Moore P A, Weyant R J, Mongelluzzo M B, Myers D E, Rossie K, Guggenheimer J, Block H M, Huber H, Orchard T
University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health, PA 15261, USA.
J Periodontol. 1999 Apr;70(4):409-17. doi: 10.1902/jop.1999.70.4.409.
The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes.
During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA).
Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA > or =4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients.
Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking.
对320名患牙成年人的牙周疾病状况进行了评估，这些患者在23.7年前被诊断为1型胰岛素依赖型糖尿病。作为匹兹堡大学一项大型纵向研究的一部分，这些患者每两年接受一次监测，该研究旨在评估与胰岛素依赖型糖尿病相关的医学并发症。
在一次定期体检中，一组320名成年患牙受试者（平均年龄32.1岁）接受了牙周检查，作为全面口腔健康评估的一部分。口腔健康评估收集了有关人口统计学、口腔健康行为、牙齿脱落、冠龋和根龋、唾液功能以及软组织病变的数据。对于牙周评估，评估右上颌/左下颌或左上颌/右下颌象限牙齿的3个面部部位（近中、颈中、远中）的牙石、探诊出血（BOP）和牙龈附着丧失（LOA）情况。
老年患者的附着丧失明显更大，而BOP和牙石水平在各年龄组中相对稳定。对可能与广泛牙周疾病（至少10%的检查部位LOA≥4mm）相关的因素进行单因素分析表明，其与年龄较大、收入和教育程度较低、过去和现在吸烟、不常看牙医、每天刷牙少于一次、发病年龄较大、糖尿病病程较长以及糖尿病神经病变并发症有关。对所有可能显著的因素进行多变量回归模型分析发现，当前吸烟（优势比[OR]=9.73）、8.4岁后发生胰岛素依赖型糖尿病（OR=3.36）以及年龄大于32岁（OR=3.00）解释了该组糖尿病患者中大部分广泛牙周疾病的情况。
对于1型糖尿病患者，广泛牙周疾病的管理和预防应包括强烈建议戒烟。
