老年中重度牙周炎相关因素的病例对照研究
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摘要
目的：探讨老年中重度牙周炎的相关因素，为临床上老年牙周炎的预防和控制提供依据。
方法：采用病例对照研究，病例组100例，对照组100例，病例和对照按照年龄、性别、文化程度、居住地进行配对。所有研究对象均进行面对面问卷调查，并进行口腔临床检查。分析整理资料，应用logistic回归模型进行单因素、多因素分析及因素间的联合作用分析。
结果：单因素分析有15个因素与老年中重度牙周炎相关。多因素分析显示：老年中重度牙周炎发病的危险因素为口腔卫生差、不良修复体、吸烟、系统性疾病和负性生活事件，其OR值及95％可信区间分别为1.277（1.149,1.420），3.165（1.047,9.569），2.753（1.095,6.923），2.417（1.043,5.606）和2.665（1.124,6.316）。此外，患中重度牙周炎的老年患者牙齿磨耗程度显著低于对照组，龋补牙数显著低于对照组，其OR值及95％可信区间分别为0.816（0.690,0.965），0.286（0.144,0.569）。
结论：预防和控制老年中重度牙周炎，应加强全民口腔健康教育宣教，改善口腔卫生状况，积极倡导戒烟，作为口腔医生应坚决杜绝不良修复体，重视牙周炎与系统性疾病的关系，并积极减少负性生活事件对老年人的影响。
Objective To investigate the relative factors of moderate to advanced periodontitis in elderly people and provide the preventing and controlling basis for them .
Methods In a pair-matched case-control study, 100 patients and 100 controls were matched according to age, sex, education degree and living area. All the cases were investigated face-to-face and were checked their oral cavity clinically. Data were made analysis of the unvaried and multivariate and combined effect.
Result In multiple logistic regressions: smoking, oral hygiene status, bad prosthesis, systemic disease, negative affairs, tooth attrition and decayed filled tooth. Showed significantly independent association with moderate to advanced periodontitis in elderly people, the odds ratio OR and OR 95% CI were2.753(1.095,6.923),1.277(1.149,1.420),3.165(1.047,9.569),2.417(1.043,5.606),2.665(1.124,6.316),0.816(0.690,0.965) ,0.286(0.144,0.569).
Conclusion It was suggested that we should strengthen oral health instruction, stop bad prosthesis as a dentist advocate giving up smoking furthermore, we also should think much of the old people’s systemic disease and also their social mental problems.
方法：采用病例对照研究，病例组100例，对照组100例，病例和对照按照年龄、性别、文化程度、居住地进行配对。所有研究对象均进行面对面问卷调查，并进行口腔临床检查。分析整理资料，应用logistic回归模型进行单因素、多因素分析及因素间的联合作用分析。
结果：单因素分析有15个因素与老年中重度牙周炎相关。多因素分析显示：老年中重度牙周炎发病的危险因素为口腔卫生差、不良修复体、吸烟、系统性疾病和负性生活事件，其OR值及95％可信区间分别为1.277（1.149,1.420），3.165（1.047,9.569），2.753（1.095,6.923），2.417（1.043,5.606）和2.665（1.124,6.316）。此外，患中重度牙周炎的老年患者牙齿磨耗程度显著低于对照组，龋补牙数显著低于对照组，其OR值及95％可信区间分别为0.816（0.690,0.965），0.286（0.144,0.569）。
结论：预防和控制老年中重度牙周炎，应加强全民口腔健康教育宣教，改善口腔卫生状况，积极倡导戒烟，作为口腔医生应坚决杜绝不良修复体，重视牙周炎与系统性疾病的关系，并积极减少负性生活事件对老年人的影响。
Objective To investigate the relative factors of moderate to advanced periodontitis in elderly people and provide the preventing and controlling basis for them .
Methods In a pair-matched case-control study, 100 patients and 100 controls were matched according to age, sex, education degree and living area. All the cases were investigated face-to-face and were checked their oral cavity clinically. Data were made analysis of the unvaried and multivariate and combined effect.
Result In multiple logistic regressions: smoking, oral hygiene status, bad prosthesis, systemic disease, negative affairs, tooth attrition and decayed filled tooth. Showed significantly independent association with moderate to advanced periodontitis in elderly people, the odds ratio OR and OR 95% CI were2.753(1.095,6.923),1.277(1.149,1.420),3.165(1.047,9.569),2.417(1.043,5.606),2.665(1.124,6.316),0.816(0.690,0.965) ,0.286(0.144,0.569).
Conclusion It was suggested that we should strengthen oral health instruction, stop bad prosthesis as a dentist advocate giving up smoking furthermore, we also should think much of the old people’s systemic disease and also their social mental problems.
引文
[1] 卞有金主编.口腔预防医学.第三版.北京：人民文学出版社，2001，5.
[2] Brown LJ, Brunelle JA, Kingman A. Periodontal status in the United States,1988～1991:Prevalence,exent,demographic variation [J].J Dent Res,1996，76:672.
[3] 全国牙病防治指导组，第二次全国口腔健康流行病学抽样调查[M].北京：人民卫生出版社，1999,55～91.
[4] 扬蒙燕, 周毅. 上海静安区800名老年人口腔健康状况调查. 上海口腔医学, 2001：10(3) 263-265
[5] 曹采方, 和璐. 老年牙周病特点 [J].实用老年医学, 2002,16(6):286
[6] Marcus SE, Drury TF, Brown LJ, et al. Tooth retention and tooth loss in the permanent dentition of adults in United States ,1988-1991[J]. J Dent Res, 1996,75:684
[7] 曹采方主编.牙周病学. 第一版. 北京: 人民卫生出版社, 2001,1.
[8] 曾光主编. 现代流行病学方法与应用 .北京医科大学中国协和医科大学联合出版社，1994,433
[9] 潘卫红, 郑望苟, 陈穗. 牙周病危险因素的病历对照研究 [J].中华流行病学杂志, 1998,19(3): 149
[10] Melnick SL, Roseman Ju, Engel D, etal, Epidemiology of acute nectotizing ulcerative gingivitis. Epidemiologic Reviews, 1988，10:191
[11] 杨丹芩, 徐文俊, 李隽,等. 上海离退休干部失牙及修复状况调查[J].口腔颌面修复学杂志,2001,2（2）：35
[12] 刘乃妤，王捷芯，侯传记. 关于影响牙周病流行因素的研究. 牙体牙髓牙周病学杂志, 2002,12（5）：266
[13] 李瑞玉,北京市321支市售牙刷现状调查95全国口腔健康科学研讨会论文汇编.
[14] 刘斌,张铭,林媛,等.刷牙及其方法与口腔卫生的关系[J].牙体牙髓牙周病学杂志,1996,6(3):173
[15] 袁冰根,周宏,台保军,等.两种刷牙方法去除菌斑效果的比较[J].华西口腔医学杂志,1989,7(2): (1)
[16] Pindborg JJ, Bhatu, Roed-petersen B. Oral changes in South Indian Children with severe protein deficiency. J periodontal. 1976, 38: 218
[17] Jones PDE, Hudson N, Hawkey CJ. Depression of salivary epidermal growth factor by smoking. Br Med J. 1992, 304:480
[18] Bergstron J, Person L, Preber H. Influence of cigaretle smoking on vascular reaction during experimental gingivitis. Scand J Dent Res. 1988,96:34-39
[19] Sheiham A. Periodontal disease and oral cleanliness in tobacco smokers. J periodontal. 1971, 42:259
[20] Bartecchi CE, Mackenzie TD, Schrier RW. N Engl J Med 1994.331(12):907～912
[21] Goldstein DD,Chin JH. Interaction of ethanol with biological membranes. Fedproc, 1981,40:2073.
[22] Lacopino AM. Diabtic Periodontitis Possbie Lipid-induced defect in tissue repair through alteration of macrophage phehorype and function Oral Dis. 1995,1(4):214
[23] Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two way relationship. Ann periodontal. 1998,3(1):25～61
[24] Joshipora KJ. Poor oral heath and coronary heart disease [J] .J Dent.1996,75:1631-1636
[25] Renk JD. A risk fector for coronary heart disease. J Periodontol. 1996,67:688～691
[26] Wu T, Trevisan M, Gerco RJ, Et al. Periodontal disease and risk of cereb-ovascular disease the first national health and nutrition examination survey and its follow-up study. Arab Catern. 2000,160(18):27～55.
[27] Kinane DF, Lawe GD. How periodontal disease may contribute it
cardiovascular disease [J]. Periodontology 200,2000,23:121.
[28] Scranapiece FA, Papancohatos GD, Dunford RG. ASSociations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol. 1998 3(1):25-16.
[29] 闫福华,陈群.口腔科老年患者系统性疾病的发生情况及其牙齿缺失的关系[J]. 口腔医学纵横谈 .2000,(3):195.
[30] Ceneo RJ, Ho AW, Grossi SG, et al. Relationship of stress, distress and inadequate coping behaviors to periodontal disease [J]. J Periodontal.1999,70970:711～723.
[31] Groucher R, Marcenes Ws, Tomes Mc, et al. The relationship between life events and periodontitis a case control study [J]. J cline Periodontol.1997,24(1):39～41.
[32] 李德懿, 顾晶晶, 赵隽隽,等. 牙周炎和龋病发病关系的初步分析[J].上海口腔医学.2002,1(4):289
[33] 刘雪楠, 陈育德 ,卞金有,等. 影响牙周健康的相关因素分析[J].现代口腔医学杂志, 2003,17:(2) 136.
[34] Williams RC, Offenbachers. Periodontal Medicine: the emergence of a new branch of periodontolgy [J]. Periodontology 2000.2000,23(1):9.
[2] Brown LJ, Brunelle JA, Kingman A. Periodontal status in the United States,1988～1991:Prevalence,exent,demographic variation [J].J Dent Res,1996，76:672.
[3] 全国牙病防治指导组，第二次全国口腔健康流行病学抽样调查[M].北京：人民卫生出版社，1999,55～91.
[4] 扬蒙燕, 周毅. 上海静安区800名老年人口腔健康状况调查. 上海口腔医学, 2001：10(3) 263-265
[5] 曹采方, 和璐. 老年牙周病特点 [J].实用老年医学, 2002,16(6):286
[6] Marcus SE, Drury TF, Brown LJ, et al. Tooth retention and tooth loss in the permanent dentition of adults in United States ,1988-1991[J]. J Dent Res, 1996,75:684
[7] 曹采方主编.牙周病学. 第一版. 北京: 人民卫生出版社, 2001,1.
[8] 曾光主编. 现代流行病学方法与应用 .北京医科大学中国协和医科大学联合出版社，1994,433
[9] 潘卫红, 郑望苟, 陈穗. 牙周病危险因素的病历对照研究 [J].中华流行病学杂志, 1998,19(3): 149
[10] Melnick SL, Roseman Ju, Engel D, etal, Epidemiology of acute nectotizing ulcerative gingivitis. Epidemiologic Reviews, 1988，10:191
[11] 杨丹芩, 徐文俊, 李隽,等. 上海离退休干部失牙及修复状况调查[J].口腔颌面修复学杂志,2001,2（2）：35
[12] 刘乃妤，王捷芯，侯传记. 关于影响牙周病流行因素的研究. 牙体牙髓牙周病学杂志, 2002,12（5）：266
[13] 李瑞玉,北京市321支市售牙刷现状调查95全国口腔健康科学研讨会论文汇编.
[14] 刘斌,张铭,林媛,等.刷牙及其方法与口腔卫生的关系[J].牙体牙髓牙周病学杂志,1996,6(3):173
[15] 袁冰根,周宏,台保军,等.两种刷牙方法去除菌斑效果的比较[J].华西口腔医学杂志,1989,7(2): (1)
[16] Pindborg JJ, Bhatu, Roed-petersen B. Oral changes in South Indian Children with severe protein deficiency. J periodontal. 1976, 38: 218
[17] Jones PDE, Hudson N, Hawkey CJ. Depression of salivary epidermal growth factor by smoking. Br Med J. 1992, 304:480
[18] Bergstron J, Person L, Preber H. Influence of cigaretle smoking on vascular reaction during experimental gingivitis. Scand J Dent Res. 1988,96:34-39
[19] Sheiham A. Periodontal disease and oral cleanliness in tobacco smokers. J periodontal. 1971, 42:259
[20] Bartecchi CE, Mackenzie TD, Schrier RW. N Engl J Med 1994.331(12):907～912
[21] Goldstein DD,Chin JH. Interaction of ethanol with biological membranes. Fedproc, 1981,40:2073.
[22] Lacopino AM. Diabtic Periodontitis Possbie Lipid-induced defect in tissue repair through alteration of macrophage phehorype and function Oral Dis. 1995,1(4):214
[23] Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two way relationship. Ann periodontal. 1998,3(1):25～61
[24] Joshipora KJ. Poor oral heath and coronary heart disease [J] .J Dent.1996,75:1631-1636
[25] Renk JD. A risk fector for coronary heart disease. J Periodontol. 1996,67:688～691
[26] Wu T, Trevisan M, Gerco RJ, Et al. Periodontal disease and risk of cereb-ovascular disease the first national health and nutrition examination survey and its follow-up study. Arab Catern. 2000,160(18):27～55.
[27] Kinane DF, Lawe GD. How periodontal disease may contribute it
cardiovascular disease [J]. Periodontology 200,2000,23:121.
[28] Scranapiece FA, Papancohatos GD, Dunford RG. ASSociations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol. 1998 3(1):25-16.
[29] 闫福华,陈群.口腔科老年患者系统性疾病的发生情况及其牙齿缺失的关系[J]. 口腔医学纵横谈 .2000,(3):195.
[30] Ceneo RJ, Ho AW, Grossi SG, et al. Relationship of stress, distress and inadequate coping behaviors to periodontal disease [J]. J Periodontal.1999,70970:711～723.
[31] Groucher R, Marcenes Ws, Tomes Mc, et al. The relationship between life events and periodontitis a case control study [J]. J cline Periodontol.1997,24(1):39～41.
[32] 李德懿, 顾晶晶, 赵隽隽,等. 牙周炎和龋病发病关系的初步分析[J].上海口腔医学.2002,1(4):289
[33] 刘雪楠, 陈育德 ,卞金有,等. 影响牙周健康的相关因素分析[J].现代口腔医学杂志, 2003,17:(2) 136.
[34] Williams RC, Offenbachers. Periodontal Medicine: the emergence of a new branch of periodontolgy [J]. Periodontology 2000.2000,23(1):9.