Tezal Mine, Scannapieco Frank A, Wactawski-Wende Jean, Grossi Sara G, Genco Robert J
Department of Oral Biology, State University of New York, Buffalo, NY 14214, USA.
J Periodontol. 2006 May;77(5):808-13. doi: 10.1902/jop.2006.050332.
Bacterial interactions in response to local and systemic factors may explain important features of the pathogenesis of periodontal disease. This study evaluates the role of supragingival plaque level on the relationship between subgingival microorganisms and the risk of attachment loss.
The study population consisted of 386 white women aged 45 years and older who had at least seven teeth. Subgingival plaque samples were taken from the mesio-buccal surface of six maxillary and six mandibular teeth using paper point technique. The samples were pooled, and immunofluorescence microscopy was performed to identify the following target microorganisms: Actinobacillus actinomycetemcomitans (Aa), Tannerella forsythensis (Tf), Campylobacter rectus (Cr), Prevotella intermedia (Pi), Capnocytophaga species (Cs), Porphyromonas gingivalis (Pg), Eubacterium saburreum (Es), and Fusobacterium nucleatum (Fn). The presence or absence of supragingival plaque and clinical attachment loss (CAL) were assessed at the same 12 sites where subgingival plaque samples were taken. The association of each microorganism with CAL was tested using multiple logistic regressions controlling for age, smoking status, and diabetes. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated.
At low supragingival plaque levels, only the presence of Pg was significantly associated with CAL (OR: 6.41, 95% CI: 1.30 to 31.70); all remaining microorganisms were also associated with increased but non-significant risk of CAL. At high supragingival plaque levels, the presence of Tf (OR: 2.40, 95% CI: 1.42 to 4.04) and Pg (OR: 3.71, 95% CI: 1.63 to 8.42) was significantly associated with increased risk of attachment loss. By contrast, the presence of Cs (OR: 0.55, 95% CI: 0.30 to 1.01) and Es (OR: 0.35, 95% CI: 0.15 to 0.82) was associated with decreased risk of attachment loss. Fn, Pi, and Cr were not significantly associated with CAL at either low or high supragingival plaque levels.
This study suggests that the association of certain subgingival microorganisms with CAL changes in relation to supragingival plaque levels in older adult women. It also suggests that the overall effect of dental plaque is a function of the balance between pathogenic and other microorganisms that colonize this environment. Therefore, all microorganisms in the biofilm, including those with no apparent association with overt disease and those with negative associations, may play roles in the pathogenesis of periodontal diseases.
细菌对局部和全身因素的相互作用可能解释牙周病发病机制的重要特征。本研究评估龈上菌斑水平在龈下微生物与附着丧失风险关系中的作用。
研究人群包括386名45岁及以上的白人女性，她们至少有七颗牙齿。使用纸尖技术从六颗上颌牙和六颗下颌牙的近中颊面采集龈下菌斑样本。将样本合并，并进行免疫荧光显微镜检查以鉴定以下目标微生物：伴放线放线杆菌（Aa）、福赛坦氏菌（Tf）、直肠弯曲菌（Cr）、中间普氏菌（Pi）、嗜二氧化碳噬纤维菌属（Cs）、牙龈卟啉单胞菌（Pg）、黏性放线菌（Es）和具核梭杆菌（Fn）。在采集龈下菌斑样本相同的12个部位评估龈上菌斑的有无及临床附着丧失（CAL）情况。使用多因素逻辑回归分析控制年龄、吸烟状况和糖尿病，检验每种微生物与CAL的关联。计算比值比（OR）及其95%置信区间（CI）。
在低龈上菌斑水平时，仅Pg的存在与CAL显著相关（OR：6.41，95%CI：1.30至31.70）；其余所有微生物也与CAL风险增加相关，但无统计学意义。在高龈上菌斑水平时，Tf（OR：2.40，95%CI：1.42至4.04）和Pg（OR：3.71，95%CI：1.63至8.42）的存在与附着丧失风险增加显著相关。相比之下，Cs（OR：0.55，95%CI：0.30至1.01）和Es（OR：0.35, 95%CI：0.15至０.82）的存在与附着丧失风险降低相关。在低或高龈上菌斑水平时，Fn、Pi和Cr与CAL均无显著关联。
本研究表明，在老年女性中，某些龈下微生物与CAL的关联随龈上菌斑水平而变化。这也表明牙菌斑的总体影响是定植于该环境中的致病微生物与其他微生物之间平衡的函数。因此，生物膜中的所有微生物，包括那些与明显疾病无明显关联以及具有负相关的微生物，可能在牙周病发病机制中起作用。
