DENTAL TREATMENT OF A PATIENT WITH BARTTER SYNDROME: CASE REPORT

Bartter syndrome is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, hyperreninemia, hyperprostaglandinism, and normal blood pressure. Bartter syndrome is classified by neonatal and classic type. Clinical manifestation of Bartter syndrome considered in dental treatment include tendency to dehydration, vomiting and erosion, attrition and abrasion of the teeth. A 2-year-4 month old boy with Bartter syndrome type III was referred to the Seoul National University Dental Hospital for dental evaluation and treatment. He showed hypokalemic hypochloremic metabolic alkalosis and had been treated with indomethacin and potassium chloride. He had hypocalcified teeth with or without multisurface caries lesions in all dentition and the erosion of maxillary teeth was detected. Dental procedure under general anesthesia was scheduled due to multiple caries and his medical condition. The dental procedure was successfully performed. This case suggests that electrolyte imbalances need to be treated prior to dental treatment and complete coverage restoration is necessary to protect the eroded teeth. An appropriate management plan for the patients with Bartter syndrome should include considerations of the need for close interaction with the pediatrician for pre- and post-operative care. General anesthesia may be recommendable to manage the patients having multiple caries with Bartter syndrome.

Bartter 증후군 환아의 치아우식 치료: 증례보고

Bartter 증후군은 심각한 헨레고리 비후 상행각(TAL)에서의 일차적인 염류(NaCl) 수송 장애로 인하여 심각한 저칼륨혈증을 특징으로 하는 질환이다. 만성 구토로 인한 치아의 부식, 교모, 마모의 구강 내 소견을 보여 구토와 관련된 적절한 칫솔질 및 식이 습관 등에 대한 정기적인 교육과 관찰이 권장되며 교합고경의 회복을 위해 전장관 수복이 추천된다. 치과 치료 시의 스트레스로 인하여 전해질 수치의 불균형이 초래될 가능성이 있어 전신마취 하 치료가 유리할 수 있으며, 전신마취 시 과환기되어 저칼륨혈증이 심화되지 않도록 지속적인 감시를 해야하고 술 후에도 전해질 불균형이 초래되지 않도록 지속적인 감시가 필요하다.