- 期刊
糖尿病與牙周病間相互影響的關係
The Interrelationship between Diabetes Mellitus and Periodontal Disease
摘要
糖尿病是最常見的內分泌疾病之一，它所造成一連串細胞功能的改變會產生許多種發炎調控物質，促成了牙周組織的慢性發炎及破壞，並且降低組織修復的能力。文獻回顧指出糖尿病患者有較高的牙周病盛行率，牙齒喪失的數目也比非糖尿病患者爲多，並有許多研究支持控制不良的糖尿病爲牙周病的危險因子。近年來的研究亦顯示牙周病引起的反應可能改變系統性生理反應並促進糖尿病合併症的產生。牙周病與脂肪酸交互作用會增加發炎調控物質的產生，其中有些具有抗胰島素的作用，因而可能加重糖尿病的病情。治療牙周病或許有助於糖尿病的控制或者減少糖尿病合併症產生，有些研究顯示物理性的牙根表面整平術或合併抗生素的使用可以幫助糖尿病代謝控制，但有部份學者研究結果顯示無顯著差異。未來需要更多的研究幫助釐清是否牙周病引起的反應確實對胰島素功能有所影響，以及牙周病與糖尿病合併症之間的相關機轉，已取得更多證據來闡明兩者之間的關係。
並列摘要
Diabetes mellitus (DM) is one of the most common endocrine disorder. It induces a series of changes in cell function and produces an inflammatory cell phenotype while the modulators predispose to chronic inflammation, progressive breakdown of periodontal tissue, and reduced tissue repair capacity. Review studies indicate that people with diabetes have higher prevalence of periodontitis and greater incidence of tooth loss, for which poor controlled DM acts as an important contributory factor for periodontal disease. Recent data indicates that periodontitis may induce changes in systemic physiology, exacerbate DM and increase incidence of its complications. Periodontitis may also elevate proinflammatory cytokines/serum lipids and potential to systemic disease arising from chronic hyperlipidemia and/or increased inflammatory mediators. These cytokines can produce insulin resistance similar to diabetes. Thus, periodontitis potentially exacerbates diabetes-induced syndrome. Treatment of periodontal disease possibilly promotes control of blood glucose level and diminish occurrence of other complication. Some authors indicate or non-surgical periodontal treatment can improve the metabolic control of DM, while others had reported adverse outcomes to their treatment of periodontitis with/without combination use of antibiotics does not improve the metabolic control of diabetes measured by glycosylated hemoglobin. Further researches are needed to clarify how inflammatory periodontal diseases may affect insulin resistance, glycemic control and the risk of developing other diabetic complications. Large, randomized and controlled trials are also needed to extend the evidence base.