牙周基础治疗对龈下牙周致病菌的影响

人类口腔是一个复杂的生态环境,许多研究证明龈下菌斑是引起和加重牙周炎的重要因素之一.目前已在口腔中发现700余种细菌,其中30余种与牙周病有关,因此学者们提出清除牙周致病菌是牙周病治疗的基础.龈下刮治和根面平整术作为一种已经被广泛认可的控制牙周致病菌的方法,在牙周病的临床治疗中被大量地应用.本文主要从以下几方面综述:①牙周致病菌的概念和特点;②龈下刮治和根面平整术在龈下牙周致病菌的消除和控制中的作用;③龈下刮治和根面平整术在龈下牙周致病菌的消除和控制中的不足.     

Effect on periodontal status of rotary electric toothbrushes vs. manual toothbrushes during periodontal maintenance. I. Clinical results

The purpose of this study was to compare the Rotadent rotary electric toothbrush with conventional toothbrushing for its effectiveness in controlling supragingival plaque and gingival inflammation in periodontal maintenance patients. Forty subjects who had received periodontal treatment, including periodontal surgery, for moderate to advanced periodontitis and were on a 3-month periodontal maintenance were divided into two equal groups matched for age and sex. One group used conventional toothbrushing, dental floss, and toothpicks and the other used only the rotary electric toothbrush for a 12-month study period. Single-blind clinical assessments (Plaque Index, Gingival Index, bleeding tendency, pocket depth, and loss of attachment) were made at baseline and at 3, 6, 9, and 12 months after baseline. Subgingival debridement was performed 1 week after the baseline assessment and the 6- and 12-month examinations. Plaque removal was reinforced at 3-month intervals. Both groups had significantly improved scores (P less than 0.01) for Gingival Index and bleeding tendency during the 12-month period, but no differences were found between the groups at any examination. These results indicate that the rotary electric toothbrush is as effective for plaque removal and control of gingival inflammation as a combination of conventional toothbrushing, flossing, and toothpicks for patients in periodontal maintenance.     

Effects of xylitol impregnated toothbrushes on periodontal status and microbial flora in orthodontic patients

ObjectivesTo investigate whether the use of xylitol-impregnated toothbrushes affects periodontal condition and microbial flora in orthodontic patients with poor oral hygiene.Materials and MethodsForty-four patients with baseline mean Turesky plaque index scores ≥1.5 were randomly divided into two groups. Half received xylitol-containing toothbrushes and the other half, xylitol-free toothbrushes. The periodontal measurements and saliva samples were taken at baseline (T0), 1 month later (T1), and 3 months after brushing (T2) to evaluate periodontal health and microflora changes. Periodontal status was assessed with plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores. Data were statistically analyzed with Mann-Whitney U and Friedman tests.ResultsAll periodontal parameters significantly decreased from T0 to T1 and from T0 to T2 in both groups. The PI and GI scores reduced significantly in the control group, while BOP scores reduced in both groups between T1 and T2. Intergroup comparisons showed significant differences for BOP, PI, and GI at T0, T1, and T2 times, respectively. For microbial parameters, there were no statistically significant differences within groups from T0 to T1. Total bacterial counts significantly decreased in the xylitol group between T1 and T2. Decreases in Streptococcus mutans and total bacteria were significant in both groups from T0 to T2. No significant differences were found between the groups in microbial flora at any time.ConclusionsA 3-month use of xylitol-containing toothbrushes showed almost the same changes and provided no positive effects on periodontal and microbial parameters compared to the control group.     

Effect of periodontal status of rotary electric toothbrushes vs. manual toothbrushes during periodontal maintenance. II. Microbiological results

We compared the use of a rotary electric toothbrush with conventional toothbrushing for their effectiveness in modulating the subgingival microbiota. Forty subjects who had received periodontal treatment for moderate to advanced periodontitis and were on 3-month periodontal maintenance were divided into two equal groups matched for age and sex. One group used only the rotary tooth cleaner and the other group used conventional toothbrushing, dental floss, and toothpicks for 12 months. Subgingival plaque samples (two sites per patient) were taken from 10 subjects per group at baseline, 6 months, and 12 months and analyzed for percentage of obligate anaerobes and colony-forming units of black-pigmented Bacteroides, Fusobacterium, Actinomyces, Streptococcus, and Veillonella spp. The percentage of spirochetes and motile rods was determined by darkfield microscopy. Results showed that levels of obligate anaerobes, Fusobacterium, and Actinomyces and percentage of spirochetes and motile rods decreased significantly (P less than 0.05), while levels of Streptococcus spp. increased (P less than 0.05) for both groups. However, there was no significant difference between the two groups, indicating that the rotary tooth cleaner and conventional toothbrushing are equally effective in controlling gingivitis and fostering a less pathogenic microflora.     

The effects of toothpastes on the residual microbial contamination of toothbrushes

BACKGROUND: Contaminated toothbrushes have been shown to harbor and transmit viruses and bacteria. The authors conducted a study to evaluate the effect of a triclosan-containing toothpaste on the residual anaerobic microbial contamination of toothbrushes. METHODS: Twenty patients who had Type III or Type IV periodontitis participated in this study. One side of each of their mouths served as a control (no toothpaste). The teeth on the other side were brushed with a regular toothpaste or a triclosan-containing toothpaste. After the toothbrushes were allowed to dry in air for four hours, the authors placed the toothbrush heads in solution, dislodged the microbes from the brushes by vortexing and plated them in culture dishes. The authors anerobically incubated the culture dishes and determined the presence or absence of Prevotella species or Ps; Porphyromonas gingivalis, or Pg; and Actinobacillus actinomycetemcomitans, or Aa. RESULTS: The authors detected Aa and Pg on the control toothbrushes more frequently than they did Ps. This variation in isolation frequency was statistically significant by chi 2 analysis (P < .001). The authors compared the isolation frequency of the three test organisms between the control and regular-toothpaste groups, between the control and triclosan-containing--toothpaste groups, and between the triclosan-containing--toothpaste and regular-toothpaste groups. They found no significant intergroup differences in the isolation frequencies after using chi 2 analysis. CONCLUSIONS: Toothpaste use reduced the residual microbial contamination for two of three test organisms, but the lower isolation frequencies were not statistically significant. Further study in this area is indicated. CLINICAL IMPLICATIONS: Dental professionals should advise patients who have systemic, localized or oral inflammatory diseases to disinfect or frequently replace their toothbrushes.     

牙周致病菌对各类抗菌药物敏感性和耐药性的研究进展

目前在临床广泛使用抗生素作为牙周炎的辅助治疗,包括抗生素的全身和局部应用。合理选择抗菌药物对于牙周炎的药物治疗效果至关重要。本文就牙周致病菌对各类抗菌药物的敏感性及抗菌药物治疗引起的细菌耐药性问题作一综述。     

CCL28 effects on periodontal pathogens

BACKGROUND: Chemokines are small proteins that signal to and attract cells of the immune system; they are vital components in the modulation of immunity and wound healing. A newly described chemokine was reported to have antibacterial and antifungal activity. This chemokine, chemokine (C-C motif) ligand 28 (CCL28; also called mucosae-associated epithelial chemokine), is secreted by mucosal epithelial cells and is found in saliva and in breast milk. The objective of this study was to test whether CCL28 has antibacterial activity against two anaerobic periodontal pathogens: Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. METHODS: We used a bacterial viability test, in which two fluorescent dyes are bound differentially to living and killed bacteria. We tested the bacteria at concentrations of 2 x 10(7)/ml, exposing them to CCL28 at concentrations from 0.04 to 10 microM. RESULTS: CCL28 was effective at killing both organisms. After 1 hour of exposure to the chemokine under appropriate oxygen conditions, the percentage of living organisms was reduced significantly for each species. We estimated the 50% effective concentration to be approximately 0.7 microM for P. gingivalis and approximately 2.0 microM for A. actinomycetemcomitans (N = five experiments each). We confirmed these observations using standard bacterial plating methods. CONCLUSION: Because this chemokine is secreted into the saliva, a reduction in salivary flow (as in xerostomia) may diminish the oral self-defense mechanisms by also reducing the exposure of bacteria to the antibacterial action of CCL28.     

光动力疗法对慢性牙周炎龈下牙周致病菌的影响

目的：应用PeriowaveTM光动力杀菌系统对慢性牙周炎患者进行治疗,通过龈下菌斑中牙周致病菌比例的变化,评价光动力疗法（photodynamic therapy,PDT）治疗慢性牙周炎的临床效果。方法：选取60名慢性牙周炎患者,分别给予SRP＋1次PDT（A组）、SRP＋2次PDT（B组）或单纯SRP（C组）治疗。利用real-time PCR技术检测A、B、C三组在治疗前、治疗后6周、治疗后12周龈下菌斑中牙周致病菌P.g、A.a、T.f所占比例的变化。结果：治疗后6周,A、B两组牙周致病菌P.g在总菌中的比例都有非常显著降低（p〈0.01）,C组有显著降低（p〈0.05）;治疗后12周,A、B组仍有非常显著的降低（p〈0.01）,与C组相比有非常显著差异（p〈0.01）,但A、B两组之间没有差异（p〉0.05）;而仅在治疗后12周,B组的A.a相对于总菌的比例与基线相比有显著降低（p〈0.05）,且这一变化显著大于A、C两组（p〈0.05）;在治疗后6周,A、B组T.f相对于总菌含量的下降与基线相比,明显大于C组（p〈0.05）,治疗后12周,A、B两组T.f相对于总菌的含量仍有非常显著的下降（p〈0.01）,但A组和B组之间都没有差异。结论：PDT对P.g、A.a和T.f3种牙周致病菌都有杀灭作用,但P.g、T.f对PDT更为敏感,PDT可以作为治疗慢性牙周炎的辅助方法。     

舌侧矫治器对牙周致病菌的影响

目的研究舌侧矫治器对患者牙周临床指标和牙周致病菌的影响。方法收集成年正畸治疗患者55例资料,28例使用颊侧矫治器作为对照组,27例使用舌侧矫治器作为试验组,于治疗前和治疗6个月后,分别记录菌斑指数、龈沟出血指数、探诊深度,PCR检测龈下菌斑中牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、伴放线放线杆菌(Actinobacillus actinomycetemcomtans,Aa)、福赛斯坦氏菌(Tannerella forsythensis,Tf)3种牙周致病菌的检出率。结果治疗6个月试验组菌斑指数、龈沟出血指数、探诊深度分别为2.36±0.71、2.05±0.49、(3.43±0.56)mm,对照组分别为1.86±0.44、1.67±0.25、(2.87±0.74)mm,2组间差异均有统计学意义(P<0.05);试验组Pg、Aa检出率分别为37.0%和22.2%,对照组的Pg、Aa检出率分别为14.3%和10.7%,试验组高于对照组(P<0.05)。结论舌侧矫治器,较颊侧矫治器,对牙周临床指标影响更大,可造成更多的牙周致病菌聚集。     

Influence of lingual appliances on periodontal pathogens

目的 研究舌侧矫治器对患者牙周临床指标和牙周致病菌的影响.方法 收集成年正畸治疗患者55例资料,28例使用颊侧矫治器作为对照组,27例使用舌侧矫治器作为试验组,于治疗前和治疗6个月后,分别记录菌斑指数、龈沟出血指数、探诊深度,PCR检测龈下菌斑中牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、伴放线放线杆菌(Actinobacillus actinomycetemcomtans,Aa)、福赛斯坦氏菌(Tannerella forsythensis,Tf)3种牙周致病菌的检出率.结果 治疗6个月试验组菌斑指数、龈沟出血指数、探诊深度分别为2.36±0.71、2.05±0.49、(3.43±0.56)mm,对照组分别为1.86±0.44、1.67±0.25、(2.87±0.74)mm,2组间差异均有统计学意义(P＜0.05);试验组Pg、Aa检出率分别为37.0％和22.2％,对照组的Pg、Aa检出率分别为14.3％和10.7％,试验组高于对照组(P＜0.05).结论 舌侧矫治器,较颊侧矫治器,对牙周临床指标影响更大,可造成更多的牙周致病菌聚集.     

Bacterial survival rate on toothbrushes and their decontamination with antimicrobial solutions

The purpose of this study was to evaluate bacterial survival rate on toothbrushes after brushing and the efficacy of their decontamination by spraying antimicrobial solutions. Thirty subjects were instructed to spray the solutions on toothbrush bristles after brushing. Each volunteer tested three sprays, one solution per week; the sprays were labeled spray 1 (cetylpyridinium chloride - CPC - and basic formulation), 2 (basic formulation only) and 3 (control - sterile tap water). At the end of each week, the brushes were collected and sonicated in Letheen Broth?; the suspensions were ten-fold diluted and the dilutions were plated on various culture media. Anaerobic bacteria, evaluated by colony count of black pigment producing organisms on Ask medium, were recovered from 83.3% of the samples, Streptococci from 80% and aerobic Gram-negative bacilli from 46.7% of them in the control tests. There was a significant decrease in toothbrush contamination with antimicrobial sprays 1 and 2, the first showing the greatest decrease on bacterial counts.     

Using antimicrobial agents to manage periodontal diseases

Periodontal diseases are bacterial infections and anti-microbials have been shown to be useful in their treatment and prevention. State-of-the-art treatment of refractory forms of destructive periodontal disease presently includes adjunctive use of systemic antibiotics directed to eliminating or suppressing pathogenic subgingival bacteria. Also, local application of antimicrobials by subgingival deposition or their use as irrigants during periodontal therapy are soon likely to be major components of anti-infective management of periodontal diseases. A new approach to anti-infective periodontal therapy combines ultrasonic surgical debridement with antimicrobial irrigation.     

Antibody responses to suspected periodontal pathogens in elderly subjects with periodontal disease

Abstract Little is known about the relationship of aging to periodontal disease. The immune response undergoes aging-related changes resulting in loss of functional capacity. The aim of this study was to investigate the relationship between levels of serum IgG antibodies against suspected periodontal pathogenic microorganisms to the presence or absence of periodontal disease in an elderly (65-75 yrs) population. From this study, we obtained information concerning: (1) the ability to differentiate elderly individuals without disease from those with disease by their levels of antibodies against periodontal pathogens and (2) which periodontal pathogen(s) triggered those responses. IgG anti- Porphyromonas gingivalis (strains W83 and 381) levels in the serum of elderly patients with severe periodontal disease were the only antibody responses measured which were elevated compared to the elderly control group of subjects with no periodontal disease. Anti- Prevoiella intermedia IgG levels in both elderly patient groups were depressed compared to anti- P. intermedia levels in the young normal control subjects. Serum IgG antibody levels to six other plaque microorganisms did not differentiate between diseased and normal, elderly or young subjects. This data suggested that P. gingtvalis was associated with periodontal disease in this elderly group of individuals and that those elderly individuals were able to respond with a normal IgG immune response.     

Direct microscopy of periodontal pathogens

Microscopic studies of the periodontal microbiota were among the first to demonstrate the existence of distinctive microbial populations in association with various states of periodontal disease and periodontal health. These findings led to further studies which indicated that conventional mechanical debridement is able to create shifts in the composition of the periodontal microbiota from a disease- to a health-associated one. Investigations of the distribution of certain bacterial morphotypes on selected tooth surfaces confirmed that significant differences exist in the composition of the microbiota between healthy and diseased sites; however, periodontal pockets of similar probing depths in the same subject had microbiotas that were more similar lo one another than to those of comparable pockets in other subjects. These findings lend support to the use of pooled microbial samples from selected surfaces with similar clinical characteristics. On the basis of microbial samples pooled in this manner, it was possible to demonstrate in patients previously treated for periodontitis, that those with elevated proportions of motile rods and spirochetes were more likely to develop subsequent recurrences of periodontitis than subjects with low proportions of these bacterial morphotypes. The predictive reliability of this microscopic assay markedly worsened in patients receiving regularly scheduled periodontal prophylaxes. This observation suggests that caution should be exercised in the utilization of potential diagnostic tests, if the object of the assay can be readily affected by environmental factors that do not affect the subject's susceptibility lo disease in a parallel manner.     

牙周可疑致病菌对胶原包被羟磷灰石黏附的体外实验研究

目的比较对牙根面具有黏附能力的具核梭杆菌、牙龈卟啉单胞菌、中间普氏菌和伴放线菌嗜血菌对胶原包被的羟磷灰石实验膜（C- HA）的黏附能力,初步探讨以上牙周可疑致病菌在牙根表面形成菌斑生物膜的能力。方法采用同位素闪烁计数法测定上述4种细菌黏附至C- HA表面的黏附量及黏附率,比较其黏附能力。结果培养相同时间,不论是培养24 h还是培养48 h,4种不同细菌两两比较,具核梭杆菌ATCC 10953和牙龈卟啉单胞菌ATCC 33277对C- HA表面黏附率的差异无统计学意义;中间普氏菌ATCC 25611和伴放线菌嗜血菌ATCC 29523的黏附率之间差异也无统计学意义,但是具核梭杆菌ATCC 10953和牙龈卟啉单胞菌ATCC 33277对C- HA表面的黏附率显著高于中间普氏菌ATCC 25611和伴放线菌嗜血菌ATCC 29523（P<0.001）。同一种细菌,在培养不同时间即培养24 h和48 h,对C- HA表面黏附率的差异均无统计学意义。结论不同的牙周可疑致病菌对胶原包被的羟磷灰石的选择性黏附作用不同,具核梭杆菌和牙龈卟啉单胞菌对胶原有较强的亲和作用,在细菌的局部定植过程和牙周炎的进展和复发中可能发挥重要作用。     

Source of suspected periodontal pathogens re-emerging after periodontal treatment

Abstract To clarify the source of re-emerging periodontal pathogens after treatment, we compared the ribotypes of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens group and Campylobacter rectus before and after treatment in 7 periodontitis patients and in 6 of the spouses. The patients harbored A. actinomycetemcomitans, P. gingivalis, P. intermedia/P. nigrescens group or C. rectus in their subgingival or salivary samples before treatment. The respective bacterial species were not detected 1 month after treatment, but reappeared by 6 months later. When available, 4 random colonies of each of the 4 species were isolated from both subgingival and salivary samples at each sampling occasion, the isolates were subcultured. identified and typed applying pheno- and genotypic intraspecies characterization methods. Altogether 90 strains of A. actinomycetemcomitans, P. gingivalis. P. intermedia, P. nigrescens group and C. rectus were available from 2, 3, 2 and 4 patients, respectively. The pre- and post-treatment ribotypes of A. actinomycetemcomitans-, P. gingivalis- and P. intermedia P. nigrescens group-isolates were identical in all respective patients. The pre- and post-treatment ribotypes of C. rectus were identical in 1 of 4 patients, whereas 2 patients harbored a previously not detected post-treatment ribotype and 1 patient harbored the initial and a previously not detected post-treatment ribotype. To study the possibility that periodontitis patients may acquire strains from the spouse after treatment, isolates of A. actinomycetemcomitans, P. gingivalis. P. intermedia/P. nigrescens group and C. rectus (n=95) from the patients' spouses were ribotyped and compared with those of the patients. The patient exhibited his own post-treatment ribotypes. different from those of the spouse, of A. actinomycetemcomitans and P. gingivalis in 1 couple and of P. intermedial, P. nigrescens group and C. rectus in 1 couple. In the 2 patients who harbored a previously not detected post-treatment ribotype of C. rectus. one patient shared the new ribotype with the spouse, whereas the other one did not. Although an exogenous source cannot be fully ruled out, the patient's own oral flora seems to be the main source of re-emerging periodontal pathogens after treatment.     

残根不同断面水平的牙周处理的疗效研究

目的 探讨残根不同断面水平的牙周处理的疗效作用,分析残根保留牙周手术适应证。 方法 85例患者(187颗患牙)入选本研究,根据残根断面位置和牙周手术方式分成三组：治疗1组（T1）67颗,PD≥3 mm,牙槽嵴顶至残根断缘距离≥4 mm,实施牙龈切除术;治疗2组（T2）71颗,PD<2 mm,牙槽嵴顶至残根断缘距离<3 mm,实施牙冠延长术;对照组49颗,PD<2 mm,牙槽嵴顶至残根断缘距离<3 mm,实施牙龈切除术;术后常规桩冠修复,观察术前、术后1周、4周、6个月和1年的SBI、GI和松动度,比较各组术后1周和1年成功率。 结果 残根保存率为97.3%;T1组和T2组在术后各时间点SBI、GI与对照组比较明显降低,在术后6个月和1年时松动牙所占比率比术前降低,对照组在6个月和1年时松动牙所占比率比术前增加;T1组和T2组术后1周和1年成功率显著高于对照组。 结论 残根不同断面水平采取不同牙周处理对残根保存修复有重要意义,可显著提高成功率。