Mombelli A
School of Dental Medicine, University of Geneva, Geneva, Switzerland.
Oral Dis. 2003;9 Suppl 1:6-10. doi: 10.1034/j.1601-0825.9.s1.2.x.
Periodontitis may be viewed as an infectious disease with a number of specific characteristics. Pathogens of the subgingival microbiota can interact with host tissues even without direct tissue penetration. Hence, antimicrobial agents must be available at a sufficiently high concentration not only within the periodontal tissues, but also outside, in the environment of the periodontal pocket. The subgingival microbiota accumulate on the root surface to form an adherent layer of plaque with the characteristics of a biofilm. Several mechanisms, such as diffusion barriers, and selective inactivation of agents lead to an increased resistance of bacteria in biofilms. Mechanical supragingival plaque control is indispensable to prevent the re-emergence of periodontal pathogens and the re-establishment of a biofilm in treated sites. Since specific features have important implications for the use of antimicrobial agents in periodontal therapy, extrapolations from experiences made in the therapy of other infections are only partially valid. The ultimate evidence for the efficacy of systemic or local chemotherapy must be obtained from treatment studies in humans with adequate follow-up.
牙周炎可被视为一种具有多种特定特征的感染性疾病。龈下微生物群的病原体即使不直接穿透组织也能与宿主组织相互作用。因此，抗菌剂不仅必须在牙周组织内，而且在牙周袋环境中以足够高的浓度存在。龈下微生物群积聚在牙根表面，形成具有生物膜特征的附着菌斑层。诸如扩散屏障和药物的选择性失活等多种机制导致生物膜中的细菌耐药性增加。机械性龈上菌斑控制对于预防牙周病原体的再次出现以及在治疗部位重新形成生物膜是必不可少的。由于特定特征对牙周治疗中抗菌剂的使用具有重要意义，从其他感染治疗经验中得出的推断仅部分有效。全身或局部化疗疗效的最终证据必须来自对人类进行的有充分随访的治疗研究。
