牙周炎及不良妊娠结局与FcγRⅡB基因多态性的关系

［摘要］牙周炎是不良妊娠结局（adverse pregnancy outcomes,APO）的危险因素,两者都与FcγRⅡB基因多态性有关,推测牙周炎与APO有关的背后机制是FcγRⅡB基因多态性的作用。本文就牙周炎、APO及FcγRⅡB基因多态性的关系作一综述,并为后续牙周炎与不良妊娠结局相关机制的研究提供依据。     

慢性牙周炎是影响全身健康的危险因素

近年来,人们的兴趣越来越多地转向于牙周感染和全身性疾病之间的可能关联。事实上,慢性牙周炎致病菌和它们的产物,以及在牙周组织产生的炎症介质,可能会进入血液,影响全身或者造成全身性疾病,包括心血管疾病、呼吸道疾病、糖尿病、不良妊娠等,慢性牙周炎是影响全身健康的危险因素。     

妊娠期牙周炎治疗对妊娠结局的影响

目的探讨牙周基础治疗对妊娠期牙周炎患者妊娠结局的影响。方法选择进行孕检,经口腔科确诊为妊娠期牙周炎孕妇63名。牙周治疗组32例,在安全期内给予牙周基础治疗,对照组31例未接受牙周基础治疗。记录初始及妊娠32周时患者简化口腔卫生指数(OHI-S)、龈沟出血指数(SBI)、探诊深度(PD)和临床附着丧失(CAL);在初始及妊娠32周时使用滤纸条法测量患者龈沟液(GCF)量,ELISA法测定龈沟液中白介素-1β(IL-1β)量;追踪妊娠结局。运用卡方检验,t检验和Spearman检验对数据进行分析。结果 1牙周治疗组妊娠32周检测的OHI-S、SBI、PD、GCF量和IL-1β量较初始时有明显降低,且低于对照组同期(P<0.05);2牙周治疗组孕妇分娩孕周较对照组长,不良妊娠结局少于对照组(P<0.05);3孕妇妊娠32周检测的GCF量、IL-1β量与分娩孕周呈负相关关系(P<0.05)。结论孕期规范的牙周基础治疗有助于减少妊娠期牙周炎孕妇不良妊娠结局的可能性。     

牙周炎与全身性疾病相关性研究的新进展

牙周炎可能是引起或加重一些全身性疾病的潜在危险因素,根据近年来有关牙周炎与全身性疾病相关性的研究新进展,笔者重点从牙周炎与妊娠不良、心血管疾病及糖尿病的关系3个方面进行综述。     

妊娠晚期孕妇牙周炎与体液中白介素-2含量关系研究

目的 研究妊娠晚期牙周炎孕妇龈沟液、唾液、血清中白介素-2（IL-2）含量变化以及三者间的关联。方法 于2011年4—7月在湖北省妇幼保健院接受口腔检查的妊娠33 ~ 38周单胎孕妇中,随机选取20例牙周炎、26例牙龈炎、22例牙周健康孕妇（对照）纳入研究。分别采集其唾液、龈沟液和血清,采用双抗体夹心ELISA检测IL-2质量浓度。结果 牙周炎组分娩时孕周（36.5 周）明显小于牙龈炎组（38.8 周）和对照组（39.3 周）,牙周炎组分娩时新生儿体重（3079.9 g）低于牙龈炎组（3452.5 g）和对照组（3462.4g）,差异均有统计学意义（均P < 0.05）。牙周炎组大专及以上学历、孕前半年行口腔保健的比例明显低于牙龈炎组和对照组（均P < 0.05）。牙周炎组龈沟液、唾液中IL-2质量浓度明显高于牙龈炎组和正常对照组,差异有统计学意义（均P < 0.05）;但3组血清中IL-2质量浓度比较,差异无统计学意义（P > 0.05）。各组孕妇龈沟液、唾液、血清中IL-2质量浓度之间均两两呈线性相关,差异有统计学意义（均P < 0.01）。结论 妊娠合并牙周炎孕妇口腔中IL-2含量较高,并与血清中IL-2质量浓度呈直线相关,在牙周炎合并不良妊娠结局（如早产、低体重儿等）的发病机制中起一定作用。重视口腔卫生是预防不良妊娠结局的方法之一。     

细胞自噬在牙周炎中的作用与机制

牙周炎是由牙菌斑生物膜引起的牙周组织的慢性炎症性疾病。细胞自噬是宿主对抗细菌感染的有效武器。近年来研究发现,细胞自噬不仅可以促进感染细胞对细菌和毒素的清除,而且有助于抑制炎症反应,以维持细胞内环境稳态,与牙周炎的发生发展关系密切。本文从细胞自噬与牙周病原菌感染的相互作用,细胞自噬与免疫炎症反应的相互调控,以及细胞自噬与牙槽骨代谢的关系3个方面,对细胞自噬与牙周炎发生发展的关系进行综述,为深入地研究细胞自噬与牙周炎相关机制提供参考,为牙周炎防治的研究提供新的思路。     

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目的研究孕妇牙周炎与早产儿、小于胎龄儿之间的相关性。方法将2009年1-4月来湖北省妇幼保健院口腔科进行孕期常规口腔检查的3251名妊娠中期孕妇的资料输入数据库,牙周检查项目包括软垢指数、龈沟出血指数、牙周袋探诊深度及临床附着丧失水平等,随访妊娠结局（新生儿体重、分娩时孕周）。运用χ2检验及logistic回归分析数据。结果3251名孕妇中最终符合调查要求2702名,妊娠中期诊断为牙周炎301例,其中重度牙周炎61例;早产儿、小于胎龄儿的发生率,在重度牙周炎孕妇分别为11。5％和9．8％,在牙周健康孕妇分别为6．0％和6．6％,差异均有统计学意义（P〈0．001）;重度牙周炎孕妇终止妊娠的孕周平均为35．2周、新生儿体重平均2478g,而牙周健康孕妇平均为39.3周和3512g,差异均有统计学意义（P〈0．001）;重度牙周炎孕妇发生早产儿和小于胎龄儿的OR值分别为2．45和3.47。结论孕妇重度牙周炎是引起早产儿、小于胎龄儿等不良妊娠的主要危险因素之一。     

细胞自噬在牙周炎中的作用与机制

牙周炎是由牙菌斑生物膜引起的牙周组织的慢性炎症性疾病。细胞自噬是宿主对抗细菌感染的有效武器。近年来研究发现,细胞自噬不仅可以促进感染细胞对细菌和毒素的清除,而且有助于抑制炎症反应,以维持细胞内环境稳态,与牙周炎的发生发展关系密切。本文从细胞自噬与牙周病原菌感染的相互作用,细胞自噬与免疫炎症反应的相互调控,以及细胞自噬与牙槽骨代谢的关系3个方面,对细胞自噬与牙周炎发生发展的关系进行综述,为深入地研究细胞自噬与牙周炎相关机制提供参考,为牙周炎防治的研究提供新的思路。     

孕妇牙周健康状况与早产的相关性研究

目的 通过调查孕妇牙周状况和分娩结局,探讨牙周感染与早产的关系。 方法 选择2012年在无锡市妇幼保健院进行孕检孕妇674名,进行临床牙周检查,记录简化口腔卫生指数(OHI-S)、龈沟出血指数（SBI）、探诊深度(PD)和临床附着丧失(CAL),追踪妊娠结局,运用卡方检验,t检验和Spearman检验的统计学方法对数据进行分析。 结果 ①早产组孕妇牙周炎患病率（36.1%）高于足月妊娠组（21.4%）;②早产组孕妇牙周指标OHI-S、SBI、PD、CAL均高于足月妊娠组（P﹤0.05）;③孕妇牙周指标OHI-S、PD、CAL与分娩孕周呈负相关关系（P﹤0.05）。 结论 孕妇牙周感染与早产之间存在着相关性,可能是早产的危险因素之一,应做好孕期口腔健康教育。     

牙龈卟啉单胞菌与不良妊娠结局的相关研究进展

龈卟啉单胞菌(Porphyromonas gingivalis, P.gingivalis)是一种革兰阴性厌氧菌,是牙周炎尤其是慢性牙周炎病变区或活动部位最主要的病原菌。研究表明,牙周炎与多种不良妊娠结局(adverse pregnancy outcomes, APO)有关,这一过程涉及多种病理生理机制,而P.gingivalis作为关键牙周致病菌之一在其中扮演重要角色。目前我们对P.gingivalis与APO的关系及其作用机制的认识仍然十分有限。该文拟通过回顾近年来发现的P.gingivalis与APO之间相关的直接或间接的证据,对P.gingivalis与APO的联系和作用机制作一综述。     

Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology

Introduction: The remit of this group was to update the knowledge base on periodontal diseases and health.
Material and Methods: The literature was systematically searched and critically reviewed in five specific topics.
Results: Prevalence of periodontitis: The data suggest a trend towards a lower prevalence of periodontitis in recent years.
Adverse pregnancy outcome: The findings indicate a likely association between periodontal disease and an increased risk of adverse pregnancy outcomes. There is no evidence that treating periodontal disease decreases the rate of adverse pregnancy outcomes.
Prevalence and distribution of periodontal pathogens: Genetic analysis of bacteria has demonstrated an unanticipated diversity within species. Carriage rates and particular subsets of these species vary between ethnic groups. Few of these differences can be related to differences in disease prevalence.
Diabetes mellitus: Evidence on the association supports the concept of increased severity but not extent of periodontitis in subjects with poorly controlled diabetes. It is inconclusive that periodontal treatment results in improved metabolic control.
Cardiovascular diseases: Evidence suggests that having periodontitis contributes to the total infectious and inflammation burden and may contribute to cardiovascular events and stroke in susceptible subjects. The impact of periodontal therapy must be further investigated.     

Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes

Aim: The aim of this secondary analysis is to explore whether the application of different definition criteria of periodontitis, used in other similar studies, has an influence on the significance of the association between periodontitis and prematurity or low birth weight. Material and Methods: Fourteen periodontitis definitions and more than 50 periodontal disease continuous measurements, found in 23 published studies, were applied to a cohort study that included 1296 pregnant women. The associations with adverse pregnancy outcomes were analysed using logistic regression analysis. Results: Six of the 14 tested definitions of periodontitis resulted in statistically significant adjusted odds ratios (ORs) for some of the adverse pregnancy outcomes, while no significance was found for the other eight case definitions. Out of more than 50 periodontal continuous measurements tested, only 17 demonstrated statistically significant ORs. Conclusions: Our results support the hypothesis that the significance of the association between periodontal disease and pregnancy outcomes may be determined by the periodontal disease definition or measurement used.     

Oral Neutrophil Levels: A Screening Test for Oral Inflammatory Load in Pregnancy in a Medical Setting

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes, but the findings have been equivocal. Although the evidence is controversial, it is biologically plausible, and the key link may be inflammation. Because periodontitis is at times either active or inactive, trying to correlate the presence of pockets, for example, to adverse outcome of pregnancy might be preordained to failure or at least confusion. Alternatively, if inflammatory activity associated with periodontitis could be measured, it might be possible to correlate oral inflammatory load (OIL) to adverse pregnancy outcomes more precisely, but given the low incidence of adverse pregnancy outcomes, large populations must be studied. This underscores the need to use a means for assessment of OIL that is reliable, reproducible, and so simple to perform that it does not require dental expertise and can be used for large numbers of patients attending obstetrics units. The objective of this study was to demonstrate that OIL can be measured in a cohort of pregnant females presenting for obstetric care and secondarily to ensure that there was a realistic correlation to the presence of periodontitis. Methods: Sixty‐three pregnant females were recruited, and 15‐second saline rinses were collected to measure OIL as represented by counts of oral neutrophil levels. Periodontal examinations were performed to determine the extent of the correlation between the presence of clinical markers of periodontitis, such as pockets and clinical attachment loss to the OIL. Results: Using this small cohort of patients, a test for oral inflammatory disease could be administered successfully in a non‐dental setting. In addition, there was a statistically significant increase (two‐fold, P <0.05) in oral neutrophil counts found in patients with periodontitis compared with those without periodontitis. Conclusion: The rinse assay can be used as a screening tool for oral inflammation, which was also related to the presence of periodontitis, in pregnant females attending a medical clinic.     

Periodontal disease and adverse pregnancy outcomes

Periodontal diseases are considered not only to affect tooth-supporting tissues but also to have a cause-and-effect relationship with various systemic diseases and conditions, such as adverse pregnancy outcomes. Mechanistic studies provide strong evidence that periodontal pathogens can translocate from infected periodontium to the feto-placental unit and initiate a metastatic infection. However, the extent and mechanisms by which metastatic inflammation and injury contribute to adverse pregnancy outcomes still remain unclear. The presence of oral bacteria in the placenta of women with term gestation further complicates our understanding of the biology behind the role of periodontal pathogens in pregnancy outcomes. Epidemiological studies demonstrate many methodological inconsistencies and flaws that render comparisons difficult and conclusions insecure. Therefore, despite the fact that a number of prospective studies show a positive association between periodontal diseases and various adverse pregnancy outcomes, the evidence behind it is still weak. Future well-designed explanatory studies are necessary to verify this relationship and, if present, determine its magnitude. The majority of high-quality randomized controlled trials reveal that nonsurgical periodontal therapy during the second trimester of gestation does not improve pregnancy outcomes. From a biological standpoint, this can be partially explained by the fact that therapy rendered at the fourth to sixth months of pregnancy is too late to prevent placental colonization by periodontal pathogens and consequently incapable of affecting pathogen-induced injury at the feto-placental unit. Thus, interventions during the preconception period may be more meaningful. With the increase in our understanding on the potential association between periodontal disease and adverse pregnancy outcomes, it is clear that dental practitioners should provide periodontal treatment to pregnant women that is safe for both the mother and the unborn child. Although there is not enough evidence that the anti-infective therapy alters pregnancy outcomes, it improves health-promoting behavior and periodontal condition, which in turn advance general health and risk factor control.     

Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis

Aim

To investigate microbial profiles in placentas from a population of East African mothers with and without adverse pregnancy outcomes and with regard to their periodontal status.

Material and Methods

Thirty-six placentas from pregnant women from Tanzania were classified into three groups according to both pregnancy outcome and the mother's periodontal health. The microbial composition in each group was then compared using 16S rRNA metagenomics. Additionally, placenta specimens were analyzed histologically for chorioamnionitis by a single pathologist blinded to the clinical data.

Results

The greatest differences were observed in the group of mothers with periodontitis. The microbial load was low in all three groups of mothers. Periodontitis had a notable influence on the structure of the placental microbiota. Three phyla and 44 genera were associated with periodontitis, whereas only the Tenericutes phylum was associated with the adverse pregnancy variable. Streptococcaceae and Mycoplasmataceae families were associated with both periodontitis and adverse pregnancy outcomes. Finally, although the differences for chorioamnionitis were not significant, this intra-amniotic infection was more frequent in the placentas from mothers with periodontitis.

Conclusions

Our findings suggest that bacteria from the oral cavity may involve the feto-placental unit, and that periodontitis may be a modulating factor of the microbial community present in this niche.     

Choosing the left fork: Steven Offenbacher and understanding maternal periodontal disease and adverse pregnancy outcomes

Steven Offenbacher was one of the first researchers to identify periodontal disease as a risk factor for various adverse pregnancy outcomes. Cohort and case-controlled studies of pregnant women have demonstrated periodontal disease as a risk factor for preterm birth, preeclampsia, and fetal growth restriction. Periodontal therapy during the second trimester improves maternal oral health but fails to reduce the risk of preterm birth. A possible association between periodontal disease and gestational diabetes has also been reported. In one model, periodontal bacteria gain access to the systemic circulation, and thereby the placenta, resulting in local inflammation, placental dysfunction, and, consequently, adverse pregnancy outcomes. It is crucial to increase awareness of the links between maternal periodontal and adverse pregnancy outcomes and to promote oral health prophylaxis during pregnancy.     

Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes

Studies conducted over the past 25 years have focussed on the role of periodontitis, an inflammatory condition of microbial aetiology that destroys the tooth‐supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis‐associated bacteraemias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, and that bacteria of oral origin may translocate into the feto‐placental unit. Epidemiological studies largely support an association between periodontitis and ASVD/APOs, independently of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD‐related clinical events are lacking. This review summarises key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.     

Does periodontal disease reflect atherosclerosis in continuous ambulatory peritoneal dialysis patients?

BACKGROUND: Chronic infection and inflammation, including periodontitis, are linked to an increased risk for atherosclerosis. To investigate the possible adverse effects of periodontitis in continuous ambulatory peritoneal dialysis (CAPD) patients, we compared periodontal severity with inflammation and malnutrition, which are associated with poor atherosclerotic outcome in CAPD patients. METHODS: A total of 110 CAPD patients were included in this study to evaluate their clinical periodontal status by using the plaque index, gingival index, and periodontal disease index. Values for nutritional and inflammatory markers and atherosclerotic risk factors were included for analysis with the periodontal index. Analysis of variance, post hoc Tukey's honestly significant difference, univariate and multivariate linear regression analysis, Pearson correlation analysis, and chi2 analysis were used in the evaluation of the data. RESULTS: Poor oral health status was exhibited by 85.5% of our CAPD patients with periodontal disease. We found that age and longer dialysis duration were associated with the severity of periodontitis. Parameters of malnutrition and inflammation and atherosclerotic risk factors also were associated with poor periodontal status. We carried out multiple regression analysis and found that age, albumin level, and duration of dialysis were associated independently with the severity of periodontitis in CAPD patients. A higher percentage of patients in the severe periodontitis group had malnutrition (chi2 = 59.4; P < 0.001), inflammation (chi2 = 60; P < 0.001), and atherosclerosis (chi2 = 65.6; P < 0.001). CONCLUSIONS: Periodontal health is poor in CAPD patients and correlates with markers of malnutrition, inflammation, and atherosclerosis. The diagnosis and treatment of periodontal diseases require better awareness.     

Anti-cardiolipin and increased serum adhesion molecule levels in patients with aggressive periodontitis

BACKGROUND: We observed that a significant proportion of patients with periodontitis have elevated serum levels of beta2-glycoprotein-I-dependent anti-cardiolipin (anti-CL). These prothrombotic autoantibodies, commonly found to be elevated in patients with systemic lupus erythematosus and the antiphospholipid syndrome, are associated with adverse pregnancy outcomes, such as fetal involution, prematurity, and low birth weight, and with cardiovascular sequelae, such as atherosclerosis, stroke, and myocardial infarction. Anti-CL is known to promote vascular inflammation and thrombosis. METHODS: We measured serum levels of markers of vascular inflammation, including soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cell adhesion molecule (sVCAM)-1, and sE-selectin, in 190 subjects with generalized aggressive or chronic periodontitis and in 90 periodontally healthy subjects. RESULTS: sVCAM-1 and sE-selectin levels were significantly higher in patients with elevated anti-CL (>15 U/ml). This relationship also was observed in the never-smoker subset of subjects, even after correction for demographic and periodontal variables. Within the diagnostic categories, sICAM-1, sVCAM-1, and sE-selectin were significantly higher in generalized aggressive periodontitis patients who had elevated anti-CL compared to those with normal anti-CL. Statistical correction for demographic and periodontal variables indicated that elevated anti-CL remained significantly associated with increased sVCAM-1 and sE-selectin in generalized aggressive periodontitis patients. CONCLUSIONS: Systemic markers of vascular inflammation in patients with aggressive periodontitis are associated with elevated levels of anti-CL. We hypothesize that a subset of periodontitis patients with elevated antiphospholipid antibodies could represent a subgroup at increased risk for obstetrical and cardiovascular sequelae.     

Changing periodontal concepts: treatment considerations

Many clinical trials conducted during the last decade have clarified controversial issues and resulted in changed periodontal paradigms. These modified concepts have therapeutic implications. Some salient altered periodontal concepts include the following: The mere presence of pathogens will not initiate periodontal diseases. Most subgingival bacteria reside in biofilms. Periodontal diseases are infections. Periodontal pathogens can be transferred between family members. The host response can be protective and destructive. Gingivitis does not usually proceed to periodontitis. Risk factors in conjunction with bacteria and the host response can affect the severity of disease, patterns of destruction, and the response to therapy. Many medical conditions (eg, diabetes, smoking, and HIV infection) may predispose patients to periodontitis. Associations between periodontitis and a number of systemic ailments (eg, diabetes, adverse pregnancy outcomes, and cardiovascular disease) have been detected and are being investigated to determine if there is a cause-and-effect relationship. Diagnostic and therapeutic implications of these altered paradigms are addressed throughout the article.