Ⅱ期牙周炎的临床诊断与治疗

2018年公布的牙周病和植体周病国际新分类对比1999年的牙周病分类系统有许多改变.旧分类系统中的"侵袭性牙周炎"和"慢性牙周炎"被归于一个类别(即牙周炎),并进行多维的分期分级描述.目前这种新分类已引入临床以指导实践,但许多口腔医生尚不熟悉.其中Ⅱ期牙周炎是中度牙周炎,此阶段炎症已对牙周组织造成一定损坏,若能早诊断、...     

侵袭性牙周炎病因的研究进展

侵袭性牙周炎（aggressive periodontitis,AgP）是牙周炎的一个亚类,典型的临床表现是快速进展的牙周结缔组织的破坏和牙槽骨的丧失,常发生于全身健康的年轻患者,具有一定的家族聚集性,不同于慢性牙周炎,对人类牙周系统危害较大,疗效欠佳。该命名于1999年由美国牙周病学会组织的牙周病分类国际研讨会上提出,包括了原分类的青少年牙周炎、快速进展性牙周炎和部分青春前期牙周炎。     

2018牙周病和植体周病国际新分类 ——牙周炎分期分级疾病定义系统临床应用体会

对比1999年牙周病分类体系,2018年公布的牙周病和植体周病国际新分类有许多改变,其中构建牙周炎分期分级疾病定义系统,对患者进行个性化的牙周炎定义尤其受到国内外牙周学者的关注。本文将简要介绍牙周炎分期分级疾病定义系统提出的背景、具体内容以及临床意义,同时尝试结合中国国情,探索牙周病新分类风险评估与预后判断的临床应用。     

牙龈卟啉单胞菌和伴放线聚集杆菌在江苏汉族牙周炎人群中的分布研究

目的:从龈下菌斑总菌数、牙龈卟啉单胞菌(P.gingivalis)、伴放线聚集杆菌(A.actinomycetemcomitans)及白细胞毒素(LTX)在江苏汉族牙周炎人群中分布的角度,比较牙周病2018年新分类与1999年分类.方法:纳入73名牙周炎患者和26名牙周健康者,分别按照牙周病2018年新分类与1999年...     

青少年牙周炎患者外周血白细胞及T淋巴细胞亚群的研究

本文应用单克隆抗体技术检测了２０例青少年牙周炎患者外周血Ｔ淋巴细胞亚群分类，同时用常规方法检测了其外周血白细胞计数与分类。结果表明：与正常对照组相比，青少年牙周炎患者总Ｔ细胞、Ｔ＾＋４、Ｔ＾＋８细胞百分率、Ｔ＾＋４／Ｔ＾＋８细胞比值、白细胞总数、中性粒细胞和淋巴细胞的百分率和绝对数无明显差异，青少年牙周炎发病的内在因素尚需进一步探索。     

牙周炎分类研究进展

牙周炎分类研究进展上海４１１医院海军口腔专科中心（２０００８１）陈铁楼综述第四军医大学口腔医学院周以钧赵瑞芳吴织芬校本文根据１９８９年世界牙周病学会（ｗｏｒｌｄｗｏｒｋｓｈｏｐｏｎＰｅｒｉｏｄｏｎｔｉｃｓ）对牙周炎的分类及其研究进展综述如下。一、成人...     

牙周非手术治疗对慢性牙周炎患者循环CD34+/CD309+/CD45-内皮祖细胞和氧化三甲胺的影响

目的:探讨牙周非手术治疗对慢性牙周炎患者的内皮功能以及血浆氧化三甲胺的影响.方法:2019年11月～2021年2月按照牙周炎新分类在中山大学附属第一医院招募III～IV期牙周炎患者68例,随机分为牙周非手术治疗组(34例)和对照组(34例),前者进行洁治术和刮治术,后者仅进行洁治术.分别在治疗前和治疗后3个月评估牙周状...     

早发性牙周炎病因研究进展

早发性牙周炎分类界限模糊,病因至今尚未完全明了,目前被认为是一种人类复杂性疾病。本文综述近年宿主遗传易感基因与组织解剖异常两方面的病因研究进展,旨在进一步阐明这种牙周炎的复杂病因,提高临床诊断防治水平。     

根分叉病变的临床诊疗思维

根分叉病变(furcation involvement)是牙周炎的病变和破坏波及多根牙的根分叉区, 在该处形成牙周袋、附着丧失及牙槽骨吸收, 是牙周炎较常见的伴发病变。根分叉病变程度可直接影响牙周炎预后, 而根分叉区解剖结构的特异性又大大增加了根分叉病变的治疗难度。因此, 根分叉病变的早期发现及治疗对牙周炎的预防和控制至关重要。本文简述根分叉病变的发生机制, 重点阐述该疾病的诊断、分类及治疗, 以期提高口腔医师对根分叉病变的临床诊疗水平。     

特异性促炎症消退介质在牙周炎中作用的研究进展

牙周炎是由牙菌斑生物膜引起的牙周支持组织的慢性炎症性疾病。特异性促炎症消退介质(SPM)是由多不饱和脂肪酸经酶促反应衍生而来的脂质介质,可积极调控炎症的消退,改变微生物组成,缓解疼痛并促进组织再生,有望在牙周炎防治中发挥辅助作用。本文就SPM的分类及作用机制进行综述,并总结了其在牙周组织炎症过程中作用的最新研究进展,以期为牙周炎发生发展机制的研究提供参考,为牙周炎的防治提供新的思路。     

Determination of smoking and obesity as periodontitis risks using the classification and regression tree method

BACKGROUND: A model that focuses on personal risk factors associated with poor lifestyle has been proposed for the etiology of generalized periodontitis. Numerous investigations have linked individual lifestyle-related factors to periodontitis risk; however, a definite relationship among lifestyle-related factors remains unclear. The objective of this study was to determine which lifestyle-related factors demonstrated the greater impact on periodontitis risk. METHODS: The association of lifestyle-related factors, such as smoking status and obesity, with periodontitis was assessed in 372 Japanese workers via a self-administered questionnaire. Smoking status and obesity were evaluated in terms of pack-years and body mass index (BMI), respectively. Clinical periodontal examination included probing depth (PD). The effective impact on periodontitis risk was analyzed by the classification and regression tree (CART) method and multiple logistic regression analysis. RESULTS: Simple logistic regression analyses revealed that factors such as age, gender, alcohol consumption, smoking status, BMI, and frequency of toothbrushing were associated with periodontitis. CART results demonstrated a significant correlation between periodontitis and pack-years, BMI, and age; in contrast, alcohol consumption, gender, and toothbrushing frequency were not correlated with periodontitis. The strongest factor for periodontitis risk was pack-years of smoking. Additionally, both pack-years and BMI exhibited clear dose-response relationships with periodontitis. These relationships were maintained despite adjustment for known confounding factors. CONCLUSIONS: Smoking displays the greatest impact on periodontitis among lifestyle-related factors. Both smoking and obesity are independent risk indicators for periodontitis; moreover, these parameters exhibit a dose-response relationship with respect to periodontitis risk.     

Lysozyme and lactoferrin quantitation in the crevicular fluid

This study was designed to determine if quantitation of lysosomal products in crevicular fluid may be useful as a diagnostic test to evaluate clinical status in periodontal disease. Levels of lysozyme and lactoferrin were quantitated in crevicular fluid from patients with gingivitis, generalized adult periodontitis, localized juvenile periodontitis and normals. Crevicular fluid (CF) was collected from each patient by standardized filter paper strips and evaluated for lysozyme and lactoferrin by rocket immunoelectrophoresis. Levels of lysozyme (micrograms of protein per microliter of CF) were significantly higher in localized juvenile periodontitis patients as compared to gingivitis and adult periodontitis. On the other hand, levels of lactoferrin (micrograms of protein per microliter of CF) did not show significant differences between gingivitis, adult periodontitis and localized juvenile periodontitis. These results indicate that a lysozyme to lactoferrin ratio could be of value as a diagnostic test for localized juvenile periodontitis patients.     

Localized juvenile periodontitis or localized aggressive periodontitis

In general, the new term "localized aggressive periodontitis" replaces what was previously known as "localized juvenile periodontitis." Similarly, "generalized aggressive periodontitis" replaces what used to be called "generalized juvenile periodontitis." Aggressive periodontitis is a specific type of periodontitis with clearly identifiable clinical and laboratory findings, making it sufficiently different from chronic periodontitis and warranting separate classification. Not all the characteristics must be present to assign a diagnosis or classify the disease. The diagnosis may be based on clinical, radiographic, and historical data, and laboratory testing may not be essential for assigning a diagnosis.     

Recent epidemiologic trends in periodontitis in the USA

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial-mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full-mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009-2014, yielding complete data for 10 683 dentate community-dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009-2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%-15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self-reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state-based surveys. These items were also included in the 2009-2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30-79 years is better understood because of application of valid periodontitis case definitions to full-mouth periodontal examination, in combination with reliable information on demographic and health-related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.     

Microbiology and management of periodontal infections

The term periodontal disease refers to all diseases that involve the supportive structures of the periodontium. Peridontal diseases commonly begin as a gingivitis and progress to periodontitis. Necrotizing ulcerative gingivitis (NUG) is the most fulminate form of gingivitis. The two main forms of periodontitis are chronic periodontitis (also known as adult periodontitis) and aggressive periodontitis (also known as early onset periodontitis, destructive periodontitis, and juvenile periodontitis). Gingivitis treatment involves removing dental plaques and maintaining good oral hygiene. Periodontitis therapy should include root debriding, draining the infected root, and surgically resecting inflamed periodontal tissues. Systemic antimicrobials often are indicated in NUG, chronic periodontitis, and aggressive periodontitis. When possible, antimicrobial selection should be based upon culture and susceptibility testing of the subgingival flora.     

Periodontitis

The purpose of this review was to assess the scientific and clinical bases for the proposed classification of periodontitis. The clinical and histopathological signs and the etiology of periodontitis were described. Cross-sectional studies were analyzed to determine when onset of periodontitis most frequently occurs in adults. In addition, the progression rates of periodontitis have been assessed from longitudinal studies. No clinical, histopathological, or microbiological features could be identified that would characterize different disease entities of chronic periodontitis. The prevalence, extent, and severity of periodontitis were found to increase continually with higher age and there was no age when onset of disease would most likely occur. The rate of periodontitis progression varies largely between patients and there is no natural threshold for distinguishing various rates of disease progression. The incidence of periodontitis unresponsive to treatment depends on pretreatment progression rate, extent and severity of disease, tooth type, smoking, high levels of putative periodontal pathogens, a deficient immune response, and the type of therapy provided. There is no scientific basis for the classification "adult periodontitis" and "refractory adult periodontitis." Extensive clinical examinations are required for the diagnosis of "rapidly progressive adult periodontitis." It appears unrealistic that these examinations can be performed routinely in clinical practice. Therefore, the classification proposed by the Organizing Committee to define adult, rapidly progressive, and refractory periodontitis as specific disease entities was replaced with a simplified classification of periodontitis based on the scientific data available.     

Three case reports of aggressive periodontitis associated with Porphyromonas gingivalis in younger patients

The terms 'early onset periodontitis' (EOP) and 'juvenile periodontitis' (JP) were replaced by that of 'aggressive periodontitis' in a recent international workshop for the classification of periodontal diseases and conditions. The chief etiologic agent for aggressive periodontitis is considered to be Actinobacillus actinomycetemcomitans in localized juvenile periodontitis. Porphyromonas gingivalis is also mentioned as the etiologic agent of the aggressive periodontitis, although to date its role remains questionable. This communication describes three cases of aggressive periodontitis found to be associated with P. gingivalis but not A. actinomycetemcomitans by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). Our findings clarify the role of P. gingivalis as an etiologic agent in this type of periodontitis and confirm its inclusion in the current definition of aggressive periodontitis.     

Defining and classifying periodontitis: need for a paradigm shift?

The past two decades have witnessed a large number of proposals for the classification of periodontitis. These proposals are all founded in an essentialistic disease concept , according to which periodontitis is a link between the causes and the signs and symptoms of periodontitis. Essentialistic definitions are necessarily rather imprecise and thereby subject to multiple interpretations. Consequently, it remains unknown to what extent current knowledge regarding 'different' forms of periodontitis is based on the 'same' type of patients. However, periodontitis is a syndrome, the clinical manifestations of which may come in all sizes. Thereby, periodontitis has no diagnostic truth, just as there is no natural basis for a sharp distinction between health and disease or between 'different' forms of periodontitis. Recognition of these facts and adoption of a nominalistic approach to the definition of periodontitis is needed to provide a rational framework for the development of a classification system that meets the needs of both clinicians and scientists.     

Association Between High Serum Total Cholesterol and Periodontitis: National Health and Nutrition Examination Survey 2011 to 2012 Study of American Adults

Background: Clinical studies have suggested that lipids increase activity of white blood cells. The objective of this study is to examine whether high serum total cholesterol (STC) is associated with periodontitis. Methods: A total of 1,061 participants from the 2011 to 2012 National Health and Nutrition Examination Survey who underwent both periodontal examination and laboratory test for STC was included. To examine effects of high STC on periodontitis, odds ratios were calculated, adjusting for age, sex, education, income, smoking status, diabetes, body mass index, and calcium levels. Results: Statistically significant associations were observed between borderline as well as high STC and periodontitis. Study participants with STC between 200 and 239 mg/dL (borderline) were 1.67 times (95% confidence interval [CI]: 1.13 to 2.47) as likely to have periodontitis as those with normal levels (≤199 mg/dL), and those with STC ≥240 mg/dL (high) were 2.22 times (95% CI: 1.27 to 3.87) as likely to have periodontitis as those with normal levels. Conclusions: Positive significant association was observed between STC and periodontitis. Results of the present study provide insight into potential risk factors for periodontitis. High STC levels could be a potential risk factor for the disease; however, further studies need to be conducted to understand the actual relationship between STC levels and periodontitis and to establish causality and directional association.