Pediatric Dentistry, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy.
UOSD Special Care Dentistry, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00100 Rome, Italy.
Nutrients. 2022 May 10;14(10):2002. doi: 10.3390/nu14102002.
Several studies have demonstrated a strong relation between periodontal diseases and chronic kidney disease (CKD). The main mechanisms at the base of this link are malnutrition, vitamin dysregulation, especially of B-group vitamins and of C and D vitamins, oxidative stress, metabolic acidosis and low-grade inflammation. In particular, in hemodialysis (HD) adult patients, an impairment of nutritional status has been observed, induced not only by the HD procedures themselves, but also due to numerous CKD-related comorbidities. The alteration of nutritional assessment induces systemic manifestations that have repercussions on oral health, like oral microbiota dysbiosis, slow healing of wounds related to hypovitaminosis C, and an alteration of the supporting bone structures of the oral cavity related to metabolic acidosis and vitamin D deficiency. Low-grade inflammation has been observed to characterize periodontal diseases locally and, in a systemic manner, CKD contributes to the amplification of the pathological process, bidirectionally. Therefore, CKD and oral disease patients should be managed by a multidisciplinary professional team that can evaluate the possible co-presence of these two pathological conditions, that negatively influence each other, and set up therapeutic strategies to treat them. Once these patients have been identified, they should be included in a follow-up program, characterized by periodic checks in order to manage these pathological conditions.
多项研究表明，牙周病与慢性肾脏病（CKD）之间存在密切关系。这种联系的主要机制是营养不良、维生素失调，特别是 B 族维生素、C 族维生素和 D 族维生素、氧化应激、代谢性酸中毒和低度炎症。特别是在血液透析（HD）成年患者中，观察到营养状况受损，这不仅是由 HD 程序本身引起的，而且还由于许多与 CKD 相关的合并症引起的。营养评估的改变会导致全身性表现，从而对口腔健康产生影响，如口腔微生物失调、与维生素 C 缺乏相关的伤口愈合缓慢，以及代谢性酸中毒和维生素 D 缺乏导致的口腔支持骨结构改变。已经观察到低度炎症会导致牙周病局部发生，并以全身方式发生，CKD 会促进病理过程的放大，呈双向放大。因此，应通过多学科专业团队来管理 CKD 和口腔疾病患者，该团队可以评估这两种病理状况的可能共存情况，这两种病理状况相互影响，并制定治疗策略来治疗这些疾病。一旦确定了这些患者，就应将他们纳入随访计划，定期检查以管理这些病理状况。
