绝经期妇女牙周状况与骨质密度的相关性分析

目的 检查绝经期妇女的牙周状况、颏孔处皮质骨厚度以及全身骨密度的情况,探索它们之间是否存在相关关系。方法 采用报名招募的方式,选择2017年3月至11月在北京大学国际医院报名的符合条件的50~65岁绝经期妇女98名纳入研究,记录患者的一般情况,包括年龄、绝经时间、绝经年龄、体重指数等。检查并记录简化口腔卫生指数、探诊深度、临床附着丧失、牙龈退缩、探诊后出血百分比等反映牙周状况的指标;拍摄曲面断层片并在曲断图像中测量下颌骨下缘颏孔处对应的皮质骨厚度。检查者和测量者均通过一致性检验。利用双能X线骨密度测量仪测量左侧髋部和腰椎的骨密度,根据世界卫生组织的标准,按照T值(测得的骨质密度与年轻白人女性的平均峰值骨量的标准差)分为骨质疏松组(T值<-2.5)和非骨质疏松组(T值≥-2.5),比较两组间的牙周指标和曲面断层片中测量的颏孔处皮质骨厚度间是否存在差异。结果 98名受试者中,共检查出骨质疏松者47例,所占比例为47.96%。骨质疏松组与非骨质疏松组间的年龄和绝经时间差异有统计学意义。骨质疏松组的年龄更大(59.64±4.58) 岁 vs. (56.94 ± 4.26) 岁,P<0.05]、绝经时间更长(10.17± 5.37) 年 vs. (6.02 ±4.48) 年,P<0.05];绝经年龄和体重指数两组间差异无统计学意义。探诊后出血阳性比例分别为21.43%±17.09%(非骨质疏松组)和29.43%±21.12%(骨质疏松组),差异有统计学意义(P=0.046);而简化口腔卫生指数、探诊深度、临床附着丧失、牙龈退缩等牙周指标差异无统计学意义;颏孔处的皮质骨厚度随着全身骨质密度减低而减少,均值分别为(4.25±0.77) mm(非骨质疏松组)和(3.61±1.04) mm(骨质疏松组),差异有统计学意义(P=0.001)。结论 绝经期妇女的牙周状况与全身骨质密度间无相关性,但曲面断层片中测得的颏孔处的皮质骨厚度与全身骨密度相关,这提示可利用颌面部影像显示的颌骨皮质骨厚度来推断全身骨密度的可能性。

Relationship between periodontitis and osteoporosis in postmenopausal women

Objective: To explore the relationships of periodontal parameters, cortical width on mental foramen and osteoporotic condition in postmenopausal women.Methods: Ninety-eight postmenopausal women between 50 to 65 years old were recruited. General conditions, such as age, menopausal age, duration of menopause, and body mass index (BMI) were recorded. Periodontal parameters were examined, including oral hygiene index simplified (OHI-S), probing depth (PD), clinical attachment loss (CAL), gingival recession (GR) and bleeding on probing (BOP). Panoramic radiograph was taken and the cortical width (CW) of mental foramen was measured on images. The examiner was celebrated. Bone mass density (BMD) of left hip and lumbar spine was assessed using standardized dual energy X-ray absorptiometry. According to World Health Organization, based on the T-score of BMD(difference of the measured BMD and the mean value of young white women in terms of standard deviations), the subjects were divided into osteoporotic group (T-score<-2.5) and non-osteoporotic group (T-score≥-2.5). These parameters were compared between the groups.Results: The number of osteoporotic group was 47 (47.96%). Ages and duration of menopause were significantly different between the groups. Osteoporotic group presented older ages (59.64±4.58) years vs. (56.94 ± 4.26) years, P<0.05], and longer duration of menopause (10.17± 5.37) years vs. (6.02 ±4.48) years, P<0.05]. There was no significant difference in menopausal age and BMI between the groups. BOP% was statistically significantly higher in osteoporotic group (29.43±21.12) than in non-osteoporotic group (21.43±17.09), with a P-value of 0.046. The other periodontal parameters, including OHI-S, PD, CAL, and GR were not statistically significantly different in the groups. The CWs were statistically significantly lower in osteoporotic group compared with non-osteoporotic group, with a P-value of 0.001. The mean values of CWs were (3.61±1.04) mm (osteoporotic group) and (4.25±0.77) mm (non-osteoporotic group), respectively.Conclusion: The study demonstrated absence of a significant association between periodontal parameters and BMD. However, the CWs were found to be related with the BMD, which may be used to detect BMD abnormal in maxillofacial imaging. The dentists should pay attention not only to the oral health, but also to the general bone mass density, which may be detected on panoramic images.