类风湿性关节炎与牙周病的关系

牙周病目前公认为多因素疾病,尤其与系统性疾病相关。近年来学者发现类风湿性关节炎与牙周病在病理、免疫等方面有共同特点,两者之间具有相关性。本文将对两者相关性研究的发展及现状作一综述。     

类风湿性关节炎与牙周病的关系

牙周病目前公认为多因素疾病，尤其与系统性疾病相关。近年来学者发现类风湿性关节炎与牙周病在病理、免疫等方面有共同特点，两者之间具有相关性。本文将对两者相关性研究的发展及现状作一综述。     

牙周炎与类风湿关节炎的相关性研究

目的　研究类风湿关节炎(RA)患者的牙周状况,初步探讨牙周炎与RA的关系。方法　选择70例RA患者为RA组,70例未患RA的健康人为对照组,两组在年龄及性别分布互相匹配。对RA组与对照组进行牙周状况检查,同时对RA组行类风湿病学检查,比较RA组和对照组间牙周状况的异同,并就RA组患者牙周状况与类风湿病学检查指标之间的关系进行分析。结果　RA组牙周炎患病率高于对照组(P<0·01),缺失牙数和探诊出血阳性率与对照组无统计学差异(P>0·05)。RA组牙周炎指数为5或6的牙数多于对照组(P<0·05),说明RA组患有中、重度牙周炎的牙数多于对照组。RA组中、重度牙槽骨丧失者,其晨僵时间、红细胞沉降率和C反应蛋白水平均高于无或轻度牙槽骨丧失者。结论　RA患者比正常人群更易罹患牙周炎,并以中、重度牙周炎较常见。     

类风湿性关节炎对牙周炎影响临床研究

目的研究类风湿性关节炎（RA）对牙周炎患病情况的影响。方法 2012年7月至2013年5月于深圳市第四人民医院风湿病分院就诊临床确诊为RA患者30例（RA组）,对照组为同期本院工作人员及口腔科门诊就诊患者及其陪同家属30例。分别检查两组缺牙数、探诊出血指数（BOP）及探诊深度（PD）,记录RA组患者晨僵持续时间,检测其红细胞沉降率（ESR）、血清C-反应蛋白（CRP）以及类风湿性因子（RF）,进行相关性分析。结果 RA组与对照组牙周炎患病率分别为76.8%和80.0%,差异无统计学意义（P〉0.05）;两组失牙数、BOP及PD差异均无统计学意义（均P〉0.05）;RA组晨僵持续时间、ESR、CRP以及RF与BOP、PD间均无相关性。结论本研究未发现RA对牙周炎患病情况有明显影响。     

牙周治疗干预类风湿性关节炎的系统评价

目的 评价牙周治疗措施在缓解类风湿性关节炎(RA)患者症状和体征中的效果及安全性.方法 电子检索Medline(OVID,1950年-2010年9月)、荷兰医学文摘(EMBASE,1984年-2010年9月)、Cochrane图书馆临床随机对照试验库(CENTRAL,2010年第3期)、中国生物医学文献数据库(1978...     

牙周植骨材料的研究

植骨修复牙周骨缺损是人们多年寻求的方法,也是牙周病治疗中研究的重要课题之一。近年来,有人试图通过整复性牙周手术以修复病变部分的牙周骨缺损。由于冻干骨具有操作简单、骨源丰富、减少患者取骨痛苦及抗原性低     

牙周病与类风湿性关节炎相关性的病例-对照研究的Meta分析

目的采用Meta分析的方法评价牙周病(PD)与类风湿性关节炎(RA)的发病风险关系。方法计算机检索Pub Med、EMbase、中国生物医学文献数据库、中国知网、维普及万方数据库,查找国内外公开发表关于PD与RA发病风险关系的病例-对照研究,检索时限均为从建库至2014年5月20日,同时追溯纳入文献的参考文献。由2位研究者根据纳入与排除标准独立选择文献、提取资料和质量评价后,采用CMA v2软件进行Meta分析。结果最终共纳入9个病例-对照研究,2篇中文文献,7篇英文文献,其中RA组465例,健康对照组421例。Meta分析结果显示暴露于PD可以显著提高RA发生率2.81倍[OR=2.81,95%CI(1.41~5.60),P=0.003],敏感性分析显示结果稳健性较好。无明显发表偏倚存在。结论 PD是RA的一个有意义的危险因子。应进一步进行按PD临床程度分级和RA临床亚型分型的研究。     

牙周引导组织再生术与植骨术联合应用的临床研究

目的　比较引导组织再生术 (GTR)和植骨术联合应用的方法与单纯GTR的方法在牙周骨内袋缺损中的疗效。方法　治疗 16例患者的 4 4个骨内袋缺损 ,其中 2 3个相似的病损联合应用了GTR加植骨术 ,而在 2 1个病损中进行了GTR术 ,疗效评价直至术后 12个月。结果　两组的手术区域 ,与术前基线比较 ,在术后 3、6、12个月观察到的临床参数如附着水平、探诊深度以及菌斑指数、探诊出血均有明显改善 (P <0 .0 0 1)。两组之间比较 ,结果无显著性差异 (P >0 .0 5 )。结论　在牙周手术中 ,植入骨代用品与GTR联合应用 ,比较单纯应用GTR方法的临床疗效没有显著性差异。     

代谢综合症患者牙周状况的临床研究

目的：分析代谢综合症患者牙周状况,探讨代谢综合症在牙周疾病发生、发展中的意义。方法：选择150例诊断明确的代谢综合症患者为研究组,150例健康人作为对照组。检查记录：菌斑指数（PLI）、探诊深度（PD）、临床附着丧失（CAL）、出血指数（BI）、失牙数并计算牙周位点率。测定龈沟液及血清中白细胞介素-6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平。结果：代谢综合症组患侵袭性牙周炎、慢性牙周炎高于对照组（P〈0．01）;代谢综合症组PD、CAL、重度百分比及失牙数除BI外均高于对照组（P〈0．01）。代谢综合症患者龈沟液中IL-6、TNF-α、CRP水平高于对照组（p〈0．01）,而血清中两组无差异。相关性分析表明：MS组患者血糖水平与PLI、CAL、BI、重度百分比呈正相关（P〈0．01）,腹型（腰围水平）与PD、CAL、PLI重度百分比呈正相关（P〈0．01）。HDL-C水平与PLI、CAL、BI、重度百分比及失牙数正相关。血糖及HDL-C水平与牙周病的发病率正相关。结论：MS患者牙周疾病的发病率明显高于正常人,其中血糖、HDL-C及肥胖程度是影响牙周状况的重要因素,这种变化可能是通过MS引发炎症失衡而发生的。     

Serum antibodies and loss of periodontal bone in patients with rheumatoid arthritis

The number of teeth, % of alveolar bone loss, serum IgG, and serum antibodies to Bacteroides gingivalis, Capnocytophaga ochracea and Eubacterium saburreum were recorded in 37 patients diagnosed with rheumatoid arthritis (RA) and in an age- and sex-matched control group of 37 individuals free from RA. The RA group had a significantly increased loss of teeth and loss of alveolar bone compared to the control group. The RA patients also had a significantly increased level of serum IgG. In the total material, 26% of the variation in loss of alveolar bone was accounted for by age, diagnosis of rheumatoid arthritis, and levels of antibodies against B. gingivalis and E. saburreum. In the RA group, 48% of this variation was accounted for by age, total serum IgG and IgG antibodies to B. gingivalis and E. saburreum.     

Effect of bone loss simulation and periodontal splinting on bone strain: Periodontal splints and bone strain

Objectives

The influence of bone loss and periodontal splinting on strains in supporting bone is still not well understood. The aim of this study was to analyse the effect of bone loss and periodontal splints on strains in an anterior mandible structure.

Methods

Ten anterior mandible models were fabricated using polystyrene resin. Eighty human teeth were divided in 10 groups (right first premolar to left premolar) and embedded in simulated periodontal ligament. Strain gauges were attached to the buccal and lingual mandible surfaces. The models were sequentially tested for 7 conditions: no bone alterations and no splinting; 5 mm of bone loss between canine teeth; bone loss associated with resin splint between canine teeth; bone loss with wire splint; bone loss with wire/resin splint; bone loss with extracoronal fibre–glass/resin splint; and bone loss with intracoronal fibre–glass/resin splint. Oblique loads (50, 100, and 150 N) were applied on the teeth. Data were analysed using 3-way ANOVA and Scheffe's test (α = .05).

Results

Strains on buccal surface were higher than on lingual surface. Bone loss resulted in strain increase at 100 and 150 N loading. Dental splinting with resin resulted in strain values similar to the control levels.

Conclusions

Bone loss increased strain mainly in the buccal region. Dental splints with adhesive system and composite resin produced lower bone strains irrespective of occlusal load.     

Periodontal conditions in patients with juvenile idiopathic arthritis

OBJECTIVE: Our aim was to compare the periodontal conditions in a group of juvenile idiopathic arthritis (JIA) patients with those in a control group of healthy subjects (CTR). MATERIAL AND METHODS: Thirty-two patients with JIA and 24 controls were selected. The measurements used to diagnose periodontal disease included plaque and bleeding scores, probing depths (PDs) and clinical attachment loss (CAL). Laboratory indicators of JIA activity included the erythrocyte sedimentation rate (ESR) and capsule-reactive protein (CRP). The Mann-Whitney test was used to evaluate the data (alpha = 0.05). RESULTS: The mean ages were 15.9 (+/- 2.7) years and 14.7 (+/- 2.3) years for groups JIA and CTR, respectively. The median ESR was 42 mm/h 13 mm/h in the CTR group (p = 0.032) and the median CRP was 1.9 and 0.4 mg/l, respectively (p = 0.001). The prevalence of patients with a proximal attachment loss of 2mm or more in the JIA group was 25% and in controls it was 4.2%. The mean percentages of visible plaque and marginal bleeding were similar in the JIA (54 +/- 22 and 30 +/- 16, respectively) and CTR groups (44 +/- 18 and 29 +/- 11, respectively). The mean percentages of sites with PD > or = 4 mm were significantly higher in the JIA group (3 +/- 4.7) than in the CTR group (0.4 +/- 1.7) (p = 0.012). The mean percentages of sites with proximal CAL > or = 2 mm were 0.7 (+/- 1.4) in the JIA group and 0.001 (+/- 0.2) in the CTR group (p = 0.022). CONCLUSION: Adolescents with JIA present more periodontal attachment loss than healthy controls, in spite of similar plaque and marginal bleeding levels.     

Periodontal conditions in adults with rheumatoid arthritis

Periodontal conditions among an adult population of 161 dentate patients with rheumatoid arthritis (RA) were compared with those of an age and sex-matched random sample of non-rheumatic subjects. The number of teeth and prevalence of dental plaque, calculus, gingivitis, and deepened periodontal pockets were recorded. Alveolar bone breakdown and the distribution of subjects according to severity of periodontal disease were also registered. There was a tendency towards better periodontal conditions among RA-patients, severe periodontal breakdown occurring less frequently among RA-patients (12%) than among the controls (16%). The RA-patients had less plaque and calculus than the control group, a finding which could indicate a difference in periodontal care.     

Gingival crevicular fluid and serum levels of APRIL,BAFF and TNF-alpha in rheumatoid arthritis and osteoporosis patients with periodontal disease

Background

This study was performed to evaluate gingival crevicular fluid (GCF) and serum levels of a proliferation inducing ligand (APRIL) and B cell activating factor (BAFF) and compare this to differences between TNF-alpha levels in rheumatoid arthritis (RA), osteoporosis (OPR) and systemically healthy women with periodontal disease (SH).

Design

Gingival crevicular fluid (GCF) and serum samples were obtained before any periodontal intervention from 17 RA, 19 OPR patients and 13 SH women with periodontitis. Full-mouth clinical periodontal measurements were recorded. APRIL, BAFF and TNF-α levels were determined by ELISA. Statistical analysis was performed using multivariate analysis, ANOVA and Spearman correlation.

Results

Pocket depths differed in site-specific comparisons, but otherwise clinical measurements were similar in the three study groups. Multivariate least squares regression ANOVA adjusted for age and for plaque index indicated that total amounts of TNF-α and concentrations of TNF-α, BAFF and APRIL were significantly greater in the RA patients than in the SH group (p < 0.05), and GCF concentrations of BAFF were greater in OPR patients than in SH. Serum TNF-α and BAFF were significantly higher in the RA group compared to SH (p < 0.05) and serum TNF-α was greater in RA than in OPR (p < 0.05). APRIL and BAFF correlated with RANKL levels in GCF and serum (p < 0.05).

Conclusion

Despite long-term usage of anti-inflammatory drugs in the RA and OPR patients, increased TNF-family cytokines, might suggest that these patients have a propensity to overproduce these inflammatory mediators but whether this results from greater disease activity or contribute to greater disease activity remains moot.     

The relationship between attachment level loss and alveolar bone loss

Standardized radiographs and repeated periodontal probe measurements were made on 22 untreated subjects with destructive periodontal disease monitored for 1 year. Radiographs of selected sites were taken at 0, 6 and 12 months. Measurements of attachment level were made monthly. Radiographic measurements were made on 7X magnified projected images. Alveolar bone height from the CEJ was computed by multiplying the average length of the root times the measured ratio of CEJ to alveolar bone over CEJ to root tip. Each radiograph was measured twice by 2 investigators. Sites were excluded as having indistinct anatomical landmarks in which the standard deviation of the 4 measurements exceeded 0.16 mm, the measurement error for repeat determination of bone height on high quality radiographic images. A 3 sigma critical value for significant bone loss was selected as 0.48 mm. Changes in attachment level were computed for the intervals preceding and during the 6-12 month radiographic measurement period. Based on these critical values, 6.1% of the 231 radiographed sites showed significant bone loss. Similarly, 5.7% of the 1155 probed sites showed significant attachment loss. However, none of the sites with significant bone loss exhibited significant attachment loss over the same time period. In general, significant attachment loss preceded bone loss by 6 to 8 months. At 4 mm, attachment loss was found to predict subsequent bone loss with a true positive ratio of 60% and a false positive ratio of 5%, indicating a high degree of predictive discrimination. These observations indicate that attachment loss precedes radiographic evidence of crestal alveolar bone loss during periods of periodontal disease activity.     

Periodontal bone loss in 15-year-old Norwegians

Abstract The prevalence of marginal bone loss was determined on bite-wing radiographs in 2,409 15-year-old schoolchildren living in the county of Buskerud, Norway. Radiographs were collected from all dentists in the area participating in the Public Dental Service. A distance exceeding 2 mm from the cementoenamel junction to the alveolar crest was recorded as bone loss. Bone loss around one or more teeth was found in 11.3% of the subjects. More males than females were affected, with prevalences of 13.7 and 9.0%, respectively. Most of the lesions were observed adjacent to the maxillary first molars. Overt infrabony pockets were found in only a very few cases (0.5%). A clinical examination of 31 of the subjects could not distinguish those with and those without bone loss. The present study has demonstrated that alveolar bone loss is a common finding in 15-year-old school children. It is concluded that bite-wing roentgenograms may be useful in the detection of early bone lesions in young individuals.     

Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fishers exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.