Lang Niklaus P, Schätzle Marc, Ramseier Christoph A
University of Berne, Bern, Switzerland.
Periodontol 2000. 2024 Mar 22. doi: 10.1111/prd.12545.
Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.
对牙周病的易感性取决于宿主对细菌挑战的个体反应因素。对这些因素的研究需要对疾病进程的自然发展进行纵向研究。基于在斯里兰卡以及挪威奥斯陆对牙周病自然组织学进行的原始纵向研究，已经对牙周参数和牙齿状况进行了多项分析。主要发现是，在完全没有口腔卫生措施或预防服务的头20年里，附着丧失的速度各不相同。可以确定三组受试者：快速进展组（RP）（8%）、中度进展组（MP）（81%）和无疾病进展组（NP）（11%）。在随后的二十年里，RP组受试者失去了大部分牙齿，再也没有发现NP患者。这二十年的进展速度要慢得多，牙齿死亡率也有所下降。可以预测，30岁时附着丧失超过2毫米的受试者在60岁时无法维持功能性牙列。在奥斯陆的相应对照人群被用于研究牙龈炎症对牙周病发生和进展的影响。在从3岁起就接受最佳和定期预防服务的人群中确定了附着丧失的模式和速度。在26年的观察期内，可以证明成年期牙龈炎症变化不大，始终有出血部位的情况持续出现在10%至20%。确定了持续性牙龈炎在附着丧失发病机制中的作用，并且在没有牙龈炎时也反映出稳定性。牙齿死亡率仅在患有持续性牙龈炎的受试者中出现。在牙齿年龄达到50岁后，63%的牙齿仍然保留，而在没有牙龈炎症的情况下，50年后99.8%的牙齿得以保留。因此，持续性牙龈炎是牙齿丧失的一个危险因素。
