糖尿病與牙周病變的醫學觀點新進展

10.6666/ClinMed.202006_85(6).0066

郝立智；楊純宜；張雅椅；范麒惠；葉乃誠；邱酩淳；吳明瑞；潘潔慧；馬瀰嘉；吳仁博

糖尿病（diabetes mellitus） ； 糖尿病併發症（diabetes complications） ； 牙周炎（periodontitis） ； 糖化血色素（A1C）

臨床醫學月刊

85卷6期（2020 / 06 / 26）

356 - 364

繁體中文

糖尿病和牙周炎都是慢性發炎疾病，會明顯地影響發病率並且是主要的醫療保健負擔。這兩種疾病之間總是存在著雙向聯繫。儘管各種理論都曾經被假定過，但是他們彼此之間如何影響的確切機制仍然是個謎。但我們確實知道對其中一方的治療會對另一方產生有利的影響。若與沒有糖尿病的患者相比，糖尿病患者的牙周疾病更為嚴重和普遍，並且與較高的A1C值有相關。縱向的研究顯示，牙周病患者的糖尿病發病率更高。目前的研究證據顯示，牙周疾病會產生不利影響糖尿病的結果，雖然治療的好處的證據仍然存在著爭議。在一項隨機臨床試驗中，發現強化牙周病治療組有更好的血糖控制（對照組和強化治療組的A1C值分別為8.3%和7.8%）並且與追蹤12個月後的炎症指標下降有相關性。每位糖尿病患者都應該包括口腔的常規檢查。早期預防、早期診斷、早期治療，是避免口腔疾病纏身的最佳方法。

1. (2003).Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus.Diabetes Care,26,S5-S20.
2. (2018).DAROC Clinical Practice Guidelines for Diabetes Care-2018.Taiwan, Diabetes Association of the ROC.
3. American Diabetes Association(2020).4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes—2020.Diabetes Care,43,S37-S47.
4. Borgnakke, WS,Anderson, PF,Shannon, C(2015).Is there a relationship between oral health and diabetic neuropathy?.Curr Diab Rep,15,93.
5. Chee, B,Park, B,Bartold, PM(2013).Periodontitis and type II diabetes: A two-way relationship.Int J Evid Based Healthc,11,317-329.
6. D´Aiuto, F,Gkranias, N,Bhowruth, D(2018).TASTE Group. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, singlecentre, investigator-masked, randomised trial.Lancet Diabetes Endocrinol,6,954-965.
7. Eke, PI,Thornton-Evans, GO,Wei, L(2018).Periodontitis in US adults: National Health and Nutrition Examination Survey 2009-2014.J Am Dent Assoc,148,576-588.e6.
8. Engebretson, SP,Hyman, LG,Michalowicz, BS(2013).The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: A randomized clinical trial.JAMA,310,2523-2532.
9. Hanes, PJ,Krishna, R(2010).Characteristics of inflammation common to both diabetes and periodontitis: Are predictive diagnosis and targeted preventive measures possible?.EPMA J,1,101-116.
10. Lalla, E,Cheng, B,Lal, S(2006).Periodontal changes in children and adolescents with diabetes: A casecontrol study.Diabetes Care,29,295-299.
11. Lamster, IB,Lalla, E,Borgnakke, WS(2008).The relationship between oral health and diabetes mellitus.J Am Dent Assoc,139,19S-24S.
12. Li, Q,Hao, S,Fang, J(2015).Effect of non-surgical periodontal treatment on glycemic control of patients with diabetes: A meta-analysis of randomized controlled trials.Trials,16,291.
13. Miller, LS,Manwell, MA,Newbold, D(1992).The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases.J Periodontol,63,843-848.
14. Newman, MG(ed.),Takei, HH(ed.),Klokkevold, PR(ed.)(2011).Carranza’s Clinical Periodontology.Elsevier.
15. O′Connell, PA,Taba, M,Nomizo, A(2008).Effects of periodontal therapy on glycemic control and inflammatory markers.J Periodontol,79,774-783.
16. Pihlstrom, BL,Michalowicz, BS,Johnson, NW(2005).Periodontal diseases.Lancet,366,1809-1820.
17. Preshaw, PM,Taylor, JJ(2011).How has research into cytokine interactions and their role in driving immune responses impacted our understanding of periodontitis?.J Clin Periodontol,38,60-84.
18. Rees, TD(1994).The diabetic dental patient.Dent Clin North Am,38,447-463.
19. Seppälä, B,Seppälä, M,Ainamo, J(1993).A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease.J Clin Periodontol,20,161-165.
20. Sharma, M,Jindal, R,Siddiqui, MA(2016).Diabetesand Periodontitis: A medical perspective.J Int Clin Dent Res Organ,8,3-7.
21. Shultis, WA,Weil, EJ,Looker, HC(2007).Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes.Diabetes Care,30,306-311.
22. Simpson, TC,Weldon, JC,Worthington, HV(2015).Treatment of periodontal disease for glycaemic control in people with diabetes mellitus.Cochrane Database Syst Rev,11,CD004714.
23. Taylor, GW,Burt, BA,Becker, MP(1996).Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus.J Periodontol,67,1085-1093.
24. Thorstensson, H,Hugoson, A(1993).Periodontal disease experience in adult long-duration insulin-dependent diabetics.J Clin Periodontol,20,352-358.
25. Walker, A(ed.),Cooper, I(ed.)(2000).Adult Dental Health Survey: Oral Health in the United Kingdom 1998.London:The Stationery Office.
26. Yalda, B,Offenbacher, S,Collins, JG(1994).Diabetes as a modifier of periodontal disease expression.Periodontol 2000,6,37-49.
27. 王研力,潘惠玲,朱毓仁,陳朝寶(2010)。牙周病整體治療病例報告。臺灣牙周病醫學會雜誌，2，123-141。
28. 葉庭君,歐陽玲(2018)。糖尿病與牙周病、植牙成功率與牙科就診的醫療觀念。社團法人中華民國糖尿病衛教學會會訊，06月，32-39。

1. 賴君瑋,陳彥臻,張珽宇,張炳華,徐桂芳,林川雄(2023)。探討飲食行為、口腔保健與預防性就醫對口腔健康之影響。運動與遊憩研究，18(1)，14-27。