Hujoel P
Department of Dental Public Health Sciences, Box 357475, School of Dentistry, University of Washington, Seattle, WA 98195-7475, USA.
J Dent Res. 2009 Jun;88(6):490-502. doi: 10.1177/0022034509337700.
Two contradictory hypotheses on the role of dietary carbohydrates in health and disease shape how dental-systemic associations are regarded. On one side, Cleave and Yudkin postulated that excessive dietary fermentable carbohydrate intake led-in the absence of dental interventions such as fluorides-first to dental diseases and then to systemic diseases. Under this hypothesis, dental and systemic diseases shared-as a common cause-a diet of excess fermentable carbohydrates. Dental diseases were regarded as an alarm bell for future systemic diseases, and restricting carbohydrate intake prevented both dental and systemic diseases. On the opposite side, Keys postulated the lipid hypothesis: that excessive dietary lipid intake caused systemic diseases. Keys advocated a diet high in fermentable carbohydrate for the benefit of general health, and dental diseases became regarded as local dietary side effects. Because general health takes precedence over dental health when it comes to dietary recommendations, dental diseases became viewed as local infections; interventions such as fluorides, sealants, oral hygiene, antimicrobials, and dental fillings became synonymous with maintaining dental health, and carbohydrates were no longer considered as a common cause for dental-systemic diseases. These opposing dietary hypotheses have increasingly been put to the test in clinical trials. The emerging trial results favor Cleave-Yudkin's hypothesis and may affect preventive approaches for dental and systemic diseases.
关于膳食碳水化合物在健康与疾病中的作用，存在两种相互矛盾的假说，这影响了人们对口腔与全身关联的看法。一方面，克里夫和尤德金提出，在缺乏氟化物等口腔干预措施的情况下，过量摄入可发酵膳食碳水化合物首先会导致口腔疾病，进而引发全身疾病。在这一假说下，口腔疾病和全身疾病有一个共同的病因，即过量的可发酵碳水化合物饮食。口腔疾病被视为未来全身疾病的警钟，限制碳水化合物摄入可预防口腔和全身疾病。另一方面，基斯提出了脂质假说：过量摄入膳食脂质会导致全身疾病。基斯主张为了整体健康应食用富含可发酵碳水化合物的饮食，口腔疾病则被视为局部饮食副作用。由于在饮食建议方面整体健康优先于口腔健康，口腔疾病被视为局部感染；氟化物、窝沟封闭剂、口腔卫生、抗菌药物和补牙等干预措施成为维护口腔健康的代名词，碳水化合物不再被认为是口腔 - 全身疾病的共同病因。这些相互对立的饮食假说在临床试验中越来越多地受到检验。新出现的试验结果支持克里夫 - 尤德金的假说，可能会影响口腔和全身疾病的预防方法。
