麻风患者的口腔及颌面部损害

Oral and Maxillofacial Deformity in Leprosy

对广东省8所麻风院村1155名(现症237名,治愈留院918名)病人进行口腔颌面7个方面38项检查,其中男911名,女244名;年齿15～90岁,平均55.7岁。多菌型842名,少菌型308名,类型不详者5名。1155人中面容受损者994人(86.1％);面部感觉障碍者483人(41.8％),面部上2/3感觉障碍多于下1/3,此两项损害均为病程愈长损害率愈高。眶上神经粗大333人(28.8％),其中兼有感觉障碍者110人,占神经粗大者的33％。接受微安电流牙髓神经感觉测试者770人,无反应者291人(37.8％),多菌型中无反应者232人(41.1％),少菌型中59人(29.2％),P>0.01,其临床及诊断意义有待进一步探讨。口腔内组织实质性破坏多表现在腭部,多菌型中109人(12.9％),少菌型16人(5.2％),P>0.01。麻风患者口腔卫生欠佳,患龋率为84.5％,龋均5.23颗,牙周病检出率为76.8％,牙齿丧失率为69.5％,平均缺牙7.7颗,与正常人比较均偏高,可能是由于被隔离而失去了求治牙病的条件及口腔科专业人员忽视了对他们的关心。作者认为对麻风患者牙功能的重建应属麻风康复工作的内容之一。

The purpose of this study was to inves- tigate the oral and maxillofacial destruc- tion caused directly or indirectly by lep- rosy and to formulate suggestions for dental-occlusal rehabilitation of the lep- rosy patientss.1155 cases were examined; multibacillary 842, paucibacillary 308 and 5 cases uncertain, with age ranging from 15 to 90. The average age was 55.7. 994 cases (86.1%) were found with disfigured face and 483 cases (41.8%) suffered from sensory impairment of various-sized areas on the face. A μamp electric dental pulp test was carried out for 770 cases, in which 233 cases (30.2%) showed retarded pulp rection and 291 (37.8%) no reaction.Mul- tibacillary cases, had a higher occurrence of retarded and noreaction than paucibacillary (P>0.01) . The diminishing pulp reaction to the electric pulp test in leprosy pati- ents has not been previously reported. The gross destruction of oral tissues was pre- dominantly on the palate and was always found along the midline. The statistical significance of the occurrence in the mul- tibacillary vs. paucibacillary patients was P<0.01. The oral hygiene was generally poor. Caries prevalence rate was 84.5% and the mean carious teeth per person was 5.23. Periodontal disease was found in 837 cases (76.8%) . The tooth mortality score was 69.5% and the mean tooth-loss per person was 7.7 teeth.According to the data gained from this pilot examination, 50% of pa- tients need operative dental work,72% need periodontal treatment and 67% need pros- thodontic restoration. The authors suppose that the poorr dental condition of leprosy a tients is due t o segregation and neglect by the dental profession.