慢性牙周炎和慢性阻塞性肺疾病急性加重患者血清PCT水平及其与疾病关系探讨

目的 通过比较慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）患者和稳定期患者的牙周、肺功能状况及血清降钙素原（serum procalcitonin,PCT）水平,探究AECOPD和牙周炎的内在联系。方法 选择AECOPD、慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）稳定期共90例患者为研究对象,根据患者的牙周炎分期分为8组：AECOPD伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎和COPD稳定期伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎。对各组患者的一般信息、牙周袋探诊深度（pocket probing depth,PPD）、临床附着丧失（clinical attachment loss,CAL）、菌斑指数（plaque index,PLI）、龈沟出血指数（sulcus bleeding index,SBI）、第1秒用力呼气容积占用力肺活量百分比（percentage of 1 second expiratory volume to forced vital capacity,FEV1/FVC%）、第1秒用力呼气的容积占预计值的百分比（percentage of the estimated volume of forced exhalation in the first second,FEV1%pred）以及血清降钙素原水平进行统计分析。结果 AECOPD和稳定期患者年龄、性别、BMI、吸烟状况均无统计学意义（P>0.05）;AECOPD患者Ⅲ期、Ⅳ期牙周炎比例明显高于稳定期患者（P＜0.05）;Ⅰ期牙周炎患者中AECOPD组PPD、SBI显著高于稳定期组;Ⅱ期牙周炎患者中AECOPD组PPD、CAL显著高于稳定期组;Ⅲ期牙周炎患者中AECOPD组SBI、CAL显著高于稳定期组;Ⅳ期牙周炎患者中AECOPD组PLI、CAL显著高于稳定期组（P＜0.05）。AECOPD及稳定期患者随着牙周炎严重程度增加,FEV1/FVC%、FEV1%pred依次降低（P＜0.01）。AECOPD组患者血清中不同牙周状况下PCT水平均显著高于稳定期组患者（P＜0.01）;血清中的PCT水平与PPD（r=0.60,P＜0.01）、CAL（r=0.58,P＜0.01）、SBI（r=0.31,P=0.03）成显著正相关,与FEV1/FVC%（r=-0.79,P＜0.01）、FEV1%pred（r=-0.80,P＜0.01）成显著负相关。结论 本研究结果提示牙周炎与AECOPD可能存在相互促进作用,血清PCT可能在一定程度上反映COPD患者牙周炎严重程度及急性加重风险。     

Association between oral health status and chronic obstructive pulmonary disease in Korean adults

Objectives: This study aimed to elucidate the association between oral health status and chronic obstructive pulmonary disease (COPD) in Korean adults (≥ 40 years old) using a representative national dataset from the 6th Korea National Health and Nutrition Examination Survey (6th KNHANES, 2013–2015). Methods: Participants aged ≥ 40 years from the 6th KNHANES who had received an oral and pulmonary function tests (N = 7719) were included in this study. The participant characteristics according to COPD were compared using t-test and chi-squared test. Logistic regression analysis was used to estimate the association between oral health status and COPD. Results: Participants with poor periodontal status exhibited a higher prevalence of COPD. Moreover, patients with COPD had a greater number of missing teeth than those without COPD. The logistic regression model adjusted for demographic, socioeconomic, health- and oral health-related factors showed that the periodontal status was not significantly associated with COPD, while participants with more missing teeth had a significantly increased possibility of having COPD. Conclusions: This study revealed that loss of teeth in adults aged ≥ 40 years was associated with COPD.Key words: Chronic obstructive pulmonary disease, Korea National Health and Nutrition Examination Survey (KNHANES), tooth loss, oral health, periodontal disease     

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目的检测慢性阻塞性肺疾病急性加重期（AE—COPD）患者呼吸道内具核梭杆菌（h．）的定植,探讨n．与AE—COPD间的关系。方法选择2008年10月至2009年4月中国医科大学附属第一医院、盛京医院确诊为AE—COPD的患者53例,采集呼吸道分泌物,提取细菌DNA,应用SYBR。GreenIPremixExTaq＇…模式的实时PCR技术,对n．进行定量检测,并计算其所占总菌的比例。同时记录患者FEVl占预计值比例（％）及口腔牙周指标。结果53例样本中有32例检出Fn．,Fn．检出率为60．38％,占总菌的比例为（44．58±16．47）％。Fn．相对含量与FEVl占预计值比例呈负相关关系（P〈0．05）。F凡．相对含量与简化口腔卫生指数及附着丧失水平呈正相关关系（P〈0．05）;与牙龈出血指数、探诊深度、缺失牙数无相关性（P〉0．05）。结论AE—COPD患者呼吸道内存在Fn,Fn相对含量随着肺功能的减弱而增加;Fn．与AE—COPD密切相关。     

Initial Periodontal Treatment for Prevention of Chronic Obstructive Pulmonary Disease Exacerbations

Background: Infective exacerbations in patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality. Therefore, effective management of COPD should include prevention and reduction of exacerbations. The oral cavity is an important reservoir for the respiratory pathogens and these pathogens can be aspirated into the lower respiratory tract, increasing the risk of respiratory infection. Periodontal therapy may reduce these pathogens colonized on the surfaces of teeth and thus may reduce the frequency of COPD exacerbations. The authors aim to assess the effect of initial periodontal therapy on exacerbation frequency in COPD patients. Methods: The authors conducted a prospective, controlled group trial of initial periodontal treatment in 40 patients with COPD with chronic periodontitis (CP) and a history of ≥1 infective exacerbation in the previous year. Number of exacerbations in the previous year was recorded. Patients were divided into two groups; the test group (n = 20) included patients who had initial periodontal treatment, and the control group (n = 20) included patients who did not have periodontal therapy. Number of exacerbations during the following 12 months was noted. Periodontal parameters were measured at baseline and 6 and 12 months. Results: The test group showed a significant reduction in the exacerbation frequency during the follow‐up period (P = 0.01). Although median exacerbations declined from 3 to 2 in the test group, they increased from 2 to 3 in the control group. Conclusion: Initial periodontal therapy in patients with COPD with CP may decrease the exacerbation frequency.     

Association between periodontitis and chronic obstructive pulmonary disease in a chinese population

Background: A relationship between periodontitis and chronic respiratory disease has been suggested by recent studies. The aim of this study is to explore the association between periodontitis and chronic obstructive pulmonary disease (COPD) in a Chinese population. Methods: We conducted a case-control study of 581 COPD cases and 438 non-COPD controls. Lung function examination, a 6-minute walk test, and the British Medical Research Council questionnaire were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PI), and alveolar bone loss. A validated index for predicting COPD prognosis, the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, was also calculated. Results: Participants with more severe COPD were more likely to have severe periodontal disease. PD, AL, PI, alveolar bone loss, and the number of teeth were significantly associated with all stages of COPD (all P <0.001). When compared to controls (BODE = 0), participants with higher BODE scores had significantly higher AL (P <0.001), BI (P = 0.027), PI (P <0.001), alveolar bone loss (P <0.001), and the number of teeth (P <0.001). PI appeared to be the main periodontal health-related factor for COPD, with an odds ratio (OR) = 9.01 (95% CI = 3.98 to 20.4) in the entire study population OR = 8.28 (95% CI = 2.36 to 29.0), OR = 5.89 (95% CI = 2.64 to 13.1), and OR = 2.46 (95% CI = 1.47 to 4.10) for current, smokers, and non-smokers, respectively. Conclusion: Our study found a strong association between periodontitis and COPD, and PI seemed to be a major periodontal factor for predicting COPD among Chinese adults.     

牙周炎与慢性阻塞性肺疾病关系的流行病学研究

目的通过流行病学调查及临床检查,探讨牙周炎与慢性阻塞性肺疾病（COPD）之间的相关性。方法收集中国医科大学附属第一医院、盛京医院、第四医院和沈阳市第八人民医院2008年10月至2009年4月确诊为COPD的患者266例,其中稳定期COPD患者160例,急性加重期COPD（AE—COPD）患者106例,检查并记录所有患者6颗指数牙（61 6、6 16）的简化1：7腔卫生指数（OHI—S）、龈沟出血指数（SBI）、牙周探诊深度（PD）、临床附着丧失（CAL）,同时对所有患者进行肺功能指标的检查,并进行口腔问卷调查。结果（1）AE—COPD组的吸烟率为47．2％,明显高于稳定期COPD组（P〈0．01）;（2）AE—COPD组的SBI、PD及CAL明显高于稳定期COPD组（P〈0．01）;（3）AE—COPD组的OHI—S、SBI、PD及CAL均与FEVl％呈负相关（r分别为-0．309、-0．333、-0．395、-0．702,均P〈0．01）,其中CAL与FEVI％的相关性最强;稳定期COPD组CAL与FEVI％呈负相关（r=-0．657,P〈0．01）。结论（1）吸烟作为牙周炎和COPD的共同危险因素,在牙周炎和COPD的发生和发展中发挥重要作用;（2）AE—COPD患者的牙周炎症程度均随着肺功能的减弱而加重,提示牙周炎与COPD之间存在一定相关性。     

Oral health of monozygotic twins with and without coronary heart disease: a pilot study

AIM: The purpose of this study was to investigate the oral health in monozygotic twins where one twin had coronary heart disease (CHD) and the other twin had no clinical signs of the disease. METHODS: Ten monozygotic twin pairs (age 55-81 years, eight male, and two female pairs) were recruited from the Swedish twin register. The inclusion criterion for participation was discordance regarding the presence of CHD within every twin pair. All participants underwent a full dental clinical examination including a panoramic radiograph. RESULTS: Twins with CHD had 51.5% bleeding on probing compared with 21.1% without CHD (p=0.01), and more pathological pockets (> or = 4 mm) were detected among those with CHD (20+/-15 versus 8+/-5), p=0.047). Twins with CHD had a reduced horizontal bone level in comparison with the healthy group (73%versus 78%, p=0.03). Logistic analyses using odds ratio (OR) showed that an increase of one periodontal pocket (> or = 4 mm) resulted in an increased risk for the actual twin of belonging to the CHD group (OR 1.17, p=0.03). CONCLUSIONS: This study indicates worsened periodontal conditions among twins with CHD compared with their siblings with no history of CHD. This strengthens the association between periodontal inflammation and the presence of atherosclerosis.     

慢性阻塞性肺病急性加重与牙周炎的相关性研究

目的：探讨牙周健康状况对慢性阻塞性肺病急性加重的影响。方法：对呼吸内科住院的81例慢性阻塞性肺病伴有慢性牙周炎的患者随机分成两组,实验组在接受慢性阻塞性肺病规范化治疗的同时进行牙周非手术治疗,对照组只接受慢性阻塞性肺病规范化治疗,不予以牙周病治疗,随访1年,测量并比较患者牙周治疗前、后的菌斑指数（PLI）、龈沟出血指数（SBI）、牙周探诊深度（PD）、牙周附着水平（AL）、FEV1／FVC、FEV 1％pred．、急性加重次数,对急性加重次数与牙周健康指数行相关分析和多元线性逐步回归分析。结果：实验组牙周健康指数明显优于对照组（P＜0．05）,且急性加重次数低于对照组（P＜0．05）;牙周健康指数PLI、SBI、PD、AL与急性加重次数呈显著正相关（分别r＝0．864,r＝0．866,r＝0．926,r＝0．905）,多元线性逐步回归分析显示急性加重次数与PD、PLI呈正相关。结论：改善慢性阻塞性肺病患者的牙周健康状况,可以降低患者的急性发作频率。     

牙周炎和慢性阻塞性肺疾病动物模型的建立及其相关性分析

目的 应用SD大鼠建立慢性牙周炎(chronic periodontitis,CP)和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)动物模型,探讨CP和COPD的相关机制.方法 将40只SD大鼠按随机数字法分为4组:A组:正常对照组;B组:CP组;C组:COPD组;D组:CP+COPD组,每组10只.各组按实验设计施加相应建模因素,于实验10周末处死动物.分别检查各组大鼠的牙周指标及肺功能状况,并观察牙周和肺部的组织病理学改变,酶联免疫吸附法检测血清中肿瘤坏死因子(TNF)-α水平,并行统计学分析.结果 A、C组出血指数分别为(0.25±0.04)、(1.30±0.25),附着丧失分别为(0.43±0.02)、(0.51±0.02)mm,与A、C组相比,B、D组大鼠的出血指数[分别为(3.85±0.34)、(4.01±0.44)]、附着丧失[分别为(0.90±0.27)、(0.98±0.18)mm]均明显升高(P＜0.05);与A组0.2 s末用力呼气量与用力肺活最比值(forced expiratory volume in 0.2 second toforced vital capital ratio,FEV0. 2/FVC值)(65.34±2.63)相比,B、C、D组大鼠FEV0 2/FVC值[分别为(57.49±6.77)、(58.10±2.40)、(49.53±2.86)]明显降低,表明动物模型建造成功.其中D组肺功能与病理学改变均较C组更大,各实验组与正常对照组TNF-α比较差异均有统计学意义(P＜0.05),D组TNF-α含量[(23.422±2.815)μg/L]升高最为明显.结论 在CP和COPD相关关系大鼠动物模型中,CP可能对COPD具有促进和诱发作用.     

慢病管理在口腔常见疾病中的应用

随着生活质量的提高,口腔疾病正逐渐受到大家的重视,近年来关于慢性口腔疾病的相关性研究越来越多。慢病管理分为生物医学管理方法、认知行为干预及心理干预手法,其已作为一种科学的管理模式,广泛应用于高血压、糖尿病、肾脏疾病和其他慢性疾病的管理中。现已有研究应用认知行为干预及心理干预等方法对牙周病、龋齿、扁平苔藓等慢性口腔疾病患者的心理及行为进行管理干预,改善了患者的口腔健康情况,提高了患者的生活质量。该文就近年来慢病管理在口腔疾病中的应用现状做一简要综述。     

牙周干预治疗对慢性阻塞性肺疾病患者BODE指数的影响

目的比较慢性阻塞性肺疾病伴慢性牙周炎患者在进行牙周干预治疗前、后,多因素分级系统BODE指数分级人数分布的变化,探讨牙周干预疗对慢性阻塞性肺疾病预后的改善作用。方法选择87名中、重度慢性阻塞性肺疾病伴牙周炎患者,分为干预组43例,对照组44例;干预组进行牙周干预治疗,对照组仅进行口腔卫生宣教;2组分别记录基线及受试1年后出血指数、牙周附着丧失及BODE指数分级情况。结果干预组牙周治疗后出血指数、牙周附着丧失与基线及对照组比差异均有统计学意义（均P〈0.05）。干预组牙周干预治疗后BODE分级人数分布与治疗前及对照组比差异均有统计学意义（均P〈0.05）。结论牙周干预治疗可促进患者的口腔卫生及牙周健康状况,可改善中、重度慢性阻塞性肺疾病伴牙周炎患者的预后,牙周干预治疗对慢性阻塞性肺疾病具有积极作用。     

Periodontal disease is associated with poor self-rated oral health among Brazilian adults

Objective: The aim of this study was to investigate the association between periodontal disease and self-rated oral health among Brazilian adults.
Material and Methods: Data on 11,874 adults in 250 cities from all the Brazilian regions were analysed. The outcome investigated was self-rated oral health (dichotomized into "Good" and "Poor") and the main exposure was periodontal disease defined as the combination of periodontal pocket depth 4 mm and clinical attachment loss 4 mm. Demographic characteristics, socioeconomic conditions, clinical oral health conditions (dental caries, dental and gingival pain, tooth loss and use of prosthesis) and use of dental services were the other explanatory variables. Simple and multivariate Poisson regression was performed allowing the estimation of prevalence ratios (PRs). All analyses were adjusted for the cluster sampling design.
Results: The prevalence of periodontal disease was 8.9% (_95%CI 7.6–10.3) and poor self-rated oral health was 23.6% (_95%CI 21.9–25.2) which was significantly higher among those who presented periodontal disease (PR 1.4; _95%CI 1.2–1.5), after the adjustment for possible confounders.
Conclusions: Periodontal disease was associated with poor self-rated oral health. The results of this study should be considered by population health planners in order to assess and plan periodontal services.     

Periodontal disease and systemic health: current status

The relationship between poor oral health and systemic diseases has been increasingly recognized over the past two decades. Indeed, the clichés "You cannot have good general health without good oral health", "The mouth is part of the body" and "Floss or die", are gaining an increasing momentum. A large number of epidemiological studies have now linked poor oral health with cardiovascular diseases, poor glycaemic control in diabetics, low birthweight preterm babies and a variety of other conditions. The majority have shown an association, although not always strong. As a result, a number of meta-analyses have been conducted and have confirmed the associations and at the same time cautioned that further studies are required, particularly with regard to the effect of periodontal treatment in reducing risk. A number of biologically plausible mechanisms have been put forward to explain the association and there is accumulating evidence in support of them, although at this stage, insufficient to establish causality. Nevertheless, the relationship between poor oral health and systemic diseases has become a significant issue, such that adult oral health can no longer be ignored in overall health strategies. This review provides an update on current understanding of the contribution of poor oral health to systemic diseases, the possible mechanisms involved and the relevance of this for general dental practitioners.     

Adolescents' sense of coherence, oral health status, and oral health-related behaviours

OBJECTIVE: To investigate the relationship between sense of coherence (SOC) and oral health. It was hypothesised that subjects with better oral health status and better oral health-related behaviours have higher levels of SOC. METHODS: A cross-sectional study was conducted in Goiania-GO, Middle-West Brazil, on a sample of 664 15-year-olds randomly selected from schools. Data were collected through questionnaires, the short version of Antonovsky's SOC Scale (13-item) and clinical dental examinations. Multiple logistic regression and polytomous ordered regression were used in the data analysis. Two sets of outcome variables were selected for the analyses: oral health status (dental caries, oral cleanliness, and periodontal disease), and oral health-related behaviours (frequency of sugar intake, toothbrushing frequency, and pattern of dental attendance). RESULTS: Adolescents' SOC was associated with their caries experience in anterior teeth (OR=0.81 for 10 units increase in SOC scale; 95% CI=0.66-0.98), but the relationship did not remain significant after controlling for other factors. Adolescents with higher SOC were less likely to visit the dentist mainly when in trouble, compared with those with lower SOC (OR=0.83, 95% CI=0.71-0.98), or equivalently more likely to visit for mainly check-ups. Other measures of oral health status and behaviours were not significantly associated with SOC. CONCLUSION: SOC was identified as a psychosocial determinant of adolescents' oral health-related behaviour, particularly affecting their pattern of dental attendance.