2型糖尿病合并牙周病患者龈沟液中基质金属蛋白酶-3水平和意义

目的:研究2型糖尿病合并牙周病患者、龈沟液中基质金属蛋白酶-3(MMP-3)和龈沟液量,及其与糖代谢状况的关系。方法:2型糖尿病合并牙周病患者、牙周病患者和全身健康者各30例;使用滤纸条法采集龈沟液,用ELISA法测定龈沟液中MMP-3含量;用自动糖化血红蛋白分析仪VarintⅡ测定2型糖尿病合并牙周病患者的糖化血红蛋白(HbA1c)水平。结果:糖尿病合并牙周病组和牙周病组龈沟液中MMP-3含量显著高于正常对照组(P<0.01)。糖尿病合并牙周病组龈沟液中MMP-3含量显著高于牙周病组(P<0.01),其龈沟液的量与牙周病组没有显著差异。糖尿病合并牙周病组龈沟液中MMP-3含量与HbA1c水平无显著相关性。结论:龈沟液中MMP-3含量受牙周炎症影响并受全身因素调控。     

维生素E与牙周病

牙周病病因学方面的概念,除感染因素外,许多学者提出与营养因素有关。牙周病还被认为是维生素E(α-生育醇)缺乏所引起的疾病之一。作者为了确定血清维生素E含量与牙周病之间是否有关而进行了本研究。他对24例(12例是炎症性牙周病,12例非牙周病者)作了牙龈牙周指数与血清维生素E的测定。血清维生素E用Quaife等的微量分析法测定。     

MMP-2在吸烟牙周炎患者牙龈组织中的表达

目的:从MMP-2的酶活性和mRNA水平探讨吸烟与牙周病的关系。方法:利用明胶酶活性分析(zymog-raphy)和RT-PCR方法,分别检测6例吸烟牙周病、6例不吸烟牙周病、6例吸烟正常人、6例不吸烟正常人的牙龈组织中MMP-2的酶活性和mRNA表达。结果:吸烟和牙周病牙龈组织中MMP-2酶活性都较正常组有增加,但吸烟牙周病组的MMP-2的酶活性与吸烟无牙周病组和不吸烟牙周病组有明显差异(P<0.01),吸烟牙周病患者牙周组织中MMP-2的mRNA水平较正常组明显增加(P<0.01)。结论:MMP-2在吸烟牙周炎牙周组织的破坏中起重要作用。     

牙周病与早产低出生体重儿关系的临床研究

目的比较分娩早产低出生体重儿(PLBW)的孕妇与足月妊娠正常分娩新生儿(NBW)孕妇的牙周状况及牙周病的发生率,探讨牙周病与PLBW的关系。方法随机选取分娩PLBW的孕妇206例为研究组,选取同期分娩NBW的孕妇209例为对照组,检测两组孕妇的牙周状况,记录菌斑指数(PLI)、探诊深度(PD),临床附着丧失(CAL)和出血指数(BI),并计算牙周炎位点率(PD>3 mm,CAL>2 mm)及牙周病的发生率。结果分娩早产低出生体重儿的孕妇牙周炎位点率(3.3%)和牙周病发生率(81.1%)明显高于对照组(1.4%,35.9%),差异有显著性(P<0.01);牙周炎位点率与孕周和新生儿体重均呈负相关系(P<0.05)。结论牙周病可能是PLBW发生的危险因素。     

牙髓病与牙周病的相互关系

一、概述牙髓病与牙周病之间是相关还是无关,目前意见尚不一致。但大多数学者的大量研究结果表明牙周病和牙髓病可互有影响,可互为因果。 (一) 关于研究方法本题目中采用的主要研究方法有:(1)观察牙周病牙的牙髓组织变化,(2)观察牙     

胶原膜引导牙周组织再生的临床观察

目的 对使用胶原膜治疗牙周病的结果进行研究，观察其治疗牙周病的效果；方法 对牙周病患牙均使用胶原膜进行引导牙周组织再生术(GTR)；结果 使用胶原膜进行引导牙周组织再生术治疗牙周病效果满意，结石、菌斑、出血、牙周袋、根分又及牙松动等临床观察指标均明显好转，尤其以牙周袋及根分叉病变的改善最为突出；结论 使用胶原膜进行引导牙周组织再生术治疗牙周病，治疗效果好。     

单核细胞趋化蛋白-1和细胞间黏附分子-1与动脉粥样硬化和牙周病的关系

以动脉粥样硬化为病理基础的冠心病是目前主要的致死性疾病之一,而牙周病与动脉粥样硬化之间存在着一定的相关性。单核细胞趋化蛋白(MCP)-1和细胞间黏附分子(ICAM)-1在动脉粥样硬化和牙周病的发生发展中起着重要的作用。本文就MCP-1和ICAM-1以及二者与动脉粥样硬化、牙周病间的关系作一综述。     

老年人牙周病与心血管疾病的关系

目的探讨老年人牙周病与心血管疾病之间的联系。方法对852名年龄59～82岁的老年人牙周病状况及心血管健康状况进行调查和临床检查[包括心血管疾病史、超声心动图、血压、甲襞微循环和脑血流图(TCD)]。将受检者分为牙周病组(A组)和非牙周病组(B组),然后对两组的状况进行统计分析。结果A组的心血管病患病率、甲襞微循环异常和TCD异常的发生率都明显高于B组,两组间存在明显差异(P<0.05)。结论牙周病和心血管疾病之间存在相关性,二者间可以相互影响。     

我国1990—2019年成人牙周病疾病负担现状分析及牙周病发病趋势预测

目的分析1990—2019年我国成人牙周病的疾病负担及变化趋势, 并预测未来25年的牙周病发病趋势, 为减轻我国牙周病负担和制订相关防治措施提供依据。方法利用2019全球疾病负担研究(GBD)数据库, 提取1990—2019年我国成人牙周病的发病率、患病率和伤残调整寿命年(DALY)率数据。采用年估计变化百分比(EAPC)估计近30年来我国牙周病的变化趋势, 并基于年龄-时期-队列(APC)模型预测2020—2044年我国成人牙周病的年龄标化发病率。结果 1990—2019年我国成人牙周病的发病率、患病率和DALY率均呈上升趋势, EAPC分别为0.3(95%CI:0.1～0.6)、0.5(95%CI:0.1～0.8)和0.5(95%CI:0.1～0.8)。35～39岁人群牙周炎发病率和40～44岁人群患病率的上升幅度最高(EAPC分别为0.8和0.7), ≥60岁人群牙周病发病率的变化趋势平稳(EAPC为0～0.1), 患病率的上升幅度相对较低(EAPC为0.2～0.4)。女性牙周病发病率(EAPC为2.1)、患病率(EAPC为2.6)和DALY率(EAPC为2.6)的上升幅度均高于...     

牙周病和冠心病相互关系的临床问卷研究

目的 :通过临床问卷调查 ,初步探讨牙周病与心血管疾病的相互关系。方法 :选取第四军医大学西京医院和解放军 32 3医院心血管内科住院患者 2 82例 ,分为冠心病组 1 4 6例 (病例组 )和非冠心病组 1 36例 (对照组 ) ,均设计相同的问卷进行调查 ,比较两组牙周病患病率和牙周健康状况 (牙龈出血、牙齿松动、牙龈退缩、牙齿缺失 )的差异。结果 :冠心病组的牙周病患病率 (52 .0 5 % )高于非冠心病组 (32 .35 % ) ,冠心病组牙周健康状况也均差于非冠心病组。经统计学检验 ,两组间有显著性差异 (P <0 .0 1 ) ,牙周病 (OR =2 .2 70 ,P <0 .0 1 )和吸烟 (OR =1 .892 ,0 .0 1

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Oral health and mortality risk from pneumonia in the elderly

Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and four-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.     

Oral health and respiratory infection

The oral cavity has long been considered a potential reservoir for respiratory pathogens. The mechanisms of infection could be aspiration into the lung of oral pathogens capable of causing pneumonia, colonization of dental plaque by respiratory pathogens followed by aspiration, or facilitation by periodontal pathogens of colonization of the upper airway by pulmonary pathogens. Several anaerobic bacteria from the periodontal pocket have been isolated from infected lungs. In elderly patients living in chronic care facilities, the colonization of dental plaque by pulmonary pathogens is frequent. Notably, the overreaction of the inflammatory process that leads to destruction of connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease, the fourth leading cause of death in the United States. These findings underline the necessity for improving oral hygiene among patients who are at risk and those living in long-term care institutions.     

Oral inflammation and infection,and chronic medical diseases: implications for the elderly

Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth‐supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high‐risk patients. For other medical conditions, because of the absence of well‐designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.     

Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study

Background: Recent research indicated that periodontal infection may worsen systemic diseases, including pulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract. Methods: A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age‐, sex‐, and race‐matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ² and Student t tests were used for statistical analyses. Results: The comparison of study‐population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high‐income patients. Smokers had significantly higher CALs compared to non‐smokers in the control group. Conclusion: The findings of the present analysis support an association between respiratory and periodontal disease.     

Role of oral bacteria in respiratory infection.

An association between oral conditions such as periodontal disease and several respiratory conditions has been noted. For example, recent evidence has suggested a central role for the oral cavity in the process of respiratory infection. Oral periodontopathic bacteria can be aspirated into the lung to cause aspiration pneumonia. The teeth may also serve as a reservoir for respiratory pathogen colonization and subsequent nosocomial pneumonia. Typical respiratory pathogens have been shown to colonize the dental plaque of hospitalized intensive care and nursing home patients. Once established in the mouth, these pathogens may be aspirated into the lung to cause infection. Other epidemiologic studies have noted a relationship between poor oral hygiene or periodontal bone loss and chronic obstructive pulmonary disease. Several mechanisms are proposed to explain the potential role of oral bacteria in the pathogenesis of respiratory infection: 1. aspiration of oral pathogens (such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, etc.) into the lung to cause infection; 2. periodontal disease-associated enzymes in saliva may modify mucosal surfaces to promote adhesion and colonization by respiratory pathogens, which are then aspirated into the lung; 3. periodontal disease-associated enzymes may destroy salivary pellicles on pathogenic bacteria to hinder their clearance from the mucosal surface; and 4. cytokines originating from periodontal tissues may alter respiratory epithelium to promote infection by respiratory pathogens.     

Periodontal disease and pneumonia mortality in haemodialysis patients: A 7‐year cohort study

Aim

To evaluate the association between periodontal disease and pneumonia mortality in haemodialysis patients.

Materials and Methods

This prospective cohort study included 211 patients (mean age, 64.4 years) undergoing haemodialysis at a single medical centre. The patients underwent a baseline clinical dental examination in 2008 and were then followed up until July 2015. Periodontal disease was defined as the presence of clinical attachment loss of ≥4 mm in ≥30% of the probed sites. The primary endpoint, that is death from pneumonia, was determined by reviewing death certificates and was analysed using the competing‐risks regression model.

Results

At baseline, 92 patients (43.6%) had periodontal disease. The median follow‐up period was 84 months (interquartile range, 36–86 months). Of the 68 deaths that occurred, 21 were from pneumonia. The multivariable competing‐risks regression model showed that periodontal disease was significantly associated with death from pneumonia (adjusted subhazard ratio, 3.49; 95% confidence interval, 1.14–10.64), after adjusting for other baseline health characteristics.

Conclusions

The results of this study suggest that periodontal disease is independently associated with pneumonia mortality in haemodialysis patients. Future studies evaluating the potential effect of oral interventions for periodontal health improvement on pneumonia in haemodialysis patients would be of great interest.     

Oral biofilms, periodontitis, and pulmonary infections

Bacteria from the oral biofilms may be aspirated into the respiratory tract to influence the initiation and progression of systemic infectious conditions such as pneumonia. Oral bacteria, poor oral hygiene, and periodontitis seem to influence the incidence of pulmonary infections, especially nosocomial pneumonia episodes in high-risk subjects. Improved oral hygiene has been shown to reduce the occurrence of nosocomial pneumonia, both in mechanically-ventilated hospital patients and non-ventilated nursing home residents. It appears that oral colonization by potential respiratory pathogens, possibly fostered by periodontitis, and possibly by bacteria specific to the oral cavity or to periodontal diseases contribute to pulmonary infections. Thus, oral hygiene will assume an even more important role in the care of high-risk subjects--patients in the hospital intensive care and the elderly. The present paper critically reviews the recent literature on the effect of oral biofilms and periodontitis on pneumonia.     

Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease

BACKGROUND: Cigarette smoking is a significant risk factor for both chronic obstructive pulmonary disease (COPD) and periodontal disease. The goal of this study was to better understand the role of smoking in a possible relationship between periodontal disease and COPD. METHODS: The study population consisted of 7,625 participants in the Third National Health and Nutrition Examination Survey (NHANES III) during 1988-1994 who were aged 30 years or older when examined and who received a spirometric examination. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES III. RESULTS: After adjustment for potential confounders, there was no statistically significant association between periodontal disease and COPD among former or non-smokers. Current smokers with > or = 4 mm mean loss of attachment had an odds ratio of 3.71 (95% confidence interval: 1.74, 7.89). CONCLUSIONS: These results suggest that cigarette smoking may be a cofactor in the relationship between periodontal disease and chronic obstructive pulmonary disease. The key role played by smoking in the etiology of both periodontal disease and chronic obstructive pulmonary disease suggests that much of the observed increase in risk may actually reflect the exposure to smoking. Additional research into smoking-related effect modification is needed to clarify the role of periodontal disease in the etiology of smoking-related systemic diseases.     

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。     

Periodontal health and systemic disorders

Recent studies in periodontal medicine suggest a mild to moderate association between human periodontal disease and certain systemic disorders such as diabetes mellitus, pneumonia, heart disease and preterm birth. The latest evidence, presented at a symposium entitled Periodontal Health and Systemic Disorders, sponsored by the University of Western Ontario School of Dentistry, showed that indeed such an association is likely. New data suggest that this association is not indicated by traditional clinical signs of periodontal disease but rather by a cluster of host immune and inflammatory mediators. The coming era of periodontal medicine based upon molecular criteria will affect the future of periodontal diagnosis, treatment and professional practice.