Tachalov V V, Orekhova L Y, Kudryavtseva T V, Loboda E S, Pachkoriia M G, Berezkina I V, Golubnitschaja O
Therapeutic Dentistry and Periodontology Department, Pavlov First Saint Petersburg State Medical University, 6/8 Lva Tolstogo Street, St. Petersburg, Russia.
City Periodontology Centre, "PAKS", Dobrolubova prospect, 27, St. Petersburg, Russia.
EPMA J. 2021 Apr 19;12(2):129-140. doi: 10.1007/s13167-021-00240-7. eCollection 2021 Jun.
An evident underestimation of the targeted prevention of dental diseases is strongly supported by alarming epidemiologic statistics globally. For example, epidemiologists demonstrated 100% prevalence of dental caries in the Russian population followed by clinical manifestation of periodontal diseases. Inadequately provided oral health services in populations are caused by multi-factorial deficits including but not limited to low socio-economic status of affected individuals, lack of insurance in sub-populations, insufficient density of dedicated medical units. Another important aspect is the "participatory" medicine based on the active participation of population in maintaining oral health: healthcare will remain insufficient as long as the patient is not motivated and does not feel responsible for their oral health. To this end, nearly half of chronically diseased people do not comply with adequate medical services suffering from severely progressing pathologies. Noteworthy, the prominent risk factors and comorbidities linked to the severe disease course and poor outcomes in COVID-19-infected individuals, such as elderly, diabetes mellitus, hypertension and cardiovascular disease, are frequently associated with significantly altered oral microbiome profiles, systemic inflammatory processes and poor oral health. Suggested pathomechanisms consider potential preferences in the interaction between the viral particles and the host microbiota including oral cavity, the respiratory and gastrointestinal tracts. Since an aspiration of periodontopathic bacteria induces the expression of angiotensin-converting enzyme 2, the receptor for SARS-CoV-2, and production of inflammatory cytokines in the lower respiratory tract, poor oral hygiene and periodontal disease have been proposed as leading to COVID-19 aggravation. Consequently, the issue-dedicated expert recommendations are focused on the optimal oral hygiene as being crucial for improved individual outcomes and reduced morbidity under the COVID-19 pandemic condition. Current study demonstrated that age, gender, socio-economic status, quality of environment and life-style, oral hygiene quality, regularity of dental services requested, level of motivation and responsibility for own health status and corresponding behavioural patterns are the key parameters for the patient stratification considering person-tailored approach in a complex dental care in the population. Consequently, innovative screening programmes and adapted treatment schemes are crucial for the complex person-tailored dental care to improve individual outcomes and healthcare provided to the population.
全球令人担忧的流行病学统计数据有力地支持了对牙科疾病目标预防的明显低估。例如，流行病学家证明俄罗斯人群中龋齿患病率达100%，随后出现牙周疾病的临床表现。人群中口腔卫生服务提供不足是由多种因素造成的，包括但不限于受影响个体的社会经济地位低、部分人群缺乏保险、专门医疗单位密度不足。另一个重要方面是基于民众积极参与维护口腔健康的“参与式”医学：只要患者没有积极性且对自身口腔健康不负责，医疗保健就会仍然不足。为此，近一半慢性病患者不接受适当医疗服务，病情严重进展。值得注意的是，与COVID-19感染个体的严重病程和不良结局相关的主要危险因素和合并症，如老年人、糖尿病、高血压和心血管疾病，常常与口腔微生物群谱显著改变、全身炎症过程和口腔健康不佳有关。提出的发病机制考虑了病毒颗粒与包括口腔、呼吸道和胃肠道在内的宿主微生物群之间相互作用的潜在偏好。由于牙周病原菌的吸入会诱导血管紧张素转换酶2（SARS-CoV-2的受体）的表达以及下呼吸道炎症细胞因子的产生，因此有人提出口腔卫生不良和牙周疾病会导致COVID-19病情加重。因此，针对该问题的专家建议集中在最佳口腔卫生方面，这对于在COVID-19大流行情况下改善个体结局和降低发病率至关重要。当前研究表明，年龄、性别、社会经济地位、环境和生活方式质量、口腔卫生质量、所要求牙科服务的规律性、对自身健康状况的积极性和责任感以及相应的行为模式是在人群复杂牙科护理中考虑个性化方法进行患者分层的关键参数。因此，创新的筛查计划和适应性治疗方案对于复杂的个性化牙科护理以改善个体结局和为人群提供医疗保健至关重要。
