职业性牙酸蚀病3例报道

Occupational dental erosion:report of three cases

目的分析职业性牙酸蚀病(ODE)的临床表现与诊断要点。方法收集3例ODE病例的职业病诊断资料进行回顾性分析。结果3例病例均有明确的较长时间酸雾和(或)酸酐接触史,工龄为9.5~17.4年;均出现前牙硬组织损害为主的临床表现,均可排除磨耗、磨损、外伤、牙釉质发育不全、氟牙症、龋齿和楔状缺损等其他牙齿硬组织疾病,并可排除酸性食物、饮料、药物和某些疾病导致的非ODE。2例病例前牙区有两个或两个以上牙齿为二级或三级牙酸蚀,在被判定为疑似ODE后5个月和8年才进入职业病诊断程序,均被诊断为ODE(贰度);1例病例前牙区有两个牙齿为一级牙酸蚀,在被判定为疑似ODE后2周进入职业病诊断程序,被诊断为ODE(壹度)。结论ODE发病具隐匿性,初期症状多不明显,容易被忽视;可根据酸雾和(或)酸酐的职业接触史、病史和临床特征进行ODE诊断和鉴别诊断。

Objective To analyze the clinical features and the key point of diagnosis of occupational dental erosion(ODE).Methods Three cases of diagnosis data of occupational disease of ODE have been collected to analyze retrospectively.Results The three cases had a clear history of long-time exposure to acid fog and/or anhydride,and their working years ranged from 9.5 to 17.4 years.The mainly clinical manifestation was sclerous tissue damage of anterior tooth in above cases.What′s more,abrasion,wear,external injury,enamel hypoplasia,dental fluorosis,dental caries,wedge defect and other diseases of dental sclerous tissues were excluded,and non-ODE due to acidic foods,beverages,drugs,and certain diseases can be excluded.In two of three cases,two or more anterior teeth were identified as secondary or tertiary acid erosion which was suspected-ODE,therefore they applied for the occupational disease diagnosis after five months/eight years,and then they were both diagnosed as ODE(gradeⅡ).The other one was first-degree dental etching,including two teeth in the anterior dental area,who processed the occupational disease diagnosis two weeks after being suspected-ODE and was diagnosed as ODE(gradeⅠ).Conclusion The onset of ODE is insidious,and the initial symptoms are not obvious,which is easy to be ignored.The diagnosis and differential diagnosis of ODE can be distinguished based on the occupational exposure history of acid fog and/or anhydride,medical history and clinical features.