Osaka University, Graduate School of Dentistry-Department of Periodontology, Osaka, Japan.
Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
J Clin Periodontol. 2018 Jun;45 Suppl 20:S17-S27. doi: 10.1111/jcpe.12937.
This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system.
Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis.
The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy.
Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.
本综述提出了对现有的牙龈疾病分类系统的修订，并为其与 1999 年分类系统的不同之处提供了理论依据。
细菌菌斑（微生物生物膜）积聚引起的牙龈炎症被认为是牙周炎发病的关键风险因素。因此，控制牙龈炎症对于牙周炎的一级预防至关重要。
与牙菌斑引起的炎症性牙龈状况相关的临床特征包括：a）局限于牙龈的炎症的临床体征和症状；b）通过去除或破坏生物膜使炎症可逆；c）存在高细菌菌斑负荷以引发炎症；d）全身性修饰因素（例如，激素、全身性疾病、药物）可改变菌斑引起的炎症的严重程度；以及 e）牙周组织上稳定（即不变）的附着水平，这些附着水平可能已经经历了附着丧失或牙槽骨丧失，也可能没有。简化的牙龈状况分类包括：1）引入“初期牙龈炎”一词；2）描述牙龈炎症的程度和严重程度；3）描述牙龈肿大的程度和严重程度；以及 4）减少牙菌斑引起的牙龈疾病分类中的类别。
各种系统性和口腔因素会改变牙菌斑引起的牙龈炎症。适当的干预对于预防牙周炎至关重要。
