酷兔英语


The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole.


眼睛也许是心灵的窗口,但嘴巴可以更全面地反映人体的健康状况。



Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue -- sometimes long before a patient knows anything is wrong.


牙龈、牙齿和舌头能够反映糖尿病、癌症、妊娠、免疫系统紊乱、荷尔蒙分泌失调、药物滥用等问题的某些最早期症状,而且有时这种反映远早于患者自己的意识。



There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.


越来越多的证据表明,口腔健康问题,尤其是牙龈问题,也可能影响患者的身体健康,增加罹患糖尿病、心脏病、中风、肺炎和妊娠并发症的风险。



'We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body,' says Anthony Iacopino, director of the International Centre for Oral-Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008. Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes.


2008年成立于加拿大曼尼托巴大学(University of Manitoba)牙医学院的国际口腔系统保健中心(International Centre for Oral-Systemic Health)的主任安东尼•伊阿考比诺(Anthony Iacopino)表示,他们获得的大量数据显示口腔炎症与身体炎症直接相关。近期的一些研究也表明,治疗牙龈疾病有助于改善血液循环,缓减炎症症状,甚至还可降低糖尿病患者的胰岛素用量。



Such findings are fueling a push for dentists to play a greater role in patients' overall health. Some 20 million Americans -- including 6% of children and 9% of adults -- saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month.


这些发现将促使牙医在改善患者整体健康状况中发挥更大的作用。《美国公共卫生杂志》(American Journal of Public Health)2011年12月刊登的一项研究显示,2008年,约有2000万美国人(包括6%的儿童和9%的成人)看过牙医,而未看过(家庭)医生。



'It's an opportunity to tell a patient, 'You know, I'm concerned. I think you really need to see a primary care provider,' so you are moving in the direction of better health,' says the study's lead researcher Shiela Strauss, co-director of statistics and data management for New York University's Colleges of Nursing and Dentistry.


纽约大学护理与牙医学院(New York University's Colleges of Nursing and Dentistry)分管统计与信息管理的主任、上述研究项目的学术带头人希埃拉•斯特劳斯(Shiela Strauss)表示,牙医可以借机劝告患者,"嗯,我有点不放心。我觉得你最好去看一下家庭医生",这会推动患者的健康状况得到改善。



George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., says he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, due to the telltale erosion of enamel on the back of the upper front teeth, and methamphetamine addiction. 'We call it 'meth mouth,' ' he says. 'The outer surface of teeth just rot in a way that's like nothing else.'


在曼哈顿和宾夕法尼亚州纽敦市(Newtown)设有诊所的修复科牙医乔治•基沃维茨(George Kivowitz)说,在32年执业生涯中,他曾根据患者上前齿内表面珐琅质受腐蚀的情况诊断出七例癌症和多个贪食症病例,还发现过甲基苯丙胺成瘾症状。他说,"我们称之为'冰毒嘴',(嗑药成瘾的人)牙齿外层会出现一种特有的腐蚀症状。"



Some of the most distinctive problems come from uncontrolled diabetes, Dr. Kivowitz adds. 'The gum tissue has a glistening, shiny look where it meets the teeth. It bleeds easily and pulls away from the bone -- and it's all throughout the mouth.'


他补充道,有些非常特别的牙疾源于控制不良的糖尿病。"牙龈与牙齿交接的地方看起来白亮白亮的,易出血,齿根松动,而且满口都是如此。"



An estimated six million Americans have diabetes but don't know it -- and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association.


据估计,约有600万美国人患有糖尿病却不自知。多项研究表明,牙医可起到预警作用。纽约大学(New York University)2009年的一项研究发现,按照美国糖尿病协会(American Diabetes Association)确立的衡量标准,93%的牙周病患者均有罹患糖尿病的风险。



It's not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other, experts say. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.


专家表示,牙龈问题和高血糖不仅源自相同的生活习惯,二者之间还会相互加重病情。牙龈感染发炎后,糖尿病患者会更难控制自身的血糖水平,而高血糖会加重蛀牙和牙龈问题,引发更多炎症。



There's also growing evidence that the link between periodontal disease and cardiovascular problems isn't a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.


此外,越来越多的证据也表明,牙周病与心血管疾病之间也存在着必然的联系。牙龈发炎会导致C-反应蛋白增多,而C-反应蛋白偏高被认为是心脏病的一个致病因素。



'They've found oral bacteria in the plaques that block arteries. It's moved from a casualrelationship to a risk factor,' says Mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.


纽约大学牙医学院龋病学与综合护理系主任马克•沃尔夫(Mark Wolff)表示,研究人员已经发现,牙斑中的细菌会阻塞动脉。原先以为它只是一个偶然因素,如今发现它其实是致病的风险因素。



Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere, which is why people contemplating elective surgery are advised to have any needed dental work performed first.


口腔中的细菌可能通过血液循环去到人体各处,引发疾病,这正是为何医生会建议考虑接受非急性外科手术的患者先把需要处理的口腔问题解决掉。



The American Heart Association no longer recommends that people with mitral valve prolapse (in which heart values close abnormally between beats) routinely take antibiotics before dental procedures, since it's now believed that oral bacteria enter the bloodstream all the time, from routine washing, brushing and chewing food.


美国心脏协会(American Heart Association)已经不再建议罹患二尖瓣脱垂(心脏瓣膜在心室收缩期无法正常闭合)的病人在口腔疾病未治愈前定期服用抗生素,因为现在的看法是,在定期洗牙、日常刷牙甚至咀嚼食物的过程中,口腔细菌随时可能进入人体的血液循环系统。



But the American Heart Association, the American Medical Association and the American Orthopedic Association all urge people who have had a full joint replacement to take an antibiotic one hour before any dental visit for the rest of their lives to reduce the risk of post-surgical infections. 'I have my guidelines taped to the door in my hygienists' room,' Dr. Kivowitz says.


而与此同时,美国心脏协会、美国医学会(American Medical Association)和美国矫形外科协会(American Orthopedic Association)均呼吁接受过全关节置换术的患者在往后每次看牙医时,应提前一个小时服用一粒抗生素,以降低术后感染风险。基沃维茨医生表示,他把有关指南就钉在其诊所的牙科保健员办公室的房门上。



Dentists say they also need to stay up to date with all medications, supplements and over-the-counter drugs their patients are taking. Blood thinners can create excess bleeding in the mouth. Bisphosphonates, often prescribed for osteoporosis, can severelyweaken jaw bones. Both should be stopped temporarily before oral surgery.


一些牙医表示,他们还需要随时了解患者服药的最新情况,包括各种处方药、补充剂和非处方药。例如,抗凝剂可导致口腔大出血,常用于治疗骨质疏松症的双磷酸盐药物可致颌骨坏死。在进行口腔手术前,这两类药物都必须暂停服用。



Antihypertensive drugs, calcium-channel blockers and some anti-inflammatory drugs can cause painful ulcerations of the gums. Many medications, from antidepressants to chemotherapy drugs, cause dry mouth, which can cause cavities to skyrocket, since saliva typically acts as a protective coating for teeth. Additional fluoride treatments can help.


降压药、钙通道阻滞剂和一些消炎药可导致牙龈严重溃疡。抗抑郁症、化学疗法等治疗用药可导致口干,导致平时可以保护牙齿的唾液分泌减少,从而可能发生大面积蛀牙。在这种情况下,可以通过添加氟化物降低因口干而引发蛀牙的风险。



Some proactive dentists have glucose monitors for another check on blood-sugar levels if they suspect diabetes. Some also take patients' blood pressure and hold off on invasive procedures if it's extremely high.


有时候,为了以防万一,一些牙医如果怀疑病人可能罹患了糖尿病,会借助血糖仪对血糖水平做进一步检查。一些牙医还会测量病人的血压,如果发现血压过高,就会暂停采取侵入性的诊疗方法。



The Centers for Disease Control and Prevention recommends that dentists offer HIV testing, because some of the first symptoms appear in the mouth, including fungal infections and lesions. Dentists can do the HIV test with a simple mouth swab and get results in 20 minutes.


美国疾病控制与预防中心(Centers for Disease Control and Prevention)建议牙医提供艾滋病毒(HIV)检测,因为感染艾滋病毒的某些初期征兆就出现在口腔内,包括真菌感染和口腔病损。牙医只需用棉签对口腔进行拭抹取样,送检后,20分钟即可得到艾滋病毒检测结果。



Breaking the bad news is often more difficult. 'I went into oral surgery because I didn't think I would have to deliver that kind of news to patients,' says Clifford Salm, an oral and maxillofacial surgeon in Manhattan who has found leukemia, lymphoma, AIDS and metastatic breast cancer after performing biopsies on suspicious spots. 'It can be a difficult conversation,' he says, 'but most patients are very grateful.'


把坏消息告诉患者往往是更难的一关。曼哈顿的口腔颌面外科医生克利福德•萨尔姆(Clifford Salm)曾在对可疑病灶进行活体组织检查后,诊断出了白血病、淋巴瘤、艾滋病和转移性乳腺癌。他说,"我选择口腔外科就是不想当一名不得不告诉患者这种坏消息的医生。这样的对话有时很艰难,但大部分患者还是会表示感谢的。"



Melinda Beck


Melinda Beck