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营养缺乏的症状

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发表于 2020-3-28 21:41:56 | 显示全部楼层 |阅读模式
CHAPTER 25口服营养状况表现
Oral Manifestations of Nutritional Status Michael T. Murray, ND
CHAPTER CONTENTS Introduction, 206
The Healthy Mouth, 206
Abnormalities of the Oral Membranes, 206
INTRODUCTION
The structures and lining of the oral cavity offer valuable and easily accessible infor-mation on the nutritional status of an individual. Lesions may indicate a nutrient deficiency or may be manifestations of gastrointestinal or other disease.1 Because of the very rapid cell turnover of the oral mucosa, these lesions often may precede other manifestations of nutrient deficiency or systemic disease. Some typical lesions are mucosal ulceration, cheilosis, gingivitis, and glossitis. Between 5% and 10% of the people in the United States are deficient in one or more nutrients, so signs of nutritional deficiency are com
口腔的结构和衬里提供关于个体营养状况的有价值且易于获得的信息。 病变可能表明了某些营养缺乏或可能是胃肠道及其他疾病的表现。【1】由于口腔粘膜细胞更新非常快,这些病变通常可能先于营养缺乏或全身性疾病的其他表现出来 一些典型的病变是口腔粘膜溃疡,唇裂,牙龈炎和舌炎。 在美国,5%至10%的人缺乏一种或多种营养素,因此营养缺乏的迹象很常见。
THE HEALTHY MOUTH
The ventral surface of the healthy tongue is covered with a smooth, pink mucous membrane and lymphoid follicles. On the dorsal surface, the filiform, fungiform, and circumvallate papillae (which contain the organs of taste) produce a rough, grayish red appearance. The thick epithelial tufts of the filiform papillae give the tongue its characteristic grayish white coating, whereas the globular, pale red fungi-form papillae give it a speckled pink appearance. Furrows are not characteristic of the healthy tongue.
健康舌头的腹面覆盖有光滑的粉红色粘膜和淋巴滤泡。 而在背面,则表现为丝状,真菌状和周缘状的乳突(含有味觉的器官)产生粗糙的灰红色外观。 厚实的丝状乳头上皮簇使舌头具有特有的灰白色涂层,而球状的淡红色菌状乳头使其具有斑点的粉红色外观。 如果出现犁沟,则是舌头不健康的表现。
The buccal mucosa has a grayish red color and may be crossed by fine grayish ridges where it touches the closed teeth.
Healthy gums have a light reddish appearance and cover the roots of the teeth completely.The assessment of oral health, obviously, must include the health and status of the teeth. Patients should be asked about their dental history and encouraged to have regular dental checkups. Here are some key nutritional considerations for examina-tion of the teeth2:
口腔粘膜呈灰红色,与闭合的牙齿接触时,可与细小的灰质脊交叉。 健康的牙龈具有浅红色外观,完全覆盖牙齿的根部。 显然,口腔健康评估必须包括牙齿的健康和状况。 应询问患者他们的牙科病史,并鼓励他们定期进行牙科检查。 以下是检查牙齿的一些关键营养考虑因素【2】:
Having fewer than 20 teeth as an adult is associated with a significantly reduced capacity to eat nutritious foods, such as salads, raw fruit and vegetables, nuts, and whole grain products. The same applies even to denture wearers.
Bulimia may manifest as erosive tooth wear.
Osteoporosis may manifest initially as changes in jaw structure and/or loose teeth. Presence of mercury amalgams may be associated with systemic disease, especially neurologic conditions.
• 成年人牙齿少于20颗,与吃营养食品的能力显着降低有关,例如沙拉,生水果和蔬菜,坚果和全谷物产品。 这同样适用于义齿佩戴者。
• 贪食症可能表现为糜烂性牙齿磨损。
• 骨质疏松症最初可能表现为颌骨结构和/或牙齿松动。
• 汞合金的存在可能与全身性疾病有关,尤其是神经系统疾病。
ABNORMALITIES OF THE ORAL MEMBRANES  口腔粘膜异常
Table 25-1 summarizes the typical oral manifestations associated with a particular nutrient deficiency, and Table 25-2 summarizes common disorders associated with oral manifestations.1-12 In general, ulceration should be considered a nonspecific expression of a disease state. A search for the etiology will usually result in a specific therapy. Aphthous stomatitis is a common example of a mucosal ulceration and is discussed in detail in Chapter 146. Similarly, cheilosis is a common expression for acquired nutrient deficiency. Gin-givitis is associated with the classic signs of scurvy, but other nutrients have now been shown to play a role in gingival health; this subject is discussed in Chapter 199. Glossitis is associated with numerous vitamin deficiency states, each with a characteristic appearance.
25-1总结了与特定营养素缺乏相关的典型口腔表现,表25-2总结了与口腔表现相关的常见疾病。【1-12】通常,溃疡应被视为疾病状态的非特异性表达。 寻找病因通常会导致特定的治 疗。 口疮性口炎是粘膜溃疡的常见例子,将在第146章详细讨论。同样,有丝分裂是获得性营养缺乏的常见表现。 牙龈炎与坏血病的典型症状相 关,但现在已证明其他营养素在牙龈健康中起作用; 这个主题在第199章讨论. 舌炎与许多维生素缺乏状态相关,每种状态都具有特征性外观。
TABLE 25-1 Oral Signs of Nutrient Deficiency
NUTRIENT 营养素
SIGNS OF ORAL DEFICIENCY 缺乏时口腔的表现
Vitamins 维生素
Biotin 生物素
Geographic tongue, atrophy of lingual papillae 地理舌头,舌乳头萎缩
Folic acid 叶酸
Gingivitis, glossitis with atrophy, or hypertrophy of filiform papillae, cheilosis
牙龈炎,舌炎伴萎缩,或fi脂状乳头肥大,唇裂
Niacin 烟酸
Intraoral burning, canker sores, halitosis, glossitis, tongue swollen with red tip and sides, swollen red fungiform papillae, filiform papillae becoming inamed and losing their epithelial tufts (giving the characteristic slick red appearance)
口内灼热,口腔溃疡,口臭,舌炎,舌尖肿胀,尖和侧面发红,肿胀的红色菌状乳头,乳状乳头变得浸润并失去上皮簇(呈现出特征性的光滑红色外观)
Pyridoxine 维生素B6
Intraoral burning, glossitis, mucosal ulcerations and erosions, cheilosis
口腔内灼伤,舌炎,粘膜溃疡和糜烂,唇裂
Vitamin B12 维生素B12
Intraoral burning, mucosal ulcerations and erosions, painful glossitis with a beefy red or fiery appearance, eventually resulting in an atrophic (smooth and shiny) tongue
口腔内灼伤,粘膜溃疡和糜烂,疼痛的舌炎,呈红肿或炽热的外观,最终导致舌萎缩(光滑和发亮。
Riboflavin 核黄素
Soreness and intraoral burning, cheilosis, angular stomatitis, glossitis with a magenta tongue
疼痛和口腔内灼伤,唇裂,口腔角质炎,舌炎伴洋红色舌
Vitamin C
Sore and bleeding gums, deep blue-red color to gums, loose teeth, follicular hyperkeratosis
牙龈肿痛出血,牙龈深蓝色,牙齿松动,毛囊角化。
Vitamin D 维生素D
Intraoral burning口腔内灼伤
Vitamin E 维生素E
Glossitis 舌炎
Minerals 矿物质
Calcium
Periodontal disease, tooth decay 牙周病,蛀牙
Iron
Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor
唇裂,萎缩性舌炎,牙龈炎,念珠菌病,口腔内灼伤或疼痛,粘膜溃疡和糜烂牙龈和嘴唇苍白
Zinc
Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor
唇裂,萎缩性舌炎,牙龈炎,念珠菌病,口腔内灼伤或疼痛,粘膜溃疡和糜烂,牙龈和嘴唇苍白
Data from references 1-12
TABLE 25-2 Common Disorders Associated with Oral Manifestations 25-2口腔表现相关的常见疾病
ORAL MANIFESTATION 口腔表现
DISORDER(S) 疾病
Cheilosis 唇裂
Crohns disease, acrodermatitis enteropathica, alcoholism, celiac disease, malabsorption syndrome
克罗恩病,肠病性肢端皮炎,酒精中毒,腹腔疾病,吸收不良综合征
Gingivitis
Crohns disease, anorexia nervosa, celiac disease, scurvy
克罗恩病,神经性厌食症,腹腔疾病,坏血病
Erythroplakia]粘膜红斑病
Dysplasia or carcinoma 不典型增生或癌
Glossitis 舌炎
Crohns disease, diabetes, alcoholism, celiac disease, malabsorption syndrome, pernicious anemia, iron-deficiency anemia,amyloidosis, carcinoid syndrome, cigarette smoking, anemia
克罗恩病、糖尿病、酗酒、腹腔疾病、吸收不良综合征、恶性贫血、缺铁性贫血、淀粉样变性、类癌综合征、吸烟、贫血
Intraoral burning口腔内灼伤
Menopause, diabetes mellitus, esophageal reflux, Sjögrens syndrome绝经、糖尿病、食管反流、SJOrens综合征
Leukoplakia黏膜白斑病
Chronic irritation, dysplasia, early invasive squamous cell carcinoma
慢性刺激性、异型增生、早期浸润性鳞状细胞癌
Ulcerations, erosions溃疡、糜烂
Crohns disease, ulcerative colitis, celiac erosions disease, corticosteroid use, acrodermatitis enteropathica, anorexia
nervosa, pernicious anemia, iron-deficient anemia, mercury poisoning, nicotine withdrawal
克罗恩病,溃疡性结肠炎,腹腔糜烂病,皮质类固醇使用,肠炎性肢端皮炎,厌食症神经性贫血,恶性贫血,缺铁性贫血,汞中毒,尼古丁戒断
Data from references 2-12. 来自参考文献2-12的数据。
Like glossitis, intraoral burning represents a nonspecific expres-sion of a possible nutrient deficiency or systemic disease.3-5 Possi-ble causes in addition to those listed in Table 25-2 are as follows: Xerostomia
Dentures
Deficiencies of iron, vitamin B12, folic acid, vitamin B6, and
protein
Steatorrhea
Antibiotic use
Changes in mucosal innervation
Anxiety states
与舌炎一样,口内灼烧代表可能的营养缺乏或全身性疾病的非特异性表达。3-5除表25-2中列出的原因外,可能的原因如下:
• 口腔干燥症
• 假牙
• 缺铁,维生素B12,叶酸,维生素B6和蛋白质
• 脂肪泻
• 抗生素使用
• 粘膜神经支配的变化
• 焦虑状态
In people who do not wear dentures, nutritional disorders are the most common causative factors.2Leukoplakia is any white lesion of the oral cavity that cannot be removed by rubbing the mucosal surface. Although lesions are usually only a sign of chronic irritation, 2% to 6% represent either dysplasia or early invasive squamous cell carcinoma.4Erythroplakia is similar to leukoplakia, except that it has a defi-nite erythematous component. This is a far more serious sign, with 90% of such lesions representing dysplasia or carcinoma.
在不戴假牙的人中,营养失调是最常见的致病因素。2 白斑是口腔的任何白色病变,不能通过摩擦粘膜表面去除。
虽然病变通常只是慢性刺激的征兆,但2%至6%代表发育异常或 早期浸润性鳞状细胞癌。4红斑病与白斑病相似,只是它有明确的红斑成分。 这是一个 更为严重的征兆,其中90%的病变代表发育异常或癌。
REFERENCES
1.  Beitman R, Frost S, Roth J. Oral manifes-tations of gastrointestinal disease. Dig Dis Sci. 1981;26:741-747.
2.  Budtz-Jorgensen E, Chung JP, Rapin CH. Nutrition and oral health. Best Pract Res Clin Gastroenterol. 2001;15:885-896.
3.  Basker RM, Sturdee DW, Davenport JC. Patients with burning mouths. Br Dent J.1978;145:9-16.
4.  Maragou P, Ivanyi L. Serum zinc levels in patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol. 1991;71:447-450.
5. Ship JA, Grushka M, Lipton JA, et al. Burning mouth syndrome: an update. J Am Dental Assoc. 1995;126:843-853.
6. Werbach MR. Nutritional inuences on
disease. Tarzana, CA: Third Line Press; 1993.
7. Shepherd A. The impact of oral health on nutritional status. Nurs Stand. 2002;16:37-38.
8. Hornick B. Diet and nutrition: implications for oral health. J Dent Hyg. 2002;76: 67-78.
9. Enwonwu CO, Sanders C. Nutrition: impact on oral and systemic health. Compend Contin Educ Dent. 2001;22:
12-18.
10. Rugg-Gunn AJ. Nutrition, diet and oral health. J R Coll Surg Edinb. 2001;46:320-328.
11. Mojon P, Budtz-Jorgensen E, Rapin CH. Relationship between oral health and nutrition in very old people. Age Ageing. 1999;28:463-468.
12. Walls AW. Oral health and nutrition. Age Ageing. 1999;28:419-420.

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