Jeffcoat M K
Department of Periodontics, University of Alabama School of Dentistry, Birmingham 35294.
Prev Med. 1994 Sep;23(5):704-8. doi: 10.1006/pmed.1994.1119.
Gingivitis and periodontitis are the most prevalent periodontal diseases in adults. Gingivitis is characterized by inflammation of the gingiva without loss of connective tissue attachment to the teeth while periodontitis results in loss of attachment and alveolar bone and may lead to tooth loss. Gingivitis is highly prevalent in adults in the United States, and up to 70% of adults have at least mild periodontitis. In only a small proportion of adults (< 15%) does periodontitis progress to severe disease. The etiology of periodontal disease is infection with pathogenic dental plaque bacteria in a susceptible host. Strategies for preventing periodontal diseases therefore may intervene at the level of the initiation of the inflammatory process, or by preventing the progression of bone and attachment loss in periodontitis. Improved mechanical and chemical plaque control as well as improved restorative materials to facilitate plaque removal continue to enhance the patient's ability to control the plaque bacteria. Strategies to target prevention to the patients who need it most include risk factor assessment, new diagnostic methods, and further elucidation of the natural history of periodontal disease. Further study of the etiology and pathophysiology of periodontitis will aid in the prevention of further destruction through targeted use of local and systemic antibiotics and well as drugs to aid in the host response. Ultimately research may yield multivalent vaccines to be used in high-risk patients.
牙龈炎和牙周炎是成年人中最常见的牙周疾病。牙龈炎的特征是牙龈发炎，但牙齿的结缔组织附着未丧失，而牙周炎则导致附着丧失和牙槽骨吸收，并可能导致牙齿脱落。在美国，牙龈炎在成年人中非常普遍，高达70%的成年人至少患有轻度牙周炎。只有一小部分成年人（<15%）的牙周炎会发展为严重疾病。牙周疾病的病因是易感宿主感染了致病性牙菌斑细菌。因此，预防牙周疾病的策略可以在炎症过程开始时进行干预，或者通过防止牙周炎中骨和附着丧失的进展来实现。改进机械和化学菌斑控制以及改进修复材料以促进菌斑清除，继续提高患者控制菌斑细菌的能力。针对最需要预防的患者的策略包括风险因素评估、新的诊断方法以及进一步阐明牙周疾病的自然史。对牙周炎病因和病理生理学的进一步研究将有助于通过有针对性地使用局部和全身抗生素以及有助于宿主反应的药物来预防进一步的破坏。最终，研究可能会产生用于高危患者的多价疫苗。
