A review of the influence of periodontal treatment in systemic diseases

The effects and consequences of periodontal diseases might not be confined to the oral cavity. A great body of evidence has arisen supporting the claim demonstrating an association with several systemic conditions and diseases. With different levels of evidence, an association between periodontal disease and cardiovascular disease, diabetes, psoriasis, rheumatoid arthritis, pregnancy outcomes and respiratory diseases has been established. However, the true nature of this association, if it is causal, still remains elusive. For a better understanding of the complex relationships linking different conditions, interventional studies now begin to focus on the possible outcomes of periodontal treatment in relation to the events, symptoms and biomarkers of several systemic disorders, assessing if periodontal treatment has any impact on them, hopefully reducing their severity or prevalence. Therefore, we proceeded to review the recent literature on the subject, attempting to present a brief explanation of the systemic condition or disease, what proposed mechanisms might give biological plausibility to its association with periodontal disease, and finally and more importantly, what data are currently available pertaining to the effects periodontal treatment may have. Raising awareness and discussing the possible benefits of periodontal treatment on overall systemic health is important, in order to change the perception that periodontal diseases are only limited to the oral cavity, and ultimately providing better and comprehensive care to patients.     

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牙周炎(periodontitis)是由细菌感染引起并侵犯牙周组织的慢性破坏性疾病,其主要特征是牙龈出血、牙周袋的形成、牙槽骨的吸收和牙齿松动等。以往,临床医生通过传统的检查,如视诊、探诊和普通X线片等方法诊断牙周病,但精确度不高,预测性低,不利于发现牙周病高危人群     

Public health aspects of periodontal diseases in Europe

There is relatively little severe periodontal disease in populations in Europe. The public health significance is therefore debateable. The fact that the costs of treating the disease are high because of the organization of dental care, qualifies it as a dental public problem. In addition, the symptoms of periodontal diseases such as bleeding, halitosis, gingival recession and tooth loss have an impact on many people, and we have sufficient information to control the common forms of the disease. The goals for dental health can be expressed in terms of health, disease, health education and health promotion and training. A reasonable objective is to achieve a rate of loss of attachment compatible with maintaining at least upper and lower shortened arches for a lifetime. 4 strategies are considered: a high risk, a population, a secondary prevention strategy or a combination of the three. A combination of the 3 is needed to achieve the objective of maintaining a functional, aesthetically and socially acceptable natural dentition for the lifespan of most people. The balance of effort should be heavily weighted towards the population strategy. If the strategy is adopted, the need for treatment will be reduced and treatment will be more successful.     

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).     

Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.     

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牙周病是目前人类最常见和高发的慢性感染性疾病,没有一个国家、地区、种族、性别、年龄的人群可以幸免,可以说每个人都处于罹患牙周病的危险之中,只是患病率和严重程度有所差异而已。目前已经公认,牙周病对口腔健     

Treatment of HIV-associated periodontal diseases

Three presentations of periodontal disease are associated with HIV infection: necrotising periodontal disease; forms of atypical gingivitis and exacerbated attachment loss. Necrotising disease resembling aggressive acute necrotising ulcerative gingivitis and is the most acute and painful of these. Response to treatment by debridement of lesions, irrigation with aqueous chlorhexidine solution and oral metronidazole 200 mg, tds is almost diagnostic of the condition. Affected individuals are prone to relapse. Prevention by meticulous home care and frequent hygiene recalls is advised. The forms of atypical gingivitis are classically not plaque related. This means that persistence of gingivitis in the absence of plaque is required to establish the diagnosis. There is a consensus that these diseases are related to candidiasis. Treatment with antifungals may be contraindicated due to the emergence of resistant strains of Candida spp. Exacerbated attachment loss may be the legacy of repeated episodes of necrotic disease or may be due to accelerated periodontitis. In either event the principles of treatment are to encourage and facilitate plaque removal.     

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牙周病是人类最常见的感染性疾病之一,与全身健康密切相关。本文就牙周感染的特点,牙周医学的概念及牙周病与全身系统性疾病间的相互关系进行综合阐述。     

基质金属蛋白酶与牙周病关系的研究进展

本文在探讨基质金属蛋白酶(matrix metalloproteinases MMPs)结构、功能的基础上,就参与牙周组织破坏MMPs的种类,来源以及主要的作用机制作一个综述,以期对牙周病的发生发展有深一步的认识,同时期望对牙周炎的诊断和治疗有所帮助。     

西藏驻军牙周健康状况流行病学抽样调查

目的：调查我国西藏驻军人员的牙周健康状况，并分析相关因素。方法：采用世界卫生组织1997年版口腔健康调查基本方法和标准器材，以分层、整群抽样方法选择拉萨驻军某部队为调查样本，对其进行问卷调查和临床检查。结果：共调查驻军人员730名，其中201人（27，53％）至少有1个区段牙龈探诊出血，505人（69．18％）检出牙结石，34人（4．66％）患有轻度牙周炎，1人（0.14％）患有重度牙周炎，牙周非健康状态的检出率为80．8％，总区段数为4380，其中牙周非健康的区段数为1941，牙周非健康状态的平均区段数为2．66。统计学表明牙结石的检出率、牙周非健康状态的检出率和年龄、军龄、军衔呈正相关，而与兵源、文化程度不相关。结论：牙周疾病已成为西藏驻军人员的常见病、多发病之一，有必要一方面加强口腔卫生教育，以促进其保持口腔卫生，另一方面需要加强配备口腔医疗设备和医疗人员，及时地为其预防和控制牙周病的病情。     

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。     

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目的评价口腔卫生宣教和指导在老年人牙周治疗中的作用。方法选择2008年6月至2009年6月肇庆市第一人民医院口腔科轻、中度牙周病患者100例,随机分为试验组和对照组,各50例。在牙周治疗过程中对试验组患者进行口腔卫生宣教和指导。在初诊及之后1周、3个月、6个月、1年时分别检测两组患者的菌斑指数-QT改良法(PLI-QT)和牙龈指数(GI)。结果试验组与对照组初诊时的PLI和GI指数差异无统计学意义(P>0.05);治疗后两组PLI和GI指数差异均有统计学意义(P<0.05)。试验组治疗后1周至1年的PLI和GI指数均明显低于治疗前,差异有统计学意义(P<0.05);而对照组治疗后1周和3个月的PLI和GI指数虽与治疗前比较,差异有统计学意义(P<0.05),但治疗后6个月至1年指数逐渐增长至治疗前水平。结论在口腔医疗服务中增加口腔卫生宣教和指导的内容,把口腔健康教育贯穿于老年牙周患者治疗的全过程,有助于牙周治疗效果的维护。     

Matrix metalloproteinases and periodontal diseases

Periodontitis is a chronic inflammatory disorder characterized a complex interaction between periodontopathic bacteria and the host inflammatory response resulting in release of pro‐inflammatory cytokines leading to the destruction of periodontal tissues and alveolar bone. One of the important host factors involved in periodontal diseases is matrix metalloproteinases (MMPs), which is responsible for collagen and extracellular matrix (ECM) degradation of the periodontal tissues. MMPs comprise a family of around 25 members broadly categorized into six groups, which are involved in various physiological and pathological conditions. The activities of MMP are generally balanced by endogenous inhibitors such as tissue inhibitors of metalloproteinase (TIMP), and any imbalance between MMP and TIMP levels plays an important role in the disease progression. Assessment of MMP in tissues, GCF, and saliva may serve as an important biomarker in diagnosis of periodontal diseases and also for prognostic follow‐up. Targeted therapy aimed at reducing effects of MMP may serve as a useful adjunct for treatment of periodontitis. This review provides an overview of MMP and its role in various physiological and pathological conditions with emphasis on its association with periodontal diseases. A note on its inhibitors and therapeutic importance is also provided.     

Diet,cardiovascular disease and oral health: Promoting health and reducing risk

BackgroundPrimary prevention of cardiovascular disease includes screening as well as education and risk-reduction efforts.MethodsThe author reviewed diet and nutritional risk factors for cardiovascular disease (CVD), as well as dietary approaches to reduce the risk of developing CVD. The author also presented applications for use in dental practice.ConclusionsThe multifaceted relationship between diet/nutrition, CVD and oral health supports the role of CVD risk-reduction strategies in dental practice.Clinical ImplicationsReinforcement of healthful lifestyle principles may help reduce patients' risk of developing CVD and improve their systemic and oral health.     

A trend of increase in periodontal interleukin-6 expression across patients with neither diabetes nor periodontal disease, patients with periodontal disease alone, and patients with both diseases

Background and Objective: Epidemiological studies have established that patients with diabetes have increased prevalence and severity of periodontal disease. However, the periodontal expression of inflammatory cytokines and matrix metalloproteinases (MMPs) in diabetic patients has not been well characterized. The objective of this study was to determine the difference in the periodontal expression of MMP‐1, MMP‐8, interleukin‐6, tumor necrosis factor‐α and interleukin‐1β between diabetic and nondiabetic patients. Material and Methods: Periodontal tissue specimens were collected from nine nondiabetic patients without periodontal disease (group 1), from 11 nondiabetic patients with periodontal disease (group 2) and from seven diabetic patients with periodontal disease (group 3). The expression of MMP‐1, MMP‐8, interleukin‐6, tumor necrosis factor‐α and interleukin‐1β was quantified using real‐time polymerase chain reaction. Results: The nonparametric Kruskal–Wallis test showed that the difference in interleukin‐6 expression among the groups was statistically significant (p = 0.04). Furthermore, the generalized Kruskal–Wallis nonparametric linear‐by‐linear association test showed a statistically significant trend of increase in the expression of interleukin‐6 from group 1 to group 2 to group 3 (p = 0.02) and a suggestion of such a trend for MMP‐1 (p = 0.05). No increase in MMP‐8 expression was observed in patients in group 3 compared to patients in groups 1 and 2. Although the average expression levels of MMP‐1, interleukin‐1β and tumor necrosis factor‐α were increased from group 1 to group 3, the differences were not statistically significant. Conclusion: A trend of increased interleukin‐6 expression in periodontal tissues was observed across patients with neither diabetes nor periodontal disease, patients with periodontal disease alone, and patients with both diseases.     

Contesting conventional periodontal wisdom: implications for periodontal classifications

This paper examines the common approach used to classify periodontal diseases and how this obstructs our understanding of the disease process. We address the implications of including etiological and pathogenesis-related considerations in the classifications of complex diseases like periodontitis and argue that the number of periodontal entities in a classification system ought to be determined by well-documented differences in the management of each entity. We finally discuss how an ecosocial theory of disease distribution can be helpful to understand the determinants of the distribution of disease in the population.     

Tetracyclines in the management of periodontal diseases

Abstract Periodontal diseases essentially comprise a group of oral infections whose primary aetiological factor is dental plaque. Removal of the cause (and its effects) is the primary aim of both non-surgical and surgical treatment regimens, although the infective nature of the diseases has led to the widespread use of antimicrobials as an adjunct to mechanical debridement. The tetracyclines are primarily bacteriostatic agents that are effective against many Gram-negative species including putative periodontopathogens such as Actinobacillus actinomycetemcomitans (A.a.). The proven efficacy of this group of drugs in the management of periodontal diseases may be related not only to their antibacterial actions, but to a number of additional properties that have been recently identified. These include collagenase inhibition, anti-inflammatory actions, inhibition of bone resorption and their ability to promote the attachment of fibroblasts to root surfaces. Consequently, tetracyclines have also been used as an adjunct to bone grafting in periodontal defects, and as agents for “conditioning” root surfaces to enhance the regeneration of periodontal tissues. When tetracyclines are taken orally, consideration must be given both to the potential unwanted effects and to interactions with other drugs that are taken concurrently. Such problems are minimised however, when the drugs are incorporated into controlled, slow-release formulations which are currently being researched and marketed for intra-oral use.     

胃、十二指肠疾病患者牙周情况的临床调查

目的 :探讨胃、十二指肠疾病与牙周病的关系。方法 :对 10 2例胃、十二指肠疾病患者和 2 5例正常对照者进行口腔卫生指数、牙周病指数等项检测和分析。结果 :胃、十二指肠疾病患者牙周疾病罹患率 10 0 %,软垢和牙石检出率 10 0 %;胃、十二指肠疾病患者牙周病指数高于对照组 (P <0 .0 1)。结论 :胃、十二指肠疾病患者均有不同程度的牙周疾病 ,牙周治疗是预防和控制胃、十二指肠疾病的重要方法。