Could Vitamin D influence risk for Periodontal Disease - to "D" or not to "D"?
Could Vitamin D influence risk for Periodontal Disease - to "D" or not to "D"?
复制标题
DOI：
10.1007/s40496-020-00253-7
复制
发表时间：
2020-03
影响因子：
--
通讯作者：
Pavlesen S
中科院分区：
文献类型：
--
作者：
Millen AE;Pavlesen S
本综述的目的是讨论维生素D和牙周病之间的关联，包括其优点和缺点的文献。提供了今后在这一领域继续开展工作的方向。横断面队列研究、调查和病例对照研究为维生素D在牙周病中的作用提供了支持，特别是使用临床指标，如探诊出血和临床附着丧失。然而，这些研究有许多局限性。他们不能确定这些联系的时间性。大多数病例对照研究的样本量有限，结果不一致。一些横断面研究仅限于选择人群（例如，艾滋病毒感染者、糖尿病患者、类风湿性关节炎患者）限制了对一般老年人群的外推研究结果。进行的前瞻性研究较少，只有三项研究使用维生素D的生物标志物来检查相关性，该生物标志物反映了所有来源（阳光，饮食和补充剂）的暴露。一项研究因使用自我报告的疾病结局指标而受到限制，只有两项使用了牙槽嵴高度的指标。然而，在已发表的前瞻性研究中，有一种观点认为维生素D可以预防牙齿脱落。只有两项随机对照试验研究了这些关联，它们支持维生素D补充剂对预防牙齿脱落和牙龈出血的作用。我们强烈建议，新的研究应侧重于前瞻性研究设计，对参与者的随访时间超过十年，并进行长期临床试验。这些研究应包括牙槽骨损失和牙齿损失的措施，并指出牙齿损失的原因。此类临床试验应设计用于检查单独补充维生素D以及补充其他营养素（例如，钙）或治疗药物（例如，二膦酸盐）。目前，没有强有力的证据表明维生素D可以预防牙周病的发展。
The purpose of this review is to discuss the literature on associations between vitamin D and periodontal disease, including its strengths and weaknesses. Future direction for continued work in this area is provided. Research in cross-sectional cohorts, surveys, and case-control studies provide support for a role of vitamin D in periodontal disease, especially using clinical indicators such as bleeding on probing and clinical attachment loss. However, these studies have a number of limitations. They cannot establish temporality of these associations. Most case-control studies have been limited in sample size and have inconsistent findings. A number of cross-sectional studies are restricted to select populations (e.g., persons with HIV, diabetes, rheumatoid arthritis) limiting extrapolation of findings to the general aging population. Fewer prospective studies have been conducted, and only three have examined associations using a biomarker for vitamin D that reflects exposure from all its sources (sunlight, diet and supplements). One study is limited by using self-reported measures of disease outcomes, and only two used measures of alveolar crestal height. However, of the prospective studies published, there is a suggestion that vitamin D might prevent against tooth loss. Only two randomized controlled trials have examined these associations, and they support the effects of vitamin D supplementation on prevention of tooth loss and gingival bleeding. We strongly suggest that new research should focus on prospective study designs with followup of participants longer than a decade and long-term clinical trials. Such studies should incorporate measures of alveolar bone loss and tooth loss with indication for reason for tooth loss. Such clinical trials should be designed to examine both the influence of vitamin D supplementation alone as well as with other nutrients (e.g., calcium) or therapeutic medications (e.g., bisphosphonates). Currently, there is no strong evidence to suggest that vitamin D protects against development of periodontal disease.