■口干,口腔念珠菌病,和复发性阿弗他溃疡是3个最常见的口腔疾病,可能与患者的不适,生活质量下降,和发病率。
■在对26项基于人群的队列和横断面研究的荟萃分析中,口干症状的全球患病率为23%(95%CI,18%至28%),将个体置于口腔念珠菌病的风险中,龋齿,熟食症,咀嚼/言语障碍,口咽吞咽困难.口干与每天使用超过3种口服药物有关(比值比[OR],2.9[95%CI,1.4至6.2]),头颈部辐射,和Sjögren病。症状可能包括吞咽困难和说话困难,口渴,和口臭.口干与口腔念珠菌病的11.5%(95%CI,3.6%至27%)的高风险相关。基于对6个观察性队列的荟萃分析。口干的管理包括机械性唾液兴奋剂,口腔保湿剂,和/或系统的sialagues。口腔念珠菌病是由白色念珠菌属的过度生长引起的机会性真菌感染,占感染的76.8%。免疫抑制患者口腔念珠菌病的患病率较高,例如,艾滋病毒感染者(35%[95%CI,28%至42%])和唾液腺功能减退者(OR,3.02[95%CI,1.73至5.28])。与口腔念珠菌病相关的常见危险因素包括使用抗生素(P=.04)和口腔粘膜疾病如扁平苔藓。口腔灼热和味觉障碍是口腔念珠菌病的常见症状。治疗包括解决风险因素和使用局部和/或全身抗真菌药物。复发性口疮性口炎的特征是有症状的圆形或椭圆形口腔溃疡,被灰白色纤维蛋白层覆盖,并被红斑环包围。对10项病例对照研究的荟萃分析显示,与IL-1β(3954C/T)多态性相关的复发性口疮性口炎的风险增加(OR,1.52[95%CI,1.07至2.17])和IL-1β(-511C/T)(OR,1.35[95%CI,1.09至1.67])。另一项对9项病例对照研究的荟萃分析报告,复发性口疮性口炎患者营养缺乏的频率更高,包括维生素B12(或,3.75[95%CI,2.38至5.94]),叶酸(或,7.55[95%CI,3.91至14.60]),和铁蛋白(OR,2.62[95%CI,1.69至4.06])。复发性口疮性口炎可与全身性疾病相关。对21项病例对照研究的荟萃分析显示,乳糜泻与复发性口疮性口炎的发生率较高有关(25%vs11%;OR,3.79[95%CI,2.67至5.39];P<.001)。外用皮质类固醇是治疗复发性口疮性口炎的一线药物;然而,在更严重的情况下,可能需要全身药物治疗。
■口干,口腔念珠菌病,复发性阿弗他溃疡是常见的口腔疾病,可能与患者的不适有关,生活质量下降,和发病率。一线治疗包括用于口干的非处方药,口腔念珠菌病的局部抗真菌药,和外用皮质类固醇治疗阿弗他溃疡。一线治疗不能改善的口腔疾病可能需要全身药物治疗。
Dry mouth, oral candidiasis, and recurrent aphthous ulcers are 3 of the most common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity.
In a meta-analysis of 26 population-based cohort and cross-sectional studies, the global prevalence of dry mouth symptoms was 23% (95% CI, 18% to 28%), placing individuals at risk of oral candidiasis, dental caries,
dysgeusia, masticatory/speech impairment, and oropharyngeal dysphagia. Dry mouth is associated with using more than 3 oral medications per day (odds ratio [OR], 2.9 [95% CI, 1.4 to 6.2]), head and neck radiation, and Sjögren disease. Symptoms may include difficulty swallowing and speaking, thirst, and halitosis. Dry mouth is associated with an 11.5% (95% CI, 3.6% to 27%) higher risk of oral candidiasis, based on a meta-analysis of 6 observational cohorts. Management of dry mouth includes mechanical salivary stimulants, oral moisturizers, and/or systemic sialagogues. Oral candidiasis is an opportunistic fungal infection caused by overgrowth of the Candida genus with C albicans, which accounts for 76.8% of infections. The prevalence of oral candidiasis is higher in patients who are immunosuppressed, for example, those with HIV (35% [95% CI, 28% to 42%]) and those with salivary gland hypofunction (OR, 3.02 [95% CI, 1.73 to 5.28]). Common risk factors associated with oral candidiasis include use of antibiotics (P = .04) and oral mucosal disorders such as lichen planus. Oral burning and
dysgeusia are common symptoms of oral candidiasis. Treatment includes addressing risk factors and use of topical and/or systemic antifungal medications. Recurrent aphthous stomatitis is characterized by symptomatic round or oval oral ulcers, which are covered by a gray-white fibrin layer and encircled by an erythematous ring. A meta-analysis of 10 case-controlled studies revealed an increased risk of recurrent aphthous stomatitis associated with polymorphism of IL-1β (+3954C/T) (OR, 1.52 [95% CI, 1.07 to 2.17]) and IL-1β (-511C/T) (OR, 1.35 [95% CI, 1.09 to 1.67]). Another meta-analysis of 9 case-control studies reported that patients with recurrent aphthous stomatitis had a higher frequency of nutritional deficiencies, including vitamin B12 (OR, 3.75 [95% CI, 2.38 to 5.94]), folic acid (OR, 7.55 [95% CI, 3.91 to 14.60]), and ferritin (OR, 2.62 [95% CI, 1.69 to 4.06]). Recurrent aphthous stomatitis can be associated with systemic diseases. A meta-analysis of 21 case-control studies revealed that celiac disease is associated with a higher incidence of recurrent aphthous stomatitis (25% vs 11%; OR, 3.79 [95% CI, 2.67 to 5.39]; P <.001). Topical corticosteroids are first-line agents to manage recurrent aphthous stomatitis; however, systemic medications may be necessary in more severe cases.
Dry mouth, oral candidiasis, and recurrent aphthous ulcers are common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. First-line treatment includes over-the-counter sialagogues for dry mouth, topical antifungals for oral candidiasis, and topical corticosteroids for aphthous ulcers. Oral conditions that do not improve with first-line treatment may require treatment with systemic medications.