Microbiological diagnostic testing in the treatment of periodontal diseases
Microbiological diagnostic testing in the treatment of periodontal diseases
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DOI：
10.1046/j.0906-6713.2002.003424.x
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发表时间：
2004-01-01
影响因子：
18.6
通讯作者：
Loomer, PM
中科院分区：
文献类型：
--
作者：
Loomer, PM
牙周病的发生和发展可归因于牙龈间隙内致病菌水平升高（70,71）。数百种已被确认的微生物，以及更多尚未被确认的微生物，栖息在牙龈缝隙中；然而，研究表明，只有少数在牙周病的病因学中起重要作用。这一证据主要基于流行病学数据、微生物引入动物后产生疾病的能力以及产生毒力因子的能力。然而，仅仅存在假定的牙周病原在牙龈间隙本身并不足以引发或引起牙周炎症。重要的是，它们的相对比例要有一个提升，这样就有了一个临界质量，可以进行有效的组织损伤反应。事实上，即使在健康的情况下，牙周病微生物作为正常常驻菌群的成员存在于牙龈缝隙中，尽管数量很少。绝大多数慢性牙周炎患者，尽管他们的口腔微生物特征不同，但对传统的牙周机械治疗方法（即口腔卫生指导、刮治和牙根刨平以及手术）的反应非常好。对于这些患者，通过专业和个人的菌斑控制，持续减少他们口袋中牙周病致病菌的总水平，通常足以阻止疾病的进展。然而，有些患者对传统的牙周治疗反应不佳。这些患者有时被称为“难治性”治疗。尽管大多数患者接受了成功的牙周治疗，但他们仍继续失去临床依恋。此外，他们通常有良好的口腔卫生，并遵守建议的牙周维护/召回计划。从概念上讲，难治性慢性牙周炎患者有持续性感染，很可能需要诊断和治疗方法，而不是那些已经尝试过的方法。其中一种方法遵循一种医学模式，即对临床样本进行微生物学测试，确定假定的病原体，并施用适当的抗生素。由于大多数牙周病是混合性感染，因此要对一系列可能的病原体进行微生物学检测。微生物学试验已经发展到确定选定的牙周病微生物在牙龈沟。这些测试提供的信息可以帮助指导临床医生确定一种抗菌剂是否，以及哪一种抗菌剂可以为患者提供额外的治疗益处。几种不同类型的微生物测试是可用的。本章将讨论这些检测对常规治疗无效的患者的效用，以及它们在监测接受维持治疗的患者疾病复发方面的用处。
The initiation and progression of periodontal disease is attributed to the presence of elevated levels of pathogenic bacteria within the gingival crevice (70, 71). Several hundred recognized species of microorganisms, and many more that have yet to be identified, inhabit the gingival crevice; however, it has been shown that only a few play significant roles in the etiology of periodontal diseases. This evidence is largely based on epidemiologic data, the ability of a microorganism to produce disease when introduced into animals, and the capacity to produce virulence factors. However, the mere presence of putative periodontopathogens in the gingival crevice is not in itself sufficient to initiate or cause periodontal inflammation. What is essential is that there be an elevation in their relative proportions such that a critical mass is present to mount an effective tissue-damaging response. Indeed, even in health, periodontopathogenic microorganisms are present in the gingival crevice, albeit in low numbers, as members of the normal resident flora. The overwhelming majority of patients with chronic periodontitis, despite their diverse oral microbiological profiles, respond remarkably well to traditional mechanical methods of periodontal treatment (ie oral hygiene instructions, scaling and root planing, and surgery). For these patients, a sustainable reduction in the total level of periodontopathogenic bacteria in their pockets, through professional and personal plaque control, is usually adequate to stop the progression of the disease. However, there are some patients who do not respond well to traditional periodontal therapy. These patients are sometimes referred to as``refractory''to treatment. They continue to lose clinical attachment despite having received periodontal therapy that succeeds in most patients. In addition, they usually have good oral hygiene and comply with recommended periodontal maintenance/recall schedules. Conceptually, patients with refractory chronic periodontitis have a persistent infection that will most likely require diagnostic and treatment approaches beyond those that have already been tried. One of these approaches follows a medical model where microbiological testing is performed on a clinical sample, putative pathogens are identified, and an appropriate antibiotic is administered. Since most periodontal diseases are mixed infections, microbiologic testing is done for a battery of possible pathogens. Microbiologic tests have been developed to identify selected periodontopathogenic microorganisms in the gingival sulcus. These tests provide information that can help guide the clinician in determining whether or not an antimicrobial agent, and which particular one, may provide an additional therapeutic benefit for the patient. Several different types of microbiological tests are available. The utility of these tests for patients who have not responded to conventional therapy, as well as their usefulness in monitoring patients on maintenance therapy for recurrence of disease will be discussed in this chapter.