牙周/牙根尖病變和口腔健康狀態與糖尿病之間的關聯性

Abstract

背景：目前已有不少的研究報告發現牙周病(Periodontal disease)、牙根尖病變(Periapical lesions)和口腔健康及糖尿病(Diabetes mellitus)之間的關聯性，但是目前關於糖尿病與這些口腔問題的關係仍然存在著不同的看法。所以本研究希望可以藉由影像醫學的方式探討牙周疾病和牙齒根尖疾病與糖尿病之間的關係。除此之外，本研究也探討了影響牙周病、牙根尖病變和口腔健康可能相關的危險因子。

材料與方法：研究對象為收集了台大醫院牙科部2021年7月份年齡為20歲至80歲(平均年齡為52.8歲)共計489位個案，利用牙科環口全景的X光片以及牙齒根尖的X光片判斷缺牙數、DMFT、牙根尖病變的顆數和齒槽骨喪失程度，並確立糖尿病的診斷標準。使用獨立樣本T檢定(Independent Sample t test)、卡方檢定(The Chi-Squared Test of Independence)、單因子獨立變異數分析(One-way Analysis of Variance, One-way ANOVA)、事後檢定(Post hoc)、簡單線性迴歸分析(Simple regression analysis)、多元線性迴歸分析(Multiple regression analysis)和羅吉斯迴歸分析(Logistic regression)進行統計分析。

結果：糖尿病患者在缺牙數、DMFT以及齒槽骨喪失的表現上都顯著高於無糖尿病的患者(p < 0.05)，但是在牙根尖病變的表現上卻無顯著的差異(p = 0.13)。在社會人口因素中，男性在缺牙和齒槽骨喪失的表現上都顯著高於女性(p < 0.05)，但是在DMFT(p = 0.25)和牙根尖病變(p = 0.07)的表現上卻無顯著的差異；年齡顯著預測了缺牙(R² = 0.21, p < 0.05)、DMFT(R² = 0.29, p < 0.05)、牙根尖病變(R² = 0.04, p < 0.05)和齒槽骨的喪失(p < 0.05)，並且在不同的齒槽骨喪失程度之間年齡也有顯著的差異(p < 0.05)；教育程度也顯著影響缺牙、DMFT、牙根尖病變的顆數以及槽骨喪失的程度(p < 0.05)。在危險行為因素中，有吸菸習慣者在牙齒缺失、DMFT、牙根尖病變以及齒槽骨喪失的表現上顯著高於沒有吸菸習慣者(p < 0.05)，但是在有無飲酒習慣之間卻無顯著的差異(p = 0.15, p = 0.06, p = 0.42, p = 0.25)，而雖然有嚼食檳榔習慣的人與無嚼食檳榔習慣的人在牙齒缺失、DMFT以及牙根尖病變的表現上無顯著的差異(p = 0.72, p = 0.67, p = 0.37)，但是有嚼食檳榔習慣者在齒槽骨喪失的表現上卻顯著高於無嚼食檳榔習慣者(p < 0.05)。

結論：本研究的結果顯示糖尿病與牙周、根尖和口腔健康之間存在著一定關聯性，並且社會人口因素和吸菸也和牙周、根尖和口腔的健康有一定的關聯性。本研究希望藉著這個研究的結果提供醫師們一個新的方式以及觀點，使得牙周病以及糖尿病的患者，能夠得到更完善的治療以及疾病預防的觀念。

Background: A number of studies have reported the association between periodontal disease, periapical lesions and oral health as well as diabetes mellitus.But there are still different views on the relationship between diabetes mellitus and these oral problems. Therefore, this study was designed to investigate the relationship between periodontal and periapical diseases and diabetes mellitus. In addition, this study also investigates the risk factors associated with periodontal disease, periapical lesions and oral health.

Materials and methods: A total of 489 cases aged 20 to 80 years (mean age 52.8 years) were collected from the Department of Dentistry, National Taiwan University Hospital in July 2021. Tooth missing, alveolar bone loss, periapical lesions, and DMFT were determined using PANO and PA, and the diagnostic criteria for diabetes mellitus were established. Statistical analyses were conducted by using the independent sample t test, chi-Squared Test of Independence, One-way ANOVA, post hoc test, simple regression analysis, multiple regression analysis, and logistic regression analysis.

Results: Patients with diabetes were significantly higher than those without diabetes in tooth missing, DMFT and alveolar bone loss (p < 0.05), but there was no significant difference in the performance of periapical lesions (p = 0.13). Among socio-demographic factors, males were significantly higher than females in tooth missing and alveolar bone loss (p < 0.05), but not DMFT (p = 0.25) and periapical lesions (p = 0.07); age significantly predicted edentulism (R² = 0.21 , p < 0.05), DMFT (R² = 0.29, p < 0.05), periapical lesions (R² = 0.04, p<0.05) and alveolar bone loss (p<0.05), and age also were significantly difference between levels of alveolar bone loss (p < 0.05); education also influenced tooth missing, DMFT, periapical lesions, and loss of alveolar bone (p < 0.05). Among the general health behavioral factors, smokers showed significantly higher in missing, DMFT, periapical lesions, and alveolar bone loss than non-smokers (p < 0.05), but there was no significant difference between alcohol consumption (p = 0.15, p = 0.06, p = 0.42, p = 0.25), and although there was no significant difference between those who chewed betel quid and those who did not chew betel quid in missing, DMFT, and apical lesions (p = 0.72, p = 0.67, p = 0.37), but those who chewed betel quid showed significantly higher than those who did not chew betel quid in alveolar bone loss (p < 0.05).

Conclusion: The results of this study suggest that there is an association between diabetes and periodontal, periapical, and oral health, and that socio-demographic and general health behavioral factors are also associated. It is hoped that the results of this study will provide physicians with a new approach and perspective for better treatment and prevention of periodontal disease and diabetes.