牙醫在糖尿病診斷上所能扮演的角色

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題名:	牙醫在糖尿病診斷上所能扮演的角色 The Role of Dentistry in the Diagnosis of Diabetes Mellitus
作者:	吳慶榕 Wu, Ching-Zong
貢獻者:	牙醫學系碩博士班李勝揚
關鍵詞:	糖尿病;血糖;牙周致病菌 DM;Blood sugar;periodontal pathogens
日期:	2019-06-27
上傳時間:	2020-02-11 10:35:09 (UTC+8)
摘要:	糖尿病盛行率由1995年的全球一億三千五百萬人推估至2025年將增加至三億人口。此增加部分主要發生在開發中國家。根據1988-1994年美國健康及營養調查報告顯示，美國大於20歲成年人被診斷出糖尿病比率約5.1％。根據美國糖尿病學會定義：空腹八小時血漿內血糖濃度大於126 mg/dl 為標準下，調查發現40-74歲族群中糖尿病（被確實診斷出及未診斷出）盛行率由在1976至1980年代由8.9% 增加至12.3%。另外在Ｇu 研究發現糖尿病當時是造成死亡的第七大死因。對牙醫師言日常牙科門診中有極大的機會碰到糖尿病患者。故牙醫師有很好的地位去協助內科醫師篩選出牙科病患中有罹患糖尿病患的機會。如牙周病患者若伴隨有糖尿病，其牙周病治療效果可能較不佳。另外造成牙周病主要致病菌群亦可能在有糖尿病的牙周病患者中也與無糖尿病的牙周病患不同。在第一部分研究中，我們想知道是否可利用牙周常用臨床評量指數加上牙齦溝內血液內血糖濃度是否有機會篩檢出未確診的糖尿病患。此意在找出牙齦溝內血液血糖濃度是否與周邊血管內血漿血糖濃度有相關性。本研究結果顯示牙醫師可檢測牙齦溝血血糖濃度代替周邊靜脈血來檢測其血糖濃度。第二部分研究在探討牙周病患者在牙周基礎治療後（口腔衛教，洗牙加上牙根整平）牙齦溝及唾液內牙周致病菌在有無糖尿病患的差異。一般牙周病患者理論上經過牙周病治療後其致病菌會減少。但糖尿病的牙周病患，經牙周基礎治療後約有百分之八十病患其致病箘卻不減反增，故表現在臨床上牙周組織在牙周治療後癒合情形不像無糖尿病的牙周病患者一樣。此是否因糖尿病影響免疫系統造成臨床此現象值得進一部探討。結論：此兩部分研究結果可使牙醫師在日常牙科門診上協助內科醫師在篩檢診斷糖尿病患者提供一些幫助。 The worldwide prevalence of diabetes mellitus (DM) is projected to increase from 135 million in 1995 to 300 million by the year 2025. The major part of this numerical increase will occur in the developing countries, and early detection and prevention of the disease will be needed. However, the US National Health and Nutrition Examination Survey (NHANES III) conducted during 1988-1994 indicated that the prevalence of diagnosed diabetes was estimated to be 5.1% for US adults > 20 years of age. Using American Diabetes Association criteria (fasting plasma glucose ≥ 126 mg/dl), the prevalence of undiagnosed diabetes was 2.7%. The prevalence of diabetes (diagnosed plus undiagnosed) in the total population of people who were 40-74 years of age increased from 8.9% in the period 1976-1980 to 12.3% by 1988-1994. In 1998 GU K at el. reported that diabetes is the seventh leading underlying cause of death, and it holds this position even though only 10%-15% of death of people with diabetes have diabetes listed as the underlying cause of death. There existed commonly acute and chronic complications happened among DM patients, i.e. hyperglycemia, microangiopathy and immune dysfunction etc.al. It will be expressed in the oral cavity with higher prevalence of periodontitis, poor healing and neuropathy in extremity, i.e. abnormal sensory response. In the daily practice for oral care, the dentist will have a very good position to assist the physicians to detect the early undiagnosed DM in their clinic practice. Dentist can observe in depth the oral tissue changes like gingival architecture and color and the tissue response after periodontal treatment or tooth extraction. If the patients have some systemic diseases i.e DM , the periodontal tissue response might not healed uneventfully as compared with those periodontitis without systemic diseases population after basic periodontal treatment such as scaling and root planning to remove the primary etiologic factor, i.e. plaque and calculus deposite. There existed a specific pathogenic microflora prevailed in the severe periodontitis as listed by Listgarten et. al.(2002). In DM patients, it is necessary to monitor the microflora change during the whole periodontal treatment procedure to prevent the recurrence of periodontitis. The purposes of the study are to find the role the dentists could play in the early detection of the DM patients and to assist the physicians for preventing the complications caused at the late stages DM in their daily dental practice. At the part A , we want to know: Is it possible to use the state of periodontal tissue healing status signs combined with the gingival crevicular blood sugar concentration to detect earlier undiagnosed DM ? It means we should know what is the correlation of the crevicular blood sugar concentration and the peripheral blood sugar concentration. At the part B, we try to find the different specific microflora change after periodontal treatment in periodontitis patients with diabetes mellitus as compared with those periodontitis patients without diabetes mellitus. Because there might existed some specific microbials pathogens in early periodontitis patients with DM. We try to find the connection between these two entities. If those two aims could be achieved, then it might be possible for dental professionals to detect the early undiagnosed DM patients in their daily practice.
描述:	博士指導教授：李勝揚委員：鄭景暉委員：林哲堂委員：袁瑞昱委員：黃豪銘
資料類型:	thesis
顯示於類別:	[牙醫學系] 博碩士論文

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