Epidemiologic patterns of chronic and aggressive periodontitis.
Epidemiologic patterns of chronic and aggressive periodontitis.
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DOI：
10.1111/j.1600-0757.2009.00326.x
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发表时间：
2010-06
影响因子：
18.6
通讯作者：
Papapanou PN
中科院分区：
文献类型：
--
作者：
Demmer RT;Papapanou PN
目前使用的慢性牙周炎和侵袭性牙周炎的定义是在1999年世界牙周病分类研讨会上介绍的（2）。这个修订的分类系统是为了解决1989年世界研讨会诊断方案的一些广泛公认的缺点，根据该方案，大多数牙周病的病理条件分为三个主要类别：“早发性牙周炎”，“成人牙周炎”和“难治性牙周炎”。1999年的分类确实解决了早期系统的一些关键缺陷，包括（i）缺乏专门描述牙龈病变的诊断类别，（ii）依赖于疾病发作时间的知识来区分“早发性”和“成人”牙周炎，以及（iii）高度异质性的“难治性牙周炎”组，该术语的适当使用需要事先了解所提供的治疗量和质量以及患者依从性。然而，尽管1999年分类明确表示的目标之一是“放弃依赖年龄或需要了解进展率的分类术语”（5），但新制度在这两方面都只能提供有限的实质性改进。例如，新引入的“侵袭性牙周炎”的主要特征之一是“快速附着丧失和骨破坏”（33）。关于年龄，“青春期周围发病”仍然是局部侵袭性牙周炎的一个关键特征，而全身侵袭性牙周炎被认为“通常影响30岁以下的人，但患者可能更年长”（33）。考虑到侵袭性牙周炎的另一个主要诊断特征是疾病的“家族聚集性”，这是一个在检查患者时通常不可能确定的特征，人们很快就认识到，临床医生-更不用说流行病学家-对这种特定诊断的适当分配仍然存在很大问题。在本文作者身份时（2009年7月），仅在PubMed数据库中使用检索词“慢性牙周炎”和“侵袭性牙周炎”就分别识别出约3，300篇和1，650篇出版物。有趣的是，使用术语“慢性牙周炎”的文章涵盖的时间跨度可以追溯到1948年，而最早的索引出版物使用“侵袭性牙周炎”作为关键字发表在同一年，这表明这些术语显然已被用于各种不同的背景下。因此，考虑到大量文献使用这些术语，并且为了与牙周炎流行病学的早期综述形成对比，这些综述严重依赖于使用不再使用的术语的出版物（9，41），我们决定限制本
The currently used definitions of chronic and aggressive periodontitis were introduced at the 1999 World Workshop for the Classification of Periodontal Diseases and Conditions (2). This revised classification system was meant to address a number of widely recognized shortcomings of the 1989 World Workshop diagnostic scheme, according to which the majority of the pathologic periodontal conditions were classified under three main categories:‘Early Onset Periodontitis’,‘Adult Periodontitis’, and ‘Refractory Periodontitis’. The 1999 classification did indeed address some key deficiencies of the earlier system including (i) the lack of a diagnostic category describing exclusively gingival lesions,(ii) the dependence on knowledge about the time of disease onset for distinguishing between ‘Early Onset-’and ‘Adult’periodontitis, and (iii) the highly heterogeneous ‘Refractory Periodontitis’ group, a term whose appropriate use required prior knowledge of the volume and quality of therapy rendered, as well as of patient compliance. Nevertheless, although one of the 1999 Classification’s explicitly expressed goals was “to discard classification terminologies that were age-dependent or required knowledge of rates of progression”(5), the new system admittedly offered only limited substantial improvement on either front. For example, one of the primary features of the newly introduced ‘Aggressive Periodontitis’ is “rapid attachment loss and bone destruction”(33). With respect to age,“circumpubertal onset” continues to constitute a key feature of Localized Aggressive Periodontitis, while Generalized Aggressive Periodontitis is suggested to “usually affect persons under 30 years of age, but patients may be older”(33). Considering that another primary diagnostic feature of Aggressive Periodontitis is “familial aggregation” of the disease, a feature that is often impossible to ascertain upon examination of a patient, one quickly recognizes that appropriate assignment of this particular diagnosis by the clinician–let alone by the epidemiologist-remains highly problematic.Nevertheless, use of the search terms ‘chronic periodontitis’ and ‘aggressive periodontitis’ in the PubMed database alone at the time of authorship of this text (July 2009) identified approximately 3,300 and 1,650 publications, respectively. Interestingly, articles using the term ‘chronic periodontitis’ covered a time span dating back to 1948, while the earliest indexed publication retrieved using ‘aggressive periodontitis’ as a keyword was published the same year, indicating that these terms have been obviously used in a variety of different contexts. Hence, given the substantial body of literature using these terms and in order to contrast with earlier reviews of the epidemiology of periodontitis that heavily relied on publications employing terminology no longer in use (9, 41), we decided to limit the present
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