Williams R C, Barnett A H, Claffey N, Davis M, Gadsby R, Kellett M, Lip G Y H, Thackray S
University of North Carolina, School of Dentistry, Chapel Hill, NC 27599, USA.
Curr Med Res Opin. 2008 Jun;24(6):1635-43. doi: 10.1185/03007990802131215. Epub 2008 Apr 30.
Evidence for a link between periodontal disease and several systemic diseases is growing rapidly. The infectious and inflammatory burden of chronic periodontitis is thought to have an important systemic impact. Current evidence suggests that periodontitis is associated with an increased likelihood of coronary heart disease and may influence the severity of diabetes.
This paper represents a UK and Ireland cross-specialty consensus review, undertaken by a group of physicians and dentists. The consensus group reviewed published evidence (PubMed search for review and original articles), focusing on the past 5 years, on the contributory role of periodontal disease to overall health. In particular, evidence relating to a role for periodontal disease in cardiovascular disease and in diabetes was considered.
Initial studies of large epidemiological data sets have sought to find links between periodontitis and systemic disease outcomes, but a causal relationship still needs to be demonstrated between periodontal disease, cardiovascular disease and diabetes through prospective studies. There is a need for prospective studies assessing the association between periodontal disease and patients at particular risk of cardiovascular events which will allow assessment of both cardiovascular disease clinical endpoints and surrogate markers of cardiovascular risk. Of note, periodontal disease is also often more severe in subjects with diabetes mellitus, a group at already increased risk for cardiovascular events.
While further research is needed to define the population-attributable risk of periodontal disease to both cardiovascular diseases and to diabetes control and progression, health education to encourage better oral health should be considered as part of current healthy lifestyle messages designed to reduce the increasing health burden of obesity, cardiovascular disease and diabetes.
牙周疾病与多种全身性疾病之间存在关联的证据正在迅速增加。慢性牙周炎的感染和炎症负担被认为会对全身产生重要影响。目前的证据表明，牙周炎与冠心病风险增加有关，并且可能影响糖尿病的严重程度。
本文是由一组医生和牙医进行的英国和爱尔兰跨专业共识综述。共识小组回顾了已发表的证据（通过PubMed搜索综述和原始文章），重点关注过去5年中牙周疾病对整体健康的促成作用。特别考虑了与牙周疾病在心血管疾病和糖尿病中作用相关的证据。
对大型流行病学数据集的初步研究试图找出牙周炎与全身性疾病结局之间的联系，但仍需通过前瞻性研究来证明牙周疾病、心血管疾病和糖尿病之间的因果关系。需要开展前瞻性研究，评估牙周疾病与具有心血管事件特定风险的患者之间的关联，这将有助于评估心血管疾病的临床终点以及心血管风险的替代标志物。值得注意的是，牙周疾病在糖尿病患者中通常也更为严重，而糖尿病患者本身就是心血管事件风险增加的群体。
虽然需要进一步研究来确定牙周疾病对心血管疾病以及糖尿病控制和进展的人群归因风险，但应将鼓励改善口腔健康的健康教育视为当前健康生活方式宣传的一部分，这些宣传旨在减轻肥胖、心血管疾病和糖尿病日益增加的健康负担。
