Karjalainen K M, Knuuttila M L
Department of Periodontology and Geriatric Dentistry, University of Oulu, Finland.
J Clin Periodontol. 1996 Dec;23(12):1060-7. doi: 10.1111/j.1600-051x.1996.tb01804.x.
Gingival health (bleeding on probing) and oral hygiene (plaque percent) were assessed in 2 groups of children and adolescents with insulin-dependent diabetes mellitus (IDDM). 1st study group included 12 newly diagnosed diabetic children and adolescents (age range 6.3-14.0 years, 5 boys and 7 girls). They were examined on the 3rd day after initial hospital admission and at 2 weeks and 6 weeks after initiation of insulin treatment. Gingival bleeding decreased after 2 weeks of insulin treatment (37.8% versus 19.0%, p < 0.001, paired t-test), and remained at the same level when examined 1 month later while glucose balance was excellent. Another group (n = 80) of insulin-dependent diabetic children and adolescents (age range 11.7-18.4 years, 44 boys and 36 girls) with a mean duration of diabetes 6.0 years (range 0.3-15.0 years) were examined 2x at 3-month intervals. Subjects with poor blood glucose control (glycosylated haemoglobin, HbA1, values over 13%) had more gingival bleeding (46.3% on examination 1, 41.7% on examination 2) than subjects with HbA1 values less than 10% (mean gingival bleeding 35.2% and 26.9%, respectively) or subjects with HbA1 values between 10 to 13% (mean gingival bleeding 35.6% and 33.4%, respectively). Differences were significant on both examinations (p < 0.05, Anova), and remained significant after controlling the groups for differences in age, age at the onset of diabetes, duration of diabetes and pubertal stage (Ancova). Results were not related to differences or changes in dental plaque status, supporting the concept that imbalance of glucose metabolism associated with diabetes predisposes to gingival inflammation. An increase in gingival bleeding in association with hyperglycaemia suggests that hyperglycaemia-associated biological alterations, which lower host resistance toward plaque, have apparently taken place. Consequently, although not all gingivitis proceeds into a destructive periodontal disease, prevention of plaque-induced gingival inflammation should be emphasised, particularly in children and adolescents with poorly controlled diabetes.
对两组胰岛素依赖型糖尿病（IDDM）儿童和青少年的牙龈健康（探诊出血）和口腔卫生（菌斑百分比）进行了评估。第一研究组包括12名新诊断的糖尿病儿童和青少年（年龄范围6.3 - 14.0岁，5名男孩和7名女孩）。他们在初次入院后第3天以及开始胰岛素治疗后2周和6周接受检查。胰岛素治疗2周后牙龈出血减少（37.8%对19.0%，p < 0.001，配对t检验），1个月后检查时牙龈出血保持在相同水平，此时血糖平衡良好。另一组（n = 80）胰岛素依赖型糖尿病儿童和青少年（年龄范围11.7 - 18.4岁，44名男孩和36名女孩），糖尿病平均病程6.0年（范围0.3 - 15.0年），每隔3个月检查2次。血糖控制不佳（糖化血红蛋白，HbA1，值超过13%）的受试者牙龈出血比HbA1值低于10%的受试者（平均牙龈出血分别为35.2%和26.9%）或HbA1值在10%至13%之间的受试者（平均牙龈出血分别为35.6%和33.4%）更多（检查1时为46.3%，检查2时为41.7%）。两次检查差异均有统计学意义（p < 0.05，方差分析），在对年龄、糖尿病发病年龄、糖尿病病程和青春期阶段的差异进行组间控制后（协方差分析）差异仍有统计学意义。结果与牙菌斑状况的差异或变化无关，支持了糖尿病相关的糖代谢失衡易导致牙龈炎症的概念。高血糖伴牙龈出血增加表明，降低宿主对菌斑抵抗力的高血糖相关生物学改变显然已经发生。因此，尽管并非所有牙龈炎都会发展为破坏性牙周疾病，但应强调预防菌斑诱导的牙龈炎症，特别是在糖尿病控制不佳的儿童和青少年中。
