Axelsson P
Public Dental Health Service, Department of Preventive Dentistry, Alvgatan, Karlstad, Sweden.
Int Dent J. 1993 Jun;43(3):223-38.
Analytical, oral epidemiological studies in adult 'toothbrushing' populations show that the highest prevalence of missing teeth is for molars and maxillary premolars ('key-risk' teeth). The highest prevalence of subgingival microflora, gingivitis (CPITN-1), plaque retentive factors, such as subgingival calculus and restoration overhangs (CPITN-2), and diseased pockets > 3 mm (CPITN-3-4) is found on the approximal surfaces of the same teeth ('key-risk' surfaces). Primary and secondary prevention, as well as treatment of periodontal disease should be focused on these 'key-risk' surfaces. One single, well-executed subgingival scaling and root-planning procedure in deep, diseased periodontal pockets, followed by oral hygiene training and professional mechanical tooth-cleaning (PMTC) at need-related intervals, will prevent further loss of periodontal attachment. However, if the root cementum is removed during instrumentation, and the post-treatment plaque control programme fails, microorganisms will recolonize and invade the rough exposed root dentine, resulting in recurrence of periodontitis and possibly, root caries and pulpitis. Some of these problems may be overcome by the application of new instruments and methods for self-care, PMTC, removal of overhangs, scaling and root-planing without removing 'non-diseased' cementum.
针对成年“刷牙”人群的分析性口腔流行病学研究表明，牙齿缺失患病率最高的是磨牙和上颌前磨牙（“关键风险”牙齿）。牙龈下微生物群、牙龈炎（社区牙周指数-1）、牙菌斑滞留因素（如牙龈下牙结石和修复体悬突，社区牙周指数-2）以及深度大于3毫米的患牙周袋（社区牙周指数-3 - 4）患病率最高的部位是相同牙齿的邻面（“关键风险”表面）。牙周疾病的一级和二级预防以及治疗应聚焦于这些“关键风险”表面。在深度患牙周袋中进行一次操作良好的龈下刮治和根面平整，随后根据需要进行口腔卫生训练和专业机械洁牙（PMTC），将防止牙周附着进一步丧失。然而，如果在器械操作过程中根骨质被去除，且治疗后牙菌斑控制计划失败，微生物将重新定植并侵入粗糙暴露的根牙本质，导致牙周炎复发，还可能引发根龋和牙髓炎。通过应用新的自我护理器械和方法、PMTC、去除悬突、刮治和根面平整而不去除“无病变”的牙骨质，其中一些问题可能会得到解决。
