糖尿病对牙周组织的影响

牙周病与糖尿病均为常见病,流行病学研究表明牙周病和糖尿病具有相关性,且两者相互影响。牙周病与糖尿病之间的相互作用已成为研究热点之一。本文就糖尿病对牙周组织的影响进行综述。探讨老年牙周病伴糖尿病患者牙周组织损伤的特点、牙周病的发生发展,为进一步的研究提供理论依据。     

糖尿病与牙周病的关系

糖尿病在发达国家已被列为第三大疾病,在我国其发病率近年来也呈迅速增长之势,而对糖尿病和牙周病的关系研究发现,在糖尿病人群中,牙周病的发病率高,病变损害严重且进展更迅速,认为牙周病是糖尿病的重要并发症之一［１］。近年来对糖尿病与牙周病的关系研究倍受瞩目...     

牙周病与糖尿病关系的研究进展

牙周病主要包括牙龈炎和牙周炎,是人类最常见的感染病之一,严重的牙周炎有可能增加心血管病、糖尿病、早产及肺部感染等系统性疾病的易感性。近年来,牙周病与全身性疾病的关系不仅引起国内外口腔医学界学者的关注,同时也受到其他医学界的重视。其中牙周病与糖尿病关系的研究更是倍受瞩目。目前,牙周病与糖尿病之间的关系虽已基本确立,但两者相互作用的内在机制尚未完全明确。本文总结有关牙周病与糖尿病关系方面的资料,对牙周病感染增加糖尿病易感性作综合阐述。     

Ⅱ型糖尿病合并牙周病患者龈沟液中肿瘤坏死因子α水平和意义

目的：比较Ⅱ型糖尿病合并牙周病患者、牙周病患者与健康者龈沟液中肿瘤坏死因子-α（TNF-α）含量和龈沟液量,以及Ⅱ型糖尿病合并牙周病患者龈沟液中TNF-α量与糖代谢状况的关系。方法：使用滤纸条法采集龈沟液,Ⅱ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;放射免疫法测定龈沟液中TNF-α含量;运用高效液相层析法测定Ⅱ型糖尿病合并牙周病患者的糖化血红蛋白水平。结果：糖尿病合并牙周病组和牙周病组龈沟液量及龈沟液TNF-α量均显著高于正常对照组（P〈0.01）,糖尿病合并牙周病组龈沟液TNF-α量显著高于牙周病组（P〈0.01）。糖尿病合并牙周病组龈沟液中TNF-α含量与糖化血红蛋白（HbA1c）水平无显著直线相关性。结论：龈沟液中TNF-α含量受牙周炎症影响同时全身因素调控,导致糖尿病合并牙周病患者龈沟液TNF-α水平显著升高,造成牙周病加重。     

2型糖尿病患者血清C反应蛋白水平与牙周病关系

目的:检测2型糖尿病伴牙周病患者血清高敏C反应蛋白(hs-CRP)水平的变化,探讨2型糖尿病患者血清hs-CRP与牙周病的关系.方法:选择2型糖尿病伴重度牙周病患者共20例,2型糖尿病无牙周病组20例,健康对照组20例.采用免疫浊度法测定所有研究对象血清hs-CRP水平,同时测定体重指数、糖化血红蛋白等临床和生化指标.结果:2型糖尿病伴重度牙周病组血清hs-CRP水平显著高于2型糖尿病无牙周病组和健康对照组,2型糖尿病无牙周病组显著高于健康对照组(P<0.05);血清hs-CRP与Homa-IR、HbA1C呈正相关.结论:牙周病可能导致2型糖尿病患者血清hs-CRP水平增高,这种炎性因子可能加重糖代谢紊乱和胰岛素抵抗.     

Ⅱ型糖尿病合并牙周病患者龈沟液中细胞因子/趋化因子的表达水平

目的 探讨Ⅱ型糖尿病合并牙周病患者与单纯牙周病患者龈沟液（gingival crevicular fluid,GCF）中细胞因子/趋化因子的表达水平。 方法 选取伴Ⅱ型糖尿病的牙周病患者52例,单纯牙周病患者40例,用Luminex FLEXMAP3D仪和Human Cytokine/Chemokine试剂盒检测GCF中14种细胞因子/趋化因子的表达水平。 结果 牙周病部位：嗜酸性粒细胞趋化因子、巨噬细胞炎症蛋白-1α、粒细胞-巨噬细胞集落刺激、白介素-6、肿瘤坏死因子-α和白介素-12的浓度,糖尿病组受试者高于非糖尿病组受试者（P<0.0035）。 结论 糖尿病可影响牙周病部位细胞因子/趋化因子的表达,糖尿病可能是牙周病的促进因素。     

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。     

青少年牙周病与成年糖尿病患者的牙周病——文献复习

Williams指出糖尿病患者与无糖尿病患者牙周病特征是不相同的,他认为糖尿病患者的牙周病应叫作“糖尿病性牙周溃坏”(diabetic peviodontoclasia)。Glickman用实验对照方法最早研究了这一问题,他提出“临床观察到的糖尿病患者的口腔病变是否实际上就是前者引起的后果?”这个问题引起了对糖尿病患者牙周病病原学一系列的研究。     

牙周病与糖尿病关联性的Meta分析

目的用Meta分析方法评价牙周病与糖尿病之间的关联性。方法检索中国知网、维普及万方数据库,以“糖尿病”和“牙周病”为检索词,对国内1999—2012年公开发表的牙周病与糖尿病相关性的文献进行筛选,根据RevMan5．0进行Meta分析,计算纳入文献数据的合并效应比值比（oddsratio,OR）。结果共检索到591篇文献,经严格筛查,符合纳入标准的文献8篇,异质性检验P〈0．00001,采用随机效应模型,Meta分析显示,牙周病合并糖尿病的OR值为2．36,95％可信区问为1．51～3．69,差异有统计学意义（P=0．0002）。结论牙周病患者并发糖尿病的患病率高于非牙周病患者,是非牙周病患者的2．36倍。     

糖尿病患者口腔牙周状态观察

口腔内菌斑(细菌及其毒素)和牙石是牙周病病因和发展过程中的重要局部因素;但对牙周病患者的全身情况,如健康状况、系统性疾病与牙病的关系,了解得并不深入。诸如糖尿病与牙周病的关系,糖尿病患者的牙周病发病情况,牙周破坏严重程度、破坏速度等方面的研究资料都不尽完善。本     

Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective

This review evaluates evidence for a bidirectional relationship between diabetes and periodontal diseases. A comprehensive Medline search of the post-1960 English language literature was employed to identify primary research reports of relationships between diabetes and periodontal diseases. Reports included in the review on the adverse effects of diabetes on periodontal health (DM-->PD) were restricted to those comparing periodontal health in subjects with and without diabetes. Review of adverse affects of periodontal infection on glycemic control included reports of periodontal treatment studies and follow-up observational studies in which changes in glycemic control could be assessed. Observational studies reporting DM-->PD provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal diseases in the large majority of reports (supportive evidence in 44/48 total reviewed; 37/41 cross-sectional and 7/7 cohort). Additionally, there were no studies reviewed with superior design features to refute this association. Treatment studies provided direct evidence to support periodontal infection having an adverse, yet modifiable, effect on glycemic control. However, not all investigations reported an improvement in glycemic control after periodontal treatment. Additional evidence to support the effect of severe periodontitis on increased risk for poorer glycemic control comes from 2 follow-up observational studies. The evidence reviewed supports viewing the relationship between diabetes and periodontal diseases as bidirectional. Further rigorous, systematic study is warranted to establish that treating periodontal infections can be influential in contributing to glycemic control management and possibly to the reduction of the burden of complications of diabetes mellitus.     

浅谈牙周病与呼吸道疾病之间的相关性

牙周病是由牙菌斑引起的慢性感染性疾病。研究发现, 牙周病与多种全身系统性疾病相关,如糖尿病、不良妊娠结局、心脑血管疾病、消化道和呼吸道疾病等。近年来, 牙周病与呼吸道疾病之间的关系备受关注。现根据以往的研究报道以及近几年的研究前沿就牙周病与呼吸道疾病的相关性做一介绍。     

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??Periodontal disease is a chronic infectious disease caused by dental plaque. The study has found that periodontal disease is associated with a variety of systemic diseases?? such as diabetes mellitus?? adverse pregnancy outcomes?? cardiovascular and cerebrovascular disease?? digestive tract and respiratory diseases?? etc. In recent years?? much attention has been paid to the relationship between periodontal disease and respiratory diseases. Based on previous research reports and the frontier research of recent years?? we now give a review of the correlation between periodontal disease and respiratory diseases.     

Antimicrobial peptides as a possible interlink between periodontal diseases and its risk factors: A systematic review

Antimicrobial peptides (AMPs) play a critical role in controlling innate and acquired immune responses. Local dysregulation of AMP is implicated in the pathogenesis of periodontal diseases as a response to periodontal pathogen challenge. Changes in AMP expression also characterize tobacco smoking, diabetes mellitus, obesity and rheumatoid arthritis, which are established risk factors of periodontal diseases, suggesting AMP may act as putative mechanistic links between these. The aim was to evaluate and summarize critically the current evidence pertaining to interrelationships between AMPs, periodontal diseases and selected periodontal disease risk factors. General and theme specific keywords were used to search the PUBMED database for studies relevant to AMP, periodontal diseases, smoking, diabetes mellitus, obesity and rheumatoid arthritis and critically reviewed. A total of 131 abstracts and 119 full text articles were screened for relevance; 13 studies were selected for inclusion after critical review. Local AMP dysregulation characteristic to periodontal diseases appears to occur within a broader landscape of complex systemic immune perturbations independently induced by smoking, metabolic and rheumatoid disease. The nature of these interactions and mechanistic pathways involved are inadequately understood. AMPs could be possible mechanistic interlinks between periodontal diseases and its risk factors. However, such evidence is very limited and more in vivo and in vitro studies are necessary to clarify the nature of such relationships. A greater understanding of AMPs as shared mediators is essential for unraveling their value as therapeutic or biomarker candidates.     

Diabetes mellitus and periodontal diseases

BACKGROUND: The purpose of this review is to provide the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Over 200 articles have been published in the English literature over the past 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of diabetes and periodontitis and different clinical criteria applied to prevalence, extent, and severity of periodontal diseases, levels of glycemic control, and complications associated with diabetes. METHODS: This article provides a broad overview of the predominant findings from research published in English over the past 20 years, with reference to certain "classic" articles published prior to that time. RESULTS: This article describes current diagnostic and classification criteria for diabetes and answers the following questions: 1) Does diabetes affect the risk of periodontitis, and does the level of metabolic control of diabetes have an impact on this relationship? 2) Do periodontal diseases affect the pathophysiology of diabetes mellitus or the metabolic control of diabetes? 3) What are the mechanisms by which these two diseases interrelate? and 4) How do people with diabetes and periodontal disease respond to periodontal treatment? CONCLUSIONS: Diabetes increases the risk of periodontal diseases, and biologically plausible mechanisms have been demonstrated in abundance. Less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. Inflammatory periodontal diseases may increase insulin resistance in a way similar to obesity, thereby aggravating glycemic control. Further research is needed to clarify this aspect of the relationship between periodontal diseases and diabetes.     

Diabetes mellitus and inflammatory periodontal diseases

THE PURPOSE OF REVIEW: Periodontal diseases are inflammatory conditions that were once thought to have manifestations localized to the oral cavity alone, and were therefore considered the concern of only dentists and other oral health professionals. Emerging evidence has changed this view and now suggests that periodontal diseases may play a role in numerous conditions that impact systemic well-being, including diabetes mellitus. This review examines the relationships that exist between periodontal diseases and diabetes mellitus, with a focus on potential common pathophysiologic pathways including those associated with inflammation, altered host responses, and insulin resistance. RECENT FINDINGS: Periodontal inflammation is associated with an elevated systemic inflammatory state and an increased risk of major cardiovascular events such as myocardial infarction and stroke, adverse pregnancy outcomes such as preeclampsia, low birth weight, and preterm birth, and altered glycemic control in people with diabetes. Intervention trials suggest that periodontal therapy, which decreases the intraoral bacterial bioburden and reduces periodontal inflammation, can have a significant impact on systemic inflammatory status. Evidence suggests that periodontal therapy is associated with improved glycemic control in many patients with both diabetes and periodontal diseases. SUMMARY: Recognition of the bilateral relationships between oral and systemic health will challenge physicians and dentists to work together closely in the future when managing patients with diabetes and periodontal disease.     

Negative effects of chronic inflammatory periodontal disease on diabetes mellitus

Periodontal disease is the result of a complex interplay of bacterial infection and host responses, and is often modified by various systemic diseases such as diabetes mellitus. Such diseases are capable of affecting the periodontium and/or the treatment of periodontal disease. However, recent research has changed our concept of how periodontal disease should be treated. Here we present several concerns directed towards the periodontal therapy of patients with diabetes mellitus based on our studies. When treating periodontitis patients who have diabetes mellitus it is important to consider the type of diabetes. Patients with non-insulin dependent diabetes mellitus can be further classified according to the degree of insulin resistance, since recent epidemiological studies have suggested that successful anti-microbial therapy might result in improved insulin resistance in highly insulin resistant patients. Because the major contributing factor for insulin resistance is currently considered to be the proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha), and because periodontal surgery may cause transient bacteremia which may up-regulate the serum TNF-alpha level, which in turn suppresses insulin action, patients should be strictly treated non-surgically and their serum TNF-alpha levels should be periodically monitored. On the other hand, diabetic patients positive for serum anti-glutamate decarboxylase auto-antibody should be examined for the source of this antibody, since 1) gingival and periodontal ligament fibroblasts were found to express glutamate decarboxylase, and 2) some otherwise healthy periodontitis patients develop anti-glutamate decarboxylase antibody. Thus, chronic periodontitis may influence the level of this antibody which is widely used as a predictive marker for slowly progressive insulin dependent diabetes mellitus. Not only is periodontal disease thereby affected by systemic diseases, but carefully managed periodontal therapy may also have a positive effect on the general health of patients with systemic diseases.     

Diabetes and periodontal diseases. Committee on Research, Science and Therapy. American Academy of Periodontology

This position paper on diabetes mellitus was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology. It is intended to: 1) update members of the dental profession on the diagnosis and medical management of patients with diabetes mellitus; 2) summarize current knowledge on the relation between diabetes mellitus and periodontal diseases; 3) provide an overview of factors in diabetic patients relevant to understanding the pathogenesis of periodontal diseases in these subjects; 4) outline special considerations associated with treatment of periodontal diseases in diabetic patients; and 5) discuss possible approaches to the management of diabetic emergencies in the dental office.     

Ⅱ型糖尿病牙周炎及牙周基础治疗对其影响的现状研究

Ⅱ型糖尿病是引起慢性牙周炎的主要危险因素之一,慢性牙周炎增加了Ⅱ型糖尿病的患病风险,但至今为止糖尿病牙周炎的发病机制尚未明确。牙周基础治疗不仅可以改善牙周炎患者的牙周状况,而且在一定程度上改善了糖尿病牙周炎患者的血糖状况。随着分子生物学技术的不断发展,研究人员对糖尿病牙周炎疾病在微生物、免疫及炎症因子方面的研究不断深入,该文对糖尿病牙周炎的微生物指标,免疫、炎症因子指标,临床指标及牙周基础治疗对疾病的影响做一综述。     

Role of periodontal therapy in management of common complex systemic diseases and conditions: An update

The goal of this review is to summarize the results of randomized trials reported since 2010 that assessed the effect of periodontal interventions on at least one systemic outcome in human subjects of any age, gender or ethnicity. Oral outcome measures included gingivitis, pocket depth, clinical attachment loss and/or radiographic bone loss and oral hygiene indices. Studies were excluded if the trial was not completed or if treatment was not randomized. The results suggest that nonsurgical periodontal intervention provided to pregnant women is safe and improves periodontal status without preventing adverse pregnancy outcomes. Nonsurgical periodontal intervention was also found to provide modest improvement in glycemic control in individuals with type 2 diabetes mellitus and periodontitis. Also, improving oral care through mechanical or chemical control of dental‐plaque biofilm formation can contribute to the prevention of respiratory infections in differing clinical settings, including hospitals and nursing homes, and in patients with chronic obstructive pulmonary disease. No clinical trials were reported that tested the effect of periodontal interventions on medical outcomes of atherosclerosis, cardiovascular diseases, stroke, rheumatoid arthritis, Alzheimer's disease, chronic kidney disease or malignant neoplasia.