Mealey Brian L, Rose Louis F
Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Curr Opin Endocrinol Diabetes Obes. 2008 Apr;15(2):135-41. doi: 10.1097/MED.0b013e3282f824b7.
Periodontal diseases are inflammatory conditions that were once thought to have manifestations localized to the oral cavity alone, and were therefore considered the concern of only dentists and other oral health professionals. Emerging evidence has changed this view and now suggests that periodontal diseases may play a role in numerous conditions that impact systemic well being, including diabetes mellitus. This review examines the relationships that exist between periodontal diseases and diabetes mellitus, with a focus on potential common pathophysiologic pathways including those associated with inflammation, altered host responses, and insulin resistance.
Periodontal inflammation is associated with an elevated systemic inflammatory state and an increased risk of major cardiovascular events such as myocardial infarction and stroke, adverse pregnancy outcomes such as preeclampsia, low birth weight and preterm birth, and altered glycemic control in people with diabetes. Intervention trials suggest that periodontal therapy, which decreases the intraoral bacterial bioburden and reduces periodontal inflammation, can have a significant impact on systemic inflammatory status. Evidence suggests that periodontal therapy is associated with improved glycemic control in many patients with both diabetes and periodontal diseases.
Recognition of the bilateral relationships between oral and systemic health will challenge physicians and dentists to work together closely in the future when managing patients with diabetes and periodontal disease.
牙周疾病是炎症性疾病，曾经被认为仅在口腔局部有表现，因此仅被视为牙医和其他口腔健康专业人员关注的问题。新出现的证据改变了这一观点，现在表明牙周疾病可能在影响全身健康的多种病症中起作用，包括糖尿病。本综述探讨了牙周疾病与糖尿病之间存在的关系，重点关注潜在的共同病理生理途径，包括与炎症、宿主反应改变和胰岛素抵抗相关的途径。
牙周炎症与全身炎症状态升高以及心肌梗死和中风等主要心血管事件、先兆子痫、低出生体重和早产等不良妊娠结局以及糖尿病患者血糖控制改变的风险增加有关。干预试验表明，牙周治疗可降低口腔内细菌生物负荷并减轻牙周炎症，对全身炎症状态有显著影响。有证据表明，牙周治疗与许多患有糖尿病和牙周疾病的患者血糖控制改善有关。
认识到口腔健康与全身健康之间的双向关系，将促使医生和牙医在未来共同密切合作，管理患有糖尿病和牙周疾病的患者。
