Lifshitz Fima, Casavalle Patricia Lucia, Bordoni Noemí, Rodriguez Patricia Noemi, Friedman Silvia Maria
Pediatric Sunshine Academics Inc, 1040 Alston Road, Santa Barbara, CA, 93108, USA.
Department of Pediatrics, Nutrition Clinic, Clinical Hospital José de San Martin, School of Medicine, University of Buenos Aires, Cordoba 2351 (C1120AAR), Buenos Aires, Argentina.
Pediatr Endocrinol Rev. 2016 Dec;14(2):159-167. doi: 10.17458/PER.2016.LCB.Oralhealth.
Oral health status must be considered in the care of children with obesity (OB) and diabetes mellitus (DM). The health of these patients' mouths may have significant effects on their overall health and evolution of their disease. Here we address periodontal disease (PD) and dental caries (DC), since these are two of the most common chronic diseases affecting OB and DM patients. OB plays a plausible role in the development of PD. Both overall OB and central adiposity are associated with increased hazards of gingivitis and its progression to PD. The inflammatory changes of PD might not be limited to the oral cavity, these may also trigger systemic consequences. Patients with type 1 and type 2 diabetes mellitus (T1DM, T2DM) present an increased prevalence of gingivitis and PD. In diabetics PD develops at a younger age than in the healthy population, it also worsens with the prolongation of DM. The progression to PD has been correlated with the metabolic control of the disease as it is more prevalent and more severe in patients with elevated hemoglobin A1c (A1c) levels. PD negatively affects glycemic control and other diabetes related complications and there is a general consensus that treatment of PD can positively influence these negative effects. Additionally, DC is a multifactorial oral disease that is frequently detected in those with OB and DM, although its prevalence in systematic reviews is inconclusive. The associations between gingivitis, PD and DC share similar behaviors, i.e. inadequate oral hygiene habits and unhealthy dietary intake. Insufficient tooth brushing and intake of sugary foods may result in greater detrimental oral effects. Maintaining oral health will prevent oral chronic diseases and ameliorate the consequences of chronic inflammatory processes. Thus, the care of obese and diabetic patients requires a multidisciplinary team with medical and dental health professionals.
在肥胖（OB）和糖尿病（DM）儿童的护理中，必须考虑口腔健康状况。这些患者口腔的健康状况可能会对其整体健康和疾病发展产生重大影响。在此，我们探讨牙周疾病（PD）和龋齿（DC），因为它们是影响OB和DM患者的两种最常见的慢性疾病。OB在PD的发展中可能起到一定作用。总体肥胖和中心性肥胖均与牙龈炎及其发展为PD的风险增加有关。PD的炎症变化可能不仅限于口腔，还可能引发全身性后果。1型和2型糖尿病（T1DM、T2DM）患者患牙龈炎和PD的患病率增加。糖尿病患者的PD发病年龄比健康人群更小，且随着糖尿病病程的延长病情会恶化。PD的进展与疾病的代谢控制相关，因为在糖化血红蛋白（A1c）水平升高的患者中，PD更为普遍且更为严重。PD会对血糖控制和其他糖尿病相关并发症产生负面影响，并且人们普遍认为治疗PD可以对这些负面影响产生积极影响。此外，DC是一种多因素口腔疾病，在OB和DM患者中经常被检测到，尽管其在系统评价中的患病率尚无定论。牙龈炎、PD和DC之间的关联具有相似的行为模式，即口腔卫生习惯不良和不健康的饮食摄入。刷牙不足和摄入含糖食物可能会对口腔产生更大的有害影响。保持口腔健康将预防口腔慢性疾病，并改善慢性炎症过程的后果。因此，肥胖和糖尿病患者的护理需要一个由医学和牙科健康专业人员组成的多学科团队。
