Tammaro S, Wennström J L, Bergenholtz G
Department of Endodontology/Oral Diagnosis, Faculty of Odontology, Göteborg University, Sweden.
J Clin Periodontol. 2000 Sep;27(9):690-7. doi: 10.1034/j.1600-051x.2000.027009690.x.
BACKGROUND, AIMS: Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops RDS.
Alterations in RDS was followed in 35 patients (29-65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow-up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10-cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra- and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow-up data included pain assessment after 1-3 weeks of OH alone, and 1-4 weeks post-instrumentation.
There was a statistically significant reduction in mean VAS scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged.
The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.
关于牙周治疗导致牙根牙本质敏感（RDS）的发生率及严重程度，临床数据较少。本临床试验的目的是研究一组需要进行非手术牙周治疗的患者发生RDS的程度。
对35例年龄在29至65岁之间、需要对中度至重度牙周病进行非手术治疗的患者的RDS变化进行跟踪。参与的纳入标准为至少2个象限需要牙周治疗，包括至少4颗牙髓活力正常的牙齿，无开放性龋损，过去3个月内未接受牙科治疗，且目前未进行RDS治疗。基线和随访记录包括牙齿对颊面疼痛刺激（定向压缩空气）的反应，由患者在10厘米视觉模拟量表（VAS）上进行评分。牙周治疗包括口腔卫生指导（OH），随后在接下来的几周内每周对一个象限进行手工龈上和龈下刮治/根面平整以及超声器械治疗。因此，随访数据包括仅进行OH治疗1至3周后的疼痛评估，以及器械治疗后1至4周的疼痛评估。
在仅维持了细致菌斑控制的象限中，平均VAS评分随时间有统计学意义的降低，而器械治疗后VAS平均值显著增加（p<0.001）。报告较高平均VAS值的受试者百分比在器械治疗后也增加了。平均VAS评分的变化一般较为适度，只有9例患者3颗或更多牙齿的VAS增加超过2厘米。与基线时无反应的牙齿相比，最初敏感的牙齿（VAS>0）的RDS增加在统计学上显著更高（p<0.001）。尽管在刮治和根面平整后的4周随访后期可以注意到RDS强度的降低，但敏感牙齿的百分比保持不变。
数据证实细致的菌斑控制将减少RDS问题，并且牙周治疗中的刮治和根面平整程序会导致对疼痛刺激有反应的牙齿数量增加。然而，总体疼痛体验似乎较轻，并且在器械治疗后只有少数患者的少数牙齿出现高度敏感的牙根表面。
