慢性牙周炎与慢性肾脏病

大量研究证据表明,慢性牙周炎与全身系统性疾病存在密切的相关性,其主要通过牙菌斑中的内毒素、炎性介质、细胞因子等随血运到全身诱导各系统疾病。在慢性肾脏病的病因研究方面,也同样有炎性介质、细胞因子等致病因素,慢性肾脏病与慢性牙周炎之间可能存在联系。现就慢性牙周炎与慢性肾脏病之间的相互关系做一概述。     

慢性牙周炎与慢性肾病相关性研究进展

慢性牙周炎是发生在牙周支持组织的一种慢性炎症性破坏性疾病,牙周炎不仅影响口腔健康,也与全身健康密切相关。慢性肾病被认为是一种严重危害生命健康的非传染性慢性疾病。近年来有研究发现慢性牙周炎与慢性肾病之间有密切联系。本文就慢性牙周炎与慢性肾病相关性研究进展作一综述。     

牙周炎可疑致病菌对慢性肾脏病的影响及可能机制

慢性肾脏病发病率高、病死率高,已逐步成为严重威胁人类身体健康的全球公共卫生问题。牙周炎作为常见的口腔慢性感染性疾病,与慢性肾脏病具有相关性。牙周可疑致病菌是牙周炎的始动因子,在慢性肾脏病的发生、发展中可能起到重要作用。文章就牙周可疑致病菌对慢性肾脏病的影响及可能机制做一综述。     

慢性牙周炎和慢性肾脏病与微炎症状态相关性研究进展

慢性牙周炎是危害人类口腔健康的常见病,是引起成人牙缺失的主要原因之一.研究发现,慢性牙周炎的危害并不仅仅局限于口腔,它还会引起全身微炎症状态.     

伴糖尿病的慢性牙周炎患者牙周基础治疗效果研究

目的研究牙周基础治疗对伴有糖尿病的慢性牙周炎患者的治疗效果。方法选择伴Ⅱ型糖尿病的老年慢性牙周炎患者(糖尿病组)与不伴糖尿病的老年慢性牙周炎患者(非糖尿病组)各20例行牙周基础治疗,记录并比较两组患者在基线和术后3、6、12个月的菌斑指数、牙龈指数、探诊出血、探诊深度、附着丧失等指标。结果牙周基础治疗对两组患者均有较好的治疗效果,各项指标均明显改善,与基线水平比较差异有统计学意义(P<0.01),而两组间各项牙周指数的改善在术后3、6、12个月差异均无统计学意义(P>0.05)。结论牙周基础治疗对伴有糖尿病的老年慢性牙周炎患者在短期内(12个月)有良好的治疗效果。     

慢性牙周炎主要牙周致病菌和口臭的相关性分析

目的：分析慢性牙周炎主要牙周致病菌与口臭程度的相关性。方法：选取慢性牙周炎伴口臭患者43例作为研究对象,检测其主要牙周致病菌VSCs含量和OS值,并对OS值和VSCs水平与临床指标以及VSCs水平与Pg、Pi、Tf、Td进行相关分析。结果：治疗前研究组的PD、BI、CAL、OS值和VSCs水平高于对照组,治疗后研究组PD、BI、CAL、OS值和VSCs水平与治疗前相比明显降低,差异均有统计学意义（P＜0．05）。治疗后研究组OS值和VSCs水平与PD、BI、CAL呈正相关,且VSCs水平与舌背、龈下菌斑中Pg、Pi、Tf、Td也呈正相关。结论：慢性牙周炎主要牙周致病菌与口臭程度存在着高度相关性,有效降低牙周致病菌水平,可以改善口臭值。     

Er:YAG激光治疗慢性牙周炎临床疗效观察

目的 比较单独应用Er:YAG激光与常规牙周基础治疗治疗慢性牙周炎的临床疗效.方法 纳入22例慢性牙周炎患者,采用单盲、随机和自身对照设计,患者一侧用Er:YAG激光治疗,另一侧用超声联合手工刮治.分别于基线、治疗后6周、3个月和6个月进行牙周临床指标检查,内容包括菌斑指数、探诊深度、牙龈出血指数和附着丧失;并对基线时探诊深度≥4mm的位点进行统计和比较.结果 2组探诊深度、牙龈出血指数和附着丧失在治疗后6周、3个月和6个月时与基线比较均有明显下降,2组菌斑指数在基线及治疗后各时间点均无明显变化.且同一时间点2组间各项临床指标均无显著性差异.结论 Er:YAG激光作为治疗慢性牙周炎的方法可行有效,可取得与常规牙周基础治疗相似的临床疗效.     

患者依从性对慢性牙周炎临床疗效影响的观察

目的：观察不同依从性的慢性牙周炎患者的临床治疗效果。方法：选择经牙周基础治疗4周后进入牙周维护治疗的广泛性中度慢性牙周炎患者150例作为研究对象,通过2年追踪随访、临床检查及再治疗,分析完全依从性与不完全依从性牙周炎患者的第1年、第2年临床指标（PD、AL、BOP）改变。结果：完全依从性组的牙周探诊深度、探诊后出血率在第1、第2年均较基线明显下降,差异有统计学意义（P〈0.001）,附着丧失均值有所下降,差异有统计学意义（P〈0.001）;不完全依从性组牙周探诊深度、探诊后出血率、附着丧失在第1、第2年均值较基线明显增高,达到初诊水平,差异有统计学意义（P〈0.001）;在第1、第2年AL≥1 mm位点百分比及活动性进展率较基线均有提高,差异有统计学意义（P〈0.001）。结论：完全依从性慢性牙周炎患者疗效稳定持久;不完全依从性慢性牙周炎患者疗效较差,活动性发生率较高。     

肥胖与慢性牙周炎相关性临床研究

目的:探讨肥胖与慢性牙周炎的关系。方法:纳入2 136例受试者,男1 091例,女1 045例。计算体重指数(BMI);将全口牙列按四分法分区,随机选择上、下颌相对侧分区作为检查牙位区,对每个牙位的6个位点进行牙周检查,记录牙龈指数(GI)、牙周袋探诊深度(PD)、附着丧失(AL),判定牙周炎程度,采用Spearman分析肥胖与慢性牙周炎及牙周临床指标的相关性。结果:BMI与慢性牙周炎程度呈显著正相关;男性人群BMI与GI、PD无相关性,但与AL呈正相关,女性人群BMI与GI、PD、AL呈显著正相关。结论:肥胖与慢性牙周炎的发生发展可能存在相关性,女性肥胖对牙周炎的影响可能更为显著。     

血脂水平与牙周炎发病相关性及牙周基础治疗对血脂的影响

目的探究血脂水平与牙周炎发病的相关性及牙周基础治疗对血脂水平的影响。 方法选取2018年3月至2019年3月深圳市龙华区中心医院口腔科收治的118例慢性牙周炎患者，根据牙周炎严重程度分为轻度组（36例）、中度组（52例）、重度组（30例），另取同期30例牙周健康且无全身系统疾病的体检者为对照组，应用t检验比较牙周炎患者和对照组之间、牙周基础治疗前后血清三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平，单因素方差分析比较轻度组、中度组、重度组的TG、TC、HDL-C、LDL-C水平，应用采用Logistic回归分析血脂与牙周炎发病的相关性，并观察牙周基础治疗后血脂水平变化。 结果118例慢性牙周炎患者牙周基础治疗前血清TG、TC、HDL-C和LDL-C水平分别为（2.2 ± 0.8）、（5.3 ± 1.0）、（1.3 ± 0.3）和（2.8 ± 0.6）mmol/L，与对照组[（1.5 ± 0.7）、（4.4 ± 0.9）、（1.9 ± 0.3）和（1.8 ± 0.5）mmol/L]相比，差异均有统计学意义（t_TG = 4.306，P_TG = 0.036；t_TC = 6.781，P_TC = 0.028；t_HDL-C = 5.023，P_HDL-C = 0.031；t_LDL-C = 4.974，P_LDL-C = 0.034）。并且，随着牙周炎程度加重，HDL-C水平逐渐降低，差异无统计学意义（F = 0.933，P = 0.192），而TG、TC和LDL-C水平及高脂血症占比逐渐升高，差异有统计学意义（F_TG = 5.762，P_TG = 0.033；F_TC = 6.237，P_TC = 0.029；F_LDL-C = 6.685，P_LDL-C = 0.024；χ²_{高脂血症占比} = 4.513，P_{高脂血症占比} = 0.039）。Logistic回归分析显示，牙周炎是导致TG、TC、LDL-C升高的独立性危险因素（OR_TG = 3.264，95% CI_TG = 1.733 ~ 5.934；OR_TC = 2.937，95% CI_TC = 1.342 ~ 4.926；OR_LDL-C = 2.427，95% CI_LDL-C = 1.256 ~ 3.125）。牙周基础治疗后，轻中度患者血清TG、TC、LDL-C水平较治疗前降低，HDL-C水平较治疗前升高，差异有统计学意义。 结论牙周炎是TG、TC、LDL-C升高的独立性危险因素，牙周基础治疗可有助改善血脂水平，降低动脉粥样硬化、心血管疾病发生风险。     

慢性牙周炎和慢性肾病相关关系的 研究进展

慢性牙周炎不仅可以导致牙周支持组织的破坏和丧失,还与多种全身系统性疾病如高血压、糖尿病等有关.慢性肾病是一种破坏肾功能的威胁人类健康的常见的全身性疾病.近年来大量研究显示,慢性牙周炎与慢性肾病可能具有相关关系,通过治疗牙周炎有可能改善肾功能.本文就慢性牙周炎与慢性肾病相关性的流行病学调查研究、牙周治疗对慢性肾病的影响以...     

Determining the relationship between atherosclerosis and periodontopathogenic microorganisms in chronic periodontitis patients

Objectives: The aim of this study is to determine the relationship between atherosclerosis and periodontopathogenic microorganisms in chronic periodontitis patients following periodontal treatment.

Materials and Methods: A total of 40 patients were included in the study. 20 of these patients diagnosed with atherosclerosis and chronic periodontitis formed the test group. The remaining 20 patients were systemically healthy patients diagnosed with chronic periodontitis and formed the control group. All patients had nonsurgical periodontal treatment. The periodontopathogenic microorganism levels were determined at baseline and at 6 months in microbial dental plaque samples and WBC, LDL, HDL, PLT, fibrinogen, creatinine and hs-CRP levels were determined by blood samples.

Results: Statistically significant reduction has been achieved in clinical periodontal parameters following non-surgical periodontal treatment in test and control groups. Following periodontal treatment, WBC, LDL, PLT, fibrinogen, creatinine and hs-CRP levels significantly decreased and HDL levels significantly increased in both test and control groups. Similarly, the periodontopathogenic microorganism levels significantly decreased following periodontal treatment in the test and control groups. A statistically significant positive correlation has been determined between the periodontopathogenic microorganism levels and WBC, LDL, PLT, fibrinogen, creatinine, and hs-CRP levels in the test group.

Conclusions: The association between hs-CRP, WBC, LDL, PLT, fibrinogen, creatinine, and the amount of periodontopathogenic microorganisms indicates the possibility that periodontal treatment could decrease the risk atherosclerosis. More studies must be conducted in order for these results to be supported.     

口腔扁平苔藓与牙周炎关系的研究进展

牙周炎为发生在牙周组织的慢性感染性疾病,同时口腔扁平苔藓也是口腔粘膜的常见疾病。临床上大多数口腔扁平苔藓患者牙周状态差,并且牙周基础治疗对其有一定疗效;在发病机制上二者都与免疫、遗传及心理精神因素等有关。牙周炎与口腔扁平苔藓这两种慢性炎症疾病可同时存在或伴随患者终身,维护好牙周健康已成为口腔医学必须面对的现实。本文对近年来牙周炎与口腔扁平苔藓的关系进行回顾总结,为牙周病和口腔扁平苔藓的进一步研究奠定基础。     

慢性牙周病与慢性肾病相关性研究进展

［摘要］ 慢性牙周病不仅累及牙周支持组织,而且还与全身系统性疾病如慢性肾病有关系。在慢性肾病患者中存在微炎状态,炎症因子是微炎症状态的主要作用因子,其中白介素6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)等炎症因子可参与慢性牙周炎与慢性肾病的发生发展过程中。该文以IL-6、CRP在慢性牙周炎与慢性肾病的作用机制为例,作一简要的综述。     

Periodontitis associated with chronic kidney disease among Mexican Americans

Objective: In comparison to non‐Hispanic whites, a number of health‐care disparities, including poor oral health, have been identified among Hispanics in general and Mexican Americans in particular. We hypothesized that Mexican Americans with chronic kidney disease (CKD) would have higher prevalence of chronic periodontitis compared with Mexican Americans with normal kidney function, and that the level of kidney function would be inversely related to the prevalence of periodontal disease. Methods: We examined this hypothesis using the National Health and Nutrition Examination Survey 1988‐1994 (NHANES III) data set. We followed the American Academy of Periodontology/Center for Disease Control and Prevention case definition for periodontitis. Glomerular filtration rate was estimated using the CKD‐Epidemiology equation for Hispanic populations. The classification to CKD stages was based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Results: Periodontitis prevalence increased across the kidney function groups showing a statistically significant dose–response association (P < 0.001). Mexican Americans with reduced kidney function were twofold more likely to have periodontitis compared with Mexican Americans with normal kidney function after adjusting for potential confounders such as smoking, diabetes, and socioeconomic status. Multivariate adjusted odds ratio for periodontitis significantly increased with 1, 5, and 10 mL/minute estimated glomerular filtration rate reduction from the mean. Conclusion: This is the first report, to the best our knowledge, that showed an increase of periodontitis prevalence with decreased kidney function in this population.     

Extent and severity of chronic periodontitis in chronic kidney disease patients

Brito F, Almeida S, Figueredo CMS, Bregman R, Suassuna JHR, Fischer RG. Extent and severity of chronic periodontitis in chronic kidney disease patients. J Periodont Res 2012; 47: 426–430. © 2011 John Wiley & Sons A/S Background and Objectve: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross‐sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. Material and Methods: Forty CAPD patients (mean age 52 ± 12 years), 40 HD patients (mean age 50 ± 10 years), 51 predialysis patients (mean age 54 ± 11 years) and 67 healthy individuals (mean age 50 ± 7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥ 6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥ 4 mm were considered to have generalized chronic periodontitis. Results: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥ 6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. Conclusion: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.     

慢性肾脏病对牙周组织的影响

在慢性肾脏病矿物质和骨代谢异常早期,颌骨骨膜下骨吸收,牙周硬骨板部分或全部消失,骨密质厚度降低,颏孔、下颌神经管和上颌窦底等解剖结构模糊不清。57.7%行血液透析的肾衰患者出现上颌骨骨质疏松,牙根周围局部骨质硬化,牙周硬骨板减少或消失。终末期肾脏病患儿的龈沟液量和渗透压以及菌斑指数和牙龈指数升高。慢性肾脏病患者口内的牙周致病菌明显升高,罹患牙周病的风险更大。血液透析者的菌斑指数、牙龈指数和牙石指数均明显升高,牙周状况的严重程度会随着透析时间的延长而加剧。慢性肾脏病患者的牙周膜周围出现草酸钙晶体沉积,导致周围骨组织的吸收和破坏,进一步加重牙周组织损伤,引起牙松动和牙根外吸收,最终导致牙缺失。随着慢性肾脏病的进展,牙周膜和牙骨质出现损伤且损伤逐渐加重。在口腔疾病治疗前,口腔医生应与肾脏病医生会诊,以获得疾病的发展状态、治疗方式以及可能引起的并发症和最佳的治疗时机。在口腔疾病治疗过程中,应避免氨基糖苷类和四环素类等肾损害药物的使用。对于血液透析者,口腔疾病治疗应选择在非透析时段,以降低出血的风险。在肾移植术后的前6个月,应避免任何可选择性的口腔疾病治疗。