肿瘤患者牙周炎治疗方案的选择

Treatment decision for periodontal patients with history of cancer

由于放疗或化疔会改变牙周愈合过程，降低牙周组织的修复能力，可导致附着丧失、牙槽骨吸收增加，从而使原有病灶加重，因此牙周治疗前必须进行口腔筛查，目标是尽可能去除口腔内的感染灶、稳定口腔环境、预防并减少肿瘤治疗后的并发症。同时伴放疗、化疗治疗史的肿瘤患者因其全身状态的特殊性，并且从肿瘤诊断到放疗、化疗间隔时间短，牙周治疗前必须进行全身状况的评估，确定患者的耐受能力，牙周治疗以保守治疗为主，同时拔牙的适应证可适当放宽。

Radiotherapy and chemotherapy might change the healing process of periodontal disease by reducing there storability of the periodontal tissues, leading the increase of attachment lose and alveolar bone absorption. The primary periodontal lesions could be aggravated. Therefore, oral screening should be conducted before periodontal treatment, in order to eliminate dental focal infection, to stabilize the oral environment and to prevent and reduce complications after cancer treatment. The patient＇s general situation should be evaluated before the periodontal treatment too, so as to ensure the patient could tolerate the radiotherapy and chemotherapy in the short interval between diagnosis and treatment of cancer. The periodontal treatment should be more conservative than normal periodontal patients. The indication for tooth extraction in these patients should be less conservative.