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題 名 | Oral Manifestations of Vitamin D-Resistant Rickets--Case Report=維生素D抗性佝僂病的口腔表徵--病例報告 |
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作 者 | 楊鵑旭; 陳和錦; 楊曜旭; | 書刊名 | 中華牙醫學雜誌 |
卷 期 | 16:4 1997.12[民86.12] |
頁 次 | 頁250-255 |
分類號 | 416.94 |
關鍵詞 | 維生素D抗性佝僂病; 口腔徵象; 牙科治療; Vitamin D-resistant rickets; Oral manifestations; Dental management; |
語 文 | 英文(English) |
中文摘要 | 維生素D抗性佝僂病通常是以X染色體性聯方式遺傳,但是也有偶發的病例。這種 病因為基因的缺陷,導致腎臟對磷酸鹽再吸收功能的降低,使血磷酸鹽過少。血清中過低的 磷酸鹽影響牙齒、骨骼的鈣化,而在臨床上表現出種種特殊症狀。 維生素 D 抗性佝僂病最 主要的牙科徵象是象牙質鈣化不全、過大的牙髓腔及較薄的琺瑯質,而導致臨床上與蛀牙無 關的多發性、自發性根尖膿腫的症狀。本篇報告一個 8 歲小女孩病患,在她 2 歲時因持續 性側彎的下肢及搖擺不穩的步行姿態而住院檢查, 經相關血液、尿液、生化及 X 光檢查, 診斷為維生素 D 抗性佝僂病。病患家族中並沒有罹患佝僂病的病史。這名小病患 2 歲開始 持續接受小兒科藥物治療,並斷斷續續接受牙科口腔衛教、洗牙、局部塗氟、填補窩隙封劑 等防蛀處理, 但仍於 3 歲 10 個月時乳牙左上正中門牙及左下第一大臼齒有自發性根尖膿 腫出現。 4 歲 6 個月時乳牙左上側門牙也產生膿腫,而 5 歲 5 個月時乳牙右上正中門牙 也出現根尖膿腫,經由牙髓切除術加上補綴處理後,這些症狀都已得到緩解。 但在 5 歲 6 個月時, 已於 3 歲 10 個月作完牙髓切除術的乳牙左上正中門牙,又有再發性膿腫出現, 經由切開引流與投與抗生素,症狀得到緩解。 5 歲 6 個月到目前為止,沒有其他病理學上 的發現。 維生素 D 抗性佝僂病的病患,在牙科處理上首重蛀牙的預防,其次運用咬合板避 免齒質磨損,也是預防牙髓壞死產生根尖膿腫的方法之一,對於已產生的膿腫,根管治療加 上後續牙冠�G復,臨床上可得到令人滿意的結果。 |
英文摘要 | Vitamin D-resistant rickets (VDRR) is inherent mainly in an X-linked mold, but sporadic cases have been reported. The defects in the proximal tubular reabsorption of phosphate leading to hypophosphatemia. The low levels of serum phosphate contribute to defective calcification of bone, cartilage and teeth. In VDRR, the basic dental defect is manifested in dentin, including large pulps, and thin enamel. The characteristic clinical feature is multiple "spontaneous" dental abscess formation. We report a 8-year-old girl. She was hospitalized at age 2, with complaints of toe-in gait and bowed legs. A series of studies were performed, the diagnosis of vitamin D-resistant rickets was made in 1991. No family history of VDRR could be traced. Since 1991, this girl has been treated with 1,25-dihydroxyvitamin D3 (calcitriol) and phosphorus supplements. Although oral hygiene instruction, prophylaxis, topical fluoride therapy and sealants were performed since hse was 2 years old, multiple spontaneous abscess formations have developed since she was 3 years old. The abscessed teeth were treated by pulpectomy, composite resin filling, incison and drainage, antibiotics, and stainless steel crowns. Prevention of caries and attrition is the most effective method to control the spontaneous abscess formation of VDRR patients. Clinically, root canal treatment and subsequent crown restoration provide abscessed teeth a good prognosis. |
本系統中英文摘要資訊取自各篇刊載內容。