Associations between periodontal disease and systemic disease: Evaluating the strength of the evidence
Associations between periodontal disease and systemic disease: Evaluating the strength of the evidence
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DOI：
10.1902/jop.2005.76.11-s.2175
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发表时间：
2005-11-01
影响因子：
4.3
通讯作者：
Garcia, RI
中科院分区：
文献类型：
--
作者：
Dietrich, T;Garcia, RI
关于牙周病和系统性疾病之间的关系，已经发表了许多研究，包括原始报告、叙述性综述、系统性综述和荟萃分析。基于现有的工作，可以使用标准的循证标准，对研究的四个主要类别的医疗结果（心血管/脑血管、妊娠、肺和糖尿病）中的可用数据分配证据水平和等级。我们讨论的方法和概念问题，在口腔系统协会的研究，重点作为一个例子，牙周疾病和心血管/脑血管疾病之间的关联。我们认为，根据证据水平对研究进行等级排序可能会产生误导。特别是，虽然需要随机对照试验（RCT）来确定牙周治疗降低心血管事件风险的疗效，但它们在确定牙周病对冠心病和中风的病因作用方面的价值可能有限。我们讨论了随机对照试验的局限性以及流行病学研究现有数据的局限性，包括研究设计、混杂因素和错误分类错误。我们的结论是，设计良好的观察性研究牙周病和系统性疾病之间的关联需要保持一个不可分割的组成部分，未来的研究工作，以充分了解这种协会。
Much work has been published on the association between periodontal disease and systemic disease, including original reports, narrative reviews, systematic reviews, and meta-analyses. Based on the existent work, one can assign an evidence level and grade, using standard evidence-based criteria, to the data available in the four major categories of medical outcomes studied: cardiovascular/cerebrovascular, pregnancy, pulmonary, and diabetes. We discuss methodologic and conceptual problems in the study of oral-systemic associations, focusing as an example on the association between periodontal disease and cardiovascular/cerebrovascular disease. We argue that the hierarchical ranking of studies by levels of evidence may be misleading. In particular, while randomized controlled trials (RCTs) are needed to determine the efficacy of periodontal treatment to reduce the risk of cardiovascular events, they may be of limited value in determining the etiologic role of periodontal disease on coronary heart disease and stroke. We discuss limitations of RCTs as well as the limitations of currently available data from epidemiologic studies, including study design and confounding and misclassification errors. We conclude that well-designed observational studies into the associations between periodontal disease and systemic disease need to remain an integral component of future research efforts in order to fully understand such associations.