结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

The authors have taken the liberty of presenting this manuscript in two parts. The first is a brief primer on microbial ecology, because, although the importance of microbial ecology in periodontal diseases is widely recognized, most of us do not know precisely what is meant by the term. The second section is a rather extensive overview of current studies of oral microbial ecology based almost entirely on recent in vivo studies.

https://laurieximenez.files.wordpress.com/2011/02/ref-2_socransky-2005_p2000.pdf

Periodontal microbial ecology.

Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management.

/pdf/periodontitis-and-diabetes-a-two-way-relationship-2ro1vta6dc.pdf

Periodontitis and diabetes: a two-way relationship

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.

Risk factors for periodontal disease.

Obesity increases morbidity and mortality through its multiple effects on nearly every human system. However, the various aspects of the association between obesity and infection have not been reviewed. Thus, we reviewed the relevant literature focusing on clinical aspects of this association. Obesity has a clear but not yet precisely defined effect on the immune response through a variety of immune mediators, which leads to susceptibility to infections. Data on the incidence and outcome of specific infections, especially community-acquired infections, in obese people are so far limited. The available data suggest that obese people are more likely than people of normal weight to develop infections of various types including postoperative infections and other nosocomial infections, as well to develop serious complications of common infections. Large prospective studies are required to further define the burden of infectious morbidity and mortality conferred by obesity.

/pdf/obesity-and-infection-ubhq4o9u1x.pdf

Obesity and infection

Background: The growing prevalence of increased body weight and obesity in the United States has raised significant public health concerns. Obesity has been implicated as a risk factor for several chronic health conditions, as well as being associated with increased mortality. Recently, an association between obesity and periodontal disease was found in a Japanese population. The purpose of the present study is to examine the relation between body weight and periodontal disease in a representative United States sample. Methods: Participants in the third National Health and Nutrition Examination Survey (NHANES III) who were ≥18 years and had undergone a periodontal examination were selected for the analysis (n = 13,665). Body mass index (BMI) and waist circumference (WC) were used as measures of overall and abdominal fat content, respectively. Univariable and multivariable logistic regression models were used to estimate the association between increased body weight and periodontal disease. BMI and WC were...

/pdf/obesity-and-periodontal-disease-in-young-middle-aged-and-4g9ndtqr0m.pdf

Obesity and periodontal disease in young, middle-aged, and older adults.

Purpose: This cross-sectional study was performed to determine whether an association exists between the width of keratinized mucosa and the health of implant-supporting tissues. Materials and Methods: Data on 200 dental implants were collected. Periodontal parameters measured included Plaque Index, Gingival Index, width of keratinized mucosa, thickness of keratinized mucosa, radiographic bone level, and bleeding on probing. Statistical analysis was accomplished with the t test, Wilcoxon rank sum test, and logistic and linear regression models. Significance was established when P was less than .05. Results: The mean Gingival Index score, Plaque Index score, and radiographic bone loss were significantly higher for those implants with a narrow zone (< 2 mm) of keratinized mucosa. Implants with a narrow zone of keratinized mucosa also were more likely to bleed upon probing, even after adjusting for Plaque Index, smoking, thickness of the gingiva, and time since implant placement (adjusted odds ratio, 2.37; 95% confidence interval, 1.04 to 5.83). Significant independent association also was found between the width of keratinized mucosa and radiographic bone loss in favor of wider zone of keratinized mucosa. Conclusion: Increased width of keratinized mucosa around implants is associated with lower mean alveolar bone loss and improved indices of soft tissue health. (Cross-sectional Study) INT J ORAL MAXILLOFAC IMPLANTS 2008;23:323–326

/pdf/width-of-keratinized-gingiva-and-the-health-status-of-the-5682qx6p3p.pdf

Width of keratinized gingiva and the health status of the supporting tissues around dental implants.

Background: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-α) medications The effect of anti-TNF-α therapy on periodontitis also was assessedMethods: Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20) To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-α before randomization Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI)

/pdf/periodontal-therapy-reduces-the-severity-of-active-1xsqqgm02a.pdf

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

BACKGROUND: Maintaining normal weight, engaging in the recommended level of
exercise, and eating healthy food are known to improve general health. The impact
of these behaviors on periodontal health is not well documented. This study is
aimed at examining whether the increased number of these behaviors is associated 
with a decrease in the prevalence of periodontitis in a United States population.
METHODS: This study utilized data on 12,110 individuals who participated in the
third National Health and Nutrition Examination Survey. Multivariate logistic
regression analysis was used to estimate the association between the number of
health-enhancing behaviors and periodontitis prevalence. Health enhancing
behaviors included maintaining normal weight (body mass index [BMI], 18.5 to 24.9
kg/m(2)), engaging in the recommended level of exercises (>or=episodes of
moderate or >or=episodes of vigorous-intensity physical activity per week), and
having a high-quality diet (healthy eating index >80). RESULTS: After controlling
for age, gender, race\ethnicity, cigarette smoking, other tobacco products,
education, diabetes, poverty index, census region, acculturation, vitamin use,
time since the last dental visit, dental calculus, and gingival bleeding, a
1-unit increase in the number of the three health-enhancing behaviors was
associated with a 16% reduction in the prevalence of periodontitis (odds ratio
[OR]=0.84; 95% confidence interval [CI]: 0.77 to 0.93). Individuals who
maintained normal weight, engaged in the recommended level of exercise, and had a
high-quality diet were 40% less likely to have periodontitis compared to
individuals who maintained none of these health-enhancing behaviors. CONCLUSION: 
An increased number of health-enhancing behaviors is associated with a lower

https://www.kau.edu.sa/Files/165/Researches/55276_25618.pdf

Periodontitis and three health-enhancing behaviors: maintaining normal weight, engaging in recommended level of exercise, and consuming a high-quality diet.

https://www.kau.edu.sa/Files/165/Researches/55275_25617.pdf

Mohammad S. Al-Zahrani

Papers

Obesity and periodontal disease in young, middle-aged, and older adults.

Width of keratinized gingiva and the health status of the supporting tissues around dental implants.

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

Periodontitis and three health-enhancing behaviors: maintaining normal weight, engaging in recommended level of exercise, and consuming a high-quality diet.

Increased physical activity reduces prevalence of periodontitis.