糖尿病和牙周炎是慢性非传染性疾病,与死亡率独立相关,并具有双向关系。
更新其流行病学和机制关联的证据,并重新检查有效的牙周治疗对代谢控制的影响(糖化血红蛋白,HbA1C)。
有强有力的证据表明,牙周炎患者的血糖异常和胰岛素抵抗风险升高。糖尿病患者的队列研究表明,牙周炎患者(与牙周健康患者相比)的HbA1C水平显着升高,但是1型糖尿病患者的数据不足。牙周炎也与2型糖尿病的发病风险增加有关。
牙周炎和糖尿病之间的机制联系涉及白细胞介素(IL)-1-β的升高,肿瘤坏死因子-α,IL-6,核因子κB受体活化因子配体/骨保护素比值,氧化应激和Toll样受体(TLR)2/4表达。
牙周治疗对糖尿病患者安全有效,它与3个月后HbA1C降低0.27-0.48%有关,尽管涉及长期随访的研究尚无定论.
欧洲牙周病联合会(EFP)和国际糖尿病联合会(IDF)报告了医生的共识指南,口腔保健专业人员和患者改善早期诊断,糖尿病和牙周炎的预防和管理。
Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship.
To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).
There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.
Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression.
Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive.
The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report
consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.