唇腭裂患者的牙周健康状况及其影响因素

Periodontal status and its influencing factors in patients with cleft lip and palate

健康的牙周条件是维持口颌系统健康的必要条件,研究显示:唇腭裂裂隙区易发生深层的牙周破坏,罹患牙龈炎和牙周疾病,唇腭裂人群的牙周疾病进展风险更高,裂隙侧较非裂隙侧更易发生牙周组织破坏;唇腭裂患儿的口腔卫生情况和平均牙龈指数明显差于健康儿童;单侧和双侧唇腭裂患者均存在明显的菌斑积聚和牙龈出血;唇腭裂患者的菌斑积聚量和牙龈炎的发生率高于健康人群,双侧唇腭裂患者的菌斑积聚量又高于单侧唇腭裂患者,裂隙侧的菌斑指数高于非裂侧,裂隙侧的牙周探诊深度大于非裂侧;唇腭裂患者常伴有的角化龈减少、牙龈退缩、牙龈炎症和牙槽骨高度降低等牙周软硬组织问题,都有可能影响牙周健康状况;唇腭裂患者假丝酵母菌的定植率明显高于健康者,尤其是接受过3次以上手术和双侧唇腭裂患者的假丝酵母菌定植率最高;裂隙区植骨术是一种改善牙槽嵴形态和增加骨量的方法,植骨术有利于牙周状况的改善,为裂隙邻牙提供健康的牙周支持组织,裂隙区牙龈炎症的发生率也明显降低。本文就唇腭裂患者的口腔卫生和牙周健康状况及其影响因素作一综述。

Healthy periodontal condition is a requirement for maintaining a healthy stomatognathic system. Studies have shown that the cleft areas in patients with cleft lip and palate（CLP） are prone to deep periodontal destruction, gingivitis, and periodontal disease. Individuals with CLP are at a high risk for periodontal disease progression, and the cleft sides tend to exhibit more periodontal tissue destruction compared with the noncleft sides. Children with CLP have poor oral hygiene and worse average gingival index compared with normal controls. Patients with unilateral and bilateral CLP（UCLP and BCLP） exhibit signifi cant plaque accumulation and gingivitis bleeding. The prevalence of plaque accumulation and gingivitis is higher in patients with CLP than in controls, and plaque accumulation is signifi cantly higher in patients with BCLP than in patients with UCLP. The cleft sides present a higher plaque index and probing depth than the noncleft sides. Periodontal problems in soft and hard tissues have often been reported in patients with CLP. Such problems include reduced keratinized gingiva, gingival recession, gingival infl ammation, and decreased alveolar bone height, and all of which can affect the periodontal status. The colonization rate of Saccharomyces in patients with CLP is signifi cantly higher than in healthy control subjects and is highest in patients with CLP who had undergone at least three surgeries and in patients with BCLP. Grafting an alveolar bone to the cleft area is a method to improve the alveolar morphology and increase bone mass. This method helps improve the periodontal status and provides healthy periodontal support for the teeth adjacent to the cleft. The incidence of gingival infl ammation is also reduced. Therefore, the aim of this study is to summarize the oral hygiene and periodontal status, including its influencing factors, of patients with CLP.