口腔疾病与抑郁症的关系  

Relationship between oral diseases and depression

作　　者：梁潇月 任彪[1] 周学东[1,2] LIANG Xiaoyue;REN Biao;ZHOU Xuedong(State Key Laboratory of Oral Diseases&National Center for Stomatology&National Clinical Research Center for Oral Diseases,Sichuan University,Chengdu 610041,China;Department of Operative Dentistry and Endodontics,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病防治全国重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院,四川成都610041 [2]四川大学华西口腔医院牙体牙髓科,四川成都610041

出　　处：《口腔疾病防治》2024年第8期625-631,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81870754)。

摘　　要：口腔健康是身心健康的重要组成部分。口腔是与外界交流的渠道,具有表达紧张、悲观等情绪的功能。口腔疾病可引发抑郁情绪,抑郁症也可导致口腔疾病的恶化。作为人体微生物群落的重要组成部分,口腔微生态失衡可释放口腔病原微生物,通过循环、神经、免疫系统等途径,传递到大脑,对中枢神经系统的功能产生重大影响,导致下丘脑⁃垂体⁃肾上腺(hypothalamic⁃pituitary⁃adrenal axis,HPA)轴失调,加重抑郁发展。同样,抑郁症患者口腔微生态的失衡,会加剧口腔疾病的发生。抑郁症与口腔疾病之间的关系并非孤立存在,而是相互影响、互为因果的复杂过程。为揭示两者之间的因果关系,并制定预防、治疗这两种疾病的共同策略,本文从口腔微生物角度探讨口腔疾病与抑郁症之间的互作机制:龋病、牙髓根尖周病和牙周病的发生与口腔内特定细菌的过度增殖密切相关,如变异链球菌、牙龈卟啉单胞菌、罗氏菌等,可通过不完整或受损的血脑屏障直接侵入大脑,激活促炎细胞因子,导致神经炎症,从而加重抑郁症状;口腔黏膜的炎症和溃疡由多种因素引起,包括感染、免疫异常等;由于抑郁症患者的免疫系统功能受损,这些炎症反应往往更为剧烈且难以控制;错畸形、三叉神经痛和颞下颌关节病等患者心理压力和免疫系统的变化,也会增加抑郁症的发生风险。未来需要探索抑郁症患者口腔微生态的治疗潜力,通过调整口腔微生态来改善抑郁症的症状和治疗效果,为抑郁症的预防和治疗提供新途径。Oral health is an integral component of overall wellbeing,with the oral cavity serving as a channel for external communication and expression of emotions such as stress and pessimism.Oral diseases can intensify feelings of depression,whereas depression can worsen oral health conditions.As a crucial part of the human microbiome,an imbalance in oral microbiota can release oral pathogenic microbes,which,through pathways including the circulation,nervous,and immune systems,can reach the brain and significantly affect the central nervous system.This can lead to dysregulation of the hypothalamicpituitaryadrenal(HPA)axis,further intensifying the development of depression.Similarly,an imbalance in oral microbiota in individuals with depression can intensify the occurrence of oral diseases.The relationship between depression and oral diseases is not isolated but rather a complex interplay in which they mutually in fluence and act as causative factors.To elucidate the causal relationship between oral diseases and depression and devise strategies for the prevention and treatment of both conditions,we explore the interaction mechanisms between oral diseases and depression from the perspective of oral microbiota.The occurrence of dental caries,periapical periodontitis,and periodontal diseases is closely associated with the excessive proliferation of specific bacteria in the oral cavity,such as Streptococcus mutans,Porphyromonas gingivalis,and Fusobacterium nucleatum.These bacteria can directly invade the brain through the compromised bloodbrain barrier,activating proinflammatory cytokines and worsening depressive symptoms.Inflammatory conditions and ulcers in the oral mucosa are caused by various factors,including infection and immune abnormalities.Because of compromised immune function in individuals with depression,these inflammatory responses are often more severe and difficult to control.Malocclusion,trigeminal neuralgia,and temporomandibular joint disorders increase the risk of depression because of psychological stress

关 键 词：口腔疾病 口腔健康 抑郁症 口腔微生态 口腔病原微生物 中枢神经系统 免疫系统 下丘脑⁃垂体⁃肾上腺轴 互作机制 

分 类 号：R78[医药卫生—口腔医学]