Results: There were no statistically significant changes in HbA1c levels in the IC and MC or their subgroups when evaluated with repeated-measures analysis of variance. However, the IC showed maintenance of baseline HbA1c levels, while the MC had a trend for HbA1c levels to steadily increase as shown by pairwise comparisons (baseline to 6 months and baseline to 12 months). IC subgroup 1 also maintained steady HbA1c levels from 6 months to 12 months, whereas MC subgroup 1 presented a steady increase during the same period. The number ofperiodontal maintenance visits had no association with changes in HbA1c levels during the 1-year study duration.
experiments in diabetic rats. However, the bone healing disturbances analyzed in these studies may not be manifested until a certain period of time has elapsed following diabetes induction. Therefore, the use of rats with unstandardized diabetesduration may create inconsistencies in experimental results, and it is therefore quite important to determine thediabetesduration when bone healing disturbances clearly appear. The purpose of this study was to determine the critical diabetesduration in a STZ-induced diabetic rat calvarial defect model for experimentation regarding bone regeneration by evaluating theassociationbetweendiabetesdurationand bone healing capacity through histological and radiographic analyses using cone-beam computed tomography (CBCT).
According to multivariate logistic regression analysis, the OR of carotid atherosclerosis according to the quartiles of thigh circumference were showed in Table 5.
However, theassociationof quartiles of calf circumference with carotid atherosclerosis was not significant (data not shown). The OR for carotid atherosclerosis increased according to the decreased thigh circumference based on an unadjusted model. Adjustments for age, durationofdiabetes, smoking status, BMI, blood pressure, lipid, kitt, WC, VAT and treatment medications, theassociationbetween carotid atherosclerosis and thigh circumference remained significant. The results of regression analysis indicated that thigh circumference was independently cor- related with insulin resistance and carotid atherosclerosis.
대상자에 대한 치주조직검사로는 지역사회치주지수 (Community periodontal index, CPI)를 이용하였다. CPI는 구강내 6개 치아에서 탐침을 이용하여 출혈여부, 치석존재 유무 , 치주낭 존재 유무를 측정하여 기준에 의한 점수를 부 여하고 치주 상태에 따라 건전치주조직 (CPI 0 ), 출혈치주조 직 (CPI 1 ), 치석형성치주조직 (CPI 2 ), 천치주낭형성치주조직 (CPI 3 ) 및 심치주낭형성치주조직 (CPI 4 )으로 분류하였으며, 경계에 해당하여 판정하기 곤란한 경우 낮은 점수를 부여하 여 각 해당치아의 점수 중 최대값을 개인에 대한 CPI로 분 류하였고 19) 치주상태에 따라 건전치주군 (CPI 0-2 )과 치주질 환군 (CPI 3-4 )으로 분류하였다. 당뇨여부에 관하여는 두 가 지의 방법으로 정의하였다. 먼저, 대상자들에게 의사로부터 당뇨 진단을 받은 적이 있는가라는 질문에 예라고 응답한 대상자를 당뇨 그룹으로 구분하였고 , 혈액검사를 통해 공복 시의 혈당을 측정 한 후 정상, 공복혈당장애, 당뇨 그룹으로 분류된 대상자에 대한 변수를 이용하여 치주염과 비교 , 분 석하였다 .
오희경 외. 수면시간과 공복혈당장애의 관계 Korean Journal of Family Practice KJFP
disappeared after controlling with sex and age ,( model 1 ) our study also suggests that differences of gender and age are major confounders which have multiplicative effect on this relationship . Sex - related differences of sleep were found to be associated with time use , social roles , menstrual cycle , hormonal differences . 22) Changes in sleep with normal aging have been explained as a circadian modulation , alteration of cardiopulmonary and endocrine function . 23) The differences of age and sex have been found as important risk factors of both sleep and metabolic diseases . 24) In addition , sleep duration was related with obesity and high blood pressure , which are great risk factors pre - diabetes , 25, 26) through similar mechanisms on glycemic control disorders . And when adjusted for general obesity and hypertension , the correlation of sleep duration with pre - diabetes grew weak . Thus , for research ofthe relationship betweenthe sleep durationand pre - diabetes , overall understanding of physiological interactions and potential confounding variables are required .
This paper reviews a current view regarding theassociationbetween periodontitis and atherosclerotic cardiovascular diseases (ACVD). Many evidences have suggested that there exist biological mechanisms by which periodontitis can lead to ACVD.
Periodontal infection can lead to direct bacterial invasion into endothelial tissues through the blood stream, then the bacteria can activate the host inflammatory response followed by atheroma formation, maturation and exacerbation. Also, chronic periodontal infections may indirectly induce endothelial activation or dysfunction through a state of systemic inflammation as evidenced by elevated plasma acute proteins, IL-6 and fibrinogen as well. There is moderate evidence that periodontal treatment can reduce systemic inflammation and improvement of both clinical surrogate markers. But there is no periodontal intervention study available on primary ACVD prevention. There is consistent and strong epidemiologic evidence, including in vitro, animal and clinical studies, that periodontitis imparts increased risk for future ACVD. However, evidences from intervention trials to date are not sufficient to confirm the multi directional causality of periodontitis in ACVD etiology. Well-designed intervention trials on the impact ofperiodontal treatment on the prevention of ACVD outcomes are needed.
however, the goal of this observational study was to determine whether a causal relationship is plausible. We found that as age increased, the prevalence of MetS (Table 1) andperiodontal disease severity (data not shown) increased. LXA4 levels may be affected by the synergistic effect of MetS andperiodontal disease. In order to characterize the relationships among periodontal parameters, MetS, and LXA4 as precisely as possible, the effects of possible confounders such as age and BMI were adjusted via various regression models. However, the effects of drugs such as statins, durationofthe disease, the number of MetS risk factors, and menopausal status, all of which may have affected the study results, were not evaluated. The mild to moderate periodontal status ofthe patients limited our ability to comment on the effects ofperiodontal disease severity on MetS and LXA4 levels.
In the initiation and progression of atherosclerosis, activated macrophages take up lipids and then these lipid-rich macrophages secret inflammatory mediators that stimulate VSMC migration and proliferation , resulting in atherosclerosis. It is known that YKL-40 is secreted by activated macrophages and neutrophils in different tissues with inflammation, vascular smooth muscle cells (VSMC), cancer cells, and arthritic chon- drocytes . In this regard, YKL-40 may be involved in the early stage of atherosclerosis and CAD. So we cate- gorized the asymptomatic type 2 diabetic patients into two groups – those with any degree of stenosis in coron- ary artery on cCTA (suspected CAD) and those with completely normal coronary artery on cCTA (no evi- dence of CAD). In our study, we did not find any signifi- cant associationbetween suspected CAD and hsCRP, the most widely used and evaluated inflammatory biomarker for cardiovascular diseases. YKL-40 levels, however, were significantly higher in patients with suspected CAD than those with no evidence of CAD. YKL-40 is produced lo- cally by inflammatory cells, however, hsCRP is produced by hepatocyte in response to high circulating cytokine levels. Taken together, YKL-40 might be more sensitive marker than hsCRP for predicting suspected CAD in type 2 diabetic patients. Because few studies have been conducted on YKL-40 as a novel marker for predicting occult CAD in asymptomatic subjects with normal glu- cose tolerance or diabetes mellitus, our results make a novel contribution to the clinical relevance of YKL-40 in asymptomatic type 2 diabetic patients.
심혈관계 질환은 사망의 주요 원인으로 지속적인 증가세에 있으며, 치과에 내원한 환자들 중 심혈관계 질환을 앓고 있는 사람들도 적지 않다. 치과에 방문한 노인환자의 전신질환은 고혈압, 협심증, 당뇨, 부정 맥, 소화기 질환, 뇌혈관질환 및 심근경색의 순으로 많았고, 고혈압이 있는 사람은 협심증, 심근경색, 부정 맥 및 뇌혈관질환과 합병증이 있었다. 또한, 구강악안면외과에 내원한 환자 중 전신질환자는 심혈관 Table 5. Multivariate analysis ofthe relationship betweenthe types of cardiovascular disease andperiodontal disease
In view of these relations betweendiabetes mellitus andperiodontal disease, it has been speculated that treatment ofperiodontaldiseases can improve metabolic control of dia- betes. 18 According to previous studies, 19,20 the magnitude ofthe reduction in HbA1c ranged from 0.27% to 0.48% 3 - 4 months after periodontal treatment. Despite periodontal treatment seeming to ameliorate metabolic control, evidence was not sufficient to significant associate periodontal treat- ment and metabolic control in patients with diabetes. 21 According to a consensus report, there is a lack of data to manifest that this effect is maintained over 6 months fol- lowing periodontal treatment. 22
All the patients with ONFH or traumatic femoral neck fracture were diagnosed independently by two orthope- dists and pathologist. The synovial tissues were provided by The Keimyung Human Bio-resource Bank in Korea, which were frozen in liquid nitrogen and stored at − 80 °C. Patients with severe chronic diseases, such as cancer, cardiovascular diseases, immunodeficiency virus infection, diabetes mellitus, and renal dysfunction were excluded.
The present study could not elucidate the direct causal relationship between dietary quality andperiodontaldiseases. Despite this limitation, the study is meaningful as it used a more comprehensive approach than the traditional approach of assessing the impact of individual nutrients or food products on diseases to assess the risk ofperiodontaldiseasesand dietary quality. A longitudinal study on dietary quality andperiodontaldiseases is warranted. In conclusion, this study identified an associationbetween dietary quality andperiodontaldiseasesand found that poor dietary quality was significantly associated with an increased risk ofperiodontaldiseases.
• 주제어 : 치주질환, 심장질환, 죽상경화증, 씨알피
Abstract Periodontal disease is a common inflammatory disorder that is being considered as a risk factor for atherosclerotic complication. Recent epidemiological evidence also supports that its potential association with increased blood pressure levels and hypertensive prevalence. Data from cross-sectional studies suggest that in hypertensive patients periodontal disease may enhance the risk and degree of target organ damage. So dental infections have been associated with cardiovascular diseases. There are potential pathophysiologic links between hypertension and periodontits. The role ofthe inflammatory pathway includes C-reactive protein(CRP). CRP is an inflammatory mediator that has been shown to predict the development of hypertension independently of baseline BP and traditional risk factors, has been consistently reported as at least mildly elevated in patients with periodontal disease.
우식증 경험, 치주질환 여부 등과 같이 객관적인 측정도구를 활용하여 상병유무를 판단하여 왔으나, 이런 방법들은 포괄 적이고 주관적인 구강건강의 개념을 만족시키지 못하였다.
일반적인 건강인식의 변화는 구강건강에도 동일하게 적용되 고 있으며, 이와 관련하여 구강건강을 측정하는 수단에도 포 괄적인 건강의 개념이 반영되고 있다. 구강건강과 관련된 삶 의 질(quality of life) 측정방법은 다양한 조사도구들이 개발 되어 있으나 가장 보편적으로 사용되는 도구중의 한 가지가 Slade 7) 의 OHIP(Oral health impact profile, 구강건강영향지 수)이다. OHIP-14(Oral Health Impact Profile-14)는 7개 범주 를 가진 49문항으로 구성된 구강건강영향조사에서 각각의 범주별로 2문항씩 추려 14문항의 단축형을 개발하여 간결성 과 편리성을 얻고 응답자의 부담을 감소시켜 자료수집이 용 이하도록 한 것이다.
연구대상자들의 일반적 특성으로 건강 ․ 설문조사에서 성별, 연령, 교육수준, 평균 월 소득, 흡연여 부, 음주횟수, 스트레스 인지 정도, 구강검진 여부, 일일 칫솔질 횟수를 변수로 사용하였다. 치주질환 유병여부는 구강검사자료에서 지역사회치주지수(community periodontal index, CPI)를 토대로 CPI 코드 3 이상(3=천치주낭형성치주조직, 4=심치주낭형성치주조직)일 때 치주질환으로 정의하였 다. 측정방법은 상악우측제1 ․ 2대구치, 상악우측중절치, 상악좌측제1 ․ 2대구치, 하악우측제1 ․ 2대 구치, 하악좌측중절치, 하악좌측제1 ․ 2대구치를 기준치아로 치주낭의 깊이, 치석부착 및 치은 출혈 유무 등을 조사하여 구강 내 6분악 중 가장 높은 점수를 기록하였다. 비만지표는 검진조사에서 신체 계측자료를 활용하였으며, 체질량지수(body mass index, BMI, kg/m 2 ) 는 18.5 kg/m 2 미만은 저체중 (underweight), 18.5 kg/m 2 이상 23 kg/m 2 미만은 정상(normal), 23 kg/m 2 이상 25 kg/m 2 미만은 과 체중(overweight), 25 kg/m 2 이상은 비만(obese)으로 분류하였다. 허리둘레(waist circumference, WC, cm) 는 여성 0.85 cm, 남성 0.90 cm 이상을 비만으로 구분하였다.
다중로지스틱회귀분석을 통해 연령, 성별, 체질량지수, 운동, 흡 연여부, 음주, 스트레스 인지율, 우울증상 경험률를 혼란변수로 통 제하였고, 수면시간과 당뇨병과의 연관성을 분석하였다. 보정을 하 지 않은 경우 짧거나 긴 수면시간은 당뇨병과 통계적으로 유의한 관 계에 있었으나 위의 혼란변수를 보정한 상태에서 남성과 여성 모두 에서 수면시간과 당뇨병과의 관계는 통계적으로 유의한 관련성이 나타나지 않았다. ( Table 2 ) 본 연구 대상자의 연령이 높아 연구 대 상자의 수면시간이 감소하여 수면시간과의 관련성이 약화될 수 있 고 또한 당뇨병 발생 원인은 서로 복잡하게 얽혀있어 수면이 당뇨병 유병율에 영향을 미치는 것이 단순하지 않고 이 관계를 정확히 밝히 Table 2. Odds ratio diabetes mellitus according to sleep duration:
주제어 : 구강건강행동, 국민건강영양조사, 융합, 지역사회치주치료요구지수, 치주염
Abstract This study aimed to identify theassociationbetween each stage of Community periodontal index of treatment needs (CPITN) and oral health behaviors. Multivariate logistic regression analysis was performed on the data obtained from 11,002 adults aged between 19 and 79 years, using data from the 7th Korea National Health and Nutrition Examination Survey. When interdental care products such as floss or interdental brush were used, the risk of CPITN1 to CPITN3 and periodontitis was significantly reduced. Brushing more than 3 times a day significantly reduced the risk for CPITN1 and CPITN2, and dental check-ups reduced the risk for CPITN1, CPITN2, and periodontitis. There were differences in related factors depending on the stage of CPITN and periodontitis. Therefore, it is essential to include training on the use of interdental care products in oral health education. In addition, it will be helpful educate subjects on select oral health behaviors based on their periodontal status.
Objectives: The objective ofthe study was to review the correlation between self-perceived oral health status andperiodontaldiseases in elderly Koreans, using data from the 6 th (2nd year) Korea National Health and Nutrition Examination Survey (2014). Methods: The subjects for this study were a total of 1,454 elderly people aged 65 years or older who responded to the health questionnaires ofthe 6 th (2nd year) Korea National Health and Nutrition Examination Survey conducted in 2014. Their general characteristics were analyzed using frequency analysis, while a cross-tabulation analysis ( 2 -test) was performed to understand the correlation with periodontaldiseases. To clarify any effect of self-perceived oral health status on periodontaldiseases, the selected variables were controlled and subsequently analyzed according to the logistic regression analysis. Results: In terms ofthe difference between elderly people with periodontal disease and those without periodontal disease, higher prevalence rates ofperiodontaldiseases were found in women, those of younger age, those with lower educational and income levels, those with poorer subjective oral health status, those in the presence of chewing discomfort, those who had a toothbrushing frequency of twice per day, and/or those who had received no oral examination over the previous one year. Regarding the effect of self-perceived oral health status on periodontaldiseases, 1.78-fold and 1.74-fold higher prevalence rates ofperiodontaldiseases were shown with poorer subjective oral health status and in the presence of chewing discomfort, respectively. Conclusions: Based upon the results above, it is considered that a better understanding of self-perceived oral health status is necessary for a healthy life ofthe elderly. Furthermore, constant relevant studies and effective prevention programs intended to moderate the progress of or prevent periodontaldiseases in the elderly in communities should be performed and implemented for the sake of better quality of life and oral health.