牙周健康状况与慢性阻塞性肺病的流行病学调查报告

目的 通过大量调查以探讨牙周健康状况与慢性阻塞性肺病（COPD）的流行病学关系。 方法 从2009年9月10日至2010年3月14日,杭州市部分干部及知识分子共计1 945名接受了口腔健康检查（CPI指数和附着丧失量AL）和全身状况评价（年龄、吸烟程度、体重指数和全身系统疾病情况）。 结果 1 945名受检者中共有253名患者被确诊为COPD,患病率13．02%。COPD组各区段AL均值普遍高于非COPD组。 结论 ①杭州市高层次高收入人群COPD患病率为13.02%,与全国水平基本一致。② 杭州市高层次高收入人群的牙周情况与全国水平相比相对较差,其人群的牙周保健意识仍待提高。③ COPD与牙周病存在联系,最高牙周附着丧失量是可能造成COPD发病的危险因素之一（OR=1.512）。④ 造成AL与COPD相关性的可能因素为a.两者具有共同的危险因素(吸烟、营养不良、基础性疾病等);b.两者具有共同的免疫反应机制。     

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。     

细胞因子在牙周病和慢性阻塞性肺疾病中的作用

流行病学显示,牙周病与全身许多疾病都有密切关系,尤其是与慢性阻塞性肺疾病（COPD）的关系越来越受到人们的重视。国内国外研究表明：一些细胞因子,如肿瘤坏死因子（TNF）、白介素-6（IL-6）、白介素-8（IL-8）等与牙周病和COPD的发病机制明显相关,本文就细胞因子在牙周病、COPD中的作用进行综述。     

与牙周病有关的细胞因子

本文着重对白细胞介素－1，白细胞介素－2，破骨细胞激活因子，前列腺素以及γ－干扰素等细胞因子的免疫学作用和与牙周病可能相关的联系进行了综述。目前研究表明：细胞因子在牙周病发病机制中可能具有重要的免疫调节作用，并且可通过参与介导某些非炎症细胞（如：成纤维细胞）的功能活动而引起牙周组织的破坏。     

牙周病与冠心病的临床联系

我院心血管疾病监护拔牙门诊，自开诊以来二十余年已数千例患者安全拔除或开髓，根管充填等治疗病齿，解决了心血管疾病患者长期不敢治疗受病齿折磨的痛苦。在工作中我们发现许多冠心病患者有较严重的牙周病，比非冠心病患者明显增多，且牙齿缺失数也与年龄不成比例。故引起我们的重视，探讨冠心病和牙周病（包括慢性牙周病）有无病因的联系。     

牙周病与慢性肾病关系研究进展

慢性肾病是各种原因引起的肾脏结构或功能异常 ≥ 3个月,伴或不伴有肾小球滤过率下降,或不明原因的肾小球滤过率下降（< 60 mL/min/1.73 m2）超过3个月。牙周病是发生在牙齿支持组织的慢性炎症性疾病。许多研究发现,慢性肾病患者牙周病的发病率显著高于普通人群,牙周病亦可增加慢性肾病的发病率与严重程度,且与后者的不良预后密切相关。但目前关于牙周病诱发或加重慢性肾病的机制尚不明确,可能与牙周致病菌、炎症因子及氧化应激等途径有关。文章就近年关于牙周病与慢性肾脏病的关系、可能的关联机制以及牙周治疗对慢性肾病预后影响等方面的研究文献进行综述,以期为临床开展二者的联合防治提供借鉴。     

与牙周病有关的细胞因子

本文着重对白细胞介素-1,白细胞介素-2,破骨细胞激活因子,前列腺素以及γ-干扰素等细胞因子的免疫学作用和与牙周病可能相关的联系进行了综述.目前研究表明:细胞因子在牙周病发病机制中可能具有重要的免疫调节作用,并且可通过参与介导某些非炎症细胞(如:成纤维细胞)的功能活动而引起牙周组织的破坏.     

龈沟液中与牙周病有关的细胞因子的研究进展

牙周病时龈沟液内含有多种可作为诊断指标的细胞因子,由于取样简单无创,且能重复取样,易为患者所接受。因此,近年来学者们对龈沟液内的细胞因子在牙周炎活动期的诊断﹑治疗及疗效评价中作用的研究很多。本文对龈沟液中与牙周病有关的细胞因子的研究进展作一综述。     

牙周病与消化系统疾病的联系

牙周病是由口腔菌群失调导致的一种慢性炎症性疾病,已成为许多全身性疾病的危险因素,其中包括消化系统疾病。口腔作为消化道的起始,并且口腔微生物群与消化道微生物群存在重叠,所以牙周病与一些消化系统疾病的关系显得格外密切。文章就当前关于牙周病与几种消化系统疾病相关性的流行病学、临床以及基础研究进行综述,以期对二者联系的内在机制有所了解,从而以牙周健康为切入点,为相关消化系统疾病的防治提供新思路。     

免疫应答与慢性炎症性牙周病

牙周病的发生、发展与转归过程中都有免疫学机制的参与。本文对牙周病变过程中的体液免疫应答，如Ｂ细胞的浸润，免疫球蛋白的产生，抗体介导形成的免疫复合物等作了介绍。同时对Ｔ细胞参与免疫调节功能的种种证据，白细胞介素１，６以及肿瘤坏死因子α等细胞因子及巨噬细胞在牙周病变中的作用作了详细的综述。     

Epidemiologic associations between periodontal disease and chronic obstructive pulmonary disease

The nature of the relationship of periodontal disease to a number of systemic health outcomes, including chronic obstructive pulmonary disease (COPD), remains unclear. Various causal mechanisms have been proposed to explain the observed epidemiologic associations between periodontal diseases and respiratory diseases. We have reviewed the epidemiologic and clinical evidence for this association. The methodologic approach we have taken is based on a structured systematic review of the indexed biomedical literature on these subjects. The primary focus of this review was on the analysis of periodontal health status measures and their association with COPD, which includes chronic bronchitis and emphysema. We found that a paucity of published results exist on this specific relationship and those which do exist typically represent secondary analyses of existing data sets. Nevertheless, the epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations.     

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。     

Correlation between periodontal disease, inflammatory alterations and pre-eclampsia

Politano GT, Passini R, Nomura ML, Velloso L, Morari J, Couto E. Correlation between periodontal disease, inflammatory alterations and pre‐eclampsia. J Periodont Res 2011; 46: 505–511. © 2011 John Wiley & Sons A/S Background and Objective: Several studies have hypothesized that periodontal disease may increase the risk of pre‐eclampsia. The correlation between the two diseases would probably be based on hypertension‐related cytokine release in the local periodontal environment. The aim of this study was to evaluate the association between periodontal disease and pre‐eclampsia, and the correlation of the two conditions with interleukin‐6 (IL‐6) and tumor necrosis factor‐α(TNFα) mRNA expression. Material and Methods: A case–control analysis of 116 pregnant women, 58 with pre‐eclampsia (cases) and 58 normotensive pregnant women (controls) was performed. In addition to collection of socio‐demographic data and periodontal evaluation, peripheral blood samples were collected for laboratory analysis of IL‐6 and TNFα mRNA expression by real‐time PCR. Results: There was an association between periodontitis and pre‐eclampsia (adjusted odds ratio 3.73; 95% confidence interval 1.32–10.58). Increased TNFα mRNA expression was observed in pre‐eclamptic women; however, there was no correlation between periodontitis and systemic cytokine expression. In the case group, systemic cytokine mRNA levels were similar in pregnant women with and without periodontitis (means ± SD): 0.73 ± 0.24 vs. 0.82 ± 0.38 for TNFα and 1.31 ± 1.49 vs. 1.09 ± 0.74 for IL‐6, respectively. Conclusion: Periodontitis was clinically related to pre‐eclampsia; however, the supposed mechanism that correlates the two diseases, i.e. a systemic inflammatory process involving cytokines TNFα and IL‐6 in the presence of periodontal disease, could not be confirmed in this study.     

牙周病与肺部感染的关系

牙周病不仅破坏局部牙齿支持组织，亦可影响许多全身性疾病。近年来，牙周病与肺感染的关系逐渐引起人们的重视。本文就牙周病与肺炎(尤其是重症卧床老年人的院内获得性肺炎)及慢性阻塞性肺病(COPD)之间的潜在联系作一综述。     

Relationship between maternal periodontal disease and low-birth-weight pre-term infants

OBJECTIVES: The purpose of this study was to determine the influence of periodontal status on low-birth-weight pre-term delivery. MATERIAL AND METHODS: Ninety-six pregnant women were examined in their first, second and third trimester to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and percentage of sites with depth of >3 mm). Binary logistic regression analyses were performed using SUDAAN 7.5 program. The type 1 (alpha) error established at 0.05 and an (alpha) error of 0.05-0.1 were considered nearly significant. RESULTS: The 96 women delivered 89 newborns: 16 were pre-term and seven of these were of low birth weight. There were seven miscarriages, all in the second trimester. No statistically significant association was found between gestational age and periodontal parameters. No significant relationship was found between low-weight delivery and plaque index measurements, although the association with gingival index was close to significant. A relationship was observed between low-weight birth and probing depth measurements, especially the percentage of sites of >3 mm depth, which was statistically significant (p=0.0038) even when gestational age was controlled for. CONCLUSIONS: According to these results, periodontal disease is a significant risk factor for low birth weight but not for pre-term delivery.     

Interactions between chronic renal disease and periodontal disease

The incidence of end-stage renal disease (ESRD) is increasing and patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or renal transplantation will comprise an enlarging segment of the dental patient population. Renal replacement therapy can affect periodontal tissues including gingival hyperplasia in immune suppressed renal transplantation patients and increased levels of plaque, calculus and gingival inflammation and possible increased prevalence and severity of destructive periodontal diseases in ESRD patients on dialysis maintenance therapy. Also, the presence of undiagnosed periodontitis may have significant effects on the medical management of the ESRD patient. Periodontitis has been found to contribute to systemic inflammatory burden including the elevation of C-reactive protein (CRP) in the general population. Atherosclerotic complications including myocardial infarction and stroke are the primary causes of mortality in the ESRD population and, in contrast to that of the general population, the best predictor of all cause and cardiac death in this population is CRP. Consequently, periodontitis may be a covert but treatable source of systemic inflammation in the ESRD population. The objective of this review was to explore the interaction between chronic renal disease, renal replacement therapy and periodontal diseases based upon the results of studies published within the last decade.     

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