根面龋微生态的研究进展

The microbial ecology of root caries

龋病的发生是在外界环境多因素作用下,牙菌斑微生态中细菌与细菌、细菌与宿主之间生态失衡,牙菌斑生物膜细菌组成由生理性组合向病理性组合演变,产酸耐酸菌获得竞争优势,牙菌斑生物膜产酸增加,牙体硬组织脱矿,最终形成肉眼可见的龋损。牙根面特殊微环境及组织学结构使根面龋的发生较牙冠部窝沟点隙龋更加复杂。根面龋的发生发展不仅包括微生物产酸导致牙体硬组织脱矿,还包括内源性、细菌源性胶原酶对牙本质胶原蛋白的溶解。牙根面微生态系中微生物具有高度多样性,相较于牙冠部,牙根面有更多的革兰阴性菌、厌氧菌和真菌定植,微生物之间的相互作用更加复杂。本文就牙根面牙菌斑微生态的研究进展进行综述,以期从微生态的角度为根面龋的防治提供新的思路。

As a clinical subtype of dental caries, root caries is a polymicrobial infectious disease resulting from dysbiosis of the microbial ecology of the mouth. In this case, highly acidogenic/aciduric species are selectively enriched while less aciduric commensal residents are suppressed within the biofilm. This feed-forward imbalance in microbial equilibrium leads to a continuous decline in pH to the threshold below which tooth hard tissue demineralization occurs. Due to the histological features of tooth dentine and cementum, as well as the impact of both saliva and gingival groove liquid, the microbial etiology of root caries is relatively complex, including not only demineralization by bacterial acidification but also organic matrix degradation. The microorganisms within root caries lesions show high diversity, including large numbers of Gram-negative bacteria, anaerobic bacteria, and even fungi. This review summarizes the characteristic microorganisms of root caries from the perspective of microbial ecology to advance our understanding of root caries.