CAJ | 학술논문

在慢性肾脏病矿物质和骨代谢异常早期，颌骨骨膜下骨吸收，牙周硬骨板部分或全部消失，骨密质厚度降低，颏孔、下颌神经管和上颌窦底等解剖结构模糊不清。57.7%行血液透析的肾衰患者出现上颌骨骨质疏松，牙根周围局部骨质硬化，牙周硬骨板减少或消失。终末期肾脏病患儿的龈沟液量和渗透压以及菌斑指数和牙龈指数升高。慢性肾脏病患者口内的牙周致病菌明显升高，罹患牙周病的风险更大。血液透析者的菌斑指数、牙龈指数和牙石指数均明显升高，牙周状况的严重程度会随着透析时间的延长而加剧。慢性肾脏病患者的牙周膜周围出现草酸钙晶体沉积，导致周围骨组织的吸收和破坏，进一步加重牙周组织损伤，引起牙松动和牙根外吸收，最终导致牙缺失。随着慢性肾脏病的进展，牙周膜和牙骨质出现损伤且损伤逐渐加重。在口腔疾病治疗前，口腔医生应与肾脏病医生会诊，以获得疾病的发展状态、治疗方式以及可能引起的并发症和最佳的治疗时机。在口腔疾病治疗过程中，应避免氨基糖苷类和四环素类等肾损害药物的使用。对于血液透析者，口腔疾病治疗应选择在非透析时段，以降低出血的风险。在肾移植术后的前6个月，应避免任何可选择性的口腔疾病治疗。
재만성신장병광물질화골대사이상조기，합골골막하골흡수，아주경골판부분혹전부소실，골밀질후도강저，해공、하합신경관화상합두저등해부결구모호불청。57.7%행혈액투석적신쇠환자출현상합골골질소송，아근주위국부골질경화，아주경골판감소혹소실。종말기신장병환인적간구액량화삼투압이급균반지수화아간지수승고。만성신장병환자구내적아주치병균명현승고，리환아주병적풍험경대。혈액투석자적균반지수、아간지수화아석지수균명현승고，아주상황적엄중정도회수착투석시간적연장이가극。만성신장병환자적아주막주위출현초산개정체침적，도치주위골조직적흡수화파배，진일보가중아주조직손상，인기아송동화아근외흡수，최종도치아결실。수착만성신장병적진전，아주막화아골질출현손상차손상축점가중。재구강질병치료전，구강의생응여신장병의생회진，이획득질병적발전상태、치료방식이급가능인기적병발증화최가적치료시궤。재구강질병치료과정중，응피면안기당감류화사배소류등신손해약물적사용。대우혈액투석자，구강질병치료응선택재비투석시단，이강저출혈적풍험。재신이식술후적전6개월，응피면임하가선택성적구강질병치료。
The early stages of chronic kidney disease-mineral and bone disorders exhibit periosteal bone of jaw bones resorption, complete of partial disappearance ofperiodontal bony plates, thickening of cortical bone reduction, and the appearance of mental foramen, mandibular canal, and maxillary sinus anatomical structures. Periodontal bony plates also decreased or disappeared in 57.7% of hemodialysis patients with renal failure, maxillary osteoporosis, and local root bone sclerosis happened. Gingival crevicular fluid volume, osmotic pressure, plaque, and gingival index increasedin children with end-stage renal disease. Periodontal pathogens in chronic kidney disease patients were significantly higher than that of a healthy person. Thus, the risk of suffering from periodontal disease was higher. Plaque index, gingival index, and calculus index in hemodialysis patients significantly increased, and the severity of periodontal disease exacerbated with prolonged duration of dialysis. The calcium oxalate crystal deposition of periodontal ligament in patients with chronic kidney lead to bone absorption and destruction, further aggravated periodontal tissue damage, loosened teeth, and caused absorption of root outside, which resulted in tooth loss. Periodontal ligament and cementum injury and damage gradually increasedwith the progression of chronic kidney disease. Patients should undergo dental and kidney disease consultation before treatment of oral diseasesto determine the state of the disease, treatment options, complications, and the best treatment time. During the treatment of oral diseases, drugs for kidney damage, such as aminoglycosides and tetracyclines, should be avoided. For hemodialysis patients, treatment of oral diseases should be selected in non-dialysis sessionto reduce the risk of bleeding. Any optional treatment of oral diseases should be avoided in the first six months of renal transplant recipients.