硝苯地平致糖尿病患者牙龈肥大1例报告及文献复习

Nifedipine-induced gingival enlargement in diabetic patient:A case report and literature review

目的:分析硝苯地平导致的糖尿病患者牙龈肥大的临床特点,为伴有系统性疾病的药物性牙龈肥大患者的诊治提供依据。方法:收集1例硝苯地平导致的糖尿病患者牙龈肥大的临床资料,并进行相关文献回顾,总结伴有系统疾病患者药物性牙龈肥大的病因、临床特点和诊治方法。结果:患者,男性,67岁,以牙龈肿胀切除2年后复发就诊。有糖尿病和高血压病史。服用硝苯地平4年。口内检查发现口腔卫生差,牙龈暗红,探诊出血,牙龈肿胀增生超过牙面的2/3,且伴有多颗牙齿不同程度松动。临床诊断为药物性牙龈肥大。首先控制血压和血糖至临床可操作范围,口腔卫生宣教,牙周基础治疗消除炎症,牙龈肿胀明显减轻。基础治疗后仍增生明显的位点采用牙龈切除术和成形术,恢复牙龈的正常形态。全程严格控制菌斑,未更换降压药,随访1年内无复发。结论:伴有系统性疾病的药物性牙龈肥大病因复杂,容易复发。须在控制系统疾病的情况下,行牙周基础治疗,必要时可以采用手术治疗,并辅以长期有效的菌斑控制以防止其复发。

Objective:To analyze the clinical features of gingival enlargement in the diabetic patients caused by nifedipine,and to provide the evidences for the diagnosis and treatment of drug-induced gingival enlargements with systemic diseases.Methods:The clinical materials of one diabetic patient with nifedipine-induced gingival enlargement were collected and the relative literatures were reviewed to summarize the etiology,clinical characteristics and treatment methods of the drug-induced gingival enlargement with system disease.Results:The patient,male,aged 67 years old,admitted hospital because of recurrence after 2 years of resection of gingival swelling.The patient had a history of diabetes and hypertension,as well as the use of nifedipine to control hypertension.Oral examination revealed poor oral hygiene,dark red gums,and bleeding during probing.The swelling of the gingiva exceeded 2/3 of the tooth,and there were varying degrees of mobility in many teeth.The clinical diagnosis was drug-induced gingival enlargement.First the blood pressure and blood glucose were controlled to the clinically operable range,oral hygiene education was performed,the periodontal basic therapy was done to eliminate inflammation,and gum swelling was significantly reduced.Gingival resection and gingivalplasty were used to restore the normal shape of the gums at the sites where the hyperplasia was still apparent after basic treatment.The plaque was strictly controlled throughout the procedure,no antihypertensive drugs were replaced,and there was no relapse within one year.Conclusion:The etiology of drug-induced gingival enlargement with systemic diseases is complex and easy to relapse.Initial periodontal therapy should be performed under the condition of controlling the systemic diseases.Surgery can be used if necessary,and long-term effective plaque control is a powerful measure to prevent the occurrence and recurrence of drug-induced gingival enlargement.