Page R C, Altman L C, Ebersole J L, Vandesteen G E, Dahlberg W H, Williams B L, Osterberg S K
J Periodontol. 1983 Apr;54(4):197-209. doi: 10.1902/jop.1983.54.4.197.
We report radiographic, clinical, historical, and laboratory observations on seven patients selected to illustrate the features and characteristics of rapidly progressive periodontitis, with the aim of establishing this disease as a distinct clinical entity. This form of periodontitis is seen most commonly in young adults in their twenties, but it can occur in postpubertal individuals up to approximately 35 years of age. During the active phase, the gingival tissues are extremely inflamed and there is hemorrhage, proliferation of the marginal gingiva, and exudation. Destruction is very rapid, with loss of much of the alveolar bone occurring within a few weeks or months. This phase may be accompanied by general malaise, weight loss, and depression, although these symptoms are not seen in all patients. The disease may progress, without remission, to tooth loss, or alternatively, it may subside and become quiescent with or without therapy. The quiescent phase is characterized by the presence of clinically normal gingiva that may be tightly adapted to the roots of teeth with very advanced bone loss and deep periodontal pockets. The quiescent phase may be permanent, it may persist for an indefinite period, or the disease activity may return. Most patients with rapidly progressive periodontitis have serum antibodies specific for various species of Bacteroides, Actinobacillus, or both, and manifest defects in either neutrophil or monocyte chemotaxis. Affected patients generally respond favorably to treatment by scaling and open or closed curettage, especially when accompanied by standard doses of antibiotics for conventional time periods. A small minority of patients do not respond to any treatment, including antibiotics, and the disease progresses inexorably to tooth loss even in the presence of aggressive periodontal therapy and maintenance. At the present time it is not possible to distinguish prior to treatment which individuals will respond to therapy and which will not.
我们报告了对7例患者的影像学、临床、病史及实验室观察结果，这些患者被选来阐明快速进展性牙周炎的特征，目的是将这种疾病确立为一种独特的临床实体。这种牙周炎形式最常见于20多岁的年轻人，但也可发生在青春期后的个体中，年龄可达约35岁。在活动期，牙龈组织极度发炎，有出血、边缘龈增生和渗出。破坏非常迅速，在几周或几个月内就会有大量牙槽骨丧失。这个阶段可能伴有全身不适、体重减轻和抑郁，尽管并非所有患者都有这些症状。疾病可能会持续进展而不缓解，直至牙齿脱落，或者在接受或未接受治疗的情况下消退并进入静止期。静止期的特征是临床牙龈正常，可能与严重骨丧失和深牙周袋的牙根紧密贴合。静止期可能是永久性的，可能会持续不确定的时间，或者疾病活动可能会再次出现。大多数快速进展性牙周炎患者血清中存在针对各种拟杆菌属、放线杆菌属或两者的特异性抗体，并表现出中性粒细胞或单核细胞趋化性缺陷。受影响的患者通常对刮治和开放或闭合刮治术治疗反应良好，尤其是在常规时间段内联合标准剂量抗生素治疗时。少数患者对任何治疗（包括抗生素）均无反应，即使在积极的牙周治疗和维护的情况下，疾病仍会不可阻挡地进展至牙齿脱落。目前，在治疗前无法区分哪些个体对治疗有反应，哪些个体没有反应。
