State of the science: chronic periodontitis and systemic health.
State of the science: chronic periodontitis and systemic health.
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DOI：
10.1016/s1532-3382(12)70006-4
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发表时间：
2012-09-01
期刊：
影响因子：
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通讯作者：
Reynolds, Mark A
中科院分区：
文献类型：
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作者：
Otomo-Corgel, Joan;Pucher, Jeffery J;Reynolds, Mark A
背景：炎症性牙周疾病与多种全身性疾病相关。目前，专家们对这些关联的性质缺乏共识，医疗服务提供者和公众对如何解读这一迅速增长的科学知识也存在困惑。本文综述了当前将牙周疾病与糖尿病、心血管疾病、骨质疏松症、早产低体重婴儿、呼吸系统疾病和类风湿性关节炎相关联的证据。
证据获取：证据来自对PubMed电子数据库检索到的系统综述、临床试验和机制研究。现有数据为应用实用的临床建议提供了基础。
证据综合：对系统综述、初步临床试验和机制研究的证据进行了总结和批判性回顾。
结论：慢性牙周炎的替代标志物，如牙齿缺失，与多种全身性疾病显示出相对一致但较弱的关联。尽管存在生物学合理性，但短期干预试验通常不支持明确的因果关系。然而，有效治疗牙周感染对于实现口腔健康目标以及降低慢性局部炎症和菌血症的全身性风险非常重要。炎症性牙周疾病与多种全身性疾病相关。除怀孕可能是个例外，牙周感染和炎症的局部和全身性影响通常会持续多年，常见于中年或老年人。因此，已有许多将慢性牙周炎与年龄相关且生物学复杂的疾病，如糖尿病、心血管疾病、骨质疏松症、呼吸系统疾病、类风湿性关节炎、某些癌症、勃起功能障碍、肾脏疾病和痴呆相关联的流行病学关联的报道。在未来几年，尽管对已知的遗传、行为和环境混杂因素进行了调整，但似乎可能会有更多的关联被报道。确定因果机制更为复杂，特别是在全身性影响可能很微妙的情况下。然而，目前专家们对这些关联的性质缺乏共识，医疗服务提供者和公众对如何解读这一迅速增长的科学知识也存在困惑。本文综述了当前将牙周疾病与糖尿病、心血管疾病、骨质疏松症、早产/低体重婴儿、呼吸系统疾病和类风湿性关节炎相关联的证据。
CONTEXT: Inflammatory periodontal diseases exhibit an association with multiple systemic conditions. Currently, there is a lack of consensus among experts on the nature of these associations and confusion among health care providers and the public on how to interpret this rapidly growing body of science. This article overviews the current evidence linking periodontal diseases to diabetes, cardiovascular disease, osteoporosis, preterm low birth weight babies, respiratory diseases, and rheumatoid arthritis.EVIDENCE ACQUISITION: Evidence was taken from systematic reviews, clinical trials, and mechanistic studies retrieved in searches of the PubMed electronic database. The available data provide the basis for applied practical clinical recommendations.EVIDENCE SYNTHESIS: Evidence is summarized and critically reviewed from systematic reviews, primary clinical trials, and mechanistic studiesCONCLUSIONS: Surrogate markers for chronic periodontitis, such as tooth loss, show relatively consistent but weak associations with multiple systemic conditions. Despite biological plausibility, shorter-term interventional trials have generally not supported unambiguous cause-and-effect relationships. Nevertheless, the effective treatment of periodontal infections is important to achieve oral health goals, as well as to reduce the systemic risks of chronic local inflammation and bacteremias. Inflammatory periodontal diseases exhibit an association with multiple systemic conditions. With pregnancy as a possible exception, the local and systemic effects of periodontal infections and inflammation are usually exerted for many years, typically among those who are middle-aged or older. It follows that numerous epidemiological associations linking chronic periodontitis to age-associated and biologically complex conditions such as diabetes, cardiovascular disease, osteoporosis, respiratory diseases, rheumatoid arthritis, certain cancers, erectile dysfunction, kidney disease and dementia, have been reported. In the coming years, it seems likely that additional associations will be reported, despite adjustments for known genetic, behavioral and environmental confounders. Determining cause-and-effect mechanisms is more complicated, especially in circumstances where systemic effects may be subtle. Currently, however, there is a lack of consensus among experts on the nature of these associations and confusion among health care providers and the public on how to interpret this rapidly growing body of science. This article overviews the current evidence linking periodontal diseases to diabetes, cardiovascular disease, osteoporosis, preterm/low birth weight babies, respiratory diseases, and rheumatoid arthritis.