伴全身系统疾病牙周炎患者的诊疗策略

doi:10.7518/hxkq.2023.2023181

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (5): 502-511.doi: 10.7518/hxkq.2023.2023181

伴全身系统疾病牙周炎患者的诊疗策略

林莉(), 李兆榕(), 晋伊宁, 尹寿成

中国医科大学附属口腔医院牙周病科，沈阳 110002

收稿日期:2023-06-08 修回日期:2023-07-06 出版日期:2023-10-01 发布日期:2023-10-08
通讯作者: 林莉 E-mail:linli_74k@163.com;1527616447@qq.com
作者简介:林莉，教授，博士，E-mail：linli_74k@163.com|林莉，中国医科大学口腔医学院教授，主任医师，博士研究生导师，国际牙医师学院院士。现任中国医科大学口腔医学院·附属口腔医院牙周科副主任。兼任辽宁省口腔医学会牙周病学专业委员会第二届主任委员、中华预防医学会微生态专业委员会委员、辽宁省预防医学会微生态专业委员会委员、国家口腔质控中心牙周亚专业质控专家组成员，为国家自然科学基金评审专家、辽宁省住院医师规范化培训基地评审专家、辽宁省医疗服务项目评审专家组组长、辽宁省口腔医疗质量控制中心专家组专家、辽宁省新型农村合作医疗专家委员会委员。任《中国实用口腔科杂志》编委，《中华口腔医学杂志》通讯编委。专业特长：在牙周病的基础治疗方面尤其是疑难病及手术治疗方面具有丰富的经验。专业特长：牙周疑难病症的诊断与治疗，牙周组织再生手术、牙周美容手术、膜龈手术等各种牙周手术。主持国家自然科学基金面上项目2项，省教育厅及科技厅项目6项，横向课题1项，市科技计划项目1项。以第一/通讯作者发表论文40余篇，参编著作5部。获国家高校科学研究优秀成果二等奖1项，辽宁医学科技奖一等奖1项，辽宁省科学技术奖二等奖1项，辽宁省科学技术奖三等奖1项。|李兆榕，硕士，E-mail：1527616447@qq.com
基金资助:
辽宁省应用基础研究计划项目(2023010019-JH2/1013)

Treatment strategies for periodontitis patients with systemic disease

Lin Li(), Li Zhaorong(), Jin Yining, Yin Shou-cheng.

Dept. of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang 110002, China

Received:2023-06-08 Revised:2023-07-06 Online:2023-10-01 Published:2023-10-08
Contact: Lin Li E-mail:linli_74k@163.com;1527616447@qq.com
Supported by:
The Applied Basic Research Program of Liaoning(2023010019-JH2/1013)

摘要/Abstract

摘要：

牙周炎是一种破坏牙齿支持组织完整性的慢性炎症性疾病，是影响全球口腔和系统健康的公共卫生问题。随着科学和医学的发展，口腔健康的重要性及其对全身健康的影响越来越受到关注。这就要求口腔科医生在临床诊疗工作中更加重视伴不同全身疾病患者的诊疗方法。本文就伴全身疾病牙周炎患者的诊疗策略进行阐述，旨在帮助口腔科医生制定更合理的诊疗决策。

关键词: 全身系统疾病, 牙周炎, 诊疗策略

Abstract:

Periodontitis is a chronic inflammatory disease that destroys the integrity of tooth-supporting tissue. Periodontitis is listed as a major oral disease by the World Health Organization and is a public-health problem affecting global oral and systemic health. The fourth national oral health epidemiological survey has revealed that periodontitis is one of the most common oral problems in China. With the development of science and medicine, increased attention is being paid to the importance of oral health and its influence on general health. Accordingly, stomatologists are required to master more relevant information on clinical diagnosis and treatment, as well as to pay more attention to the diagnosis and treatment methods of patients with different systemic diseases. This article expounds the diagnosis and treatment strategy of patients with systemic disease periodontitis. We aimed to help stomatologists make more reasonable diagnosis and treatment decisions.

Key words: systemic disease, periodontitis, treatment strategy

中图分类号:

R 781.4

林莉, 李兆榕, 晋伊宁, 尹寿成. 伴全身系统疾病牙周炎患者的诊疗策略[J]. 华西口腔医学杂志, 2023, 41(5): 502-511.

Lin Li, Li Zhaorong, Jin Yining, Yin Shou-cheng.. Treatment strategies for periodontitis patients with systemic disease[J]. West China Journal of Stomatology, 2023, 41(5): 502-511.

参考文献 64

1	Miller WD. The human mouth as a focus of infection[J]. Lancet, 1891, 138(3546): 340-342.
2	Linden GJ, Herzberg MC, group working 4 of the joint EFP/AAP workshop. Periodontitis and systemic disea-ses: a record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases[J]. J Clin Periodontol, 2013, 40(): S20-S23.
3	Van Dyke TE, van Winkelhoff AJ. Infection and inflammatory mechanisms[J]. J Clin Periodontol, 2013, 40(Sup-pl 14): S1-S7.
4	Vieira CL, Caramelli B. The history of dentistry and medicine relationship: could the mouth finally return to the body[J]. Oral Dis, 2009, 15(8): 538-546.
5	Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities[J]. Nat Rev Immunol, 2021, 21(7): 426-440.
6	Han YW, Houcken W, Loos BG, et al. Periodontal disease, atherosclerosis, adverse pregnancy outcomes, and head-and-neck cancer[J]. Adv Dent Res, 2014, 26(1): 47-55.
7	D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes[J]. J Clin Periodontol, 2013, 40(): S85-105.
8	Teeuw WJ, Slot DE, Susanto H, et al. Treatment of pe-riodontitis improves the atherosclerotic profile: a systematic review and meta-analysis[J]. J Clin Periodontol, 2014, 41(1): 70-79.
9	Herrera D, Sanz M, Shapira L, et al. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe)[J]. J Clin Periodontol, 2023, 50(6): 819-841.
10	Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH)[J]. J Hypertens, 2023. doi: 10.1097/HJH.00-00000000003480 .
11	Nicolas E, Lassauzay C. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology[J]. Clin Interv Aging, 2009, 4: 67-72.
12	Collado V, Nicolas E, Faulks D, et al. A review of the safety of 50% nitrous oxide/oxygen in conscious sedation[J]. Expert Opin Drug Saf, 2007, 6(5): 559-571.
13	Sandhu G, Khinda PK, Gill AS, et al. Comparative evaluation of stress levels before, during, and after periodontal surgical procedures with and without nitrous oxide-oxygen inhalation sedation[J]. J Indian Soc Periodontol, 2017, 21(1): 21-26.
14	Muzyka BC, Glick M. The hypertensive dental patient[J]. J Am Dent Assoc, 1997, 128(8): 1109-1120.
15	Weinberg MA, Froum SJ, Segelnick SL. The dentist’s drug and prescription guide[M]. New Jersey: Wiley-Bla-ckwell, 2013.
16	Beaumont J, Chesterman J, Kellett M, et al. Gingival overgrowth. Part 1: aetiology and clinical diagnosis[J]. Br Dent J, 2017, 222(2): 85-91.
17	Zhao Y, Yu X, Cao X, et al. Cluster analysis for syndromes of real-world coronary heart disease with angina pectoris[J]. Front Med, 2018, 12(5): 566-571.
18	Lampropoulos K, Megalou A, Bazoukis G, et al. Pre-loading therapy with statins in patients with angina and acute coronary syndromes undergoing PCI[J]. J Interv Cardiol, 2017, 30(6): 507-513.
19	丁芳, 杨红霞, 孟焕新. 伴心脑血管疾病患者牙周治疗的风险及防范对策[J]. 中华口腔医学杂志, 2022, 57(6): 563-568.
	Ding F, Yang HX, Meng HX. Risks and preventive strategy of periodontal treatments for patients with cardiovascular and cerebrovascular diseases[J]. Chin J Stomatol, 2022, 57(6): 563-568.
20	国家卫生计生委合理用药专家委员会, 中国药师协会. 心力衰竭合理用药指南(第2版)[J]. 中国医学前沿杂志(电子版), 2019, 11(7): 1-78.
	Expert Committee of Rational Drug Use, National Heal-th and Family Planning Commission, Chinese Pharmacists Association. Guidelines for rational use of drugs of heart failure (2 edition)[J]. Chin J Front Med Sci (Electr Vers), 2019, 11(7): 1-78.
21	章靖, 苏冠华, 张晓东, 等. 心血管疾病患者口腔诊疗风险防范专家共识(2022版)[J]. 中华口腔医学杂志, 2022, 57(5): 462-473.
	Zhang J, Su GH, Zhang XD, et al. Consensus of experts on the medical risk prevention for the patients with cardiovascular diseases during dental treatment (2022 edition)[J]. Chin J Stomatol, 2022, 57(5): 462-473.
22	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur J Cardiothorac Surg, 2021, 60(4): 727-800.
23	Zandi S, Imani B, Safarpor G, et al. Self-management of patients with heart valve replacement and its clinical outcomes: a systematic review[J]. Kardiochir Torakochirur-gia Pol, 2021, 18(1):40-49.
24	Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report[J]. J Clin Periodontol, 2020, 47(3): 268-288.
25	Angiolillo DJ, Bhatt DL, Cannon CP, et al. Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention: a North American perspective: 2021 update[J]. Circulation, 2021, 143(6): 583-596.
26	Elad S, Chackartchi T, Shapira L, et al. A critically severe gingival bleeding following non-surgical periodontal treatment in patients medicated with anti-platelet[J]. J Clin Periodontol, 2008, 35(4): 342-345.
27	Nathwani S, Martin K. Exodontia in dual antiplatelet therapy: the evidence[J]. Br Dent J, 2016, 220(5): 235-238.
28	Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antith-rombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based cli-nical practice guidelines[J]. Chest, 2012, 141(2 ): e326S-e350S.
29	孟焕新. 牙周病学[M]. 5版. 北京: 人民卫生出版社, 2020.
	Meng HX. Periodontology[M]. 5th ed. Beijing: People's Medical Publishing House, 2020.
30	Thomas H, Plummer C, Wright IJ, et al. Guidelines for the peri-operative management of people with cardiac implantable electronic devices: guidelines from the British Heart Rhythm Society[J]. Anaesthesia, 2022, 77(7): 808-817.
31	McCrea MA, Giacino JT, Barber J, et al. Functional outcomes over the first year after moderate to severe traumatic brain injury in the prospective, longitudinal TRA-CK-TBI study[J]. JAMA Neurol, 2021, 78(8): 982-992.
32	Joshi C, Bapat R, Anderson W, et al. Detection of perio-dontal microorganisms in coronary atheromatous plaque specimens of myocardial infarction patients: a systema-tic review and meta-analysis[J]. Trends Cardiovasc Med, 2021, 31(1): 69-82.
33	Leira Y, Seoane J, Blanco M, et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis[J]. Eur J Epidemiol, 2017, 32(1): 43-53.
34	Lee YL, Hu HY, Huang N, et al. Dental prophylaxis and periodontal treatment are protective factors to ischemic stroke[J]. Stroke, 2013, 44(4): 1026-1030.
35	American Diabetes Association. Diagnosis and classification of diabetes mellitus[J]. Diabetes Care, 2013, 36(): S67-S74.
36	Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology[J]. J Clin Periodontol, 2018, 45(2): 138-149.
37	Simpson TC, Clarkson JE, Worthington HV, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus[J]. Cochrane Database Syst Rev, 2022, 4: CD004714.
38	Oettinger-Barak O, Barak S, Machtei EE, et al. Periodontal changes in liver cirrhosis and post-transplantation patients.Ⅰ: clinical findings[J]. J Periodontol, 2001, 72(9): 1236-1240.
39	Dongari A, McDonnell HT, Langlais RP. Drug-induced gingival overgrowth[J]. Oral Surg Oral Med Oral Pathol, 1993, 76(4): 543-548.
40	Kamata Y, Kessoku T, Shimizu T, et al. Periodontal treatment and usual care for nonalcoholic fatty liver disease: a multicenter, randomized controlled trial[J]. Clin Transl Gastroenterol, 2022, 13(11): e00520.
41	Stevens PE, Levin A, Disease Kidney : Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11): 825-830.
42	Chopra A, Sivaraman K. An update on possible pathogenic mechanisms of periodontal pathogens on renal dy-sfunction[J]. Crit Rev Microbiol, 2019, 45(5/6): 514-538.
43	Deschamps-Lenhardt S, Martin-Cabezas R, Hannedou-che T, et al. Association between periodontitis and chronic kidney disease: systematic review and meta-analysis[J]. Oral Dis, 2019, 25(2): 385-402.
44	Grubbs V, Vittinghoff E, Taylor G, et al. The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study[J]. Nephrol Dial Transplant, 2015, 31(3): 466-472.
45	Rahmati MA, Craig RG, Homel P, et al. Serum markers of periodontal disease status and inflammation in hemodialysis patients[J]. Am J Kidney Dis, 2002, 40(5): 983-989.
46	Westbrook SD. Dental management of patients receiving hemodialysis and kidney transplants[J]. J Am Dent Assoc, 1978, 96(3): 464-468.
47	Canet E, Lengline E, Zafrani L, et al. Acute kidney injury in critically ill allo-HSCT recipients[J]. Bone Marrow Transplant, 2014, 49(8): 1121-1122.
48	Miller CS, Little JW, Falace DA. Supplemental corticosteroids for dental patients with adrenal insufficiency: reconsideration of the problem[J]. J Am Dent Assoc, 2001, 132(11): 1570-1579; quiz 1596-1597.
49	中华口腔医学会牙周病学专业委员会. 重度牙周炎诊断标准及特殊人群牙周病治疗原则的中国专家共识[J]. 中华口腔医学杂志, 2017, 52(2): 67-71.
	Professional Committee of Periodontology, Chinese Stomatological Association. Consensus of Chinese experts on diagnosis of severe periodontitis and treatment principles of periodontitis in special population[J]. Chin J Stomatol, 2017, 52(2): 67-71.
50	Molina A, Huck O, Herrera D, et al. The association between respiratory diseases and periodontitis: a systema-tic review and meta-analysis[J]. J Clin Periodontol, 2023, 50(6): 842-887.
51	Nwizu N, Wactawski-Wende J, Genco RJ. Periodontal disease and cancer: epidemiologic studies and possible mechanisms[J]. Periodontol 2000, 2020, 83(1): 213-233.
52	Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review[J]. Int J Oral Maxillofac Surg, 2011, 40(3): 229-243.
53	潘亚萍. 肿瘤患者牙周炎治疗方案的选择[J]. 中华口腔医学杂志, 2017, 52(2): 77-80.
	Pan YP. Treatment decision for periodontal patients with history of cancer[J]. Chin J Stomatol, 2017, 52(2): 77-80.
54	中华医学会骨质疏松和骨矿盐疾病分会, 章振林. 原发性骨质疏松症诊疗指南(2022)[J]. 中国全科医学, 2023, 26(14): 1671-1691.
	Chinese Society of Osteoporosis and Bone Mineral Research, Zhang ZL. Guidelines for the diagnosis and treatment of primary osteoporosis (2022)[J]. Chin General Pract, 2023, 26(14): 1671-1691.
55	Yu B, Wang CY. Osteoporosis and periodontal diseases—An update on their association and mechanistic links[J]. Periodontol 2000, 2022, 89(1): 99-113.
56	Angst PDM, Maier J, Dos Santos Nogueira R, et al. Oral health status of patients with leukemia: a systematic review with meta-analysis[J]. Arch Oral Biol, 2020, 120: 104948.
57	阙佳佳, 邹静. 血液系统疾病的常见口腔表征[J]. 现代口腔医学杂志, 2012, 26(2): 123-126.
	Que JJ, Zou J. Common oral signs of hematological disorders[J]. J Modern Stomatol, 2012, 26(2): 123-126.
58	Zimmermann C, Meurer MI, Grando LJ, et al. Dental treatment in patients with leukemia[J]. J Oncol, 2015: 571739.
59	Sanz M, Kornman K, groupworking 3 of the joint EFP/AAP workshop. Periodontitis and adverse pregnancy out-comes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases[J]. J Perio-dontol, 2013, 84(4 ): S164-S169.
60	Albert DA, Begg MD, Andrews HF, et al. An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States[J]. Am J Public Health, 2011, 101(1): 151-156.
61	Bobetsis YA, Graziani F, Gürsoy M, et al. Periodontal disease and adverse pregnancy outcomes[J]. Periodontol 2000, 2020, 83(1): 154-174.
62	叶畅畅, 吴亚菲. 口腔微生态失衡与妊娠期牙周病和不良妊娠结局的相关性研究进展[J]. 中华口腔医学杂志, 2022, 57(6): 635-641.
	Ye CC, Wu YF. Oral microbiome dysbiosis triggers gestational periodontal disease and adverse pregnancy outcomes[J]. Chin J Stomatol, 2022, 57(6): 635-641.
63	Russell SL, Mayberry LJ. Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research[J]. MCN Am J Matern Child Nurs, 2008, 33(1): 32-37.
64	Sanz M, Teughels W, Group A of European Workshop on Periodontology. Innovations in non-surgical periodontal therapy: consensus report of the Sixth European Work-shop on Periodontology[J]. J Clin Periodontol, 2008, 35(8 ): 3-7.

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伴全身系统疾病牙周炎患者的诊疗策略

Treatment strategies for periodontitis patients with systemic disease

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