Tanzer J M, Livingston J, Thompson A M
School of Dental Medicine, University of Connecticut, Farmington 06030-1605, USA.
J Dent Educ. 2001 Oct;65(10):1028-37.
A systematic literature review from 1966 to 2000 revealed 2,730 English-language publications on the role of bacteria in human primary dental caries in vivo. The most pertinent 313 papers were analyzed in evidence tables accessible online (http://www.nidcr.nih.gov). The search targeted all bacterial types implicated previously in caries and asked two questions. First, what is the association of specific bacteria with tooth decay and can causation be attributed to any of those bacteria? Retrieved studies were categorized as randomized-blinded-interventional, longitudinal, case-control, and cross-sectional and were weighted in descending order in terms of significance. Although many studies, due to ethical requirements, had confounding variables, they still indicate strongly: 1) the central role of the mutans streptococci in initiation of caries of smooth surfaces and fissures of crowns of teeth and suggests their potent role in induction of root surface caries; and 2) that lactobacilli are implicated as important contributory bacteria in tooth decay, but their role in induction of lesions is not well supported. Second, what is the source of infection by cariogenic bacteria? Molecular/genetic studies of implicated bacteria isolated from humans, randomized-blinded-interventional, and longitudinal studies indicate that mutans streptococci are spread vertically among humans, mostly from mothers to their children. Implications of these conclusions are briefly discussed. The most significant problems of literature interpretation include the benefits/shortcomings of salivary and plaque monitoring of the flora, the role of sugar(s) in decay as it influences the flora, and modeling strategies to predict lesion score increments as distinct from determination of the etiological role of specific bacteria. Future directions for microbiological clinical caries research are suggested, and the use of the term "caries" to describe the disease, not its lesions, is urged.
一项对1966年至2000年期间的系统性文献综述发现，有2730篇关于细菌在人类原发性龋齿体内作用的英文出版物。对最相关的313篇论文在可在线访问的证据表中进行了分析（http://www.nidcr.nih.gov）。该搜索针对先前涉及龋齿的所有细菌类型，并提出了两个问题。第一，特定细菌与龋齿的关联是什么，以及能否将病因归因于这些细菌中的任何一种？检索到的研究分为随机双盲干预、纵向、病例对照和横断面研究，并根据重要性按降序加权。尽管由于伦理要求，许多研究存在混杂变量，但它们仍然强烈表明：1）变形链球菌在牙齿冠部光滑表面和裂隙龋齿的起始中起核心作用，并表明它们在诱导根面龋方面具有重要作用；2）乳酸杆菌被认为是龋齿中的重要促发细菌，但其在病变诱导中的作用缺乏充分支持。第二，致龋细菌的感染源是什么？对从人类分离出的相关细菌进行的分子/遗传学研究、随机双盲干预和纵向研究表明，变形链球菌在人类之间垂直传播，主要是从母亲传给孩子。简要讨论了这些结论的意义。文献解读中最显著的问题包括唾液和菌斑菌群监测的益处/缺点、糖在龋齿中对菌群影响的作用，以及预测病变评分增加的建模策略，这与确定特定细菌的病因学作用不同。提出了微生物学临床龋齿研究的未来方向，并敦促使用“龋齿”一词来描述疾病，而不是其病变。
