Soskolne W A
Department of Periodontics, Hebrew University-Hadassah, Faculty of Dental Medicine, Jerusalem, Israel.
Ann Periodontol. 1998 Jul;3(1):3-12. doi: 10.1902/annals.1998.3.1.3.
The association between diabetes mellitus and periodontal disease has long been discussed, with conflicting conclusions. On the one hand, numerous reports indicate a high prevalence of periodontal disease in diabetics compared to healthy controls, while others fail to show such a relationship. Clarification of this dilemma has been occurring as the diagnostic criteria for periodontal disease destruction improve and the number and size of the populations surveyed grow. This review is based on a selective review of the literature from the present decade. To date, based mainly on an extensive study of the Pima Indians who have an extremely high incidence of non-insulin-dependent diabetes mellitus (NIDDM), it seems to be clear that patients with NIDDM have a higher prevalence and severity of periodontal disease destruction than non-diabetics in the same population. However, it must be borne in mind that these data are for a special population. Studies on patients with insulin-dependent diabetes mellitus (IDDM) indicate results similar to those found in studies on NIDDM. There is an increase in prevalence and severity of periodontitis compared to controls. For both IDDM and NIDDM, there does not appear to be any correlation between the prevalence or the severity of periodontal disease and the duration of diabetes. Well-controlled diabetic patients as measured by blood glycated hemoglobin levels have less severe periodontal disease than poorly controlled diabetics. The principles of treatment of periodontitis in diabetics are the same as those for non-diabetic patients and are consistent with our approach to all high-risk patients who have already developed periodontal disease. The major efforts should be directed at the prevention of periodontitis in patients at risk of developing diabetes. Another important clinical question relates to the influence of periodontal disease on the control of the diabetic state. Here again the literature is unclear; however, a recent development suggests that effective control of periodontal infection in patients with diabetes reduces the level of advanced glycosylation end products in the serum. If future studies can confirm this effect, then periodontal infection control must be considered an integral part of diabetic control.
糖尿病与牙周病之间的关联长期以来一直备受讨论，结论不一。一方面，众多报告指出，与健康对照组相比，糖尿病患者中牙周病的患病率较高，而其他报告则未显示出这种关系。随着牙周病破坏的诊断标准不断完善以及调查人群数量和规模的增加，这一困境正在逐步得到澄清。本综述基于对近十年文献的选择性回顾。迄今为止，主要基于对非胰岛素依赖型糖尿病（NIDDM）发病率极高的皮马印第安人的广泛研究，似乎很明显，在同一人群中，NIDDM患者牙周病破坏的患病率和严重程度高于非糖尿病患者。然而，必须牢记这些数据是针对特殊人群的。对胰岛素依赖型糖尿病（IDDM）患者的研究表明，结果与NIDDM研究中发现的结果相似。与对照组相比，牙周炎的患病率和严重程度有所增加。对于IDDM和NIDDM，牙周病的患病率或严重程度与糖尿病病程之间似乎没有任何关联。通过糖化血红蛋白水平衡量，血糖控制良好的糖尿病患者的牙周病严重程度低于血糖控制不佳的糖尿病患者。糖尿病患者牙周炎的治疗原则与非糖尿病患者相同，并且与我们对所有已患牙周病的高危患者的治疗方法一致。主要努力应针对预防有患糖尿病风险的患者发生牙周炎。另一个重要的临床问题涉及牙周病对糖尿病状态控制的影响。在这方面，文献同样不明确；然而，最近的一项进展表明，有效控制糖尿病患者的牙周感染可降低血清中晚期糖基化终产物的水平。如果未来的研究能够证实这种效果，那么牙周感染控制必须被视为糖尿病控制的一个组成部分。
