替硝唑棒局部应用治疗牙周周炎的细菌学研究

目的：探讨局部应用替硝唑棒对牙周炎病原菌的抗菌作用。方法：选择41例牙周炎患者，局部应用替硝唑棒和甲硝唑棒前后采集龈下细菌并分离、培养，测定产黑色素厌氧杆菌、梭杆菌、优杆菌等牙周病原菌的检出变化。结果：替硝唑棒对产黑色素厌氧杆菌、梭杆菌和普氏菌的清除率均高于甲硝唑棒。替硝唑棒和甲硝唑棒使用前后，龋下优势牙周病原菌的检出量均有显著性差异，但替硝唑棒的抗菌效果优于甲硝唑棒。结论：局部应用替硝唑棒对牙周病原菌有明显的抗菌作用。     

甲强复合凝胶治疗牙周炎的细菌学研究

目的:评价甲强复合凝胶对牙周炎病原菌的抗菌作用.方法:选择慢性牙周炎患者20例,选择其左右侧对应牙,局部应用甲强复合凝胶和甲硝唑前后采集龈下细菌并分离、培养.测定产黑色素厌杆菌、梭杆菌、优杆菌等牙周袋原菌的检出变化.结果:甲强复合凝胶对牙周炎病原菌的消除率均高于甲硝唑棒;甲强复合凝胶的抗菌效果优于甲硝唑,用药前后龈下优势牙周病原菌的检出量二者有显著性差异(P＜0.01).结论:局部应用甲强复合凝胶对牙周病原菌有明显的抗菌作用.     

替硝唑棒对牙周炎和冠周炎病原菌的抗菌作用

目的:评价替硝唑棒对牙周炎和冠周炎病原菌的抗菌作用。方法:(1)采用厌氧菌药物敏感试验的二倍琼脂稀释法测定替硝唑和甲硝唑对200株临床分离株的MIC50和MIC90。(2)采用厌氧菌培养方法测定51例牙周炎和冠周炎患者局部应用替硝唑和甲硝唑前后,牙周炎病原菌和冠周炎病原菌的变化。结果:替硝唑棒剂对牙龈卟啉单胞菌、中间普氏菌、梭杆菌和消化链球菌具有明显抗菌作用,其MIC50和MIC90分别为0.25、0.25、0.25、8 mg/L和0.5、0.5、1、8mg/L;其清除率为94.4％～100％,细菌数量均有明显减少。替硝唑对牙周炎和冠周炎病原菌的抗菌活性明显强于甲硝唑(P<0.05)。结论:局部应用替硝唑棒可明显抑制牙周炎和冠周炎的病原菌。     

替硝唑治疗成人牙周炎的疗效评价

为进一步观察替硝唑的临床疗效，作者应用替硝唑治疗５２例成人牙周炎患者，并以甲硝唑为对照，检测了治疗前后病变部位厌氧菌的变化。结果表明，替硝唑治疗成人牙周炎的疗效（显效率７３．１％）优于甲硝唑（４３．５％）。替硝唑对口腔厌氧菌的杀灭效果较甲硝唑好，特别对牙周炎的常见致病菌——牙龈类杆菌和产黑色素类杆菌的杀灭效果明显优于甲硝唑。     

68例慢性牙周炎患者龈下菌斑致病菌的分布及耐药性分析

目的：了解慢性牙周炎患者龈下菌斑可疑致病菌的分布及抗生素耐药情况,为临床治疗提供参考。方法对口腔门诊诊断为慢性牙周炎患者龈下菌斑中的致病菌进行分离培养,采用琼脂稀释法测定分离菌对甲硝唑、阿莫西林等10种常用抗生素的敏感性。结果从68例慢性牙周炎患者龈下菌斑中共分离到262株可疑致病菌,所有病例均检出有致病菌感染,其中以牙龈卟啉单胞菌和产黑色素普雷沃菌分离率较高,分别检出66.2%和60.3%,其次为伴放线嗜血杆菌（55.9%）、具核梭杆菌（51.5%）和消化链球菌（45.6%）等。药敏结果显示：所测菌株对硝基咪唑类药物敏感性较高,对甲硝唑、替硝唑、奥硝唑的敏感率均在90%以上,对阿莫西林/克拉维酸全部敏感,对阿奇霉素、米诺环素、克林霉素的敏感率在51%~78%之间,但对青霉素、红霉素耐药性高,敏感率仅分别为2.3%和17.9%。结论牙龈卟啉单胞菌、产黑色素普雷沃菌等菌为宁夏青铜峡市小坝地区慢性牙周炎患者龈下菌斑中主要的可疑致病菌,对阿莫西林/克拉维酸和硝基咪唑类药物普遍敏感。     

替硝唑棒治疗牙周炎、冠周炎近期疗效观察

口腔厌氧菌特别是牙龈卟啉单胞菌、中间普氏菌、梭杆菌等革兰氏阴性的无芽胞厌氧菌是牙周炎和冠周炎的主要病原菌 ,所以抗厌氧菌的硝基咪唑类药物甲硝唑 (ｍｅｔｒｏｎ ｉｄａｚｏｌｅ ,ＭＮＺ)被作为首选药物用于治疗牙周炎和冠周炎[1 ,2 ] 。临床用甲硝唑棒治疗牙周炎和冠周炎取得较好效果。替硝唑 (ｔｉｎｉｄａｚｏｌｅ ,ＴＮＺ)是 5＿硝基咪唑类新药 ,其抗厌氧菌作用为甲硝唑的 2～ 4倍[3 ] 。笔者将自制替硝唑棒局部应用治疗牙周炎和冠周炎 ,观察其近期疗效显著 ,现报道如下。1　材料和方法选择 2 0 0 0年 6～ 10月在成都市第九人民医…     

与青少年牙周炎有关的革兰氏阴性细菌的培养研究

本文报告应用选择性培养基和厌氧手套箱系统,研究与国内青少年牙周炎(JP)病人有关的革兰氏阴性茵群。对照组5个健康青年人龈下菌斑的培养结果显示:龈下茵斑内细菌量少,细菌种类也较少。10个JP病人14个疾病部位的研究结果表明:疾病区细菌量多,种类复杂。优势菌群主要为口类杆菌、产黑色素类杆菌和核粒梭杆菌。检出率和比例均远远高于其他种类的细菌。本研究无一例检出放线共生嗜血杆菌,提示该菌不是国内JP病人的主要致病菌。     

2型糖尿病患者慢性牙周炎龈下菌群分析

目的 :比较 2型糖尿病 (DM )慢性牙周炎与非糖尿病慢性牙周炎的龈下菌群 ,为牙周炎的防治提供参考。方法 :厌氧菌培养、PCR检测技术。结果 :①糖尿病慢性牙周炎与非糖尿病慢性牙周炎患者临床指标无明显差别 (P >0 .0 5 )。②糖尿病慢性牙周炎的龈下菌群与非糖尿病慢性牙周炎相似 ,以厌氧菌为主 ,兼有少量口腔链球菌 ;产黑色素类杆菌、核梭杆菌、二氧化碳噬纤维菌、中间普氏菌为牙周优势菌 (P <0 .0 1)。③糖尿病慢性牙周炎的龈下菌群厌氧菌总数、口腔链球菌总数、口腔乳杆菌及核梭杆菌数量少于非糖尿病慢性牙周炎者。结论 :2型糖尿病慢性牙周炎与非糖尿病慢性牙周炎龈下菌群相似 ,致病菌数量低于非糖尿病牙周炎患者。     

替硝唑甲硝唑对主要口腔致病厌氧菌株的MIC、MBC测定

替硝唑是继甲硝唑后研制成功的疗效高、疗程短、耐受性好的抗滴虫药物。对阴道滴虫、阿米巴等原生动物具有较高的省略,对厌氧菌群如产黑色素类杆菌群、脆弱类杆菌、梭形杆菌均有较强的抑菌杀菌作用。替硝唑用于牙周炎、冠周炎治疗总有效率高达97.1％,明显高于甲硝唑。本文实验测定替硝唑、甲硝唑对6株口腔重要厌氧菌的国际标准菌株的最低抑菌浓度(MIC)和最低杀菌浓度(MBC)。评价其对口腔优势厌氧菌的抑菌性能。     

牙周炎患者健康部位与病变部位龈下菌群细菌学研究

本研究着重比较牙周炎患者病变部位与健康部位龈下菌群的细菌组成差异,寻找优势菌及其相互关系.结果显示血链球菌是健康部位主要优势菌,血链球菌与产黑色素G~-厌氧杆菌部位百分比呈负相关,牙周可疑致病菌之间呈正相关关系.比较同一患者病变部位与健康部位龈下菌群变化,对研究牙周微生态环境有指导意义.     

三种硝基咪唑类药物对牙周病原菌的抗菌活性比较

目的：比较甲硝唑、替硝唑和奥硝唑对4种牙周优势病原菌的抗菌活性。方法：采用琼脂稀释法测定三种实验药物对牙龈卟啉单胞菌、中间普氏菌、具核梭杆菌和消化链球菌的最低抑菌浓度（MIC）。结果：甲硝唑对以上4种实验细菌的MIC90分别为0.125、0.5、0.5、1.0mg/L和0.125、0.5、1.0、4.0mg/L；替哨唑的MIC50和MIC90分别为0.062、0.25、0.125、0.25mg/L和0.125、0.25、0.25、0.5mg/L；奥硝唑的MIC50和MIC90分别为0.062、0.15、0.125、0.125mg/L和0.125、0.25、0.25、0.25mg/L。细菌浓度对其抗牙周病原菌的MCI值略有影响。结论：三种药物对牙周优势病原菌活性均较强，其大小依次为奥硝唑、替硝唑和甲硝唑。     

甲氧凝胶用于牙周炎辅助治疗的疗效观察

目的：评价甲氧凝胶作为牙周炎基础治疗辅助措施的临床效果。方法：选择成人牙周炎患者13例,每例患者口内至少有两个部位真性牙周袋≥4mm,共统计210个牙位点,基础治疗后,随机分为3组。试验组用甲氧凝胶,标准组用甲硝唑棒,对照组用空白凝胶,采用牙周代局部上药治疗,每周1次,共治疗12周。临床观察PD、PAL、GI、BOP、PLI等指标。结果：甲氧凝胶组和甲硝唑棒组各临床指标改善幸免优于对照组,但甲氧凝胶组和甲硝唑棒组间疗效无显著差异。结论：甲氧凝胶作为牙周炎基础治疗辅助措施是有效的。     

中间普氏菌在家庭成员牙周菌斑中的分布调查

目的：调查了解中间普氏菌在牙周健康人群中的分布状况。方法：收集符合纳入标准的６０个家庭、１８１例受试者的牙周颈缘龈上菌斑和龈下菌班，采用厌氧菌培养获得２７９株产黑色素的Ｇ＾－厌氧杆菌，然后进行产黑色素的Ｇ＾－厌氧杆菌的纯化培养及微量生化鉴定。结果：中间普氏菌在牙周较健康的父母和儿童牙周菌班中均可检出，儿童群体中中间普氏菌阳性率达７０．４９％，而成人群体中中间普氏菌阳性率为４３．３３％，二者有显著性     

替硝唑局部控释给药治疗牙周炎的应用研究

目的：观察替硝唑局部控释给药治疗牙周炎的临床疗效。方法：应用替硝唑棒缓释剂治疗45例成人牙周炎患者,并以口服替硝片剂为对照组,进行对比研究,检测了治疗前后牙周炎的各项指数以及病变部位厌氧菌的变化。结果：替硝唑棒治疗成人牙周炎的疗效显效率为93．33％,优于对照组73．33％。替硝唑局部给药对口腔厌氧菌的杀灭效果较口服替硝唑强,用药后无任何毒副作用。结论：替硝唑局部控释给药治疗牙周炎疗效显著,前景广阔。     

Specific antibiotics in the treatment of periodontitis--a proposed strategy

BACKGROUND: The purpose of the present study was to propose a strategy for the selection of antibiotics that specifically target complexes of periodontal pathogens present in patients with periodontitis. METHODS: Seven hundred seventy-four (774) patients with various forms of periodontitis were included in the study. Subgingival plaque samples were taken from the deepest periodontal pockets in each quadrant using a sterile curet, and pooled. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens, Tannerella forsythensis, Prevotella intermedia, and Prevotella nigrescens were identified by polymerase chain reaction, and the prevalence of combinations of these pathogens was determined. To each pathogen complex (PC), i.e., combination of pathogens, those antibiotics were assigned that were most specific according to the published minimum inhibitory concentration (MIC90) values and the gingival crevicular fluid (GCF) concentrations achievable in vivo. Antibiotic GCF concentrations had to be at least 10 times the MIC90 values, and the narrowest spectrum was selected with respect to the assessed periodontal pathogens. RESULTS: Nine major PCs (each > or = 3% of all patients) were found in 73.4% of all patients, whereas 38 minor PCs (each < 3% of all patients) were distributed in 26.6% of all patients. Ten different antibiotic regimens were found to be specific for the total of 46 PCs; i.e., metronidazole and amoxicillin in 11 PCs (55.0% of all patients), metronidazole and amoxicillin/clavulanic acid or metronidazole and ciprofloxacin in 13 PCs (18.9%), amoxicillin in 4 PCs (8.3%), doxycycline in 2 PCs (6.1%), metronidazole in 8 PCs (4.1%), amoxicillin/clavulanic acid in 3 PCs (2.9%), clindamycin in 2 PCs (1.5%), ciprofloxacin in 2 PCs (0.4%), and tetracycline in 1 PC (0.3%). CONCLUSION: The results of the study indicate that there are at least 46 different combinations of the assessed periodontal pathogens in subjects with periodontitis, and at least 10 different antibiotic regimens might be required to specifically target the various pathogen complexes.     

茶多酚对牙周主要病原菌的体外抗菌活性研究

目的　探讨茶多酚对牙周主要病原菌的抗菌活性。方法　采用琼脂稀释法药物敏感试验,测定茶多酚对牙周主要病原菌的最小抑菌浓度(MIC)。结果　茶多酚对99株牙周主要病原菌均有明显的抗菌作用,对牙龈卟啉单胞菌的MIC50 、MIC90 为2 5 0mg/L ,对中间普氏菌的MIC50 、MIC90 为5 0 0mg/L ,对产黑色素普氏菌、具核梭杆菌和生痰二氧化碳噬纤维菌的MIC50为5 0 0mg/L ,MIC90 为10 0 0mg/L。本实验中1×10 6CFU/ml与1×10 8CFU/ml细菌接种密度对茶多酚的MIC值无明显影响。结论　茶多酚对牙周主要病原菌具有抗菌活性。     

The microbial outcome observed with polymerase chain reaction in subjects with recurrent periodontal disease following local treatment with 25% metronidazole gel

The aim of this study was to evaluate the microbial outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel using the polymerase chain reaction (PCR). Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing a total of 40 sites, 2 in each patient, with pocket probing depth of > or = 5 mm were selected. One site randomly selected was treated with 25% metronidazole gel (test) and the other site with a placebo gel (control). A bacterial sample was collected on paperpoint from each test and control site at baseline and 12 weeks after treatment. The following pathogens were analysed and detected with PCR:Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.) and Prevotella nigrescens (P.n.). At baseline, A.a., P.g. and P.n. were detected in 30, 60 and 70% of all test sites and in 32, 58 and 21% of all control sites. There was a statistically significant difference between the test and control sites for P.n. at baseline. The major difference after treatment with 25% metronidazole gel was the increase of positive control sites for P.g. and P.n. However, there were no statistically significant differences in the occurrence rate of A.a., P.g. and P.n. at test and control sites after treatment. This study has shown that 25% metronidazole gel treatment did not seem to influence the microbial outcome, when PCR was used to analyse the presence/absence of A.a., P.g. and P.n. in this group of subjects with recurrent periodontal disease.     

Resistance profile survey of 50 periodontal strains of Actinobacillus actinomyectomcomitans.

BACKGROUND: Antibiotic resistance has been increasingly described among bacterial species colonizing periodontal pockets, particularly in Prevotella and Porphyromonas spp. strains producing beta-lactamases, and frequently associated with resistance to tetracycline and erythromycin. These resistance genes may be carried on motile genetic elements, or transposons, capable of interspecies and intergeneric transmission among bacterial strains colonizing a same ecological niche. The aim of this prospective study was to determine the resistance profile of Actinobacillus actinomycetemcomitans and the prevalence of A. actinomycetemcomitans strains producing beta-lactamases in periodontal pockets. METHODS: Fifty strains of A. actinomycetemcomitans were isolated from 42 patients with adult periodontitis. No patient had periodontal or antibiotic therapy in the previous 6 months. Bacterial samples were collected from periodontal pockets > or =5 mm, appropriately diluted, inoculated onto selective medium (chocolate blood agar with bacitracin 75 microg/ml and vancomycin 5 microm/ml) and incubated for 5 days at 37 degrees C in air with 5% CO2. After conventional identification, susceptibility testing to 11 antibiotics was performed by the broth dilution method, in trypticase soy broth supplemented with yeast extract, hemin, and 0.1% NaHCO3 to maintain microaerophilic conditions in the microtitration plate wells by CO2 formation. RESULTS: No strain demonstrated resistance to amoxicillin, amoxicillin-clavulanic acid combination, pristinamycin, or ciprofloxacin at the breakpoint, but 40% of the strains were slightly resistant to penicillin G, and 4% were resistant to erythromycin, 90% to spiramycin, 18% to clarythromycin, 4% to tetracycline, 72% to metronidazole, and 12% to ornidazole. Amoxicillin, followed by tetracycline and erythromycin, was the most effective antibiotic on A. actinomycetemcomitans. The phenotypic research of a beta-lactamase was negative for all the strains tested. CONCLUSIONS: In this work, most A. actinomycetemcomitans strains were resistant to metronidazole, but the amoxicillin-metronidazole association may be of interest against subgingival anaerobic and capnophilic mixed flora. Pristinamycin and ciprofloxacin appeared as effective alternative monotherapies against A. actinomycetemcomitans. The threat of beta-lactam antibiotic resistance related to beta-lactamase production is currently not a problem with A. actinomycetemcomitans as it has been reported in oral anaerobes.