Hitomi Nishizaki, Yoshinari Morimoto, Yamada Shin-Ichi, Kurita Hiroshi, Tanaka Akira, Yamaguchi Akira, Miyata Masaru, Yoshikawa Hiromasa, Yanamoto Souichi, Imai Yutaka
Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University.
The survey and research-planning committee, Japanese Society for Dentistry of Medically Compromised Patient.
Acta Med Okayama. 2021 Apr;75(2):115-123. doi: 10.18926/AMO/61877.
The aim of this study was to investigate the awareness and experience, among dental practitioners, of adverse events resulting from dental treatment of patients undergoing therapy with drugs that affect the immune system [angiogenesis inhibitors, biological agents, immunosuppressants, and disease-modifying anti-rheumatic drugs (DMARDs)]. For this purpose, a nationwide questionnaire survey was conducted. Questionnaires were sent to 2,050 dentists, of which 206 (10.1%) were completed and returned. The results showed that most dentists were aware of complications associated with dental treatment of patients treated with drugs that affect the immune system, and about half had actually experienced such complications. Delayed wound healing, osteonecrosis of the jaw (ONJ), and postoperative infections were reported. Whereas approximately 50% of dentists did not discontinue the drugs during dental treatment, about 18% did. During temporary drug discontinuation, some patients experienced aggravation of the primary disease, such as worsening of rheumatism, growth of tumors, and rejection reactions of transplanted organs. As for medical cooperation, only less than half of the dentists were asked for oral hygiene management by a physician prior to starting the drug treatment. Prospective studies are needed because evidence for dental treatments in patients treated with these drugs remains limited.
本研究的目的是调查牙科从业者对接受影响免疫系统药物（血管生成抑制剂、生物制剂、免疫抑制剂和改善病情抗风湿药[DMARDs]）治疗的患者进行牙科治疗所导致不良事件的认知和经验。为此，开展了一项全国性问卷调查。问卷被发送给2050名牙医，其中206份（10.1%）被填写并返回。结果显示，大多数牙医知晓与接受影响免疫系统药物治疗的患者进行牙科治疗相关的并发症，约一半牙医实际经历过此类并发症。报告了伤口愈合延迟、颌骨骨坏死（ONJ）和术后感染。约50%的牙医在牙科治疗期间未停用药物，约18%的牙医则停用了药物。在暂时停药期间，一些患者出现了原发疾病的加重，如风湿病恶化、肿瘤生长和移植器官的排斥反应。至于医疗合作，在开始药物治疗前，只有不到一半的牙医被医生要求进行口腔卫生管理。由于这些药物治疗患者的牙科治疗证据仍然有限，因此需要进行前瞻性研究。
