Newman H N
Department of Periodontology, Eastman Dental Institute and Hospital, University College London, UK.
Int Dent J. 1998 Jun;48(3):173-9. doi: 10.1111/j.1875-595x.1998.tb00474.x.
Research in recent years in periodontology has seen a shift from surgery towards medicine. While surgery, particularly regenerative, and including implants, continues to form an important element of periodontal treatment, the volume of treatment required and the results of recent and ongoing non-surgical studies clearly show that most future periodontics will be based on a physician-type approach. Improved diagnostics based on more precise periodontal disease classification, simplification of mechanical oral hygiene equipment and procedures, and the development of conventional and non-conventional chemical and physical adjuncts may be expected to reduce the rate of common periodontal disease advance, resulting in less complex treatments, and more of the latter coming to lie within the competence of the generalist and the hygienist working together. The rationale for non-surgical adjunctive therapy is extensive, far beyond the usual antimicrobial logic. It will also be important to control the oral microflora for systemic reasons, since increasingly strong links are being established between focal infection of oral origin, much of it periodontal, and a range of systemic diseases, including coronary heart disease, stroke, gastrointestinal disorders, and low birth weight, apart from severe, overt systemic infections. All these developments derive from a greatly improved understanding of the fundamentally ecological nature of the natural microbial biofilm that is dental plaque, and of its interactions with its human host.
近年来，牙周病学的研究已从外科手术转向医学。虽然外科手术，尤其是再生手术，包括种植牙手术，仍然是牙周治疗的重要组成部分，但所需治疗量以及近期和正在进行的非手术研究结果清楚地表明，未来大多数牙周病治疗将基于医生式的方法。基于更精确的牙周疾病分类的诊断改进、口腔卫生机械设备和程序的简化，以及传统和非传统化学及物理辅助手段的开发，有望降低常见牙周病的进展速度，从而减少治疗的复杂性，并且更多此类治疗将由全科医生和保健员共同完成。非手术辅助治疗的基本原理广泛，远远超出了通常的抗菌逻辑。出于全身健康的原因控制口腔微生物群也很重要，因为口腔局部感染（其中大部分是牙周感染）与一系列全身性疾病（包括冠心病、中风、胃肠道疾病和低出生体重）之间的联系日益紧密，严重的显性全身感染更是如此。所有这些进展都源于对牙菌斑这种天然微生物生物膜的基本生态本质及其与人类宿主相互作用的极大深入理解。
