Periodontal diagnostics.
Periodontal diagnostics.
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牙周诊断。
DOI：
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
D. Kinane
中科院分区：
文献类型：
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作者：
D. Kinane
牙周炎影响一部分人群，我们目前的想法是牙周病的进展可能是连续的或周期性的（突发假说）。这些特征使得筛查和诊断工具在这种疾病的管理中是可取的。虽然存在许多潜在的标记物，但一些困难阻碍了我们宣布它们具有已证实效用的诊断测试的能力。活动性牙周病的“金标准”是不可用的，并且由于牙龈局限性病变（牙龈炎）引起的炎症和导致附着丧失的牙周炎症是基于评估疾病的宿主反应元素的任何测试的潜在混淆因素。目前缺乏牙周病进展的证据，即，突发假设是否正确是另一个问题。虽然有很多关于当前或未来疾病的标志物的需要，这将防止我们过度治疗口袋，时间，精力和成本涉及测试这些网站必须与相对容易和速度的常规治疗，如根面平整。此外，我们距离开发和验证可靠的宿主或微生物检测方法还有一段距离。在疾病的筛查测试方面，例如早发性牙周炎，涉及患者的遗传多态性、特异性基因、系统性抗体或白细胞细胞表面标志物的诊断工具的研究和开发可能及时成为临床现实。人们可以设想，利用拇指刺血进行椅旁测试，能够确定年轻人在以后的年龄患疾病的风险，因此需要及时制定预防方案。在应用任何测试之前，我们应该重新考虑阳性或阴性结果会对治疗计划产生什么影响，任何不影响治疗计划的测试都是多余的。是否牙周诊断测试将开发，这将表明临床医生需要各种治疗制度以外的根面平整，仍然是一个悬而未决的问题。例如，在未来，在治疗前检测患者的特异性抗体水平可能表明他们对治疗的可能反应，从而需要额外的治疗药物，如抗生素。牙周病诊断测试仍处于早期发展阶段，仍有许多工作要做，以充分验证其效用，使其成为临床治疗计划，筛查或患者监测的重要和成本效益方面。
Periodontitis affects a subset of the population and our current thinking is that progression of periodontal disease may be either continuous or cyclical (burst hypothesis). These features make screening and diagnostic tools desirable in the management of this disease. Although many potential markers exist, several difficulties hamper our ability to declare them diagnostic tests with proven utility. The 'gold standard' for active periodontal disease is not available and inflammation due to gingivally confined lesions (gingivitis) and periodontal inflammation which results in attachment loss is a potential confounder of any test based on assessing the host response elements of the disease. The current absence of proof for the progression of periodontal disease i.e., whether or not the burst hypothesis is correct, is a further problem. Although much is written about the need for markers of current or future disease which will prevent us from overtreating pockets, the time, effort and cost involved in testing these sites has to be balanced against the relative ease and speed of routine therapy such as root planing. In addition, we are still some way from the development and validation of reliable host or microbial testing methods. In terms of screening tests for diseases such as the early-onset forms of periodontitis, the research and development on diagnostic tools involving genetic polymorphisms, specific genes, systemic antibodies or leucocyte cell surface markers of the patients, may become a clinical reality in time. One could envisage chairside tests using blood from thumb pricks being capable of determining a young individual's risk of developing disease at a later age, and thus the need for a timely prevention programme. Before applying any test we should reconsider what treatment planning effects a positive or negative result will have, and any test which does not influence the treatment plan is redundant. Whether periodontal diagnostic tests will be developed which will indicate to the clinician the need for various treatment regimes other than root planing, is still an open question. For example, in the future, a test of specific antibody levels in patients prior to treatment might indicate their likely response to therapy and thus the need for additional therapeutic agents such as antibiotics. Periodontal diagnostic tests are still at an early stage of development and much work remains to be performed to fully validate their utility such that they become an important and cost effective aspect of clinical treatment planning, screening or patient monitoring.