所有心血管病人都该看牙科!欧洲牙周病学联盟与世界心脏联盟共识

2020-06-09 卢芳 中国循环杂志

口腔不健康,心脏也跟着受累。近期,欧洲牙周病学联盟(EFP)与世界心脏联盟(WHF)联合发布了牙周病和心血管病的专家共识。

口腔不健康,心脏也跟着受累。近期,欧洲牙周病学联盟(EFP)与世界心脏联盟(WHF)联合发布了牙周病和心血管病的专家共识。

这份文件回顾了牙周炎和心血管病之间的最新流行病学,以及牙周治疗对心血管病及替代结局的影响。此外针对接受抗栓治疗患者的牙周治疗和潜在风险进行了阐述。

文件指出,牙周炎患病率较高达45%~50%,影响全球11.2%的人。

值得注意的是,牙周炎不仅病在口腔,还与糖尿病、心血管病、慢性阻塞性肺病和慢性肾病等均独立相关。

而且系列证据显示,长期的全身性炎症负担增加与心血管病的发展及转归有因果。

该共识文件具体推荐如下:

对医生的建议

对于心血管病患者,应告知牙周炎对心脏健康的危害;询问有无牙周炎的体征或症状,比如刷牙或进食时有无牙龈出血,有无牙齿松动,有无牙龈脓肿,有无口腔不良气味等。

对于有牙周炎的心血管病患者,建议进行进一步的牙周评估和定期牙周检查及治疗;对于无牙周炎者,建议定期接受预防性牙周监测。

对所有新诊断的心血管病患者,均应转诊接受牙周检查,并视为心血管病管理的一部分。

应与口腔科医生建立学科合作关系,尤其在抗凝或抗血小板治疗患者中尽量避免出血或缺血事件。

对心血管病患者及高危人群的建议

心血管病患者应意识到牙龈疾病是种慢性病,可能会加重其心血管病,需要终生关注并接受专业护理。

应注意保持牙齿和牙龈的清洁,比如每天两次刷牙,注意牙齿间的清洁,根据医生建议使用抗牙菌斑的漱口水或特定洁牙剂。

如果不积极治疗牙周炎,或会导致牙齿脱落,进而也可能给心血管病预防带来阻碍。

牙龈疾病的发生或恶化可能并无症状,因此即使没有牙龈疾病,也应定期接受口腔科检查,这也是心血管病管理的一部分。

口腔科医生会注意到牙龈疾病的早期迹象,但患者本人也应注意到这些问题:牙龈发红或肿胀、刷牙后出血、口臭、牙齿松动、牙间距增加、牙结石。

对口腔科医生的建议

关注牙周炎患者心血管病风险因素,并适当转诊到心内科,同时建议患者对牙周炎治疗、防护以及其他心血管病危险因素积极管理。

对所有牙周炎患者进行口腔健康教育,并施行个体化口腔卫生策略,其中包括每日刷牙两次、定期洗牙以及某些情况下进行牙菌斑的特殊处理等。

对确诊心血管病者应彻底进行口腔检查,进行全面的牙周评估,包括全口探查及出血分数的评估。

对无牙周炎的心血管病患者应进行至少每年一次的预防护理以监测牙周状态的变化;若已患牙周炎则积极治疗。

不论患者心血管病程度或特定药物使用,非手术性的牙周治疗应积极施行,最好在数个30~45分钟的疗程中,最大可能减少急性全身性炎症发作。

对于无心血管病的牙周炎患者,适当给予外科牙周治疗及植入物治疗。不过如果患者血压高于180/100 mmHg,手术需在血压稳定后方能实施。

对于使用抗血小板或抗凝药物的患者,牙周外科治疗具有中低出血风险。口腔科医生不应改变患者用药,如有需要手术前请心内科医生会诊。

此外,还需考虑局部的出血并发症。局部止血剂、麻醉、血管收缩药物都可考虑应用。

对于有心内膜炎风险的患者应预防性给予抗生素。

对于牙齿脱落较多的患者,鼓励进行牙齿康复,恢复咀嚼能力以保证营养摄入。

来源:Sanz M, Del Castillo AM, Jepsen S, et al. Periodontitis and Cardiovascular Diseases. Consensus Report. Glob Heart,2020, 15(1): 1.

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    2020-08-24 1474e843m09暂无昵称

    学到了

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    2020-07-10 lyh994

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1644848, encodeId=c83916448483e, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Thu Dec 17 14:17:47 CST 2020, time=2020-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=812776, encodeId=0cda812e76e5, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2e25206552, createdName=1474e843m09暂无昵称, createdTime=Mon Aug 24 18:01:33 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802033, encodeId=2f70802033c0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/04/24/1c2dbd6706e64df33befd6663f1d6b37.jpg, createdBy=94f61661779, createdName=lyh994, createdTime=Fri Jul 10 10:56:20 CST 2020, time=2020-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282314, encodeId=16551282314cf, content=<a href='/topic/show?id=46a06e5220c' target=_blank style='color:#2F92EE;'>#牙周病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67522, encryptionId=46a06e5220c, topicName=牙周病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1376173, createdName=linagood, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339327, encodeId=fb6f133932ec8, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1451280, encodeId=37f514512808e, content=<a href='/topic/show?id=f0476e49582' target=_blank style='color:#2F92EE;'>#牙周#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67495, encryptionId=f0476e49582, topicName=牙周)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461377, encodeId=b9cb14613e72d, content=<a href='/topic/show?id=67356e62003' target=_blank style='color:#2F92EE;'>#牙科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67620, encryptionId=67356e62003, topicName=牙科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d786418402, createdName=xzw115, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496691, encodeId=92ef14966918c, content=<a href='/topic/show?id=bbd780e4884' target=_blank style='color:#2F92EE;'>#联盟#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80748, encryptionId=bbd780e4884, topicName=联盟)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7fc9269968, createdName=zexyw04, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1644848, encodeId=c83916448483e, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Thu Dec 17 14:17:47 CST 2020, time=2020-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=812776, encodeId=0cda812e76e5, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2e25206552, createdName=1474e843m09暂无昵称, createdTime=Mon Aug 24 18:01:33 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802033, encodeId=2f70802033c0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/04/24/1c2dbd6706e64df33befd6663f1d6b37.jpg, createdBy=94f61661779, createdName=lyh994, createdTime=Fri Jul 10 10:56:20 CST 2020, time=2020-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282314, encodeId=16551282314cf, content=<a href='/topic/show?id=46a06e5220c' target=_blank style='color:#2F92EE;'>#牙周病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67522, encryptionId=46a06e5220c, topicName=牙周病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1376173, createdName=linagood, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339327, encodeId=fb6f133932ec8, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1451280, encodeId=37f514512808e, content=<a href='/topic/show?id=f0476e49582' target=_blank style='color:#2F92EE;'>#牙周#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67495, encryptionId=f0476e49582, topicName=牙周)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461377, encodeId=b9cb14613e72d, content=<a href='/topic/show?id=67356e62003' target=_blank style='color:#2F92EE;'>#牙科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67620, encryptionId=67356e62003, topicName=牙科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d786418402, createdName=xzw115, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496691, encodeId=92ef14966918c, content=<a href='/topic/show?id=bbd780e4884' target=_blank style='color:#2F92EE;'>#联盟#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80748, encryptionId=bbd780e4884, topicName=联盟)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7fc9269968, createdName=zexyw04, createdTime=Thu Jun 11 06:17:47 CST 2020, time=2020-06-11, status=1, ipAttribution=)]
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    2020-06-11 xzw115
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