牙結石與牙周病的關係一文獻回顧

The Relationship between the Dental Calculus and Periodontal Dental a Comparative Review

吳逸民(Yih-Ming Wu) ； 蔡吉政(Chi-Cheng Tsai)

《臺灣齒科醫學會雜誌》 11卷2期 (1988/10) Pp. 366-373

摘要

”牙結石曾經有一段很長的時間被認為是引起牙周喪庸的主要原因。但由近30 年來許多研究指出,細菌才是真正引發許多牙周病變得主要致病因子,而且無可否認的,牙菌斑的生長確實比牙結石更接近組織破壞區,因此牙結石被認為是牙周炎的結果,而非造成牙周炎的原因,若有,也只是提供細菌一個滯留的機會。然而由許多臨床研究中發現,單純的清潔牙菌斑,不論是齒齦上或是齒齦下菌斑,若不配合牙結石刮除草牙根面平整術,則無
法改善牙齦的發炎。從形態學的結果也可以知道,牙結石粗糙的表面是提棋細菌極好的滯留條件,因此一且有齒臨下結石的存在, 則牙菌斑將無法徹底地清除乾淨,即使是使用抗生素,對組織健康的改善程度亦極為有限。 臨床上,從物理性割除牙結石及牙根面平整術對組織有很明顯改善的現象來看,牙結石對牙周組織的破壞應不只是個間接因素。由實驗性研究結果,更直接顯示,牙結石可視為細菌及細菌毒素的貯藏室,可以長時間不斷的將
毒性釋放出來,引起組織長期的發炎與破壞,因缸,牙結石與牙周病的關係，除了傳統中認為只是握棋細菌一個滯留機會的被動因素外,它應該還掛連一個更主動的角色才是。”

並列摘要

”Calculus was previously considered to be the prime etiologic agent in periodontal disease. In the past 30 years, numerous
investigations have documented the fact that bacterial plaque is the direct etiologic agent in most of periodontal disease. There is now no question that apical growth of a bacterial plaque precedes the fonnation of subgingival calculus and there is no longer an issue of whether calculus is the cause or the result of periodontal diseas. Many clinical studies
revealed that the removal of bacterial plaque alone, whether supra- or sub-gingivally, is insufficient to prevent gingival disease.Morphologically, marked roughness of the outer surface of the calculus promote the retention of bacterial plaque. With sub-gingival calculus present subgingival plaque cannot be adequately removed. Even the antibiotic therapy without mechanical remove of deposits has been showen to have a limited efficacy. In contrast to the study on chemical control of supragingival calculus, the clinical evidence for mechanical control is strongly suggestive that in addition to the traditional indirect effects, there is a direct role for subgingival calculus in the progression ofperiodontitis. More direct evidence is avail-able from experimental studies that calculuscan be considered a toxic waste dump site and' in a sense a slow release device deliver-ing pathogenic products. This would suggest that the porous, toxic bacterial productretentive calculus plays more than a passiverole.”

並列關鍵字

calculus ； periodontal disease