牙周炎与帕金森病：关于关联、推测机制及临床考量的叙述性综述。

文献信息

中文摘要

牙周炎是一种常见的慢性炎症性疾病，而口腔健康问题在帕金森病（PD）患者中很常见。观察性研究一致表明PD患者牙周状况较差，但牙周炎增加PD发病率或促进其进展的证据并不一致，且不能确立因果关系。本叙述性综述总结了关于流行病学关联、生物学上合理的机制以及牙科管理考量的当前证据。人类数据支持PD与更重的牙周疾病负担之间存在关联，这可能与运动障碍、自我护理能力下降、唾液功能障碍以及口腔微生物生态改变有关。相比之下，从牙周炎到PD的推测通路，包括全身性炎症、血脑屏障破坏、微生物产物以及口腔-肠道-脑轴，主要得到临床前、间接或低水平人类证据的支持，应被视为假说而非已确立的机制。关于接受牙周洁治的个体PD发病率较低的观察性报告，并不能证明牙周治疗具有预防作用。因此，在临床实践中，牙周护理应以已确立的口腔健康需求为依据，并针对PD相关的运动、吞咽、认知、药物及装置相关因素进行个体化处理，而不应被表述为一种预防或改变PD的策略。需要更好的纵向研究和干预性试验来阐明时序性、机制以及牙周治疗可能带来的任何神经学效应。

英文摘要

Periodontitis is a common chronic inflammatory disease, and oral health problems are frequent in people with Parkinson's disease (PD). Observational studies consistently indicate poorer periodontal status in PD, but evidence that periodontitis increases the incidence or progression of PD is inconsistent and does not establish causality. This narrative review summarizes current evidence on epidemiological associations, biologically plausible mechanisms, and dental management considerations. Human data support an association between PD and greater periodontal disease burden, plausibly related to motor impairment, reduced self-care capacity, salivary dysfunction, and altered oral microbial ecology. By contrast, proposed pathways from periodontitis to PD, including systemic inflammation, blood-brain barrier disruption, microbial products, and the oral-gut-brain axis, are supported mainly by preclinical, indirect, or low-level human evidence and should be regarded as hypotheses rather than established mechanisms. Observational reports of lower PD incidence among individuals receiving dental scaling do not demonstrate a preventive effect of periodontal treatment. In clinical practice, periodontal care should therefore be justified by established oral-health needs and individualized for PD-related motor, swallowing, cognitive, medication, and device-related considerations, rather than presented as a strategy to prevent or modify PD. Better longitudinal studies and interventional trials are needed to clarify temporality, mechanisms, and any neurological effects of periodontal treatment.