Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Oral and Maxillofacial Diseases, University of Helsinki Clinicum, Helsinki, Uusimaa, Finland.
J Periodontol. 2019 May;90(5):484-492. doi: 10.1002/JPER.18-0450. Epub 2018 Nov 28.
The aim of this study was to investigate how different patient-related risk indicators might be associated with the odds of developing subclinical periodontitis in adolescents.
This cross-sectional study included 252 Finnish individuals aged 15 to 16 years, of whom 141 were boys and 111 girls. A specially trained dentist performed clinical examinations: measurements included periodontal indexes (bleeding on probing, visible plaque index, root calculus, and probing depth, smoking by pack-years, periodontal bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens, and Treponema denticola) and the potential salivary periodontal biomarkers (active matrix metalloproteinase-8 [aMMP-8], polymorphonuclear leukocyte elastase [PMN elastase], and total protein, albumin, immunoglobulin A, immunoglobulin G, and immunoglobulin M). Results were analyzed by ordinal logistic regression, one-way analysis of variance, Fisher exact test, and Kruskal-Wallis H test.
The main finding of this study was that subclinical periodontitis in adolescents was statistically significantly associated with elevated salivary aMMP-8 but not with PMN elastase. Also, adolescents with subclinical periodontitis had statistically significantly higher levels of bleeding on probing, root calculus, and dental plaque than adolescents without subclinical periodontitis.
We suggest that the main risk factor for subclinical periodontitis in adolescents is the partly calcified, dysbiotic bacterial biofilm, which interacts with the immune defenses of the host; this leads to gingival inflammation and eventually to deepening periodontal pockets. This proinflammatory subclinical periodontitis stage, which represents stage I periodontitis in the new classification, is reflected as elevated salivary aMMP-8 levels in oral fluids.
本研究旨在探讨不同与患者相关的风险指标如何与青少年发生亚临床牙周炎的几率相关。
这是一项横断面研究，共纳入 252 名年龄在 15 至 16 岁的芬兰人，其中 141 名男性，111 名女性。由经过专门培训的牙医进行临床检查：测量包括牙周指数（探诊出血、可见菌斑指数、根面牙石、探诊深度、吸烟包年数、牙周细菌（伴放线放线杆菌、牙龈卟啉单胞菌、福赛斯坦纳菌、中间普氏菌、变黑普氏菌和牙髓密螺旋体）和潜在的唾液牙周生物标志物（活性基质金属蛋白酶-8[aMMP-8]、多形核白细胞弹性蛋白酶[PMN 弹性蛋白酶]和总蛋白、白蛋白、免疫球蛋白 A、免疫球蛋白 G 和免疫球蛋白 M）。结果采用有序逻辑回归、单因素方差分析、Fisher 确切检验和 Kruskal-Wallis H 检验进行分析。
本研究的主要发现是，青少年的亚临床牙周炎与唾液中 aMMP-8 升高有统计学显著相关性，但与 PMN 弹性蛋白酶无关。此外，有亚临床牙周炎的青少年探诊出血、根面牙石和牙菌斑水平明显高于无亚临床牙周炎的青少年。
我们认为，青少年亚临床牙周炎的主要危险因素是部分钙化、生态失调的细菌生物膜，它与宿主的免疫防御相互作用；这导致牙龈炎症，最终导致牙周袋加深。这种促炎的亚临床牙周炎阶段反映为唾液中 aMMP-8 水平升高，在新分类中代表牙周炎 I 期。
