Systemic effects of periodontitis: Epidemiology of periodontal disease and cardiovascular disease
Systemic effects of periodontitis: Epidemiology of periodontal disease and cardiovascular disease
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DOI：
10.1902/jop.2005.76.11-s.2089
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发表时间：
2005-11-01
影响因子：
4.3
通讯作者：
Offenbacher, S
中科院分区：
文献类型：
--
作者：
Beck, JD;Offenbacher, S
已有42项已发表的研究描述了口腔疾病和心血管疾病之间的关联。在没有随机对照试验的情况下，16项纵向研究代表了现有证据的最高水平。然而，两个数据库产生了16项研究中的8项。口腔暴露的定义也有很大的差异，包括唾液流量、报告的牙周病、牙齿数量、口腔微生物、口腔微生物抗体、总牙科指数、社区牙周病治疗需求指数、牙菌斑评分、探测深度、附着丧失和骨水平。心血管结局也存在变异性，包括动脉粥样硬化指标和事件，如因冠心病（CHD）住院、慢性CHD、致死性CHD、总卒中、缺血性卒中和血运重建手术。对这项研究的批评之一是，暴露没有通过感染的措施来表示。为了开始解决这一问题，我们提出了新的数据显示，模式的高和低水平的8种牙周病原体和抗体水平对这些生物体相关的临床牙周疾病以及其他特征的个人，如年龄，种族，性别，糖尿病状态，动脉粥样硬化和冠心病。正如我们之前的其他人一样，我们得出结论，上述累积证据支持但不能证明牙周感染与动脉粥样硬化性心血管疾病或其后遗症之间存在因果关系。一些合理的关注已经出现的关系的性质，事实上，牙周病的适当定义时，它被认为是一个暴露的全身性疾病。仍然需要做很多工作来确定暴露的哪些方面与结果的哪些方面相关。主成分分析说明了风险因素、风险暴露和结果之间相互作用的复杂性。这些分析提供了一个初步的聚类，描述和提示特定综合征的存在。
There have been 42 published studies describing associations between oral conditions and cardiovascular diseases. In the absence of randomized controlled trials, the 16 longitudinal studies represent the highest level of evidence available. However, two databases produced eight of the 16 studies. There also is extensive variability in definitions of the oral exposure that include salivary flow, reported periodontal disease, number of teeth, oral organisms, antibodies to oral organisms, Total Dental index, Community Periodontal Index of Treatment Needs, plaque scores, probing depth, attachment loss, and bone level. Variability also exists in the cardiovascular outcomes that include atherosclerosis measures and events, such as hospitalization for coronary heart disease (CHD), chronic CHD, fatal CHD, total stroke, ischemic stroke, and revascularization procedures. One of the criticisms of this research is that the exposure has not been represented by measures of infection. To begin to address this concern, we present new data showing that patterns of high and low levels of eight periodontal pathogens and antibody levels against those organisms are related to clinical periodontal disease as well as other characteristics of the individuals, such as age, race, gender, diabetic status, atherosclerosis, and CHD. As others before us, we conclude that the cumulative evidence presented above supports, but does not prove, a causal association between periodontal infection and atherosclerotic cardiovascular disease or its sequelae. A number of legitimate concerns have arisen about the nature of the relationship and, indeed, the appropriate definitions for periodontal disease when it is thought to be an exposure for systemic diseases. There is still much work needed to identify which aspects of the exposure are related to which aspects of the outcome. Principal component analyses illustrate the complexity of the interactions among risk factors, exposures, and outcomes. These analyses provide an initial clustering that describes and suggests the presence of specific syndromes.