间未观察到复发。牙周治疗后，HbA1c水平从8.5%改善至6.3%，随后在超过10年的SPT期间一直保持在良好水平。本研究表明，牙周治疗、停药和控制糖尿病可使患有慢性牙周炎和硝苯地平引起的牙龈增生的2型糖尿病患者有显著改善。这些结果表明，综合牙周治疗与糖尿病治疗相结合可对糖尿病患者的血糖水平和牙周状况产生积极影响。
