Integrated hypothesis of dental caries and periodontal diseases
Integrated hypothesis of dental caries and periodontal diseases
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DOI：
10.1080/20002297.2019.1710953
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发表时间：
2020-01-01
影响因子：
4.5
通讯作者：
Takahashi, Nobuhiro
中科院分区：
文献类型：
--
作者：
Nyvad, Bente;Takahashi, Nobuhiro
这篇评论认为，龋齿和牙周疾病的理论生态学原则的基础上建立一个综合的假设。该假说的支柱是基于口腔微生物群的动态稳定阶段，在该阶段，内在（主要是唾液和龈沟液）和细菌（主要是代谢）弹性因子保持生态动态稳定，与临床健康相容。然而，内在弹性因子的丧失和/或微生物代谢底物可用性的长期变化可能使微生物群的生态平衡转变为糖解（产酸）或氨基酸降解/蛋白水解（产碱）阶段，这取决于主要底物的性质，导致临床疾病。因此，为了维持和恢复口腔微生物群的动态稳定性，有必要控制疾病的驱动因素，例如唾液流和细菌营养素流入口腔。与传统观点相反，过量摄入可发酵碳水化合物可能会导致牙周组织炎症，导致高脂血症。综合假说强调龋齿和牙周病都起源于动态稳定阶段，并在响应微生物群中的营养失衡时出现。牙周病可能与糖尿病、肥胖症、心血管疾病一样，属于糖驱动的炎症性疾病。
This review considers an integrated hypothesis of dental caries and periodontal diseases that builds on theoretical ecological principles. The backbone of the hypothesis is based on the dynamic stability stage of the oral microbiota, at which intrinsic (mainly saliva and gingival crevicular fluid) and bacterial (mainly metabolic) resilience factors maintain ecological dynamic stability, compatible with clinical health. However, loss of intrinsic resilience factors and/or prolonged changes in the availability of microbial metabolic substrates may shift the ecological balance of the microbiota into either saccharolytic (acidogenic) or amino acid-degrading/proteolytic (alkalinogenic) stages, depending on the nature of the predominant substrates, leading to clinical diseases. Therefore, to maintain and restore the dynamic stability of the oral microbiota, it is necessary to control the drivers of disease, such as salivary flow and influx of bacterial nutrients into the oral cavity. Contrary to conventional wisdom, excessive intake of fermentable carbohydrates may contribute to inflammation in periodontal tissues resulting from hyperglycaemia. An integrated hypothesis emphasizes that both dental caries and periodontal diseases originate in the dynamic stability stage and emerge in response to nutritional imbalances in the microbiota. Periodontal diseases may belong to the sugar driven inflammatory diseases, similar to diabetes, obesity, and cardiovascular diseases.