How do the two theories stack up?It is not easy to say from the evidence
now in hand,which comes mainly from obseving correlations between gum disease and other diseases;either or both of the proposed mechanisms could be responsible.Take the evidence linking periodontal disease with premature birth,which could be caused by the infection reaching the uterus or,alternatively,by the release into the bloodstream of such proinflammatories as prostaglandin E2,a drug used by obstetricians to induce labor.There is also evidence that oral disease destabilizes blood sugar control in diabetic patients,although the mechanism remains unclear.It is known that high blood sugar contributes to gum disease and that all kinds of stress badly impact diabetic control.Periodontal disease may put stress on the body by spreading bacteria,increasing the inflammatory burden,or both.
so,too,many treatments whose success may seem to confirm one theory or another turn out to be hard to interpret.Asprin,an anti-inflammatory,is used to reduce the risk of heart attack, but again,no one can say that this proves that inflammation,pure and simple,is the culprit.It could be that aspirin merely limits clotting.
What is needed are large clinical trials in which patients are divided, at random,into two groups: one that gets treatment for periodonatl disease,another that gets a placebo.Two such studies are trying to determine whether such treatment alleviates the risk of premature birth in women with gum disease.Another is testing whether antibiotic treatment can alleviate heart disease.Yet,even here,one must beware of the possibility that antibiotics themselves may exert a subtle anti-inflammatory effect.
We need interventionist studies to learn whether treating oral disease
unmistakably shows a preventative benefit against heart disease.Such
trials are needed to justify any public investment in such treatment,and
several are now planned and in line for funding.
now in hand,which comes mainly from obseving correlations between gum disease and other diseases;either or both of the proposed mechanisms could be responsible.Take the evidence linking periodontal disease with premature birth,which could be caused by the infection reaching the uterus or,alternatively,by the release into the bloodstream of such proinflammatories as prostaglandin E2,a drug used by obstetricians to induce labor.There is also evidence that oral disease destabilizes blood sugar control in diabetic patients,although the mechanism remains unclear.It is known that high blood sugar contributes to gum disease and that all kinds of stress badly impact diabetic control.Periodontal disease may put stress on the body by spreading bacteria,increasing the inflammatory burden,or both.
so,too,many treatments whose success may seem to confirm one theory or another turn out to be hard to interpret.Asprin,an anti-inflammatory,is used to reduce the risk of heart attack, but again,no one can say that this proves that inflammation,pure and simple,is the culprit.It could be that aspirin merely limits clotting.
What is needed are large clinical trials in which patients are divided, at random,into two groups: one that gets treatment for periodonatl disease,another that gets a placebo.Two such studies are trying to determine whether such treatment alleviates the risk of premature birth in women with gum disease.Another is testing whether antibiotic treatment can alleviate heart disease.Yet,even here,one must beware of the possibility that antibiotics themselves may exert a subtle anti-inflammatory effect.
We need interventionist studies to learn whether treating oral disease
unmistakably shows a preventative benefit against heart disease.Such
trials are needed to justify any public investment in such treatment,and
several are now planned and in line for funding.
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因此，有太多的治療，它們的成功看起來可以證實某個理論，但卻難以解釋。有人用阿斯匹林這個抗發炎藥，來降低心臟病發作的危險，但是仍然沒有人能說，這證明了發炎絕對是心臟病發作的凶手。它可能是只因那片阿斯匹林減少了血液凝結的緣故罷了。
目前所需要的是大型的臨床試驗，將病患隨機分成兩組︰一組治療他們的牙周病，另一組則給予一粒安慰劑。有兩個類似這樣的研究正試圖確定這樣的治療是否可以減輕牙床有病之婦女早產的危險。另有一個研究正測試抗生素治療是否能減輕心臟病。然而，即使是這裡，我們必須注意抗生素本身帶有輕微抗炎效應的可能性。我們需要介入型的研究以獲悉是否治療口腔疾病真的能顯示具有預防心臟病的好處。需要這樣的試驗來證明任何對這樣治療的公共投資是正確的，並且幾個試驗正規畫中及排隊等待研究經費的資助。