Hirsch R S, Clarke N G
Department of Dentistry, University of Adelaide, South Australia.
Rev Infect Dis. 1989 Sep-Oct;11(5):707-15. doi: 10.1093/clinids/11.5.707.
Contemporary hypotheses that consider the severe forms of periodontal disease to be infections caused by site-specific microbes fail to satisfactorily explain the epidemiologic, anthropologic, and clinical features of periodontal diseases. The microbes that have been designated as periodontopathogens are commensal bacteria present in periodontal health and disease. Association of specific bacteria with various disease forms has been established, but association is confused with causation. None of the periodontal diseases can be transmitted between individuals or between diseased and healthy sites of a susceptible person. Past and present concepts of the etiology of the periodontal diseases are reviewed, and the deficiencies of contemporary periodontal theory are outlined. Host factors rather than bacteria determine whether gingivitis extends to horizontal periodontitis. Angular alveolar lesions, the severe form of periodontal bone loss, are hypothesized to be caused by the spread of pulpal inflammation to the adjacent periodontal tissues. When the resultant dental abscess becomes contiguous with the alveolar crest and gingival sulcus, secondary colonization of deep pockets by site-specific oral bacteria-selected for by the complex conditions of the site-can occur. This explanation accounts for the distribution of periodontopathogens, the localization of angular alveolar lesions, and the bursts of activity by which the disease progresses.
当代一些假说认为严重形式的牙周病是由特定部位的微生物感染所致，但这些假说未能令人满意地解释牙周病的流行病学、人类学及临床特征。那些被认定为牙周病原体的微生物是存在于牙周健康及患病状态下的共生菌。特定细菌与各种疾病形式之间的关联已被确立，但这种关联被混淆为因果关系。没有一种牙周病能够在个体之间传播，也不能在易感个体的患病部位与健康部位之间传播。本文回顾了过去和现在关于牙周病病因的概念，并概述了当代牙周病理论的不足之处。宿主因素而非细菌决定了牙龈炎是否会发展为水平型牙周炎。角形牙槽骨病变是牙周骨丧失的严重形式，据推测是由牙髓炎症扩散至相邻牙周组织所致。当由此产生的牙脓肿与牙槽嵴和龈沟相邻时，特定部位的口腔细菌（因该部位的复杂条件而被选择）就可能在深牙周袋中继发定植。这一解释说明了牙周病原体的分布、角形牙槽骨病变的定位以及疾病进展所呈现的活动爆发情况。
