歯周病における喫煙の役割とインプラント治療の治療成績について

The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy.

抄録

タバコは，歯周病原体に対する炎症反応や宿主反応，歯肉縁下の微生物群集の変化，組織の恒常性維持の不均衡につながる組織の治癒能の低下など，さまざまな機序で歯周病と関係していると考えられている．本総説では，喫煙と歯周病との関係について，喫煙が全身的および局所的な経路で歯周組織に悪影響を及ぼす可能性のある機序を説明することを試みる．初期および最近の研究では、喫煙による歯周病臨床指標の変化、歯肉縁下の微生物叢の変化について、特定の微生物に対する従来の検出方法に加えて、微生物群集の特徴を完全に把握することができるディープシーケンスやバイオインフォマティクス解析などの最新の手法を用い、炎症および免疫反応について研究の限界や研究プロトコルのデザインの違いを批判的に評価しながら検討されている。歯周治療成績とインプラント治療成績については、喫煙者の治療成績が劣ることのメカニズムを明らかにすることを試みた。また、受動喫煙の有害性を検討し、禁煙の有用性を示した。禁煙は歯科医師が推奨すべきことであり，喫煙者には喫煙が歯周病状態やインプラント治療成績に与える悪影響を伝える努力が必要である．

Tobacco smoking has been implicated in periodontal pathology through various mechanisms, including perturbations of the inflammatory and host responses to putative periodontal pathogens, alterations in the subgingival microbial communities, and a compromised healing potential of the tissues leading to imbalance of tissue homeostasis. This review provides the evidence for the relationship between cigarette smoking and periodontal disease in an attempt to explain possible mechanisms of how tobacco smoking may exert its negative effects on the periodontal tissues via systemic and localized pathways. Early and more recent studies explore cigarette smoking-induced changes in periodontal clinical indices; in subgingival microbial flora by employing traditional detection methods for selected microorganisms, in addition to modern techniques such as deep sequencing and bioinformatics analyses that are able to fully characterize the microbial communities; and in inflammatory and immune responses critically appraising study limitations and differences in study protocol designs. Periodontal treatment outcomes and implant therapy outcomes are reviewed in an attempt to shed light on possible mechanisms for the inferior treatment outcome noted in smokers. The potential harmful effects of passive smoking are also reviewed, providing evidence for the advantages of smoking cessation. Quitting cigarette smoking should be recommended by the dentist, and effort should be made to inform smokers about the negative effects of smoking on the periodontal status and implant therapy outcomes.