歯周病。肺疾患の主な増悪因子？

Periodontal Diseases: Major Exacerbators of Pulmonary Diseases?

抄録

歯周病は、歯肉炎や歯周炎など、歯を支える組織を侵す多菌性の感染症で、いくつかの肺疾患の増悪に関与していると言われています。肺炎，慢性閉塞性肺疾患（COPD），喘息，結核，COVID-19，気管支拡張症などの肺疾患は，QOL の低下や死亡率に大きく関与している．歯周病と肺の予後との関連は重要なテーマであり，さらなる注意が必要である．口腔内と肺には多数の常在微生物が共存している．しかし，口腔疾患，高齢，生活習慣，歯科介入による正常な微生物叢の変化が，口腔内の歯周病菌の肺への吸引や炎症反応の変化を助長している可能性がある．同様に、歯周病はスパイロメトリー肺活量の縦断的な低下と関連している。歯周病治療が肺機能の改善に有効であり，増悪の頻度が減少し，呼吸器系の有害事象や罹患のリスクが減少する可能性が示唆されている研究が複数ある．ここでは、口腔と肺の予後との関連について概説した現在の文献をレビューし、口腔と肺の予後に影響を与えうる口腔内の微生物叢、環境および遺伝的要因、既往症に焦点をあてる。

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.