本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0953

摘要内容如下：

重要性

口干、口腔念珠菌病和复发性阿弗他溃疡是3种最常见的口腔疾病，可能与患者不适、生活质量下降和发病率有关。

观察

在一项对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%-28%），使个体处于口腔念珠菌病、龋齿、味觉障碍、咀嚼/言语障碍和口咽吞咽困难的风险中。口干与每天使用3种以上口服药物（优势比[OR]，2.9[95%CI，1.4至6.2]）、头颈部放疗和舍格伦病相关。症状可能包括吞咽和说话困难、口渴和口臭。根据一项对6个观察性队列的荟萃分析，口干与11.5%（95%CI，3.6%至27%）的口腔念珠菌病风险升高相关。口干的处理包括机械唾液刺激剂、口腔保湿剂和/或全身催涎剂。口腔念珠菌病是一种由念珠菌属和白色念珠菌过度生长引起的机会性真菌感染，占感染的76.8%。免疫抑制患者的口腔念珠菌病患病率较高，例如，HIV患者（35%[95%CI，28%-42%]）和唾液腺功能低下患者（OR，3.02[95%CI，1.73-5.28]）。与口腔念珠菌病相关的常见危险因素包括抗生素的使用（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。复发性阿弗他口炎表现为有症状的圆形或椭圆形口腔溃疡，溃疡表面有灰白色纤维蛋白层覆盖，周围有红斑环。一项对10项病例对照研究的荟萃分析显示，IL-1β（+3954C/T）（OR，1.52[95%CI，1.07-2.17]）和IL-1β（-511C/T）（OR，1.35[95%CI，1.09-1.67]）的多态性与复发性阿弗他口炎的风险增加相关。另一项对9项病例对照研究的荟萃分析报道，复发性阿弗他口炎患者营养缺乏的发生率较高，包括维生素B12（OR，3.75[95%CI，2.38-5.94]）、叶酸（OR，7.55[95%CI，3.91-14.60]）和铁蛋白（OR，2.62[95%CI，1.69-4.06]）。复发性阿弗他口炎可伴有全身性疾病。21项病例对照研究的荟萃分析显示，乳糜泻与较高的复发性阿弗他口炎发病率相关（25%比11%；OR为3.79[95%CI为2.67~5.39]；P<.001）。局部皮质类固醇是治疗复发性阿弗他口炎的一线药物。然而，在更严重的情况下，可能需要全身用药。

结论和相关性

口干、口腔念珠菌病和复发性阿弗他溃疡是常见的口腔疾病，可能与患者不适、生活质量下降和发病率有关。一线治疗包括治疗口干的非处方催涎剂、治疗口腔念珠菌病的局部抗真菌药物和治疗阿弗他溃疡的局部皮质类固醇。一线治疗不能改善的口腔疾病可能需要全身药物治疗。

英文原文如下：

Abstracts

Importance  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.

Observations  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.

Conclusions and Relevance  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.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。