Periodontol 2000. 2012 Oct;60(1):110-37. doi: 10.1111/j.1600-0757.2011.00429.x.
Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.
牙周炎是一种复杂的传染病，对低收入人群的影响不成比例。牙周炎与特定的细菌物种和疱疹病毒有关，成功预防和治疗这种疾病取决于对这些病原体的有效控制。本文提出了一种有效、高度安全、微创、实用且低成本的牙周治疗方法，涉及专业和患者管理的机械治疗和抗菌剂。主要成分包括去除牙石的洁治、牙周袋强力防腐剂冲洗和用于治疗晚期疾病的全身抗生素。聚维酮碘和次氯酸钠都具有成为牙周病管理首选防腐剂的所有特征。这两种药物都具有出色的抗菌和抗病毒特性，在全球范围内都有供应，在牙周治疗中已安全使用数十年，为经济资源非常有限的个人带来了显著的益处，并且被大多数牙科专业人员和患者所接受。将 4%的洗必泰用牙刷涂到舌背的最后部分，可以显著减少或消除大多数个体的口臭。全身抗生素用于治疗局部治疗不易到达的牙周病细菌，如牙龈组织、分叉缺损内、牙周袋底部和舌、扁桃体和颊黏膜上的病原体。对于年轻和中年患者，有价值的抗生素治疗是阿莫西林-甲硝唑（阿莫西林 250mg 和甲硝唑 250mg，每日 3 次，连用 8 天），对于老年患者和经常有龈下肠杆菌的发展中国家患者，是环丙沙星-甲硝唑（各 500mg，每日 2 次，连用 8 天）。去除牙石的洁治和谨慎使用廉价的抗菌剂可以显著延缓或阻止大多数患者的牙周炎进展。
