口腔医学本科实习医师牙周探诊检查的准确性及影响因素分析

目的 评估口腔医学本科实习医师牙周邻面探诊的准确性并分析可能的影响因素,以期为牙周临床教学提供参考.方法 按照临床带教常规,选取北京大学口腔医学院38名初次进入牙周临床实习的本科生,每名实习医师均使用Williams刻度探针检查并记录1～2例(共58例)慢性牙周炎患者的探诊深度,教师进行重复探诊并加以核对,记录Ramfjord代表牙(6|14/41|6)邻面探诊深度的复核结果作为本项研究的结果数据.根据实习医师与教师探诊深度的差异,将所有位点分为完全一致位点(实习医师与教师探诊深度相同的位点)、基本一致位点(实习医师与教师探诊深度差异为1 mm的位点)和不一致位点(实习医师与教师探诊深度差异≥2 mm的位点).结果 随着牙周袋加深,学生的探诊准确性下降.完全一致位点百分比磨牙[58.8％ (261/444)]显著低于切牙[73.1％(339/464)],P＜0.01.实习医师邻面探诊不准确的最主要原因是不能探入龈谷,此项因素占70.7％ (87/123).结论 邻面探诊角度的培训应成为牙周临床前期探诊教学的重点,临床实习时教师需重点核查实习医师对深牙周袋和磨牙的邻面探诊.     

牙周袋内硫化物水平与牙周临床指数的关系

目的分析慢性牙周炎患者治疗前、后牙周袋内硫化物水平的变化及与牙周临床指数的关系。方法对35名慢性牙周炎患者,分别在牙周基础治疗前、治疗后2、6周、3个月时进行硫化物的检测和牙周探诊深度（probing depth,PD）和出血指数（bleeding index,BI）的检查。对所得数据进行分析。结果治疗前在PD≥4mm或BI≥2的位点,牙周袋内硫化物检出率和浓度明显高于PD〈4mm或BI〈2的位点（P〈0.05）;治疗后,硫化物水平和PD、BI均明显下降（P〈0.05）;治疗后3个月硫化物水平有上升趋势,但无统计学意义。牙周袋内硫化物水平与牙周炎严重程度之间有相关关系。在深牙周袋、出血的位点硫化物水平增高,治疗后牙周袋内硫化物水平与探诊深度、出血指数变化一致。结论牙周袋内硫化物水平的检测可反映牙周炎症的严重程度,并可作为判断牙周疗效的指标。     

对新一代Florida探针临床测量可重复性和舒适度的评价

目的：评价新一代Florida探针测量牙周袋深度的可重复性和舒适度。方法在基础治疗后3个月维护期内,选择35例牙周炎患者为研究对象,2位检查者先后使用普通探针与Florida探针重复测量每个位点的探诊深度各2次,分别比较2种探针测量牙周袋探诊深度的可重复性,及2位检查者使用同1种探针测量牙周袋探诊深度的可重复性。应用视觉模拟评分法,比较患者接受2种探针检查时的舒适度。结果新一代Florida探针与普通牙周探针测量的牙周袋探诊深度重复性均良好（P>0.05）,浅袋和中袋的可重复性比深袋更好（P<0.05）。但在不同测量者之间Florida探针可重复性略优于普通牙周探针（P<0.05）,且比使用普通牙周探针让患者感觉更舒适（P<0.05）。结论新一代Florida探针可可靠的在慢性牙周炎维护期患者的临床研究中使用。     

全瓷冠粘固前排龈对基牙牙周指数的影响

目的分析美学修复中全瓷冠粘固前排龈对牙周组织的影响。方法选择前牙全瓷冠修复患者80例,分为粘固前排龈组和不排龈组,每组各40例。所有患者均分别于粘固后1、3、6及12个月复查,观察记录各组不同时段临床各相关牙周指数的变化并进行统计学分析。结果牙周探诊深度在全瓷冠粘固后12个月,粘固前排龈组明显小于不排龈组,差异具有统计学意义(P<0.05)。菌斑指数和出血指数在全瓷冠粘固后6个月及12个月,粘固前排龈组明显小于不排龈组,差异具有统计学意义(P<0.05)。结论前牙全瓷修复体粘固前排龈能够有效减少牙周损伤,防止牙周疾病的发生。     

牙周基础治疗对药物性牙龈增生疗效的纵向观察

目的评价单纯牙周基础治疗对钙拮抗荆类药物导致的牙龈增生的治疗效果。方法选取钙拮抗荆类药物导致的牙龈增生患者13例，男8例，女5例，其中6例进行纵向观察，，在未停药的情况下进行牙周基础治疗，在治疗前和龈下刮治后1个月、3个月、6．5～29个月后记录牙龈增生指数、茵斑指数、出血指数和探诊深度。6名患者完成了纵向观察。结果在纵向观察期间，牙龈增生逐步减轻。在153个增生位点中，龈下刮治1个月后有69个位点痊愈，其中包括17个位点从2度、3度增生变为痊愈。3个月后痊愈的位点为105个，从2度、3度牙龈增生变为痊愈的位点数上升到41个。半年以上痊愈的位点数为122个，从2度、3度牙龈增生变为痊愈的位点数达50个。结论牙周基础治疗可改善钙拮抗剂药物引起牙龈增生的程度，其效果至少可保持半年以上。     

重度广泛型侵袭性牙周炎患者牙周序列治疗的临床研究

目的：观察重度广泛型侵袭性牙周炎（generalized aggressive periodontitis, GAgP）患者牙周序列治疗后临床指标的变化,并评价其治疗效果。方法：15例GAgP患者在龈上洁治后1个月内完成龈下刮治、根面平整及光动力治疗,刮治后4周再评估,行翻瓣及翻瓣植骨术,每3个月进行1次牙周维护,序列治疗后纵向观察12个月。在基线和维护期各时间点记录全口探诊深度（probing depth,PD）、探诊出血（bleeding on probing, BOP）和牙齿松动度,磨牙记录根分叉病变的程度。结果：在基线时患者平均PD（3．96±2．21）mm,BOP阳性位点占88．1％。序列治疗后12个月平均PD（2．36±1．28）mm,BOP阳性位点减少至8．7％,其中轻、中、重度位点治疗后PD值与治疗前比较差异有统计学意义（P〈0．05）。结论：GAgP患者经牙周序列治疗和定期牙周维护能取得良好的治疗效果。     

牙周探针及探诊技术的进展及临床应用

牙周病的正确诊断和治疗依赖规范化的牙周检查,在诸多的牙周检查中牙周探诊是最重要的检查方法之一。牙周探诊不仅可以探测牙龈出血、牙周袋深度、牙周附着水平,还可以探查袋内是否有牙石、是否出现根分叉病变等情况。文章就目前牙周探针及探诊技术的进展及临床应用做一介绍,以期牙周探诊技术在临床诊疗中发挥更大的作用。     

浅谈牙周病的临床诊断技术

牙周病的临床诊断技术是每个牙周病科医师需要掌握的基本功 ,其主要包括牙周探诊、咬合检查、松动度检查及Ｘ线片检查等。这些方法是制订最佳的牙周治疗措施的基础 ,临床医生必须熟练掌握并对检查结果加以综合分析 ,才能作出准确的诊断。同时在此基础上 ,优化治疗决策 ,以获得最佳临床疗效〔1〕。1　牙周探诊牙周探诊是牙周病诊断最重要和最常用的方法之一 ,主要包括探查牙周袋深度 ,附着水平和探诊出血情况等 ,其中牙周袋深度是指龈缘至袋底的距离 ,而附着水平是釉牙骨质界至袋底的距离。这些指征在评估牙周炎症程度和治疗效果方面有重要作…     

口腔卫生指导对慢性龈炎的临床疗效的影响

目的：探讨口腔卫生指导对慢性龈炎的临床疗效的影响。方法：采用随机分组法将100名慢性龈炎患者分为实验组和对照组。对照组行龈上洁治术和龈下刮治术,不作口腔卫生指导;实验组在龈上,下刮治后增加口腔卫生指导。分别于术后第1、2、4、12周通过探诊出血百分率来评价口腔卫生指导的效果。应用SPSS16.0软件对实验数据进行统计学分析。结果：在第1、2周,实验组与对照组相比探诊出血百分率无统计学差异（P〉0.05）,到第4、12周,实验组探诊出血百分率明显低于对照组,有统计学差异（P〈0.05）。结论：口腔卫生指导可以有效地控制探诊出血,从而影响慢性龈炎的远期临床疗效。     

牙周袋内硫化物与牙周状况的相关性研究

目的探讨牙周袋内硫化物（VSCS）与牙周状况的相关性。方法选择慢性牙周炎患者14例,慢性牙龈炎患者15例,对全口牙齿进行探诊深度及出血指数的检查,并用硫化物检测仪对牙周袋内VSCS进行测定。结果牙周袋内VSCS水平与探诊深度具有正相关性（P〈0.05）;牙周炎组VSCS阳性牙位率和阳性位点率与牙龈炎组具有非常显著性差异（P〈0.005）。结论牙周袋内VSCS测定可作为评价牙周状况的辅助指标之一。     

Evaluation of 2 methods to assess gingival bleeding in smokers and non-smokers in natural and experimental gingivitis

Abstract. The purpose of the present study was to compare the bleeding tendency as elicited by probing the marginal gingiva (BOMP) and probing to the bottom of the pocket (BOPP) in smokers and non-smokers in natural gingivitis and during experimental gingivitis, 11 smokers (sm) and 14 non-smokers (nsm) were recruited. When they had less than 20% approximal bleeding sites, they entered a 14-day trial period of experimental gingivitis'. Subjects returned 30 days later, after resuming normal oral hygiene procedures, for a final gingival assessment. A split-mouth design was chosen using 2 contra-lateral quadrants for each index (being either BOMP or BOPP). A consistently higher bleeding score of approximately 10% was observed by probing to the bottom of the pocket. At day 14 with both indices, a significant difference between smokers and non-smokers was detected (BOMP: sm=15%, nsm = 30%; BOPP: sm = 27%, nsm=44%). The increment between gingival health and experimental gingivitis was significantly higher in non-smokers than in smokers but comparable for both indices (BOMP: sm=8%, nsm = 23%; BOPP: sm=9%, nsm=26%). Probing to the bottom of the pocket results in significantly more bleeding in gingival health and gingivitis as compared to probing of the marginal gingiva. This shows that evaluation of the gingival condition with BOMP, the method of choice with respect to gingivitis, can be used as a parameter for inflammation when comparing smokers and nonsmokers. The suppressed inflammatory response to plaque accumulation, as observed in smokers, indicates that they should be identified as a separate group when they participate as panellists in (experimentally induced) gingivitis     

Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitis

AIM: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. METHODS EXPERIMENT 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. RESULTS EXPERIMENT 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). METHODS EXPERIMENT 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). RESULTS EXPERIMENT 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. CONCLUSION: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.     

Comparison of different approaches to assess bleeding on probing as indicators of gingivitis

Abstract. The purpose of this study was to evaluate different methods of eliciting gingival bleeding as indicators of gingival inflammation in the experimental gingivitis model. Following a period of stringent oral hygiene, 103 dental students were scored for plaque and gingival bleeding assessed by 4 methods. From this group, 41 volunteers were randomly allocated to 2 treatment groups. Dental students with clean teeth and healthy gingivae were asked to abolish all mechanical tooth cleaning in the lower jaw for a period of 3-weeks. During the 21-day experimental period, chlorhexidine (Peridex®) or a placebo mouthrinse was applied to the lower jaw. Subjects brushed the upper jaw with a standard toothpaste. In principal, 2 different methods were employed to provoke bleeding: (1) at the marginal gingival tissue by running a probe along the soft tissue wall at the orifice of the pocket, and (2) by probing to the "bottom" of the pocket. Variations in the methods were based on angulation (AngBI, ParBI) of the probe in relation to the tooth surface and to the probing force (PPBI.25N, PPBI.757V). 1 randomly selected quadrant in the lower jaw was scored using the AngBI. The opposing quadrant was scored with a randomly-allocated bleeding index, either ParBI, PPBI.25 N or PPBI.75 N . The results of this study confirm earlier findings that the angulation of the probe determines the number of sites with bleeding observed. It also indicates that bleeding as elicited by probing to the bottom of the pocket is a poor indicator of early gingivitis. It is recommended that gingivitis should be assessed by probing the marginal gingiva.     

Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants

Objectives: To assess the bleeding on probing (BOP) tendency and periodontal probe penetration when applying various probing forces at implant sites in patients with a high standard of oral hygiene with well-maintained peri-implant tissues.
Material and methods: Seventeen healthy patients with excellent oral hygiene in a maintenance program after having been treated for periodontitis or gingivitis were recruited. Missing teeth had been replaced using oral implants. The BOP and probing depth (PPD) were assessed at the mid-buccal, mid-oral, mesial and distal aspects of the buccal surfaces of each implant. Moreover, contralateral teeth were designated and assessed for BOP and PPD in the same locations and at the same observation visits. At each visit, implants and contralateral teeth were randomly assigned to one of the standardized probing forces (0.15 or 0.25 N). The second probing force was applied at the repetition of the examination 7 days later.
Results: Increasing the probing pressure by 0.1 N from 0.15 N resulted in an increase of BOP percentage by 13.7% and 6.6% for implants and contralateral teeth, respectively. There appeared to be a significant difference of the mean BOP percentage at implant and tooth sites when a probing pressure of 0.25 N was applied. A significantly deeper mean PPD at implant sites compared with tooth sites was found irrespective of the probing pressure applied.
Conclusions: The results of the present study demonstrated that 0.15 N might represent the threshold pressure to be applied to avoid false positive BOP readings around oral implants. Hence, probing around implants demonstrated a higher sensitivity compared with probing around teeth.     

Gingival bleeding on repeat probing after different time intervals in plaque-induced gingivitis

The aim of this study was to assess agreement and association of gingival bleeding after repeated probing at different time intervals in subjects with gingivitis. Twenty adults participated. Periodontal probing (P≈1.27 MPa) was conducted at six sites of every tooth present. Probing was repeated in different quadrants immediately after the first probing (T0), after 1 h (T1), 4 h (T4), and 24 h (T24). A total of 3,459 sites were probed twice. The mean proportion of sites bleeding on probing (BOP) was 0.23 (standard deviation 0.08, range 0.10–0.41). Probing itself had a significant effect on the results of repeated probing. For T0 through T24, respective mean differences of proportions were 0.04, 0.04, 0.01, and −0.03. Ninety-five percent repeatability coefficients of proportions were 0.17–0.18. Estimates of overall kappa were 0.390, 0.234, 0.233, and 0.046 for T0 through T4, respectively. Adjusted two-level binary response models revealed odds ratios (95% confidence interval) for BOP at T0 through T4 of 6.52 (4.34, 9.80), 3.23 (2.19, 4.76), 3.80 (2.63, 5.50), and 2.68 (1.85, 3.89). It was concluded that a certain degree of agreement of site-specific bleeding scores in subjects with plaque-induced gingivitis could be observed only if probing was repeated at once. Adjusted associations between repeat BOP were weak in general, but strongest immediately after first probing. There appears to be a significant effect of probing itself, which may last for more than 1 h, whereas 24-h results are obtained under different conditions.     

Bleeding on probing as it relates to probing pressure and gingival health

The present study was designed to determine the threshold pressure value to be applied in provoking bleeding on probing (BOP) in clinically healthy gingival units. 12 female dental hygiene students volunteered for the study. They were selected on the basis of excellent oral hygiene standards, absence of probing depths greater than 3 mm and absence of caries or dental restorations on smooth and proximal tooth surfaces. Applying a probing force of 0.25, 0.5, 0.75 and 1.0 N in one of the 4 jaw quadrants, respectively, on 2 different occasions with an interval of 10 days, bleeding on probing was assessed. Oral hygiene and gingival conditions were determined using the criteria of the plaque control record and the gingival index. On the basis of the BOP values, obtained using the lowest probing force (0.25 N), the subjects were divided into 2 groups: group 1 ("minimal BOP" value) consisted of 6 subjects yielding practically no bleeding (mean BOP = 0.9%) at both examinations, while the subjects of group 2 ("low BOP" value) had slightly higher BOP% (mean BOP = 13.4%). Both groups showed significant increase in mean BOP% with increasing probing force (0.9%-36.1% in group 1 and 13.4%-47.0% in group 2). Regression analysis revealed an almost linear correlation and a high correlation coefficient between BOP% and probing force. The comparison of the regression lines of the 2 groups showed almost identical slope inclination. However, slight differences in slope inclination were found for different sites: approximal sites clearly yielded steeper regression lines than buccal/oral sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relationship of "bleeding on probing" and "gingival index bleeding" as clinical parameters of gingival inflammation

Abstract Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E.= 1.36) BOP sites and 35.3% (S.E, = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with <4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PH. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1–2 mm). In contrast, when sites presenting with both BOP and GI bleeding were analyzed, the highest % of agreement (85,4%) was found for sites with PD >4.0 mm. In this gingivitis population group, it appears that BOP and GI bleeding evaluate distinct inflammatory1 conditions of the gingival tissues, and the relationship between the 2 clinical parameters may vary according to PD at the individual site examined.     

A combination of alleles 2 of interleukin (IL)-1A(-889) and IL-1B(+3954) is associated with lower gingival bleeding tendency in plaque-induced gingivitis in young adults of Arabic heritage

The aim of this study was to investigate the possible association of a distinct combination of polymorphisms in the interleukin (IL)-1 gene cluster on gingival bleeding tendency in young adult Arabs with plaque-induced gingivitis. Fifty otherwise healthy, nonsmoking volunteers, 19–28 years of age, participated. Clinical examinations included periodontal probing depth, bleeding on probing, and plaque index. Probing was done with a pressure-controlled probe at about 1.27 MPa. Examinations were repeated after 2 and 4 weeks. Polymorphisms in the IL-1 gene cluster were assessed using a reverse hybridization assay. A subject carrying alleles 2 at IL-1A ⁻⁸⁸⁹ and IL-1B ⁺³⁹⁵⁴ was designated genotype-positive. Twenty-six subjects were genotype-positive (52%). A repeated measures two-level (occasion, subject) model of the proportion of sites bleeding on probing, which was adjusted for gender, average plaque index, probing depth, and calculus, revealed a significantly lower proportion of bleeding sites in genotype-positive subjects (estimate −0.050, standard error 0.025, p < 0.05). Biserial correlations of bleeding proportions were high (0.71–0.78), confirming the steady-state plaque environment. It was concluded that inflammatory responses to dental plaque were considerably dampened in genotype-positive, nonsmoking young adults of Arabic heritage.     

Variance components of gingival thickness

OBJECTIVES: Distinct periodontal phenotypes have been identified by cluster analysis, which is an explorative method with very low external validity. The aim of the present study was to investigate variance components of facial gingival thickness in young adults with mild gingivitis. MATERIAL AND METHODS: Thirty-three non-smoking females, 18-23 years of age, with mild or moderate plaque-induced gingivitis participated. Gingival thickness was measured at every tooth present by use of ultrasound technology to the next 0.1 mm with a lowest measurement of 0.5 mm. Periodontal probing depth and clinical attachment level were measured with a pressure-controlled probe. Gingival bleeding index was assessed after probing on a 0-2 scale, where 1 was slight, and 2 was profuse bleeding on probing. The Silness-Loe plaque index was recorded. Multilevel variance components and random intercept models were built. RESULTS: A 2-level (subject, tooth) variance component model of gingival thickness without any explanatory variable revealed an intercept (mean) of 0.93 +/- 0.02 mm. Subject variation of gingival thickness amounted to 4.2% of the total variance. Addition of tooth- and subject-related covariates to the model revealed, after adjusting for tooth type, an association with periodontal probing depth (estimated coefficient 0.067 +/- 0.025), and considerable association with average bleeding index (-0.395 +/- 0.149) and plaque index (0.125 +/- 0.048). Variation at the tooth level was drastically reduced; subject variation amounted to 5.2%. CONCLUSION: Gingival thickness is mainly associated with tooth-related variables. Bleeding tendency is higher if gingiva is thin. Subject variability related to periodontal phenotype may add to the total variance, however, to a very low extent.     

Predicting gingivitis using visual gingival redness examination on 11 years old Japanese schoolchildren: A ROC analysis

AimsTo identify more reliable and cost-effective methods to detect gingivitis, such as visual examinations, questionnaires, and salivary occult blood tests (SOBT).MethodsSixty-five elementary school students in Yahiko Village, Niigata, Japan were recruited. Questionnaire was used to assess subjective gingival status. Hemoglobin (Hb) and lactate dehydrogenase (LDH) levels were measured by SOBT. Bleeding on marginal probing (BOMP) method at three labial sites per tooth for all anterior teeth was used to examine clinical gingiva condition. Occurrence of at least 1 site with BOMP positive was defined as gingivitis. Visual gingival redness examination was done at the same sites examined by probing.ResultsParticipants with gingivitis had higher numbers of sites with redness than those without [6 (0.25–12) vs 0 (0–2), p < 0.001]. Participants with more sites with redness had a 1.29-fold higher risk of suffering from gingivitis (p = 0.002). The overall model had a 77.3% probability of predicting a gingivitis event by the number of sites with gingival redness (p < 0.001). Highest Youden Index was 1.453, yielded from the cut-off value of 4–5 sites with gingival redness.Conclusion(s)This study found that a predictive model using visual gingival redness examination is a viable non-invasive screening test for gingivitis.