Periodontal therapy in humans. I. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive tetracycline therapy.
Periodontal therapy in humans. I. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive tetracycline therapy.
复制标题
人类牙周治疗。
DOI：
10.1902/jop.1979.50.10.495
复制
发表时间：
1979
影响因子：
4.3
通讯作者：
R. J. Genco
中科院分区：
文献类型：
--
作者：
Jørgen Slots;P. A. Mashimo;Michael J. Levine;R. J. Genco
目前的结果表明，显著和持久的变化与牙周病相关的龈下菌群可以通过一个疗程的牙周治疗。治疗后即刻，龈下微生物总数减少10- 100倍，可培养的革兰氏阴性菌和厌氧菌的比例通常减少3- 4倍或更多。治疗后，大多数牙周袋填充了少量的微生物区系占主导地位的兼性放线菌和链球菌物种。龈下细菌增殖的动力学显示，即使在6个月后，总细胞计数以及螺旋体和二氧化碳噬纤维菌属物种的比例也未达到其治疗前水平。其他革兰氏阴性厌氧菌在3至6个月后恢复至治疗前比例。在整个6个月研究中，几种革兰氏阳性菌在给药后的比例高于给药前。微生物的变化是牙周组织临床状态的显著变化。治疗后，牙周袋深度下降一般1至4毫米，牙龈炎症指数，牙龈液流量，和化脓指数普遍较低，和33个测试口袋检查9个显示出牙槽骨并置。所描述的微生物学和临床变化表现出的两名患者与牙周洁治和根面平整单独治疗和两名患者连续使用系统四环素治疗。在另外两名患者中，机械牙周治疗仅略微减少龈下微生物的总数以及螺旋体和其他革兰氏阴性厌氧杆菌的比例。四环素治疗后，这两名患者的龈下微生物组成发生了变化。牙周病的治疗模式如下：（1）常规治疗，包括彻底的牙周洁治和根面平整术;（2）监测龈下植物群和临床过程;（3）在难治性病例中使用抗菌治疗。需要进一步的研究来开发快速识别难治性患者的方法，并确定最佳的抗菌剂，最佳的给药途径和最佳的给药方案。
The present results showed that maarked and long-lasting changes in the subgingival microflora associated with periodontal disease could be achieved by a single course of periodontal treatment. Immediately following therapy, the total number of subgingival organisms decreased 10- to 100-fold and the proportions of cultivable Gram negative organisms and anaerobic organisms generally decreased 3- to 4-fold or more. After treatment, most periodontal pockets were populated by a scant microflora predominated by facultative Actinomyces and Streptococcus species. The kinetics of the subgingival bacterial recolonization revealed that the total cell counts and the proportions of spirochetes and Capnocytophaga species did not reach their pretreatment levels even after 6 months. Other Gram negative anaerobic species returned to pretreatment proportions after 3 to 6 months. Several Gram positive species exhibited higher posttreatment than pretreatment proportions throughout the 6 months study. The microbiological shifts paralleled significant changes in the clinical status of the periodontal tissues. Following therapy, the periodontal pocket depths decreased generally 1 to 4 mm, the gingival inflammatory index, the gingival fluid flow, and the suppurative index were generally lower, and nine of 33 test pockets examined showed apposition of alveolar bone. The microbiological and clinical changes described were exhibited by two patients treated with periodontal scaling and root planing alone and by two patients treated with the adjunctive use of systemic tetracycline therapy. In two other patients, mechanical periodontal therapy only slightly reduced the total number of subgingival organisms and the proportions of spirochetes and other Gram negative anaerobic rods. A shift in the subgingival microbial composition was achieved in these two patients after tetracycline therapy. The following model for treatment of periodontal disease is proposed: (1) Conventional therapy including thorough periodontal scaling and root planing; (2) Monitoring the subgingival flora and the clinical course; and (3) Use of antimicrobial therapy in refractory cases. Further studies are needed to develop means for rapid identification of refractory patients, and to determine the optimal antimicrobial agent, the optimal route of administration, and the optimal dosage regime.