916例2型糖尿病患者牙周健康调查及影响因素分析

目的： 调查上海市第六人民医院内分泌科就诊的2型糖尿病患者的牙周健康状况,探讨相关影响因素,为针对性地开展区域内2型糖尿病患者的牙周病防治工作提供流行病学依据。方法： 对2018年11月—2018年12月间至上海市第六人民医院内分泌科就诊的2型糖尿病患者进行牙周检查以及问卷调查。牙周检查参考WHO推荐的《口腔健康调查基本方法》中的检查标准,对指数牙的相关牙周指标进行检查和计分,包括探诊深度、探诊出血、临床附着丧失、牙石指数、菌斑指数等。通过问卷调查获取社会人口学信息、糖尿病史、牙周健康相关行为等信息。采用SPSS 22.0软件包进行数据统计和分析。结果： 参与完成调查的916名2型糖尿病受试者中,共有670例牙周炎患者,牙周炎总体患病率为73.14%,牙周炎患者人均缺牙数4.85（颗）。糖尿病患者较高的年龄、较长的病程及糖尿病并发症是牙周炎的危险因素。随着患者年龄增加、病程延长以及糖尿病相关并发症的出现,糖尿病患者牙周炎的患病率显著上升（P<0.05）。结论： 2型糖尿病患者的牙周健康情况不容乐观,牙周炎的早期预防和治疗极为关键,需要关注高龄、长期病程的糖尿病患者的牙周健康状况,并对该人群开展针对的口腔预防保健。     

牙周冲洗与牙周健康维护

牙周冲洗与牙周健康维护韩璐①高翔①综述张世卫②史久成①审校①佛山市口腔医院（５２８０００）②北京医科大学口腔医学院（１０００８３）成功的牙周治疗，除医生认真的机械清创（手术或非手术）外，很大程度上有赖于患者自身的菌斑控制。Ａｄｒｉａｅｎｓ等指出：严格...     

环孢素A诱发牙龈增生的发生率与牙周健康指数的关系

环孢素A(cyclosporinA ,CsA)免疫抑制作用强 ,毒性及感染发生率低 ,应用广泛。CsA不良反应中牙龈增生的发生率较高 ,因目前尚无更加安全、有效、廉价的药物可替代CsA ,因此了解CsA诱发牙龈增生与牙周健康指数的关系 ,有助于寻求有效的综合防治措施 ,以提高器官移植 (及某些免疫性疾病 )患者的生存质量。1 材料和方法 :( 1)病例选择 :对象为 1997年 1月～ 2 0 0 1年 6月期间 ,同济医院器官移植病房的肾移植患者 2 34例 ,男性 198例 ,女性 36例。年龄 12～ 6 7岁 ( <2 5岁 :6例 ;>0岁 :13例 ) ,平均 ( 4 7 1± 11 9)岁。患者均未进行过牙…     

牙周基础治疗调节2型糖尿病患者代谢的研究进展

牙周炎与糖尿病密切相关,糖尿病是牙周炎的全身促进因素之一,牙周炎会加重糖尿病的病情和代谢紊乱程度。牙周基础治疗在这个双向关系中意义重大,能显著改善牙周支持组织状态、降低血清和龈沟液中炎症因子的表达,研究发现这与牙龈卟啉单胞菌fimA II型减少和内皮祖细胞免疫炎症基因等体内相关炎症基因表达降低有关。一些研究还表明牙周基础治疗能减少胰岛素拮抗脂肪因子释放、增加胰岛素敏感脂肪因子生成,缓解胰岛素抵抗;或因加强脂肪组织代谢相关基因和炎症标志物基因的表达,而对患者的糖脂代谢有益。因此,明确牙周基础治疗对2型糖尿病伴牙周炎患者的影响及相关机制,可为防治2型糖尿病及其并发症提供新的理论依据。     

牙周基础治疗对2型糖尿病伴牙周炎患者血清氧化应激水平的影响

目的 探讨2型糖尿病伴牙周炎患者牙周基础治疗后对牙周临床指标及外周血血清氧化应激水平的影响.方法 选择2017年7月至2018年2月在我院就诊接受牙周基础治疗的2型糖尿病伴牙周炎患者24例及中重度牙周炎患者22例,以牙周健康者20例作为对照,采集2型糖尿病伴牙周炎患者、中重度牙周炎患者及健康者的外周血,采用酶联免疫吸附...     

牙周测定值与牙周临床指数关系的研究

目的 观察牙周测定值与牙周临床指数间的关系。方法 对牙周测验仪(Periotest)数值、牙周袋探诊深度、牙龈退缩程度、牙龈出血指数以及全颌X线片上牙槽骨吸收程度的测量值进行相关关系研究。结果 牙周测定值与牙槽骨吸收的关系最为密切，与牙周袋探针深度的关系次之，而与牙龈退缩程度和牙龈出血指数的关系不密切。牙周测定值与牙槽骨的吸收成正比关系。结论 牙周测定值能在一定程度上反映牙槽骨的吸收情况。     

牙周炎对大鼠血清瘦素水平及胰岛素抵抗的影响

目的探讨实验性牙周炎对正常和肥胖大鼠血清瘦素水平及胰岛素抵抗的影响。方法 32只雄性SD大鼠随机等量分为肥胖组、牙周炎组、肥胖与牙周炎复合组以及正常对照组。采用皮下注射谷氨酸钠的方法建立肥胖大鼠模型,结扎双侧上颌磨牙建立牙周炎模型。4组大鼠饲养20周后处死,采集血样,运用酶联免疫吸附法检测大鼠血清中瘦素,空腹胰岛素和空腹血糖水平,并计算胰岛素抵抗指数。结果牙周炎组和肥胖与牙周炎复合组大鼠的血清瘦素浓度分别为（11.10±3.36）ng/mL和（50.51±7.60）ng/mL,空腹血糖分别为（12.83±1.87）mmol/L和（7.10±1.32）mmol/L,分别高于正常对照组和肥胖组,差异均有统计学意义（P〈0.05）。血清瘦素水平的升高与胰岛素抵抗指数存在正相关关系。结论牙周炎可诱导正常与肥胖大鼠的血清瘦素水平和胰岛素抵抗指数升高,尤其是肥胖大鼠更显著,牙周炎可加重其高瘦素血症和胰岛素抵抗状态。     

糖尿病伴牙周炎患者牙周植骨术的疗效评价

目的 探讨Ⅱ型糖尿病伴牙周炎患者牙周植骨术的临床疗效.方法 选择Ⅱ型糖尿病伴牙周炎需植骨患者为实验组,慢性牙周炎需植骨患者为对照组,每组20例.牙周基础治疗3个月后行牙周翻瓣植骨术.检测术前与术后1个月牙龈出血指数、牙周探诊深度、附着丧失水平并拍摄术后4、8、12周平行定位投照片.Ⅱ型糖尿病患者术前及术后3个月测量糖化血红蛋白,术前与术后1个月测量肿瘤坏死因子水平.结果 两组38例手术均获成功,失败2例.对照组术后1个月各项临床指标与实验组比较统计学无意义(P＞0.05);两组术后较术前各指标明显降低(P＜0.001);手术前后肿瘤坏死因子及糖化血红蛋白检测统计学意义(P＞0.05).结论 对Ⅱ型糖尿病伴牙周炎患者牙周基础治疗后行牙周植骨手术可取得满意疗效.     

伴2型糖尿病的慢性牙周炎牙周可疑致病菌的检测

目的 检测伴2型糖尿病(diabetes mellitus,DM)的慢性牙周炎(chronic periodontitis,CP)患者龈下菌斑中牙周可疑致病菌的种类和构成,从微生物学角度探讨牙周炎与DM的相互作用机制.方法 采集伴2型DM的CP患者154例(DM组)、不伴DM的单纯CP患者120例(CP组)及40名全身及牙周健康者(N组)的龈下集合菌斑,传统酚-氯仿法提取菌斑DNA,以牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg),伴放线放线杆菌(Actinobacillus actinomycetemcomitans,Aa),具核梭杆菌(Fusobacterium nucleatum,Fn),中间普氏菌(Prevotella intermedia,Pi),福塞坦氏菌(Tannerella forsythia,Tf),齿垢密螺旋体(Treponema denticola,Td)为目标菌,应用以16SrRNA为基础的聚合酶链反应(PCR)技术对龈下菌群进行检测.结果 Pg、Aa、Fn、Pi、Tf、Td在DM组中均可检出;与CP组相比,在性别、年龄、牙周状况基本一致的情况下,轻度牙周炎者DM组Pi的检出率为35%(8/23),CP组为65%(13/20),两组间差异有统计学意义(P<0.05);重度牙周炎者DM组Pg、Aa、Tf的检出率分别为78%(72/92)、27%(25/92)、67%(62/92),CP组分别为58%(35/60)、17%(10/60)、43%(26/60),DM组均显著高于CP组,差异有统计学意义(P<0.05).同时,DM组Aa、Tf PCR产物的平均灰度值(average gradation,AVG)比值显著高于CP组,Pi的AVG比值明显低于CP组,P<0.05.结论 与单纯CP相比,伴2型DM的牙周炎患者龈下菌斑中Pg、Aa、Tf的数量增多,Pi的数量减少.     

从牙周致病菌检出探讨冠修复体与牙周炎的相关性

目的:探讨不同材质冠修复体对基牙牙周状况的影响。方法:选取冠修复患者120例,分别用镍铬合金(Ni-Cr)、钴铬合金(Co-Cr)、全瓷冠组(All ceramic)进行全冠修复(n=40),修复前后检查记录临床牙周指数(牙龈出血指数、菌斑指数和牙周探诊深度);采集龈下菌斑,PCR技术检测标本中的牙龈卟啉单胞菌(Pg)、伴放线嗜血杆菌(Aa)、中间普氏菌(Pi)、具核酸杆菌(Fn)。结果:修复后6~24月全瓷冠组牙周指数与修复前无显著差异(P>0.05),Ni-Cr组和Co-Cr组牙周指数均升高(P<0.05)。Ni-Cr组合金烤瓷冠在修复后12个月牙周致病菌Pg、Pi、Fn检出率显著高于Co-Cr组和氧化锆全瓷组(P<0.05);全瓷组牙周致病菌的检出率最低。结论:牙冠修复中全瓷对牙周组织的损害小于镍铬合金、钴铬合金。     

糖尿病与牙周病相关机制的研究进展

糖尿病和牙周病都是临床常见的慢性高发性疾病,两者互相作用,相互影响。下面从免疫炎症反应、胰岛素抵抗以及牙周治疗对糖尿病患者血糖控制的影响等角度,对目前有关糖尿病与牙周病相关机制的研究进展作一综述。     

A population-based study of periodontal care among those with and without diabetes

Background: Our objectives were to describe the prevalence of periodontal care (a marker of periodontitis) among persons with and without diabetes and to examine the association between periodontal care and diabetes. Methods: We conducted a cross‐sectional analysis, using 5 years of electronic data from a population‐based cohort (N = 46,132), aged 40 to 70 years, with dental and medical insurance, and ≥1 dental and ≥1 medical visit. Periodontal care (yes/no) was defined by dental claims codes for procedures used to manage periodontitis. The association between periodontal care and diabetes was determined using logistic regression adjusted for and stratified by age, sex, insurance type, smoking status, body mass index (BMI) (in kilograms per square meter), and resource utilization band (RUB) (a measure of expected health care utilization attributable to comorbidity). Results: Overall, 11.2% (5,153 of 46,132) met diabetes criteria. The age‐adjusted prevalence of periodontal care among those with and without diabetes was 39.1% and 32.5%, respectively (P <0.0001). The association between diabetes and periodontal care decreased with increasing age (interaction, P <0.0001), adjusting for BMI and RUB. The aged‐stratified, adjusted odds ratio (OR) for periodontal care associated with diabetes was highest among those aged 40 to 44 years [OR, 1.6; confidence interval (CI), 1.30 to 1.97] and lowest among those aged 60 to 64 years (OR, 0.97; CI, 0.81 to 1.15) and was significant only among those aged 40 to 54 years. Conclusion: We found that the prevalence of periodontal care was significantly higher among those with diabetes compared to those without diabetes and that the magnitude of this association decreased with increasing age.     

The effect of periodontal therapy in diabetics

Abstract The present investigation was performed to study the frequency of recurrence of periodontitis in diabetic subjects, who, prior to the initiation of a 5-year period of monitoring, were treated for moderate to advanced periodontal disease. 20 patients with diabetes, type 1 (LDDM) or type 2 (N1DDM) and 20, sex and age matched, controls with similar amounts of periodontal tissue destruction, were selected for the study. Following a screening examination, all patients were subjected to non-surgical periodontal therapy (oral hygiene instruction, supra-and subgingival scaling). 3 months later, the baseline examination for the study was performed. This included assessments of several parameters such as: number of teeth, plaque, gingivitis, probing pocket depth and probing attachment level. 6 months after the baseline examination, all 40 subjects were recalled for a 2nd examination. Sites which at this 6-month examination exhibited bleeding on probing, and had probing depth >5 mm, were scheduled for additional surgical therapy (modified Widman flap). Following this selective additional therapy, the main period of monitoring was initiated. During this period, a plaque control program was repeated every 3 months. Re-examinations regarding plaque, gingivitis, probing depth and probing attachment level were performed 12, 24 and 60 months after the baseline examination. The findings from the examinations disclosed that diabetics and non-diabetics alike, treated for moderately to advanced forms of adult periodontitis, during a subsequent 5-year period, were able to maintain healthy periodontal conditions. Thus, the frequency of sites which exibited signs of recurrent disease was similar in the 2 study groups.     

Insulin resistance predicts the risk of gingival/periodontal inflammation

1 Objectives

Evaluate whether insulin resistance (IR) predicts the risk of oral inflammation, assessed as the number of sites with bleeding on probing (BOP) and number of teeth with probing pocket depths (PPD) ≥ 4 mm and BOP.

2 Methods

Data on 870 overweight/obese diabetes free adults, aged 40–65 years from the San Juan Overweight Adults Longitudinal Study over a three‐year period, was analyzed. Baseline IR, assessed using the Homeostasis Model Assessment of IR (HOMA‐IR) index, was divided into tertiles. BOP was assessed at buccal and lingual sites, and PPD at six sites per tooth. Negative binomial regression was used to estimate the risk ratios (RRs) for oral inflammation adjusted for baseline age, gender, smoking status, alcohol intake, education, physical activity, waist circumference, mean plaque index, and baseline number of sites with BOP, or number of teeth with PPD≥4 mm and BOP. The potential impact of tertiles of serum TNF‐α and adiponectin on the IR‐oral inflammation association was also assessed in a subsample of 597 participants.

3 Results

Participants in the highest HOMA‐IR tertile at baseline had significantly higher numbers of sites with BOP [RR = 1.19, 95% confidence interval (CI): 1.03–1.36] and number of teeth with PPD ≥ 4 mm and BOP (RR = 1.39, 95% CI: 1.09–1.78) at follow‐up, compared with individuals in the lower two HOMA‐IR tertiles. Neither TNF‐α nor adiponectin confounded the associations.

4 Conclusion

IR significantly predicts gingival/periodontal inflammation in this population.     

Effect of antimicrobial periodontal treatment and maintenance on serum adiponectin in type 2 diabetes mellitus

Aims: The aims of this study were to evaluate the effect of mechanical periodontal treatment with local application of minocycline (APT) on serum adiponectin as a marker of insulin resistance improvement in type 2 diabetes mellitus (T2DM) patients and to investigate if effect of APT on serum adiponectin level was sustained by periodontal maintenance (PM).
Material and Methods: Twenty-seven T2DM patients were randomly assigned into test or control groups. Test received scaling with ultrasonic devices at baseline and APT biweekly for 2 months while control received scaling at baseline and mechanical tooth cleaning (MPT) at the same interval. At 6 months, all patients received mechanical tooth cleaning as PM. Periodontal examination and blood measurements were performed at baseline, 4 and 9 months.
Results: Adiponectin concentrations in test had significantly increased by 31.4% after APT ( p =0.024) and by 30.4% after PM ( p =0.002) compared with baseline. The percentage of 4 mm probing depths (PD) had shown 8.3% and 9.3% reduction after APT and PM ( p =0.046, 0.02) in test while 5.0% reduction after MPT in control group ( p =0.031).
Conclusions: Our results suggested that APT and PM not only improve periodontal disease but also increase serum adiponectin in T2DM patients.     

牙周基础治疗对2型糖尿病患者糖脂代谢的影响

目的:观察伴发2型糖尿病的慢性牙周炎患者的牙周状况,探讨牙周基础治疗对牙周状况及糖脂代谢的影响.方法:选择伴发2型糖尿病的慢性牙周炎患者30例,非糖尿病慢性牙周炎患者30例,分析治疗前及治疗后1、3个月的牙龈指数、牙周探诊深度、附着丧失水平以及糖化血红蛋白、甘油三酯、总胆同醇水平.研究数据采集完成后,以SAS 6.12软件包对结果进行双因素方差分析.结果:牙周治疗后,患者的牙周状况均有改善,差异有显著性(P＜0.05).血糖控制欠佳的患者,治疗后糖化血红蛋白有所改善,差异有显著性(P＜0.05);而血糖控制较好者,其糖化血红蛋白治疗后下降不明显.基础治疗对患者的血脂水平无显著影响.结论:伴发2型糖尿病的慢性牙周炎患者接受基础治疗后,短期效果良好;血糖控制欠佳的患者,基础治疗有助其糖代谢水平的改善,但血糖控制良好者,基础治疗对其糖代谢水平无显著影响.     

A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease

Abstract In the present two-year longitudinal investigation, the progression of periodontal disease was assessed after 1 year from the baseline examination in 38 dentate subjects and after 2 years in 22 dentate subjects with a mean duration of 18 years of insulin-dependent diabetes mellitus. The diabetics, aged 35 to 56 years at baseline, were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at 2 diabetic clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were at baseline identified as having poorly controlled insulin-dependent diabetes (PIDD) with a mean blood glucose level of 12.5 mmol/1 and a mean glycosylated hemoglobin (HBA₁) level of 10.1%. 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) with a mean blood glucose level of 6.7 mmol/1 and a mean HBA, level of 9.2% at baseline. For each individual, recordings were made at baseline and after 1 and 2 years from the baseline for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession, and radiographic loss of alveolar bone. At baseline and 2 years after the baseline examination, the PIDD subjects had similar plaque conditions as the CIDD subjects. At baseline and after 1 and 2 years from baseline the PIDD subjects had more gingivitis and bleeding after probing (P<0.05, χtest) than the CIDD subjects. Both at baseline and at the 1-year and 2-year examinations, the long-term PIDD subjects had lost more tooth attachment and approximal bone than the corresponding CIDD subjects (P<0.01, χ-test). At all 3 examinations, the PIDD subjects also exhibited more gingival recession than the CIDD subjects (P<0.05, χ-test).