牙周炎应纳入糖尿病管理的现有科学证据

W. Borgnakke
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摘要

本视角简要概述了牙周病与高血糖(糖尿病[DM]和糖尿病前期)之间双向联系的科学证据。它简明扼要地提供了当前的科学证据,说明高血糖对牙周健康状况的影响,以及牙周疾病对血糖水平的影响,进而对糖尿病的发病率、进展和并发症的影响。最重要的是提供科学证据,证明常规牙周治疗具有降低血糖水平的潜力,为糖尿病管理提供了一种新颖、经济的工具。非手术牙周治疗("深层清洁")可由普通牙科诊所的牙科卫生员或牙医提供,但严重病例应转诊至专科医生。这种治疗可以减少 DM 患者的 DM 护理费用和其他医疗费用。健康的口腔没有感染和随之而来的炎症--尤其是牙周炎,如果不及时治疗,会导致患牙松动并最终脱落--的重要性在很大程度上没有被医学界注意到,因为医疗保健课程中基本上没有关于口腔健康和全身健康之间双向联系的内容,尽管血糖水平的升高是全身炎症反应不可分割的一部分。保持无病的天然牙齿对于正确的咬合和咀嚼、微笑、自尊和避免疼痛的重要性怎么强调都不过分。我们强烈建议医疗和牙科专业人员合作,以患者为中心,共同护理高血糖患者或有高血糖风险的患者。
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Current scientific evidence for why periodontitis should be included in diabetes management
This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment (“deep cleaning”) can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation – especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth – has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with – or at risk for – hyperglycemia.
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