儿童常见口腔黏膜病药物治疗浅析

多种类型的口腔黏膜病均可发生于儿童,常见的儿童口腔黏膜病包括:口腔黏膜感染性疾病、口腔黏膜溃疡类疾病及地图舌等。儿童作为一个特殊的群体,处在不断的生长发育过程中,许多脏器尚未发育成熟,肝、肾的解毒、排泄功能还不完善,在药物的应用方面与成人有所区别,处于不同年龄段的儿童对药物的反应也不尽相同。本文就儿童常见口腔黏膜病用药及注意事项进行分析和探讨。     

妊娠期和哺乳期患者的口腔卫生保健

妊娠期和哺乳期患者为口腔卫生保健工作者提出了一系列独特的管理问题。临床医师有责任为妊娠母亲提供安全有效地护理．同时应考虑到胎儿或者新生儿的安全。还要考虑到药物的影响．有些药物能从母体的血浆通过胎盘扩散到胎儿体内．或者分布到乳汁中，达到潜在的危险浓度．影响母乳喂养的婴儿。另外，有些母亲口腔状况的改变，可能是妊娠期一系列生理改变的结果．这些改变需要引起口腔医师关注。考虑到临床口腔医师在诊治妊娠期或哺乳期患者时要负的双重责任．因此熟悉妊娠生理学．胎儿的发育过程、孕妇潜在的口腔问题以及牙科干预（治疗）对孕妇和胎儿或者婴儿的影响是必要的     

妊娠期口腔疾病患者的治疗

随着医疗保健知识的普及,很多人认识到牙周炎等感染性疾病可致胎儿发育异常甚至流产。目前,越来越多的准备怀孕的女性主动到口腔诊室进行潜在牙病处理及口腔保健。怀孕后发生的一系列生理变化,可引发或加剧口腔疾患,并在妊娠各时期出现。对于孕妇的常规口腔疾病治疗,国内传统观点与国外最新观点在检查、治疗、预防宣教等多方面存在不同。口腔医生如何评价孕妇和胎儿的生理指标？在保证孕妇和胎儿安全前提下,如何提供口腔疾病的有效救治？本期争鸣栏目邀请以下几位专家,就妊娠期患者口腔疾病治疗时机的选择、诊疗方案的确定以及孕婴生理指标的评价进行探讨。     

妊娠期口腔急症的临床考量

妊娠期是口腔疾病患病和治疗的特殊时期,妊娠期发生的口腔急症需得到恰当的处置。一方面,孕妇生理环境、个人习惯的改变增加了部分口腔疾病的易患性;另一方面,为了保证孕妇和胎儿安全,临床治疗策略局限。孕妇应掌握口腔健康知识、增强口腔保健意识。口腔医生应在“孕前预防,孕期治标,孕后治本”的原则下,根据不同的妊娠时期制定合适的治疗方案,以最安全、简单、有效的手段控制急症、防止疾病进展,避免对孕妇和胎儿的不良影响。防治结合,让孕妇和口腔医生共同维护妊娠期口腔健康。本文围绕妊娠期治疗原则,对妊娠期口腔急症治疗的时机选择、临床管理和不同疾病的治疗策略等进行了总结。     

北京市口腔医师对孕期用药的认知和行为调查分析

目的: 了解北京市口腔医师对孕期用药的认知和行为,并分析其影响因素。方法: 以北京市医疗机构在职口腔医师259名为研究对象,进行横断面调查。采用SAS 9.4软件包中的精确计算法计算口腔医师对孕期用药安全的知晓率和相关药物的使用率,采用二元Logistic回归探讨口腔医师孕期用药安全认知的影响因素。结果: 口腔医师对孕期各项用药安全认知正确率为1.93%~57.92%,合计得分超过8分的比例仅达10.42%（满分16分）。此外,口腔医师在孕期开具、使用各项药品比例普遍较低（2.8%~27.09%）。结论: 北京市口腔医师对孕期用药相关知识了解相对不足,需加强医务人员的继续教育,行业内应尽早出台统一的治疗指南。     

口腔黏膜病抗菌药物应用分析

目的:分析口腔黏膜病治疗中抗菌药物的应用现状及趋势。方法:抽取上海交通大学医学院附属第九人民医院口腔黏膜科2011~2013年抗菌药物使用量及药费等数据,采用限定日剂量法来分析抗菌药用药频度、日均药费,并对各类抗菌药物使用情况进行分析。结果:抗菌药物费用占总药费比重较低,每年比重均小于2%;头孢呋辛酯、甲硝唑、氟康唑是口腔黏膜病的常用抗菌药物,最常用抗菌药物为头孢呋辛酯。结论:抗菌药物占口腔黏膜病用药比重较低,2011~2013年各大类抗菌药物比重变化不大,常用抗菌药物即可满足口腔黏膜病的临床需要。     

口腔念珠菌病的规范化诊断理念与防治策略

口腔念珠菌病是口腔黏膜最常见的感染性疾病, 其临床表现多样, 类型各异。目前, 临床上口腔念珠菌病的诊断常缺乏必要的病原学证据, 抗真菌药物不当或过度使用的情况屡见不鲜, 该病的诊断与治疗需引起口腔医师的足够重视。本文将结合近年口腔念珠菌病微生物学诊断技术进展及国内外诊疗指南更新, 重点解读规范化诊疗理念, 以期为口腔念珠菌病的科学诊断、合理用药及精准防治策略制订提供参考。     

309例口腔扁平苔藓患者药物依从性与饮食依从性调查分析

目的:探讨口腔扁平苔藓患者药物依从性和饮食依从性,分析其影响因素.方法:采用横断面取样,使用自制问卷调查表以及Morisky量表收集309例口腔扁平苔藓(OLP)患者的数据信息,采用SPSS16.0软件包对数据进行统计学分析.结果:口腔扁平苔藓患者饮食依从率为89％,药物依从率为55.02％.与患者的饮食依从性相关的因素为对疾病的认知水平和不良饮食习惯,未发现与药物依从相关的因素.阻碍患者遵医用药的3大原因分别是药物使用不便、忘记用药以及担心药物的副作用.结论:患者治疗依从性受多种因素的影响,需要政府、医务工作者及患者共同努力,建立有效的口腔扁平苔藓患者疾病管理机制.     

复发性口疮的药物治疗

复发性口疮是口腔黏膜病中最常见的溃疡类疾病,病因复杂,存在明显的个体差异.对于复发性口疮,目前首选药物治疗.本文对临床上常用的局部用药和全身用药做一介绍.     

姜黄素介导光动力治疗口腔感染性疾病的研究进展

姜黄素是一种天然药物,来源广泛、毒性低,具有抗细菌、抗真菌、抗炎等多种药理作用.近年来,姜黄素在口腔感染性疾病防治领域备受关注.单一姜黄素在应用中易降解、水溶性差、生物利用率较低,但它可作为一种天然光敏剂,可介导光动力治疗口腔感染性疾病.光动力治疗抗菌效率高,可较好地保护患处的美观和功能.本文就姜黄素介导光动力治疗口腔...     

Drug therapy for the pregnant dental patient

Providing needed dental treatment, managing oral infection, and controlling pain are essential functions of dentists for helping patients maintain overall health during pregnancy. Medications commonly required for dental care consist of local anesthetics and associated vasoconstrictors, centrally and peripherally acting analgesics, sedative and anxiolytic agents, and antibiotics. Therapeutic drugs routinely used in dental practice are selected because of their known safety and effectiveness. However, for a pregnant patient requiring dental care, the agents routinely prescribed should be reevaluated for potential risks to the mother and/or fetus. The decision to administer a specific drug requires that the benefits outweigh the potential risks of the drug therapy. This article reviews and updates the recommendations for using dental therapeutic agents, thereby enabling general practitioners to select the safest drugs when treating pregnant dental patients.     

Drug interactions: COMT inhibitors

To reduce the incidence of adverse drug interactions during dental treatment, always consult drug references when an unfamiliar drug is detected via the health history. It is crucial to understand the effects of a patient's preexisting disease and the medications used to treat it and their implications on dental therapy.     

Managing patients on warfarin therapy: a case report

Coagulotherapy is a common therapeutic regimen most frequently utilizing warfarin. This therapy may have important dental ramifications. An understanding of the mechanisms of action and drug interactions may help avoid problems. Questions commonly arise as to what dental procedures may be safely considered when a patient is on anticoagulant therapy. The coagutherapy level is measured in values of the International Normalized Ratio (INR). Any question about the appropriateness of dental procedures should be referred to the physician prescriber of the anticoagulant therapy. Generally, controlling bleeding is less of a problem than the management of thrombi and vascular occlusion from decreased coagutherapy. A case is presented in which the INR reached a critical value as the result of drug interactions and miscommunication.     

Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system

BACKGROUND: Little is known about the use of dental services during pregnancy. Yet research suggests that a pregnant woman's oral health and her pregnancy outcome may be associated. METHODS: Four states collected oral health data a part of the Pregnancy Risk Assessment Monitoring System, or PRAMS, in 1998. PRAMS is an ongoing, population-based survey designed to obtain information from mothers who recently delivered live-born infants about their experiences and behaviors before, during and immediately after pregnancy. RESULTS: Reports of dental care use during pregnancy ranged from 22.7 to 34.7 percent. In three states, 12.2 percent to 25.4 percent of respondents reported having a dental problem and of these, 44.7 percent to 54.9 percent went for care. Among mothers reporting a dental problem, prenatal care, or PNC, insurance through public funding and late PNC entry were significantly associated with their not getting dental care. CONCLUSIONS: Most mothers did not go for dental care during their pregnancy; among those who reported having problems, one-half did not get dental care. PRACTICE IMPLICATIONS: Attention toward the oral health needs of pregnant women is warranted. A coordinated effort from the dental and obstetric communities to establish guidelines could benefit maternal oral health and perinatal outcomes.     

Dental treatment planning and management in the patient who has cancer

The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.     

Methotrexate and oral ulceration

Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can occur as a side effect of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Illustrations of these problems, which have initially presented in a dental setting, are given. Important drug interactions of methotrexate relevant to dentistry are discussed.     

Adverse drug interactions in dental practice: interactions associated with local anesthetics, sedatives and anxiolytics. Part IV of a series

BACKGROUND: This article is the fourth in a five-part series based on a 1998 International Association for Dental Research symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts." The symposium evaluated the significance of various drug interactions associated with dental therapeutics. METHODS: Local anesthesia and preoperative oral sedative/anxiolytic therapy often are indicated for routine oral surgery and restorative dentistry. The author conducted a literature review of the drug interactions associated with the use of local anesthetics and sedatives. The quality of the information used to document these interactions and the severity of the possible adverse outcome were assessed using a significance rating scale for dental drug interactions. RESULTS: Many of the frequently described drug interactions were found to be poorly documented in the dental and medical literature. Others were determined not to be relevant to current dental practice. The use of local anesthetics, sedatives or anxiolytic agents in combination with other central nervous system depressant agents or in combination with drugs that inhibit their metabolism was associated with a few serious adverse drug interactions or complications. CONCLUSIONS: The adverse drug interactions associated with the use of local anesthetics and oral sedative/anxiolytic agents in general practice vary in significance. An understanding of possible adverse drug interactions in dentistry may help practitioners avoid and prevent these complications.     

Migraine drug therapy: dental implications

Triptan drugs continue to constitute the major pharmacotherapeutic interventional agents for migraine therapy. Interactions of dental drugs with migraine medications are limited, but their seriousness dictates that dentists be aware of the use of ergot alkaloids, triptans, or other migraine drugs. While many migraine sufferers avoid dental therapy dur ing migraine attacks, the practitioner who is treating a patient who has taken migraine medications must carefully monitor the cardiovascular status of the patient, which may affect the use of vasoconstrictors. Macrolide antibiotics and azole antifungals represent additional drug groups that are prescribed by dentists but which may potentiate the adverse effects of migraine drugs. Migraine patients prefer agents that offer rapid onset of relief and total relief within a couple hours of drug administration; they also prefer therapy that prevents recurrences and does not require "rescue" medications, and, of course, a lack of adverse effects and interactions with other medications. Currently, no single drug or class of drugs offers this ideal combination of actions in all patients.     

Physiologic and pharmacologic factors related to the provision of dental care during pregnancy

During pregnancy, numerous physiologic changes occur that allow the mother to accommodate the needs of the developing fetus. Oral health care professionals should be knowledgeable about these changes and the impact they have on the safe provision of prophylactic and therapeutic dental care to pregnant women. Herein, the authors describe maternal physiologic adaptations and discuss changes in drug processing and placental drug transfer in order to enhance the knowledge base of oral health care professionals.