โพรไบโอติกส์เพื่อการรักษาโรคปริทันต์
คำสำคัญ:
โรคปริทันต์, การรักษาโรคปริทันต์โพรไบโอติกส์บทคัดย่อ
ในระยะหลังได้มีการศึกษาจำนวนมากให้ความสนใจการค้นหาวิธีที่มีประสิทธิภาพสำหรับการรักษาทางปริทันตวิทยาที่ให้ผลดีในระยะยาวและเกิดผลข้างเคียงต่อผู้ป่วยน้อยที่สุดโพรไบโอติกส์ถือเป็นอีกวิธีการหนึ่งที่ได้รับการยอมรับว่าประสิทธิภาพในการรักษาโรคในช่องปาก และได้ถูกนำมาใช้ศึกษาวิจัยในการรักษาโรคปริทันต์อักเสบด้วย บทความนี้มีวัตถุประสงค์เพื่อทบทวนความรู้สาเหตุของโรคปริทันต์อักเสบความรู้พื้นฐานเกี่ยวกับโพรไบโอติกส์การวิจัยเกี่ยวกับโพรไบโอติกส์ในการรักษาโรคปริทันต์อักเสบ เพื่อเป็นประโยชน์สำหรับการศึกษาค้นคว้าข้อมูล และนำไปพัฒนางานวิจัยในอนาคต กล่าวโดยสรุปการใช้โพรไบโอติกส์ร่วมกับการขูดหินน้ำลายเกลารากฟันช่วยเพิ่มประสิทธิภาพในการรักษาโรคปริทันต์อักเสบ เนื่องจากมีผลลดเชื้อก่อโรคปริทันต์ ลดการมีเลือดออกหลังการหยั่งร่องเหงือกลดร่องลึกปริทันต์และเพิ่มระดับการยึดเกาะของอวัยวะปริทันต์ด้วย อย่างไรก็ตามการนำโพรไบโอติกส์มาใช้ยังต้องการการศึกษาในระยะยาวต่อไป
References
1. Sanz M, D'Aiuto F, Deanfield J, Fernandez-Avilés F. European workshop in periodontal health and cardiovascular disease—scientific evidence on the association between periodontal and cardiovascular diseases: a review of the literature. European Heart Journal Supplements2010;12(suppl_B):B3-B12.
2. สำนักทันตสาธารณสุข, กรมอนามัย, กระทรวงสาธารณสุข. รายงานผลการสำรวจสภาวะสุขภาพช่องปากแห่งชาติ ครั้งที่ 8 ประเทศไทย พ.ศ. 2560. บริษัท สามเจริญพาณิชย์ (กรุงเทพ) จำกัด นนทบุรี; 2561.
3. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL, Jr. Microbial complexes in subgingival plaque. J Clin Periodontol1998;25(2):134-44.
4. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res1994;8(2):263-71.
5. Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: the polymicrobial synergy and dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol 2012;27(6):409-19.
6. Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control. II: As observed on extracted teeth. J Periodontol1978;49(3):119-34.
7. Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent1981;1(5):30-41.
8. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B. Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol1984;11(3):193-207.
9. Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, et al. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc2015;146(7):508-24.e5.
10. FAO/WHO. Health and nutritional properties and guidelines for evaluation - Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food including Powder Milk with Live Lactic Acid Bacteria. 2006Report No.: 92-5-105513-0.
11. Laleman I, Teughels W. Probiotics in the dental practice: a review. Quintessence Int2015;46(3):255-64.
12. Teughels W, Loozen G, Quirynen M. Do probiotics offer opportunities to manipulate the periodontal oral microbiota? J Clin Periodontol2011;38 Suppl 11:159-77.
13. Kõll-Klais P, Mändar R, Leibur E, Marcotte H, Hammarström L, Mikelsaar M. Oral lactobacilli in chronic periodontitis and periodontal health: species composition and antimicrobial activity. Oral Microbiol Immunol2005;20(6):354-61.
14. Boyle RJ, Robins-Browne RM, Tang ML. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006;83(6):1256-64; quiz 446-7.
15. Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S, et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999;28(5):1159-60.
16. Mattia A, Merker R. Regulation of probiotic substances as ingredients in foods: premarket approval or "generally recognized as safe" notification. Clin Infect Dis. 2008;46 Suppl 2:S115-8; discussion S44-51.
17. van Essche M, Loozen G, Godts C, Boon N, Pauwels M, Quirynen M, et al. Bacterial antagonism against periodontopathogens. J Periodontol2013;84(6):801-11.
18. Zhu Y, Xiao L, Shen D, Hao Y. Competition between yogurt probiotics and periodontal pathogens in vitro. Acta Odontol Scand2010;68(5):261-8.
19. Teughels W, Newman MG, Coucke W, Haffajee AD, Van Der Mei HC, Haake SK, et al. Guiding periodontal pocket recolonization: a proof of concept. J Dent Res2007;86(11):1078-82.
20. Messora MR, Oliveira LF, Foureaux RC, Taba M, Jr., Zangerônimo MG, Furlaneto FA, et al. Probiotic therapy reduces periodontal tissue destruction and improves the intestinal morphology in rats with ligature-induced periodontitis. J Periodontol2013;84(12):1818-26.
21. Maekawa T, Hajishengallis G. Topical treatment with probiotic Lactobacillus brevis CD2 inhibits experimental periodontal inflammation and bone loss. J Periodontal Res 2014;49(6):785-91.
22. Oliveira LF, Salvador SL, Silva PH, Furlaneto FA, Figueiredo L, Casarin R, et al. Benefits of Bifidobacterium animalis subsp. lactis Probiotic in Experimental Periodontitis. J Periodontol2017;88(2):197-208.
23. Krasse P, Carlsson B, Dahl C, Paulsson A, Nilsson A, Sinkiewicz G. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. Swed Dent J2006;30(2):55-60.
24. Twetman S, Derawi B, Keller M, Ekstrand K, Yucel-Lindberg T, Stecksen-Blicks C. Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid. Acta Odontol Scand2009;67(1):19-24.
25. Nadkerny PV, Ravishankar PL, Pramod V, Agarwal LA, Bhandari S. A comparative evaluation of the efficacy of probiotic and chlorhexidine mouthrinses on clinical inflammatory parameters of gingivitis: A randomized controlled clinical study. J Indian Soc Periodontol2015;19(6):633-9.
26. Hallström H, Lindgren S, Yucel-Lindberg T, Dahlén G, Renvert S, Twetman S. Effect of probiotic lozenges on inflammatory reactions and oral biofilm during experimental gingivitis. Acta Odontol Scand 2013;71(3-4):828-33.
27. Staab B, Eick S, Knöfler G, Jentsch H. The influence of a probiotic milk drink on the development of gingivitis: a pilot study. J Clin Periodontol2009;36(10):850-6.
28. Iniesta M, Herrera D, Montero E, Zurbriggen M, Matos AR, Marín MJ, et al. Probiotic effects of orally administered Lactobacillus reuteri-containing tablets on the subgingival and salivary microbiota in patients with gingivitis. A randomized clinical trial. J Clin Periodontol2012;39(8):736-44.
29. Riccia DN, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Amicosante G, et al. Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis2007;13(4):376-85.
30. Shah MP, Gujjari SK, Chandrasekhar VS. Evaluation of the effect of probiotic (inersan®) alone, combination of probiotic with doxycycline and doxycycline alone on aggressive periodontitis - a clinical and microbiological study. J Clin Diagn Res2013;7(3):595-600.
31. Shimauchi H, Mayanagi G, Nakaya S, Minamibuchi M, Ito Y, Yamaki K, et al. Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21: a randomized, double-blind, placebo-controlled study. J Clin Periodontol 2008;35(10):897-905.
32. Vivekananda MR, Vandana KL, Bhat KG. Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. J Oral Microbiol2010;2.
33. Teughels W, Durukan A, Ozcelik O, Pauwels M, Quirynen M, Haytac MC. Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol2013;40(11): 1025-35.
34. Vicario M, Santos A, Violant D, Nart J, Giner L. Clinical changes in periodontal subjects with the probiotic Lactobacillus reuteri Prodentis: a preliminary randomized clinical trial. Acta Odontol Scand2013;71(3-4):813-9.
35. Szkaradkiewicz AK, Stopa J, Karpiński TM. Effect of oral administration involving a probiotic strain of Lactobacillus reuteri on pro-inflammatory cytokine response in patients with chronic periodontitis. Arch Immunol Ther Exp (Warsz) 2014;62(6):495-500.
36. İnce G, Gürsoy H, İpçi Ş D, Cakar G, Emekli-Alturfan E, Yılmaz S. Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis. J Periodontol2015;86(6):746-54.
37. Tekce M, Ince G, Gursoy H, Dirikan Ipci S, Cakar G, Kadir T, et al. Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study. J Clin Periodontol2015;42(4):363-72.
38. Iwasaki K, Maeda K, Hidaka K, Nemoto K, Hirose Y, Deguchi S. Daily Intake of Heat-killed Lactobacillus plantarum L-137 Decreases the Probing Depth in Patients Undergoing Supportive Periodontal Therapy. Oral Health Prev Dent2016;14(3):207-14.
39. Morales A, Carvajal P, Silva N, Hernandez M, Godoy C, Rodriguez G, et al. Clinical Effects of Lactobacillus rhamnosus in Non-Surgical Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Trial With 1-Year Follow-Up. J Periodontol2016;87(8): 944-52.
40. Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, et al. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol2018;45(10):1198-210.
41. Mayanagi G, Kimura M, Nakaya S, Hirata H, Sakamoto M, Benno Y, et al. Probiotic effects of orally administered Lactobacillus salivarius WB21-containing tablets on periodontopathic bacteria: a double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol2009;36(6):506-13.
42. Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol2016;43(6):520-30.
43. Ikram S, Hassan N, Raffat MA, Mirza S, Akram Z. Systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials using probiotics in chronic periodontitis. J Investig Clin Dent2018;9(3):e12338.
44. Matsubara VH, Bandara HM, Ishikawa KH, Mayer MP, Samaranayake LP. The role of probiotic bacteria in managing periodontal disease: a systematic review. Expert Rev Anti Infect Ther 2016;14(7):643-55.
45. Slawik S, Staufenbiel I, Schilke R, Nicksch S, Weinspach K, Stiesch M, et al. Probiotics affect the clinical inflammatory parameters of experimental gingivitis in humans. Eur J Clin Nutr2011;65(7):857-63.
46. Penala S, Kalakonda B, Pathakota KR, Jayakumar A, Koppolu P, Lakshmi BV, et al. Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial. J Res Pharm Pract2016;5(2):86-93.
2. สำนักทันตสาธารณสุข, กรมอนามัย, กระทรวงสาธารณสุข. รายงานผลการสำรวจสภาวะสุขภาพช่องปากแห่งชาติ ครั้งที่ 8 ประเทศไทย พ.ศ. 2560. บริษัท สามเจริญพาณิชย์ (กรุงเทพ) จำกัด นนทบุรี; 2561.
3. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL, Jr. Microbial complexes in subgingival plaque. J Clin Periodontol1998;25(2):134-44.
4. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res1994;8(2):263-71.
5. Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: the polymicrobial synergy and dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol 2012;27(6):409-19.
6. Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control. II: As observed on extracted teeth. J Periodontol1978;49(3):119-34.
7. Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent1981;1(5):30-41.
8. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B. Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol1984;11(3):193-207.
9. Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, et al. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc2015;146(7):508-24.e5.
10. FAO/WHO. Health and nutritional properties and guidelines for evaluation - Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food including Powder Milk with Live Lactic Acid Bacteria. 2006Report No.: 92-5-105513-0.
11. Laleman I, Teughels W. Probiotics in the dental practice: a review. Quintessence Int2015;46(3):255-64.
12. Teughels W, Loozen G, Quirynen M. Do probiotics offer opportunities to manipulate the periodontal oral microbiota? J Clin Periodontol2011;38 Suppl 11:159-77.
13. Kõll-Klais P, Mändar R, Leibur E, Marcotte H, Hammarström L, Mikelsaar M. Oral lactobacilli in chronic periodontitis and periodontal health: species composition and antimicrobial activity. Oral Microbiol Immunol2005;20(6):354-61.
14. Boyle RJ, Robins-Browne RM, Tang ML. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006;83(6):1256-64; quiz 446-7.
15. Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S, et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999;28(5):1159-60.
16. Mattia A, Merker R. Regulation of probiotic substances as ingredients in foods: premarket approval or "generally recognized as safe" notification. Clin Infect Dis. 2008;46 Suppl 2:S115-8; discussion S44-51.
17. van Essche M, Loozen G, Godts C, Boon N, Pauwels M, Quirynen M, et al. Bacterial antagonism against periodontopathogens. J Periodontol2013;84(6):801-11.
18. Zhu Y, Xiao L, Shen D, Hao Y. Competition between yogurt probiotics and periodontal pathogens in vitro. Acta Odontol Scand2010;68(5):261-8.
19. Teughels W, Newman MG, Coucke W, Haffajee AD, Van Der Mei HC, Haake SK, et al. Guiding periodontal pocket recolonization: a proof of concept. J Dent Res2007;86(11):1078-82.
20. Messora MR, Oliveira LF, Foureaux RC, Taba M, Jr., Zangerônimo MG, Furlaneto FA, et al. Probiotic therapy reduces periodontal tissue destruction and improves the intestinal morphology in rats with ligature-induced periodontitis. J Periodontol2013;84(12):1818-26.
21. Maekawa T, Hajishengallis G. Topical treatment with probiotic Lactobacillus brevis CD2 inhibits experimental periodontal inflammation and bone loss. J Periodontal Res 2014;49(6):785-91.
22. Oliveira LF, Salvador SL, Silva PH, Furlaneto FA, Figueiredo L, Casarin R, et al. Benefits of Bifidobacterium animalis subsp. lactis Probiotic in Experimental Periodontitis. J Periodontol2017;88(2):197-208.
23. Krasse P, Carlsson B, Dahl C, Paulsson A, Nilsson A, Sinkiewicz G. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. Swed Dent J2006;30(2):55-60.
24. Twetman S, Derawi B, Keller M, Ekstrand K, Yucel-Lindberg T, Stecksen-Blicks C. Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid. Acta Odontol Scand2009;67(1):19-24.
25. Nadkerny PV, Ravishankar PL, Pramod V, Agarwal LA, Bhandari S. A comparative evaluation of the efficacy of probiotic and chlorhexidine mouthrinses on clinical inflammatory parameters of gingivitis: A randomized controlled clinical study. J Indian Soc Periodontol2015;19(6):633-9.
26. Hallström H, Lindgren S, Yucel-Lindberg T, Dahlén G, Renvert S, Twetman S. Effect of probiotic lozenges on inflammatory reactions and oral biofilm during experimental gingivitis. Acta Odontol Scand 2013;71(3-4):828-33.
27. Staab B, Eick S, Knöfler G, Jentsch H. The influence of a probiotic milk drink on the development of gingivitis: a pilot study. J Clin Periodontol2009;36(10):850-6.
28. Iniesta M, Herrera D, Montero E, Zurbriggen M, Matos AR, Marín MJ, et al. Probiotic effects of orally administered Lactobacillus reuteri-containing tablets on the subgingival and salivary microbiota in patients with gingivitis. A randomized clinical trial. J Clin Periodontol2012;39(8):736-44.
29. Riccia DN, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Amicosante G, et al. Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis2007;13(4):376-85.
30. Shah MP, Gujjari SK, Chandrasekhar VS. Evaluation of the effect of probiotic (inersan®) alone, combination of probiotic with doxycycline and doxycycline alone on aggressive periodontitis - a clinical and microbiological study. J Clin Diagn Res2013;7(3):595-600.
31. Shimauchi H, Mayanagi G, Nakaya S, Minamibuchi M, Ito Y, Yamaki K, et al. Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21: a randomized, double-blind, placebo-controlled study. J Clin Periodontol 2008;35(10):897-905.
32. Vivekananda MR, Vandana KL, Bhat KG. Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. J Oral Microbiol2010;2.
33. Teughels W, Durukan A, Ozcelik O, Pauwels M, Quirynen M, Haytac MC. Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol2013;40(11): 1025-35.
34. Vicario M, Santos A, Violant D, Nart J, Giner L. Clinical changes in periodontal subjects with the probiotic Lactobacillus reuteri Prodentis: a preliminary randomized clinical trial. Acta Odontol Scand2013;71(3-4):813-9.
35. Szkaradkiewicz AK, Stopa J, Karpiński TM. Effect of oral administration involving a probiotic strain of Lactobacillus reuteri on pro-inflammatory cytokine response in patients with chronic periodontitis. Arch Immunol Ther Exp (Warsz) 2014;62(6):495-500.
36. İnce G, Gürsoy H, İpçi Ş D, Cakar G, Emekli-Alturfan E, Yılmaz S. Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis. J Periodontol2015;86(6):746-54.
37. Tekce M, Ince G, Gursoy H, Dirikan Ipci S, Cakar G, Kadir T, et al. Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study. J Clin Periodontol2015;42(4):363-72.
38. Iwasaki K, Maeda K, Hidaka K, Nemoto K, Hirose Y, Deguchi S. Daily Intake of Heat-killed Lactobacillus plantarum L-137 Decreases the Probing Depth in Patients Undergoing Supportive Periodontal Therapy. Oral Health Prev Dent2016;14(3):207-14.
39. Morales A, Carvajal P, Silva N, Hernandez M, Godoy C, Rodriguez G, et al. Clinical Effects of Lactobacillus rhamnosus in Non-Surgical Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Trial With 1-Year Follow-Up. J Periodontol2016;87(8): 944-52.
40. Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, et al. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol2018;45(10):1198-210.
41. Mayanagi G, Kimura M, Nakaya S, Hirata H, Sakamoto M, Benno Y, et al. Probiotic effects of orally administered Lactobacillus salivarius WB21-containing tablets on periodontopathic bacteria: a double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol2009;36(6):506-13.
42. Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol2016;43(6):520-30.
43. Ikram S, Hassan N, Raffat MA, Mirza S, Akram Z. Systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials using probiotics in chronic periodontitis. J Investig Clin Dent2018;9(3):e12338.
44. Matsubara VH, Bandara HM, Ishikawa KH, Mayer MP, Samaranayake LP. The role of probiotic bacteria in managing periodontal disease: a systematic review. Expert Rev Anti Infect Ther 2016;14(7):643-55.
45. Slawik S, Staufenbiel I, Schilke R, Nicksch S, Weinspach K, Stiesch M, et al. Probiotics affect the clinical inflammatory parameters of experimental gingivitis in humans. Eur J Clin Nutr2011;65(7):857-63.
46. Penala S, Kalakonda B, Pathakota KR, Jayakumar A, Koppolu P, Lakshmi BV, et al. Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial. J Res Pharm Pract2016;5(2):86-93.
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เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นลิขสิทธิ์ของมหาราชนครศรีธรรมราชเวชสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากวารสารมหาราชนครศรีธรรมราชเวชสาร ก่อนเท่านั้น
