Стан тканин порожнини рота і пародонта у пацієнтів з хронічною нирковою недостатністю

Abstract

Всі різноманітні прояви захворювань в порожнині рота при ХНН у хворих, що отримують гемодіаліз, є наслідком тяжкого загального стану організму. Щорічне зростання кількості таких хворих збільшує вірогідність зустрічі з ними кожного стоматолога. До теперішнього часу відсутня систематизована інформації про стан порожнини рота, і рекомендації щодо особливості реалізації стоматологічних лікувальних маніпуляцій у хворих на ХНН, що знаходяться на замісній нирковій терапії. Для забезпечення цих пацієнтів адекватною стоматологічною допомогою необхідно визначити особливості діагностики, профілактики, а також розробити тактику дій лікаря стоматолога. Все разнообразные проявления заболеваний в полости рта при ХПН у больных, получающих гемодиализ, являются следствием тяжелого общего состояния организма. Ежегодный рост количества таких больных увеличивает вероятность встречи с ними у любого стоматолога. До настоящего времени отсутствует систематизированная информация о состоянии полости рта и рекомендации об особенностях реализации стоматологических лечебных манипуляций у больных ХПН, находящихся на заместительной почечной терапии. Для обеспечения этих пациентов адекватной стоматологической помощью необходимо определить особенности диагностики, профилактики, а также разработать тактику действий врача стоматолога. Periodontal disease pathogenesis associated with a number of systemic diseases. One of these diseases are chronic renal failure (CRF). Effect of chronic renal failure in course of periodontal disease is insufficiently studied [2,3,4]. Research actuality in this direction is the conditioned prevalence of KHNN, which is 3-7% adults. Over the past decade, improved methods of dialysis and renal transplantation significantly improved the quality and duration of life in patients with chronic renal failure [5]. On the other hand in Ukraine every year the number of patients increases by 3-7%. Most patients with chronic renal failure complain of bad breath, metallic taste, changes in taste sensitivity, dry mouth [11,12,13,14,15,16]. The literature describes a wide range of diseases of the oral mucosa in patients with chronic renal failure [19, 20]. Red flat lichen can develop as a result of patients receiving diuretics and P-blockers. Hairy leukoplakia development is the result of secondary process towards imunosupresive therapy. In many cases, mouth and skin, showed white plaques that are called "uremic frost." They are formed by the deposition of crystals of urea on the surface epithelium. [19]. At the oral mucosa, many authors have observed the presence of petechiae and ehimoziv, manifestations of candidiasis and taxation tongue [20]. During the study of oral health in patients who are at DG revealed its low, or no, indicating a lack of awareness of medical personnel and the dominance of the underlying disease. In patients with chronic renal failure periodontal lesions associated with increased blood creatinine test. In addition, increased IgG levels observed in generalized periodontitis in patients who are on dialysis therapy, causes increase synthesis of C - reactive protein (CRP). The elasticity of blood vessels is reduced, peripheral resistance is increased, rheographic index is decrease in patients with chronic renal failure in comparison with patients who have renal disease [25]. Typically, patients have pale mucous membrane gums due to anemia. However, bleeding gums can be caused as a result of receiving anticoagulants and platelet dysfunction. In patients with chronic renal failure and generalized periodontal breach calcium - phosphorus metabolism and, consequently, reduce bone density, the development of osteoporosis, the impact on mobility of the teeth, gum recession and tooth availability - gingival pockets [26]. As a rule patients which get dialysis therapy visit a dantist rarely. Mainly it takes place on the measure of necessity in spite of the fact that each such patient is a potential candidate on the operation of transplantation of bud and must be treated by dantist for diminishing of authenticity of tearing away of transplant to development of infectious complications [28]. All various displays of diseases in the cavity of mouth at KHNN for patients which get dialysis treatment, appears investigation of grave general condition of organism. Year-on-year growth of amount of such patients is increased by authenticity of meeting with them of every stomatology. To the present tense in domestic literature we did not succeed to find exhaustive state information cavity of mouth, or to recommendation in relation to the feature of realization of stomatological medical manipulations for patients on KHNN, which are on kidney therapy. For providing of these patients an adequate stomatological help it is necessary to define what a doctor can clash with, and also to develop tactic of his actions.