吸烟对慢性牙周炎患者术后龈沟内致病微生物的影响

Effects of smoking on gingival sulcus of pathogenic microorganisms in postoperative patients with chronic periodontitis

目的:探讨吸烟对慢性牙周炎患者术后龈沟内致病微生物的影响。方法:将2012月1月-2012年12月于我院治疗的60例中重度慢性牙周炎患者根据吸烟状况分为吸烟组(n=30)与非吸烟组(n=30)两组,两组患者均采用改良Widman翻瓣术对慢性牙周炎进行治疗,分别在治疗前及治疗后4、8、12周检测如下项目:1采用聚合酶链式反应(PCR)技术检测龈沟内伴放线放线杆菌(Actinobacillus actinomycetemcomitans,Aa)、牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、福赛斯坦纳菌(Forsyth Tanner Rand,Tf)、中间普氏菌(Prevotella intermedia,Pi)、具核梭杆菌(Fusobacterium nucleatum,Fn)、变黑普氏菌(Prevotella nigrescens,Pn);2检测牙菌斑指数(Plaque Index,PLI)、龈沟出血指数(Sulcus bleeding Index,SBI)、牙周袋探诊深度(Probing pocket depth PPD)等临床指标;观察并记录龈沟内微生物和临床指标的变化。结果:术后两组的PLI、SBI和PPD等临床指标的数值与治疗前比较均有不同程度降低,两组的PLI、SBI和PPD数值在术后4周的降幅明显,差异均具有统计学意义(P<0.01),且术后8、12周与术后4周比较,PLI、SBI和PPD数值均有不同程度的升高;在治疗4、8及12周的时间内,将吸烟组与非吸烟在PLI、SBI和PPD数值的变化程度进行同期比较,差异(尤其是术后4周)具有统计学意义(P<0.05)。Pg、Tf、Pi具有较高检出率。Aa、Pg、Tf、Pi、Fn、Pn的位点检出率于治疗后4周均明显低于治疗前,差异均具统计学意义(P<0.05);Pg、Tf、Pi的位点检出率在治疗后8周、12周也明显低于治疗前,差异均具统计学意义(P<0.05)。治疗前吸烟组Fn、Pn的位点检出率比非吸烟组相对较高,差异具有统计学意义(P<0.01);术后4周,吸烟组的6种微生物位点检出率比非吸烟组相对较高,差异均具有统计学意义(P<0.01);术后8周和12周,吸烟组的Pg、Tf、Pi、Fn、Pn位点检出率比非吸烟组相对较高,差异具有统计学意义(P<0.05)。结论:Aa、Pg、Tf、Pi、Fn、Pn均可在患者龈沟内检出,其共同感染有可能是慢性牙周炎的发病原因之一;牙周手术治疗对中重度牙周病具有良好的临床及控制菌斑微生物的效果;吸烟作为慢性牙周炎的危险因素之一,会造成龈沟内致病微生物的增长,对慢性牙周炎的治疗效果具有显著的影响。

Objective To investigate the effects of smoking on gingival sulcus of pathogenic microorganisms in postoperative patients with chronic periodontitis. Methods According to the smoking status,60 cases in our hospital from January 2012 to December 2012 with chronic periodontitis were divided into smoking group（n=30） and non-smoking group（n=30）.Both groups were treated with modified Widman flap surgery. The following items were set on before operation and4,8 and 12 weeks after operation,respectively. 1 The microorganisms on gingival sulcus such as Actinobacillus actinomycetemcomitans（Aa）,Porphyromonas gingivalis（Pg）,Forsyth Tanner Rand（Tf）,Prevotella intermedia（Pi）,Fusobacterium nucleatum（Fn） and Prevotella nigrescens（Pn） were detected by polymerase chain reaction（PCR）. 2The clinical indicators of plaque index（PLI）,sulcus bleeding index（SBI）,probing pocket depth（PPD） were detected.The variations of microbial and clinical index on gingival sulcus were observe and recorded. Results The numerical of PLI,SBI,PPD of two groups were reduced compared before and after operation.The numerical of PLI,SBI,PPD of two groups were reduced significantly in 4 weeks,and the differences were statistically significant（P 0.01）.PLI,SBI,PPD of two groups were increased comparison of 8 and 12 weeks after operation with 4weeks after operation. In the treatment of 4,8 and 12 weeks after operation,the degree of changes in PLI,SBI and PPD were compared between smoking group and non-smoking,the differences（especially two weeks after operation） were statistically significant（P 0.05）.Pg,Tf and Pi were the pathogen and they had higher detection rate compared to Aa,Fn and Pn.The site detection rates of Aa,Pg,Tf,Pi,Fn and Pn in 4 weeks after treatment were significantly lower than that before treatment,and the differences were statistically significant（P0.05）.The site detection rates of Pg,Tf and Pi in 8and 12 weeks after treatment were significantly lower than that before treatment,and the differences were statistically significant（P0.05）.They were statistically significant of the site detection rates of Fn and Pn in two groups compared before and after operation（P0.01）,and the rates of smoking group was higher than non-smoking group.They were statistically significant of the site detection rates of the six microbial in 4 weeks after operation were compared between smoking group and non-smoking（P0.01）,and the rates of smoking group was higher than non-smoking group.They were statistically significant of the site detection rates of Pg,Tf,Pi,Fn and Pn in 8 and 12 weeks after operation were compared between smoking group and non-smoking,and the rates of smoking group was also higher than non-smoking group（P0.05）. Conclusion The microorganisms of Aa,Pg,Tf,Pi,Fn and Pn were detected in patients with gingival sulcus,and the common infection could be the causes of chronic preiodontitis.As one of the risk factors of chronic periodintitis,smoking had significant effect on treatment of chronic periodontitis. In addition,smoking could also cause growth of pathogenic microbial in gingival sulcus.