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原文題目(出處)： Periodontal disease and diabetes mellitus
原文作者姓名： Carlos Antonio NEGRATO, Olinda TARZIA, Lois JOVANOVIC, Luiz Eduardo Montenegro CHINELLATO
通訊作者學校： Research Support Center, Oral Biochemistry, Sansum Diabetes Research Institute Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
報告者姓名(組別)： 余政輝 Intern A 組
報告日期： 102/08/13
內文：
一. Abstract
Periodontal disease (PD) is one of the most commonly known human chronic disorders.The relationship between PD and several systemic diseases such as diabetes mellitus (DM) has been increasingly recognized over the past decades.
Objective:
Data interpretation is often confounded by varying definitions of DM, PD and different clinical criteria were applied to determine the prevalence, extent and severity of PD, levels of glycemic control and diabetes-related complications.
Methods:
Primary research reports on investigations of relationships between DM/DM control, PD/periodontal treatment and PD/DM diabetes-related complications identified relevant papers and meta-analyses published in this period.
Results:
1) The effect of DM on PD
2) The effects of glycemic control on PD
3) The effects of PD on glycemic control and on diabetes-related complications
Conclusions:
The scientific evidence reviewed supports diabetes having an adverse effect on periodontal health and PD having an adverse effect on glycemic control and on diabetes-related complications.
二. Introduction
PD is a chronic infectious disease, caused by Gram-negative microorganisms. An imbalancebetween a localized infection and an exaggerated host inflammatory response plays a pivotal role in determining gingival tissue damage.
Recent evidence suggests that the effect of PD might not be limited just to the oral cavity but it might have systemic consequences. Indeed, PD has also been associated with a moderate systemic inflammatory response.
Although, the mechanisms behind this association remain unclear, PD might represent one distant source of low-grade systemic inflammation
There is strong evidence that the prevalence, severity and progression of PD are significantly higher in people with DM
三. Periodontal disease
PD is a chronic bacterial infection that affects both the gingiva and the bone that supports the teeth and is caused by anaerobic Gram-negative microorganisms that are present in the bacterial plaque that adheres to the teeth.
PD has even higher prevalence in minorities, in poor and developing countries and a considerable global variation
The presence of anaerobic Gram-negative bacteria causes a local inflammatory response that becomes chronic and progressive; this inflammationof the gingiva causes alveolar bone destruction and loss of the tissue attachment to the teeth,
口腔病理科 On-Line KMU Student Bulletin
caused by components of microbial plaque that have the capacity to induce an initial infiltrate of inflammatory cells, such as lymphocytes, macrophages, and polymorphonuclear leukocytes (PMNs)
Some microbial components, especially lipopolysaccharide (LPS), activate macrophages that synthesize and secrete a great variety and amount of pro-inflammatory molecules, such as the cytokines interleukin-1 (IL-1) and tumor necrosis factor-α(TNF-α): prostangladins, especially prostaglandin E2 (PGE2); and some other enzymes
Bacterial toxins can also activate T lymphocytes to produce IL-1 and lymphotoxin (LT), a molecule with properties that are similar to those of TNF-α
These cytokines show potent pro-inflammatory and catabolic activities, and have important roles in periodontal tissue destruction caused by collagenolytic enzymes such as metalloproteinases (MMPs)
The attachment loss deepens the sulcus, creating a periodontal pocket that contains thousands of millions of bacterial cells. This stage is the transition between gingivitis and periodontitis, the most common PDs
Many conditions can predispose and/or facilitate the occurrence of PD such as smoking, genetic influences, estrogen deficiency, estrogen excess, dyslipidemia and obesity. The prevalence of obesity is increasing worldwide. This epidemic is also associated with an increased occurrence of obesity-related diseases like hypertension, cardiovascular disease, metabolic syndrome and DM that are also linked to PD
四. Diabetes mellitus
DM is classified according to its etiology as type 1 (T1D), type 2 (T2D), gestational diabetes (GDM) and other specific types.
T1D results from the destruction of beta-cells within the islets of Langerhans of the pancreas, which results in a complete insulin deficiency; it can be immune-mediated or have an idiopathic etiology
T2D ranges from an insulin resistance which progresses into an insulin deficiency due to a secondary failure in the pancreatic beta-cells
GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
Developed countries have a higher prevalence of DM than developing countries and more women than men are affected with DM
In developed countries, the majority of people with DM are older than 65 years.
DM will be increasingly occurring in urban areas 五. Effects of diabetes mellitus on periodontal disease
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六. Effects of glycemic control on periodontal disease
Current evidence also supports poorer glycemic control contributing to poorer periodontal health
Glycemic control worsens in parallel with the worsening of PD
口腔病理科 On-Line KMU Student Bulletin
七. Effects of periodontal disease on glycemic control and on diabetics-related complications
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八. Summary and conclusions
The clinical and epidemiological evidence found in the literature we reviewed provides support for the concept that DM can have adverse effects on PD, that PD worsens in parallel with glycemic control and finally that PD is associated with an increase in the risk for diabetes-related complications.
However, further prospective, rigorous, controlled trials with a larger number of patients, in ethnically diverse populations are warranted to establish these relationships and that treating PD can positively influence glycemic control and possibly reduce the burden of diabetes-related complications.
題號 題目
1 下列有系統性疾病與牙周炎關係的敘述，何者錯誤
(A) 隨著牙周炎的嚴重度增加，心臟冠狀動脈疾病的發生率也有增高的趨 (B) 未經控制或控制不好的糖尿病患者，會有增高的牙周炎感染率 勢 (C) 若患者曾患有慢性阻塞性肺病（chronic obstructive pulmonary disease）
可能會有較多的牙周附連組織喪失情形
(D) 牙周炎不是造成早產、體重過輕嬰兒（preterm、low-birth-weight infants）的危險因數之一
答案(D) 出處：Lindhe Clinical Periodontology and Implant Dentistry, 2008
題號 題目
2 55 歲女性病患有糖尿病，HbAlc 值為 6.5%，接受牙周基本治療後，再評估 時發現左下顎第二大臼齒遠心側囊袋從9 mm 改善至 7 mm，X 光片顯示為 3 壁骨缺損，有探測流血，最適合之治療方式為何?
(A) 牙周翻瓣手術，但不適合放置骨粉等材料，會容易造成感染 (B) 給予抗生素 HbAlc 降至 6 %以下才能手術
(C) 牙周再生手術
(D) 傷口癒合差，不適合進行牙周手術，直接安排定期維護治療
答案(C) 出處：Clinical Periodontology, Carranza and Newman, Saunders W.B. Co, 2006
