吸烟对牙周炎患者牙龈组织上皮和血管的影响

目的观察未经治疗的吸烟和不吸烟中重度牙周炎患者的牙龈组织标本,探讨吸烟在牙周炎发生和发展中的作用。方法选取12例吸烟和10例不吸烟的中、重度牙周炎患者以及5例牙周健康者的牙龈组织标本,分为吸烟组、不吸烟组和对照组,分别采用组织病理学方法和免疫组织化学染色方法,观察吸烟和不吸烟2组牙周炎患者牙周袋袋壁上皮结构和牙龈血管的管径及密度。结果吸烟组牙周炎患者牙周袋袋壁上皮向根尖方向呈连续性增生,基底细胞增生;不吸烟组患者的袋壁上皮多出现糜烂、溃疡,上皮组织多呈网状增生;2组血管密度差异无统计学意义。吸烟组患者小管径血管比例显著高于不吸烟组,大管径血管比例则明显低于不吸烟组。结论吸烟可能刺激牙周袋袋壁上皮增生和角化,妨碍牙周组织再附着,进而加深牙周袋;大管径毛细血管比例减少,可能造成牙龈组织局部血液供应不足,导致吸烟者牙周组织的抵抗能力和修复能力下降。

The Effect of Smoking on Epithelium and Vessels in Gingival Tissue of Patients with Periodontitis

Objective By comparing the histopathological characteristics of gingiva taken from untreated smoking and non-smoking patients with advanced periodontitis, to investigate the possible role of smoking in the genesis and development of periodontitis. Methods The gingival biopsies of untreated smoking and non-smoking advanced patients with periodontitis were performed, and routine histopathological and immunohistochemical methods were used to assess the general histological characteristics and the changes of gingival blood vessel density and circumference respectively. Results Compared with non-smokers, the hyperplasia of pocket epithelium in smokers was continuously extending toward root apex, and the layer of keratin is thicker. The difference between the vascular density of smokers and non-smokers was not significant, however, smokers showed a higher proportion of small and a lower proportion of large blood vessels. Conclusion These results indicated that smoking maybe deepen the pocket and disturb the reattachment of periodontal tissue by prompting the hyperplasia and keratinization of pocket epithelium. The incremental proportion of small vessels proportion maybe result in a decline of the total blood flow in gingiva, which may in turn impair the resistibility and restoration of tissue.