Shay Kenneth
Geriatrics and Extended Care Service Line, Ann Arbor Veterans Affairs Healthcare System, and University of Michigan School of Dentistry, Ann Arbor, MI, USA.
Clin Infect Dis. 2002 May 1;34(9):1215-23. doi: 10.1086/339865. Epub 2002 Apr 2.
Retention of teeth into advanced age makes caries and periodontitis lifelong concerns. Dental caries occurs when acidic metabolites of oral streptococci dissolve enamel and dentin. Dissolution progresses to cavitation and, if untreated, to bacterial invasion of dental pulp, whereby oral bacteria access the bloodstream. Oral organisms have been linked to infections of the endocardium, meninges, mediastinum, vertebrae, hepatobiliary system, and prosthetic joints. Periodontitis is a pathogen-specific, lytic inflammatory reaction to dental plaque that degrades the tooth attachment. Periodontal disease is more severe and less readily controlled in people with diabetes; impaired glycemic control may exacerbate host response. Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home-acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia. Bloodborne periodontopathic organisms may play a role in atherosclerosis. Daily oral hygiene practice and receipt of regular dental care are cost-effective means for minimizing morbidity of oral infections and their nonoral sequelae.
牙齿保留到高龄会使龋齿和牙周炎成为终身关注的问题。当口腔链球菌的酸性代谢产物溶解牙釉质和牙本质时，就会发生龋齿。溶解会发展为空洞，如果不进行治疗，还会导致细菌侵入牙髓，从而使口腔细菌进入血液循环。口腔微生物与心内膜、脑膜、纵隔、椎骨、肝胆系统和人工关节的感染有关。牙周炎是对牙菌斑的一种病原体特异性的溶解性炎症反应，会破坏牙齿附着。糖尿病患者的牙周疾病更严重且更难控制；血糖控制受损可能会加剧宿主反应。口咽（包括牙周）病原体的吸入是养老院获得性肺炎的主要原因；反映口腔健康状况差的因素与发生吸入性肺炎的风险增加密切相关。血源性病原体可能在动脉粥样硬化中起作用。日常口腔卫生习惯和定期接受牙科护理是将口腔感染及其非口腔后遗症的发病率降至最低的经济有效的方法。
