纳米载药系统防治龋病和牙周病的研究进展

龋病和牙周病是严重危害口腔健康的常见慢性感染性疾病,菌斑生物膜中的细菌是其始动因子。由于口腔独特的生理、解剖等特点,化学药物作为牙菌斑控制方法之一在口腔应用中面临巨大挑战。纳米载药系统是运用纳米技术而产生的一系列粒径在纳米级的新型微小载药系统,具有靶向性、缓释性、生物降解等显著优点,在龋病和牙周病的防治中具有很多优势。本文就近年来纳米载药系统防治龋病和牙周病的研究进展作一综述。     

Tobacco smoking and supragingival dental calculus

Supragingival calculus is frequent in all ages from adolescence to old age. The influence of tobacco smoking on the occurrence and severity of supragingival calculus has received surprisingly little attention. The present investigation conducted in a population of 258 dentally aware individuals in the age range 20-69 years, was initiated to elucidate the relationship between tobacco smoking and supragingival calculus, taking into account possible confounding factors such as age, gender, oral hygiene and gingival inflammation. The calculus deposition was bilaterally assessed on the lingual surfaces of the mandibular anteriors and the vestibular surfaces of the maxillary premolars and molars. The overall prevalence of supragingival calculus was 69% ranging from 59% in age group 20-34 years to 84% in age group 50-69 years. The prevalence rates for current smokers, former smokers, and nonsmokers were 86%, 66%, and 65%. The differences between smoking groups were statistically significant (p<0.05). The influence of smoking was independent of age, plaque and gingival inflammation. In former smokers who had stopped smoking in the distant past, the occurrence and severity of supragingival calculus were very close to those in individuals who had never smoked, suggesting that the effect of smoking is reversible. The observations indicate a strong and independent association between tobacco smoking and supragingival calculus deposition. The avoidance of excess deposition of supragingival calculus, therefore, is a further argument for reducing smoking in the population.     

古菌与牙周病的关系

三域分类系统将古菌区别于真核生物和细菌。古菌可生存于极端的生态环境中,如高温、高盐度、高低酸碱度、低氧等环境,也可在普通环境下生长。古菌的细胞结构和分子代谢以及基因转录既不同于原核细胞也不同于真核细胞。用16SrRNA序列研究检测的方法可以检测出人体菌群中无法培养的古菌。牙周病患者口腔中检测出的产甲烷类古菌能加剧牙周组织的破坏,但至今尚未发现致病性的古菌。下面就古菌与牙周病关系的研究进展作一综述。     

Tobacco smoking and subgingival dental calculus

Objective: A radiographic investigation into the relationship between tobacco smoking and subgingival dental calculus was conducted in an adult population, including 48 current smokers, 57 former smokers, and 125 non‐smokers. Material and Methods: Assessment of subgingival calculus was based on a full set of radiographs. Mesial and distal root surfaces were assessed as to presence or absence of radiopaque deposits apical to the cemento‐enamel junction. The severity of subgingival calculus deposition, labeled subgingival calculus load, was estimated from both the total number and the proportion of proximal sites affected. Results: The overall prevalence of individuals exhibiting at least one subgingival calculus positive site was 43%, ranging from 15% in age stratum 20–34 years to 72% in age stratum 50–69 years. The prevalence among current smokers, former smokers, and non‐smokers was 71%, 53%, and 28%, respectively. The differences between smoking groups were statistically significant (p<0.001). The mean subgingival calculus load of current smokers, former smokers, and non‐smokers was 3.4, 1.2, and 0.6 affected sites per person, respectively, or expressed as mean proportions, 6.2%, 2.4%, and 1.1%, respectively. The association between smoking and subgingival calculus load was statistically significant (p<0.001). The subgingival calculus load increased with increasing smoking exposure, suggesting a dose–response relationship. Conclusion: The present observations in dentally aware adults indicate a strong and independent impact of tobacco smoking on subgingival calculus deposition.     

Effects of interdental cleaning devices in preventing dental caries and periodontal diseases: a scoping review

To identify and map existing evidence on the effectiveness of interdental cleaning devices in preventing dental caries and periodontal diseases, a scoping review was carried out by electronically searching PubMed, Scopus and Embase. Studies on interdental cleaning devices, written in English, and published from January 2008 up to April 2019 were included in the review. Of 1860 studies identified, six systematic reviews (SR) were included in the review. One SR each was on flossing, interdental brushes, wood sticks and oral irrigation. Of two SR on multitude of interdental cleaning devices, one assessed comparative efficacy while the other both the individual and comparative efficacy. All reviews had assessed the heterogeneity and the methodological quality of studies included, and performed data extraction and meta‐analysis where appropriate. Evidence ranged from weak to moderate with very low‐ to low‐certainty for the adjunctive benefit of these devices to control plaque and gingivitis. It warrants long‐term studies with sufficient power and those assessing the impact of interdental cleaning on interproximal caries to corroborate such evidence. Available evidence on the efficacy of interdental cleaning devices suggests that dental practitioners recommend patient‐specific interdental cleaning devices that enable patients to achieve a safe and high standard of interdental cleaning.     

Gingival recession and its association with calculus in subjects deprived of prophylactic dental care

Abstract. This paper describes the prevalence and severity of gingival recession in Tanzanian adults covering the age range from 20 to 64 years. In addition, it attempts to assess the relationship between the degree of gingival recession and the presence and amount of calculus. In the 20–34 years age group recession occurred in ≥32% of the buccal. ≥25% of the lingual, and ≥13% of the approximal surfaces. These %s increased to ≥64%, ≥52%, and ≥48%, respectively, in the 45–64 years age group. In the 20 34 years age group, lingual surfaces of mandibular incisors and canines followed by buccal surfaces of these teeth were the sites most severely affected with gingival recession. With increasing age, all sites became gradually more severely affected, particularly the buccal and lingual surfaces of the maxillary first molar. The lingual surfaces of mandibular incisors exhibited on an average 1.3 mm. 2.4 mm and 3.2 mm recession in the 20–34 years, 35–44 years and 45–64 years age group, respectively. Most of the correlation coefficients between gingival recession and calculus at the individual tooth surface in three age groups were statistically significant. The highest correlation coefficients (0.50–0.67) were found in the youngest (20–34 years) age group al the lingual surfaces of the mandibular incisors, canine and first premolar and al the buccal surfaces of the mandibular incisors. Based on these findings, the working hypothesis is advanced that longstanding calculus is an important determinant in the onset of gingival recession at sites exhibiting pronounced recession at a young age in populations deprived of prophylactic dental care.     

Serum antibodies to plaque bacteria in subjects with dental caries and gingivitis

abstract – Correlations were sought between indices of gingival inflammation and dental caries experience and serum antibody titers to five species of oral bacteria. The material comprised 53 young adult males. A statistically significant, negative correlation was observed between the antibody titer to a pool of Veillonella strains and dental caries experience. Multiple regression analyses failed to reveal significant associations between periodontal disease and serum antibody titers. However, the data suggested a combined association of the titers to the strains of Veillonella and a strain of Fusobacterium with the periodontal index.     

Why be down in the mouth? Three decades of research in oral microbiology

This paper describes some of the work done in the author's laboratory over the past 35 years. The research covers the following areas: the physiology of oral streptococci and their interactions; the physiology of some Gram-negative anaerobes and their interactions in relation to periodontal diseases; preventing the major dental diseases; and the future of oral microbiology.     

Energy intake, dental caries and periodontal disease in 11-year-old black children in two regions of Southern Africa: KwaZulu and Namibia

Abstract The study examined energy intake in relation to dental caries and periodontal disease in 11-yr-old rural and urban black children in low fluoride areas of KwaZulu and Namibia (0.15 ppm F) and one higher fluoride area of Namibia (1.56 ppm F). Twenty-four hour dietary recalls were conducted by trained interviewers and daily energy intake estimated using the MRC dietary analysis programme. DMFS was recorded according to WHO criteria; periodontal disease was measured using CPITN and SAS was used for statistical analysis. The prevalence of dental caries and periodontal disease (using CPITN), were compared within three energy groupings; ≤850 kcal/day; > 850, < 1400 kcal/day and ≥1400 kcal/day. The rural low fluoride Namibian children had the lowest mean energy intake (616 kcal/day), which also was the grouping with highest healthy periodontal prevalence (65%). The urban groups had higher energy intakes than the rural communities. Statistically significant effects on caries prevalence were seen for country and fluoride grouping; for periodontal disease, significant effects were noted for country, fluoride group and environment. Energy intake had no statistically significant effect, so this is not a risk marker for the disease.     

Management of shortened dental arches and periodontal health: 5‐year results of a randomised trial

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2‐1 to 2‐6, WO 677/2‐1.1 to 2‐2.1.; controlled‐trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre‐molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior‐most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL‐V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL‐V and PPD, significant differences were also found for the study jaw as a whole. For CAL‐V, the estimated group differences over 5 years amounted to 0·27 mm (95% CI 0·05; 0·48; P = 0·016) for the study jaw and 0·25 mm (95% CI 0·05; 0·45; P = 0·014) for the distal sites of the posterior‐most teeth. The respective values for PPD were 0·22 mm (95% CI 0·03; 0·41; P = 0·023) and 0·32 mm (95% CI 0·13; 0·5; P = 0·001). It can be concluded that even in a well‐maintained patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.     

A dental health study of children attending dental hospitals in Rangoon and Birmingham

abstract A survey of dental conditions at the dental hospitals in Rangoon and Birmingham was carried out on children of two different ethnic groups, Burmese (n= 284) and English (n= 289). Caries experience as measured by the average dmf counts of the primary teeth was lower in the Birmingham children aged 3 to 6 years, compared with the children of the same age range in Rangoon. Though the causes for the lower caries prevalence in the primary dentition of the English children compared with the Burmese children cannot be established with certainty, it is likely that the artificial fluoridation of drinking water in the Birmingham area since December 1964- may have played a part. The DMF scores of the permanent teeth in children aged 10 to 12 years, on the other hand, were considerably lower in Rangoon than in Birmingham. It may be suggested that the lower prevalence of dental caries in the permanent dentition among the Burmese children is related to the low intake of refined carbohydrates. Gingival conditions were worse in the Burmese children and for this the lack of artificial cleansing aids and knowledge of oral hygiene procedures was probably to blame. The dietary patterns in the two populations are discussed and it is suggested that they may be relevant to some of the differences in dental conditions.     

小分子化合物抗牙菌斑生物膜的研究进展

牙菌斑生物膜是引起龋病和牙周病的主要原因,生物膜中的细菌对抗生素和宿主防御的抵抗力显著高于浮游细菌.传统去除生物膜的方法存在许多不足之处,小分子化合物因细胞渗透性强和合成简单等优点,成为近年来研发生物膜抑制剂的热点.目前已经发现的小分子抗牙菌斑生物膜的化合物大致可分为三类:群体感应抑制剂、细菌粘附抑制剂和关键致病毒力因...     

Gingival inflammation and subgingival calculus as determinants of disease progression in early-onset periodontitis

Abstract. This study was undertaken to test the hypothesis that gingival inflammation and dental calculus are important determinants of the development and progression of early-onset periodontitis. The study sample included 156 individuals who were 13–20 years old at baseline and who were examined 2× during 6 years to assess the attachment loss, gingival state and the presence of dental calculus. 33 (21%), 62 (40%), and 61 (39%) individuals were classified as having localized, generalized, or incidental EOP, respectively. The results showed an increase in the % of teeth with overt gingivitis and subgingival calculus, and also an increase in the % of teeth showing attachment loss during the 6-year period in ail classification groups. Of teeth with 0–2 mm attachment loss at the beginning of the study and which developed ≥3 mm attachment loss during the following 6 years, there were 2× as many teeth with overt gingival inflammation, and 4× more teeth with subgingival calculus at baseline than teeth without. Gingivitis and subgingival calculus when present at both examinations resulted in a stronger association with the development of new lesions than presence of these variables at baseline. Teeth with gingivitis at baseline had a significantly higher mean attachment loss during 6 years than teeth without gingivitis (p<0.0001), and teeth with subgingival calculus at baseline had a significantly higher mean attachment loss than teeth without subgingival calculus (p<0.0001), The presence of gingivitis and subgingival calculus at baseline and 6 years later was associated with the occurrence of even higher disease progression during this period. The association between gingival inflammation and subgingival calculus and the development and progression of attachment loss during the study period in the generalized and the localized EOP groups was significantly higher than the association in the incidental EOP group. In an appreciable % of the sites in all 3 groups, however, the presence of the 2 factors was not associated with attachment loss during 6 years. The results suggest a significant association between gingival inflammation and subgingival calculus and the development and progression of early-onset periodontitis.     

Effectiveness of a dental education program on oral cleanliness of schoolchildren in Israel

The purpose of this study was to examine the effectiveness of a dental health education program providing dental health information and toothbrushing instruction on oral cleanliness. Two methods of instruction, individual and group instruction, are presented in this study. The plaque situation was assessed in a group of 175 children, 11-14 years of age, by the Patient Hygiene Performance (PHP) method at the beginning of the study and at 1, 2, and 12 months. It was found that immediately after instruction the dental health education program resulted in improved oral hygiene home care for the two experimental groups. However, the improvement noted was achieved regardless of the method of toothbrushing instruction (individual versus group). Moreover, it was demonstrated that maintenance of a satisfactory level of oral hygiene home care was dependent upon review of educational programs and toothbrushing instruction and not related to the method of instruction.     

Associations between the total fluoride content of dental plaque and individual caries experience in Australian children

Individual caries experience (DMFT) and the total fluoride content of dental plaque were determined for 72 schoolchildren, aged 9.7-13.0 years, lifelong residents in one of three New South Wales towns, where the fluoride levels of the reticulated water supplies were: Katoomba, less than 0.1 parts/10(6); Sydney, 1.0 parts/10(6) for 4 years; and Yass, 1.0 parts/10(6) for 16 years, prior to sampling. The mean fluoride content of plaque in Sydney (22.6, s.d. = +/- 16.8 parts/10(6)) and Yass (25.6, s.d. = +/- 16.4 parts/10(6)) differed significantly (t = 2.27, P less than 0.05 and t = 3.30, P less than 0.02, respectively) from that in Katoomba (13.5, s.d. = +/- 8.3 parts/10(6)). Significant inverse associations were demonstrated between total plaque fluoride and individual caries experience (DMFT) in Sydney (r = -0.45, P less than 0.025) and overall (r = -0.28, P less than 0.010). Inverse trends were established between plaque quantity (dry weight of plaque collected) and fluoride levels. No associations could be demonstrated between fluoride treatment (dentifrice, tablets or topical application) and plaque fluoride, DMFT or plaque quantity.     

Oral conditions and their social impact among HIV dental patients

This study aimed to assess oral health status and the social impact of oral conditions among dental patients with HIV infection in comparison with general dental patients receiving public-funded care in Adelaide, South Australia. DMFT and CPITN indices were recorded by one dentist at a clinic for HIV dental patients. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using the Oral Health Impact Profile questionnaire and responses from HIV dental patients were compared with responses from a telephone interview survey of Adelaide residents. HIV patients were aged 21 to 49 years (median *** 34), 90.7 per cent were male and 29.6 per cent had stage 4 HIV infection. Oral candida was present among 32.0 per cent, hairy leukoplakia among 24.1 per cent, HIV gingivitis among 18.5 per cent, and HIV periodontitis among 33.3 per cent. The DMFT index and its components did not differ significantly between HIV and general dental patients, while CPITN scores were lower among HIV patients (p = 0.01). However social impact among HIV patients was frequent: 64.6 per cent reported toothache, 43.7 per cent avoided foods, and 16.7 per cent avoided going out because of dental problems. HIV patients reported significantly greater levels of social impact than the Adelaide sample (p < 0.01). Patients to this clinic frequently presented with severe and disabling oral conditions which were not adequately captured using standard clinical indices.     

Tobacco‐induced suppression of the vascular response to dental plaque

Cigarette smoking presents oral health professionals with a clinical and research conundrum: reduced periodontal vascular responsiveness to the oral biofilm accompanied by increased susceptibility to destructive periodontal diseases. This presents a significant problem, hampering diagnosis and complicating treatment planning. The aim of this review is to summarize contemporary hypotheses that help to explain mechanistically the phenomenon of a suppressed bleeding response to dysbiotic plaque in the periodontia of smokers. The influence of smoke exposure on angiogenesis, innate cell function, the production of inflammatory mediators including cytokines and proteases, tobacco‐bacteria interactions, and potential genetic predisposition are discussed.