应用16S rDNA检测固定矫治患者牙周可疑病原菌变化研究

应用16S rDNA检测固定矫治患者龈下菌斑中牙周可疑病原,探讨戴用固定矫治器对牙周组织健康的影响。随机选择36例治疗时间超过6个月的固定矫治患者组成实验组,29例未经正畸治疗者组成对照组。分别检验特定部位牙周临床指数并收集龈下菌斑样本。采用16S rDNA检测9种牙周可疑致病菌。实验组与对照组相比牙龈指数、牙周袋深度、探诊出血差异有明显统计学意义(P<0.05);牙周可疑病原菌中牙龈卟啉菌、齿垢密螺旋体在实验组的检出率明显高于对照组(P<0.05)。固定矫治器戴入可引起患者牙周可疑病原菌的明显变化。     

口腔卫生预防措施对固定正畸患者牙周菌群和牙周临床指数的影响

目的 采用牙周洁治和强化的口腔健康教育方法,通过检测牙周菌群和牙周临床指数的动态变化,探讨口腔卫生预防措施对固定正畸患者牙周菌群的影响。方法 选择正畸初诊患者20例,平均分为试验组（T组）和对照组（C组）。于正畸治疗开始前检查右上颌第一磨牙16和右下颌中切牙41牙周状况,并采集其近中颊轴嵴处龈缘菌斑做细菌分离培养。T组于治疗前进行全口洁治,每月复诊加力时均给予口腔卫生检查,强调口腔卫生的重要性;C组仅在初诊时进行口腔卫生指导,其余不作处理。2组患者分别于矫治器安装后1、3和6个月进行临床及细菌学检查。结果 随观察时间的延长,T组颊侧菌斑指数和牙龈指数在第1、3、6个月时较基线降低;C组颊侧菌斑指数第6个月时较基线降低,舌侧探诊深度则升高（P＜0.05）。细菌检出率和检出量的变化在T组可见韦荣球菌属降低而弯曲杆菌属和Gn产黑色素厌氧杆菌（BPAR）升高,C组消化链球菌属和BPAR升高（P＜0.05）;BPAR在第3个月、消化链球菌属在第6个月时T组检出率低于C组（P＜0.05）,而细菌检出量和牙周临床指数在2组间没有观测到处理因素的作用（P＞0.05）。结论 正畸前即存在牙龈炎的患者,建议进行预防性牙周洁治;牙周洁治必须和口腔卫生教育、正确的日常菌斑控制措施结合进行。     

乳杆菌代谢产物对于固定矫治患者牙周指数和龈下菌群的敏感性研究

目的对已佩带固定矫治器6个月的患者采用乳杆菌DM9811代谢产物提取液制成的含漱液含漱治疗,探讨治疗前后牙周指数和牙周可疑病原菌的动态变化过程。方法采取自身前后对照和组间对照。记录治疗前后牙周指数的变化情况。并采用细菌培养鉴定法检测含漱前后龈下菌群的变化情况,测定牙周可疑病原菌的检出量和检出率。结果（1）试验组的牙龈指数（GI）、菌斑指数（PI）、龈沟出血指数（SBI）、探诊深度（PD）在治疗后均有下降,且试验组低于对照组。（2）试验组G^-产黑色素厌氧杆菌（BPAR）、梭杆菌、拟杆菌的检出量以及BPAR的检出率治疗后均有下降,试验组低于对照组;血链球菌的检出量有所上升,试验组高于对照组。结论乳杆菌DM9811代谢产物对固定矫治患者带环牙牙龈炎的各项临床指标均有改善作用,且颊侧优于舌侧;对龈下菌斑中梭杆菌、拟杆菌、BPAR等均有抑制作用,对有益菌中的血链球菌有扶植作用。     

镍铬合金烤瓷冠修复牙与对照牙牙周微生态及龈沟液蛋白水平的比较

目的观察比较镍铬合金烤瓷冠（Ni-Cr based porcelain-fused-metal crown）修复患牙与牙周健康对照牙龈下菌斑微生物分布、龈沟液总蛋白水平及牙周临床指标的差异。方法选择临床病例13例,前牙区咬合关系基本正常。采用镍铬合金烤瓷冠修复上颌切牙17颗,对侧同名健康天然牙作为对照。烤瓷冠戴入6～8个月后复诊,进行牙周健康状况的临床检查,分别取患牙、对照牙龈沟液及龈下菌斑盐水涂片。龈沟液定量并检测总蛋白水平。龈下菌斑涂片革兰染色,分类计数革兰阴性球菌、杆菌、弯曲菌、螺旋体及革兰阳性球菌、杆菌,共计数200个细菌。结果修复患牙与对照牙比较探诊深度、龈沟出血指数、龈沟液量、龈沟液总蛋白水平、龈下菌斑中革兰阴性杆菌增加,革兰阳性球菌减少,差异均有显著性（P〈0．05）。而菌斑指数及其他形态的细菌数差异无显著性。结论临床合格的镍铬合金烤瓷冠修复亦使患牙龈下菌群分布发生变化,可能是导致患牙牙龈炎症的原因之一;龈沟液量及总蛋白水平增加;牙周临床指标显示不良改变。     

PCR直接检测龈下菌斑主要可疑牙周致病菌

目的：应用PCR方法直接检测龈下菌斑主要可疑牙周致病菌与牙周病活动部位的关系,探讨其方法的可行性并探讨其主要可疑牙周致病菌的分布规律。方法：应用聚合酶链反应(polymerase chain reaction,PCR)直接检测龈下菌斑主要可疑致病菌16s RNA保守区域片段。40名受试者包括牙周病患者20人,每人同口取一个牙周病活动部位,一个相对健康或牙周病静止对照部位;成人健康者20人,每人各取一个标本。结果：龈下菌斑5种可疑牙周致病菌在牙周病活动部位的检出率牙龈卟啉菌为86％,福赛类杆菌为95％,螺旋体为86％,中间普氏菌和黑色普氏菌分别为95％和33％,均显著高于同口部位对照组和健康对照组。结论：PCR直接检测菌斑牙龈卟啉单胞菌、中间普氏菌、福赛类杆菌、齿密螺旋体及黑色普氏菌匀与牙周炎活动部位相关。     

正常口腔中的可疑牙周致病菌

本实验对49例正常口腔的龈上和龈下菌斑内的可疑牙周致病菌(SPB)的分布情况进行了观察分析。 49例研究对象男21例,女28例;6～25岁,无龋,无牙周病的健康人。三月内未服用抗生素,未接受任何牙周治疗。定对在右上颌第一磨牙(No.3)的龈上及龈下菌斑。用BHI培养基厌氧培养37℃,4天以后进行细菌菌落计数,转种分离和鉴定。龈上菌斑内SPB的检出率按其高低顺序依次为:二氧化碳噬纤维菌、梭杆菌、消化链球菌、唾液弯曲杆菌、产黑色素类杆菌、优杆菌,溶蚀艾肯氏菌、生疾月形单胞菌。二氧化碳噬纤维菌中依次为牙龈二氧化碳噬纤维菌、黄褐二氧化碳噬纤维菌及生疾二氧化碳噬纤     

牙龈卟啉单胞菌、嵴链球菌、口腔链球菌属在口腔内不同解剖部位的分布

目的探讨牙龈卟啉单胞菌(Porphyromonas gingivalis)、嵴链球菌(Streptococcus cristatus)、口腔链球菌属(Streptococci oralis)在慢性牙周炎患者及牙周健康者不同口腔解剖部位生物膜的分布情况。方法选取慢性牙周炎患者25例,牙周健康者24例,分别作为慢性牙周炎组及健康对照组。测量临床指标(探诊深度、附着丧失和探诊出血),取受试者龈下菌斑、舌背、颊黏膜和唾液样品。Real-time PCR分析受试者不同受检部位S.cristatus、P.gingivalis、Streptococci oralis相对数量。结果慢性牙周炎组四个受检部位中P.gingivalis数量均大于健康对照组;慢性牙周炎组龈下菌斑中P.gingivalis数量大于其余受检部位;而慢性牙周炎组龈下菌斑、舌背、颊黏膜三个受检部位S.cristatus、Streptococci oralis数量小于健康对照者。结论与牙周健康者比较,慢性牙周炎患者口腔内不同解剖位置P.gingivalis数量增多,S.cristatus、Streptococci oralis数量减少;P.gingivalis检出数量增加提示牙周炎患病风险增加,而S.cristatus、Streptococci oralis检出数量降低提示牙周炎患病风险降低。     

固定矫治器对牙周指数及龈下菌群影响的实验研究

选择15例口腔卫生良好、牙周组织健康的正畸患者的90个牙位点,在黏接固定矫治器附件前进行菌斑指数、牙龈指数和探诊深度等临床牙周指数及龈下细菌的检测;根据患者上下颌牙齿错位畸形严重程度进行单颌牙齿黏接固定矫治器附件作为实验组,以暂不黏接固定矫治器附件的对颌牙齿作为对照组,在患者4周、8周复诊时进行重复检测。结果显示,戴用固定矫治器后牙齿的临床牙周指数与对照组及戴用矫治器前相比较,没有显著性差异(p>0.05);龈下细菌构成及比例亦未发生明显变化(p>0.05)。研究表明,戴用固定矫治器的患者如能认真保持口腔卫生,对牙周组织健康不会产生显著不良影响。     

致龋菌与牙周致病菌混合感染动物模型的初步研究

目的通过建立龋病与牙周病共同发生的动物模型,初步探讨致龋菌与牙周致病菌的相关性。方法 5~6周龄金黄地鼠22只,雌雄各半,随机分成2组,均给予高蔗糖饮食。对照组10只,感染组12只,双侧下颌第一磨牙丝线结扎,接种牙龈卟啉单胞菌(P.g)和变形链球菌(S.m);种菌结束后8周检查下颌第一磨牙牙体和牙周组织损害情况。结果感染组产生明显的牙周损害:探诊出血(BOP)、菌斑指数(PLI)以及牙槽骨吸收(ABL)均显著大于对照组(P0.01),同时,感染组冠部龋坏率达到90.0%,大于对照组(66.7%),但差异没有统计学意义。2个组均未产生根龋。结论牙龈卟啉单胞菌与变形链球菌分别作用于牙周和牙体组织发生龋及牙周损害,二者没有显著的相互抑制作用,可在地鼠口腔中同时出现龋和牙周炎病损的模型。     

血链球菌在不同牙周状态下的分布及相关研究

目的：探讨口腔主要过氧化氢产生菌血链球菌和口腔链球菌在不同牙周健康状态下龈下菌群中的分布,及与牙周健康状态和牙龈卟啉单胞菌群中分布的相互关系。方法：纳入符合标准的受试者30人,受试位点86个,其中健康组11人,位点30个,龈炎组9人,位点29个,慢性牙周炎组10人,位点27个,检查记录牙周健康状态[包括牙龈指数（GI）和牙周袋深度（PD）],采集龈下菌斑标本,经厌氧菌培养基和AP-PCR及PCR鉴定后,将各受试组进行比较分析。结果：共获得草绿色链球菌523株,产黑色素菌241株。经AP-PCR及PCR鉴定后,得到血链球菌112株,口腔链球菌56株,牙龈卟啉单胞菌84株,健康组龈下菌斑中血链球菌,口腔链球菌和牙龈卟啉单胞菌构成比与牙周炎组相比有差异显著性;血链球菌和口腔链球菌与GI、PD呈负相关,牙龈卟啉菌与GI、PD呈正相关;血链球菌的构成与牙龈卟啉单胞菌的构成比呈负相关。结论：血链球菌等过氧化氢产生菌在龈下菌斑中比例的下降。可能是微生态失衡,致病菌过度增殖的重要机制。     

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

Objective: The aim of this study was to describe the oral health status of older adults living in north‐eastern Germany. Materials and Methods: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross‐sectional, population‐based study. Data on 1446 subjects aged 60–79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss. Results: The prevalence of edentulousness varied from 16% in the 60–65‐year‐old group to 30% in the 75–79‐year‐old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60–65 years) to one in the oldest (75–79 years). Among subjects aged 60–69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70–79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70–79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60–69 years: 85% vs. 71% in 70–79‐year‐old men; women aged 60–69 years: 71% vs. 62% in 70–79‐year‐olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern. Conclusions: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.     

纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响

摘要 目的：探讨纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响。方法：选取2018年1月至2019年3月期间我院收治的103例患者作为研究对象,按修复材料的不同分为对照组（n=52,患牙62颗）和研究组（n=51,患牙63颗）。对照组给予金属桩核、金属烤瓷冠修复,研究组给予纤维桩、纳米复合树脂结合氧化锆烤瓷冠修复。修复1年后,评价两组的修复成功率和修复效果。比较两组修复前及修复后1年的牙龈指数、菌斑指数、牙周探诊深度、龈沟液量及龈沟液中碱性磷酸酶（ALP）、天门冬氨酸转氨酶（AST）水平。结果：研究组的修复成功率比对照组高（P<0.05）。研究组修复体的表面光滑率、边缘密合性、固定良好率及颜色匹配率均明显高于对照组（P<0.05）。两组治疗后牙龈指数、菌斑指数及牙周探诊深度均明显低于治疗前（P<0.05）,龈沟液量及龈沟液中ALP、AST水平均明显低于治疗前（P<0.05）,同时研究组治疗后牙龈指数、菌斑指数及牙周探诊深度均低于对照组（P<0.05）,但两组治疗后龈沟液量及龈沟液中ALP、AST水平比较无差异（P>0.05）。结论：纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损的修复成功率高,修复后美学效果佳,对牙周组织影响小。     

Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease

doi: 10.1111/j.1741‐2358.2011.00507.x Oral status in home‐dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease Objectives: The aim of this study was to compare the prevalence of edentulous subjects, caries and periodontal disease among the home‐dwelling elderly with moderate and substantial needs of support for daily living. Materials and method: A sample of 302 randomly selected elderly with moderate or substantial needs of supportive care were examined in Sweden. Several oral clinical variables were registered: number of teeth, dentures, caries, probing pocket depth, gingival bleeding and Eichner’s index. Results: Both in general and in oral health, the differences were small when comparing elderly with moderate and substantial care needs for daily living. Those with substantial needs had more caries lesions (p < 0.01) and more gingival bleeding (p < 0.05), while the number of teeth and prevalence of edentulous subjects did not differ in relation to the need of daily support. The elderly had, on average, 9.8–11.7 teeth, one‐third of whom had no natural teeth. According to Eichner’s index, half of the elderly in both groups had no opposing tooth contacts. Fifty‐five per cent used dentures. Conclusions: Elderly people with needs of supportive care have lost many teeth before they become dependent. Health promotion should be a priority in early ageing populations to prevent oral diseases and tooth loss.     

牙周夹板联合正畸治疗对牙周炎所致前牙扇形移位患者咀嚼功能和龈沟液PGE2、sICAM-1、PAK5的影响

目的:探讨牙周夹板联合正畸治疗对牙周炎所致前牙扇形移位患者咀嚼功能和龈沟液中前列素E2(PGE2)、可溶性细胞间黏附分子-1(s ICAM-1)、p2l活化激酶5(PAK5)的影响。方法:采用随机数字表法,将我院2018年2月~2020年2月间接收的93例牙周炎所致前牙扇形移位患者分为对照组(46例,牙周基础治疗、牙周夹板治疗)和研究组(47例,牙周基础治疗、牙周夹板治疗联合正畸治疗),观察两组疗效,对比两组治疗前后的牙周情况,咀嚼功能、美观度,龈沟液PGE2、s ICAM-1、PAK5水平。结果:研究组的临床总有效率高于对照组(P<0.05)。研究组治疗后牙周菌斑指数(PLI)、探诊深度(PD)、牙龈指数(GI)、附着丧失(AL)、龈沟出血指数(SBI)低于对照组(P<0.05)。研究组治疗后探诊出血率、前牙咬合低于对照组,咀嚼功能评分高于对照组(P<0.05)。研究组治疗后牙周袋深度、前牙覆盖度、牙槽骨高度低于对照组(P<0.05)。研究组治疗后龈沟液PGE2、s ICAM-1、PAK5水平低于对照组(P<0.05)。结论:牙周夹板联合正畸治疗可有效恢复牙周炎所致前牙扇形移位患者牙周功能和咀嚼功能,且美观效果好,还可减轻对龈沟液PGE2、s ICAM-1、PAK5水平的影响。     

Association between serum calcium and periodontal disease progression in non-institutionalized elderly

Objective: To assess the effect of baseline serum calcium on the progression of periodontal disease in non‐institutionalized elderly. Background: Although a few studies have found some evidence of the role played by dietary calcium in periodontal disease process, there is a paucity of information pertinent to longitudinal assessment of serum calcium‐periodontal relationships. Material and methods: Clinical attachment levels of 266 Japanese subjects aged 70 years were recorded at baseline and annually for six consecutive years. Progression of periodontal disease (PPD) was defined as the number of teeth that showed additional attachment loss of ≥3 mm during the 6 years. The number of PPD was calculated for each subject and categorised into four levels, namely, PPD₀, PPD₁, PPD₂ and PPD₃ where the number of teeth with additional attachment loss ranged from 0, 1–10, 11–20 and >20 respectively. The levels of serum calcium, albumin, random blood sugar, immunoglobulin (IgG, IgA and IgM), gender, smoking habits, education, gingival bleeding and the number of teeth present were obtained at baseline. Results: Serum calcium, IgA, smoking, gingival bleeding and teeth present were associated with PPD at p ≤ 0.10 and were included in a multinomial logistic regression analysis. Serum calcium was the only variable that was significantly associated with PPD with relative risks of 100 at PPD₁ and PPD₂, respectively, and 1000 at PPD₃. Conclusion: Serum calcium may be considered a risk factor for periodontal disease progression in non‐institutionalized elderly.