Newman H N
Department of Periodontology, University of London, UK.
J Clin Periodontol. 1990 Sep;17(8):533-41.
The nature of the relationship between dental plaque and chronic inflammatory periodontal disease (CIPD) remains unclear, although there is no doubt that plaque is the direct cause. Non-specific, specific and exogenous hypotheses have been proposed to explain plaque-host relationships. Current evidence indicates that plaque is part of the natural human microflora, one of many such in nature, and that disruption of oral microbial ecology, due primarily to diet texture changes, leads to gingivitis and periodontitis. These result in increased plaque accumulation, and particularly in increased interdental effective plaque thickness. The latter leads to alterations in plaque ecology, particularly increasing anaerobiosis, with resultant shifts in proportions of its constituent species. These shifts are responsible for the increased counts of, for example, Bacteroides gingivalis, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Wolinella recta, spirochaetes and others, associated with chronic periodontitis in its various forms. Measures to prevent or control chronic periodontitis should aim, not to eliminate plaque, which ignores ecology and would compromise host defence, but to restore the species distribution in plaque to that compatible with health.
尽管毫无疑问牙菌斑是慢性炎症性牙周病（CIPD）的直接病因，但牙菌斑与该病之间关系的本质仍不明确。人们提出了非特异性、特异性和外源性假说，以解释牙菌斑与宿主的关系。目前的证据表明，牙菌斑是人类自然微生物群的一部分，是自然界众多此类菌群之一，并且主要由于饮食质地变化导致的口腔微生物生态破坏会引发牙龈炎和牙周炎。这些会导致牙菌斑积聚增加，尤其是牙间隙有效牙菌斑厚度增加。后者会导致牙菌斑生态发生改变，特别是厌氧环境增加，其组成物种的比例也随之发生变化。这些变化导致了例如牙龈拟杆菌、伴放线放线杆菌、具核梭杆菌、直肠沃氏菌、螺旋体等菌数量增加，这些菌与各种形式的慢性牙周炎有关。预防或控制慢性牙周炎的措施不应旨在消除牙菌斑，因为这忽视了生态且会损害宿主防御，而应旨在将牙菌斑中的物种分布恢复到与健康相符的状态。
