【作者】 刘惠莉；

【导师】 施学忠； 谢婧；

【作者基本信息】 郑州大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 慢性牙周炎(chronic periodontitis,CP)是一种感染性疾病,导致牙齿支持组织的炎症、进行性附着丧失和骨吸收。其特点为牙周袋形成和/或牙龈退缩。慢性牙周炎是最常见的一型牙周炎,可在任何年龄发病,但最常发现于成年人。其患病率和疾病的严重程度随年龄增长而增加,可累及不同数目的牙齿,进展程度可不同。慢性牙周炎的发病和持续存在依赖于菌斑,但宿主的防御机制也在发病机制中起着必要的作用。疾病的进展只能通过重复检查得知。慢性牙周炎约占牙周炎患者的95%,由长期存在的慢性牙龈炎向深部牙周组织扩展而引起。牙周炎患病率在35岁以后明显增高,且随着年龄增长,其严重程度也增加。据2005年第3次全国口腔健康流行病学调查结果显示,我国12岁少年牙龈出血率为57.7%,牙石率为59.0%。35～44岁成人组的牙石率高达97%,牙龈出血率为75%;牙周袋深度=4 mm或附着丧失4～5 mm者高达38%。调查结果还显示,该年龄组的牙周健康率仅为14.2%。65～74岁老年人组没有牙龈出血、没有牙周袋、也没有重度牙周附着丧失的比率仅为13.6%。目前牙周炎已成为我国牙齿丧失的主要原因,牙周病的流行状况和防治形势十分严峻。牙周炎比较明确的危险因素有口腔卫生情况,性别,年龄,种族,某些全身疾病,某些微生物等。近年来越来越多的研究结果表明易感的宿主及某些能增加宿主易感性的因素是影响牙周病的发生,类型进程和对治疗的反应的重要因素。对牙周病进行病因学研究,有助于我们发现对中重度慢性牙周炎影响大的危险因素。对各种危险因素进行分析,有助于对中重度慢性牙周炎的诊断及治疗,更重要的是早期预防,降低牙周炎造成的失牙率,提高患者的生命健康质量。为了探讨中重度慢性牙周炎的危险因素,为临床上的预防和治疗提供依据,在郑州市中心医院口腔科进行了研究。材料与方法1.选择2006年1月至2007年6月期间在郑州市中心医院口腔科就诊的203例中重度慢性牙周炎成人患者作为病例组,同期在该科就诊的牙周健康的口腔科患者作为对照。对调查对象采用问卷调查、口腔检查和影像学检查。采用1:1配对设计,按照年龄、性别、文化程度、居住地进行配对。若符合条件对照多于1个,则抽取1个年龄更接近的人作为对照。2.问卷调查内容包括研究对象的人口学数据、行为危险因素、精神因素、牙周炎相关疾病的现病史、口腔健康行为和习惯以及就医行为等;口腔检查内容包括简化软垢指数(debris index-simplified,DI-S)、简化牙石指数(calculusindex-simplified,CI-S)、个人简化口腔卫生指数(oral hygiene index-simplified,OHI-S)、牙周探诊深度(probing depth,PD)、龋补牙数(decayed and filled tooth,DFT)、有无不良修复体、有无食物嵌塞、错颌畸形、有无创伤颌;影像学检查内容包括摄取全颌曲面断层片。3.用Excel录入数据库,利用SAS9.1.3软件进行分析。调整前OR及95%CI的计算用卡方检验,条件Logistic回归分析用来计算调整后的OR及95%CI,筛选中重度慢性牙周炎危险因素,检验水准取0.05。结果1.研究对象的一般情况研究对象共203对,男性108对,占53.20%,女性95对,占46.80%,大学或以上文化程度者51对,占25.12%,高中(中专)或以下文化程度者152对,占74.88%,城市居民189对,占92.86%,农村居民14对,占7.14%。病例组和对照组平均年龄分别为53.24±4.32岁和53.02±2.36岁,年龄均衡(t=0.88,P=0.38)。病例组和对照组中农民分别占4.93%和11.33%,工人分别占47.78%和43.84%,干部分别占18.23%和21.18%,专业技术人员分别占25.62%和23.65%,饮酒者分别占5 1.23%和45.32%,饮茶者分别占62.56%和58.62%,吸烟者分别占34.96%和24.14%。2.研究对象的牙周情况2.1病例组和对照组牙周检查情况病例组中度牙周炎患者165例,占81.3%,重度牙周炎患者38例,占18.6%。病例组受检牙和缺失牙分别为4714颗和974颗;对照组受检牙和缺失牙分别为5375颗和309颗。病例组平均PD和平均临床附着丧失(clinical attachmentloss,CAL)分别为2.53±0.64mm和2.66±0.78 mm;对照组平均PD和平均CAL分别为2.11±0.32 mm和0.37±0.43 mm。两组平均PD和平均CAL有统计学差异,t=7.87,P＜0.01;t=57.24,P＜0.01。2.2病例组和对照组骨组织情况病例组牙槽骨骨高度和PMI分别为6.17±1.66mm和0.28±0.08;对照组牙槽骨骨高度和PMI分别为10.99±1.26mm和0.47±0.16。两组牙槽骨骨高度和PMI有统计学差异,t=26.79,P＜0.01;t=9.44,P＜0.01。3.单因素分析15个因素与中重度慢性牙周炎相关。CI-S、不良修复体、吸烟、OHI-S、食物嵌塞、系统性疾病、工作压力大、创伤颌、近两年负性生活事件和DI-S为中重度慢性牙周炎危险因素,其OR值及95%CI分别为4.33(1.42,13.15)、3.99(1.71,9.32)、3.91(1.93,7.93)、2.90(1.96,4.29)、2.67(1.33,5.40)、2.31(1.21,4.42)、2.28(1.09,4.77)、1.93(1.12,3.69)、1.48(1.22,1.79)和1.35(1.22,1.50)。而口腔健康教育、换牙刷时间短、刷牙时间长、正确的刷牙方法、刷牙次数多为保护因素,其OR值及95%CI分别为0.80(0.67,0.96)、0.68(0.47,0.99)、0.36(0.18,0.72)、0.17(0.07,0.39)和0.15(0.07,0.30)。4.多因素条件Logistic回归分析将单因素分析有意义的因素进行多因素条件Logistic回归分析,结果有8个因素引入模型:CI-S、吸烟、OHI-S、工作压力大、系统性疾病和负性生活事件为中重度慢性牙周炎发病的危险因素,其OR值及95%CI分别为3.37(1.05,10.78)、3.30(1.51,7.23)、2.50(1.59,3.94)、2.19(1.13,4.71)、2.11(1.04,4.46)和1.43(1.21,1.68)。正确的刷牙方法和刷牙次数多是保护因素,其OR值及95%CI分别为0.26(0.12,0.57)和0.21(0.11,0.40)。结论1、中重度慢性牙周炎患者同时具有牙槽骨吸收及下颌骨皮质骨丢失,下颌骨骨密度降低。2、CI-S、OHI-S、吸烟、系统性疾病、工作压力大和负性生活事件为中重度慢性牙周炎发病的危险因素,正确的刷牙方法、每日刷牙次数多为保护因素。因此,预防和控制中重度慢性牙周炎,应加强口腔健康教育的宣传和指导,培养良好的口腔卫生习惯,推广正确的刷牙方法,改善口腔卫生状况,提高牙周炎患者自我口腔保健和维护牙周健康的能力;积极倡导戒烟;治疗与牙周炎相关的全身性疾病,保持健康的生理和心理状态。更多还原

【Abstract】 Chronic periodontitis is an infectious disease which can lead to the inflammation of dental organizations for supporting,progressive loss of attachment and bone resorption.It’s characterized by the formation of gum pockets or gingival recession. Chronic periodontitis is the most common type of periodontitis,and it may happen at any age,but most of them are adult persons.The prevalence rate and severity of this disease increases with age,involving a different number of teeth,the degree of progress can be different.The incidence and the continued existence of chronic periodontitis dependent on the plaque,but the host defense mechanism of pathogenesis also plays an essential role.The progress of the disease can only be learned through repetition check.Periodontitis patients with chronic periodontitis account for about 95%,from the long-standing chronic gingivitis to the deep periodontal tissue caused by the expansion.Periodontitis in the prevalence rate increased significantly after the age of 35 and with age,severity increased.According to the 3rd national oral health epidemiological survey of 2005^[1],12-year-old boy bleeding gums rate of Chinese is 57.7%,calculus rate is 59.0%.The rate of calculus between 35 to 44-year-old adult is as high as 97%,bleeding gums rate is 75%;the rate of pocket depth = 4 mm or attachment loss being 4～5 mm was as high as 38%.The survey also revealed that the age group of periodontal health was only 14.2 percent. 65 to 74-year-old elderly group did not bleeding gums,there is no pocket and no severe periodontal attachment loss rate of only 13.6 percent.At present,China has become periodontitis tooth loss of the top reasons^[2],prevention and treatment of periodontal disease is extremely critical^[3].Periodontitis compared with clear risk factors for oral hygiene,there are situations,sex,age,race,certain systemic diseases, some of the micro-organisms and so on.In recent years,a growing number of studies show that the susceptible host and the host can increase susceptibility to certain factors that affect the incidence of periodontal disease,the type of process and response to treatment an important factor.Etiology research on periodontal disease research,help us to find moderate to severe chronic periodontitis impact of risk factors.For a variety of risk factors,contribute to severe chronic periodontitis in the diagnosis and treatment and,more importantly,early prevention,to reduce periodontitis caused by tooth loss rate and improve the quality of life and health of patients.In order to explore the moderate to severe chronic periodontitis risk factors for clinical prevention and treatment to provide a basis in Zhengzhou City Center Hospital carried out this study dentistry.Materials and methods1.We choose 203 cases of adult patients with severe periodontitis cases as case group and the patients without periodontitis in the same period as a control from January 2006 to June 2007 in Zhengzhou City Hospital’s stomatology.We did survey questionnaires,oral examination and imageological examination for the subjects.We matched them with 1:1 matching design,in accordance with the age, sex,education,place of residence.2.Questionnaires surveys include the study of demographic data,behavioral risk factors,mental factors related to periodontal disease,the history of oral health habits and medical treatment,as well as behavior;the oral examination will include debris index-simplified（DI-S）,calculus index-simplified（CI-S）,oral hygiene index-simplified（OHI-S）,probing depth（PD）,decayed and filled tooth（DFT）,whether or not with repair bad,food impaction,wrong deformed jaw, jaw trauma.Imageological examination included oral pantomography.3.The SAS 9.13 statistical package was used to analyse data.We used the chi-square test to calculate OR and 95%CI before to be adjusted.Logistic regression analysis was used to calculate the adjusted OR and 95%Cl,then to screen of risk factors of moderate to severe chronic periodontitis.Statistical significance was defined at the 5%level.Results1.The general situation of the object of study203 pairs of subjects were recruited in this study including 108 pairs of male subjucts（53.20%） and 95 pairs of female subjucts（46.80%）,51 pairs of subjects with college or above（25.12%） and 152 pairs with high school or below（74.88%）,189 pairs of city residents（92.86%） and 14 pairs of rural residents（7.14%）.Cases had balanced age（t=0.88,P =0.38）.The average age were 53.24±4.32 and 53.02±2.36.The case group and control group included peasant 4.93%and 11.33%,worker 47.78%and 43.84%,cadres 18.23%and 21.18%,professionals＆technical 25.62% and 23.65%,drinker 51.23%and 45.32%,tea-drinker 62.56%and 58.62%,smoker 34.96%and 24.14%,respectively.2.The periodontal situation of object of study2.1 The check status of periodontal organization between the case and control groupsIn case group there were 165 moderate cases of periodontitis patients and they accounted for 81.4 percent of those surveyed.Patients with severe periodontitis were 38 cases and accounted for 18.6 percent.There were 4714 examined teeth and 974 missing teeth in case group,5375 examined teeth and 309 missing teeth in control group.The average PD and average clinical attachment loss（CAL） were 2.53±0.64mm and 2.66±0.78 mm respectively in case group,and 2.11±0.32 mm and 0.37±0.43 mm respectively in control group.The average PD and CAL of the two groups had statistical difference,t =7.87,P＜0.01;t =57.24,P＜0.01. 2.2 The bone situation of case and control groupsThe high degree of alveolar bone and PMI of case group were 6.17±1.66mm and 0.28±0.08;the high degree of alveolar bone and PMI of control group were 10.99±1.26mm and 0.47±0.16.By statistical tests,two groups of alveolar bone and the PMI have a high degree of statistical difference,t =26.79,P＜0.01:t =9.44, P＜0.01.3.Single-factor analysis15 factors were related to the chronic moderate to severe periodontitis.Simplify the index calculus,non-performing repair,smoking,simplified oral hygiene index for personal,food impaction,systemic diseases,stress,jaw trauma,the last two years of negative life events,debris index simplified to the risk factors,the value of the OR and 95%CI were 4.33（1.42,13.15）,3.99（1.71,9.32）,3.91（1.93,7.93）,2.90（1.96, 4.29）,2.67（1.33,5.40）,2.31（1.21,4.42）,2.28（1.09,4.77）,1.93（1.12,3.69）,1,48 （1.22,1.79） and 1.35（1.22,1.50）.The oral health education,toothbrush for a short time,brush their teeth longer,the correct brushing methods,brush their teeth more often are the protection of factors,the OR and 95%CI were 0.80（0.67,0.96）, 0.68（0.47,0.99）,0.36（0.18,0.72）,0.17（0.07,0.39） and 0.15（0.07,0.30）.4.Multivariate logistic regression analysisSingle factor analysis of the significant factors that conditions for multi-factor logistic regression analysis,the results of the 8 factors into the model:simplify the index calculus,smoking,simplified oral hygiene index for personal,stress,systemic diseases and negative life events for moderate to severe chronic periodontitis disease risk factors,the value of the OR and 95%CI were 3.37（1.05,10.78）,3.30（1.51,7.23）, 2.50（1.59,3.94）,2.19（1.13,4.71）,2.11（1.04,4.46） and 1.43（1.21,1.68）.Brush the correct approach,the number of brush for the protection of factors,the value of the OR and 95%CI were 0.26（0.12,0.57） and 0.21（0.11,0.40）.Conclusions1.Patients with moderate and severe chronic periodontitis have alveolar bone absorption and mandibular cortical bone loss,bone mineral density lower at the same time.2.CI-S,OHI-S,smoking,systemic disease,work pressure and negative life events are risk factors of moderate and severe periodontitis chronic periodontitis,the correct method of brushing teeth and the more brushing the teeth are protective factors.As a result,the prevention and control of chronic moderate and severe periodontitis,oral health education should be enhanced publicity and guidance to develop good oral hygiene habits,the promotion of the right brush for ways to improve the oral health status,patients with periodontitis to improve oral health and the ability to maintain periodontal health;actively promote smoking cessation;the treatment of periodontitis associated with systemic diseases,maintain a healthy physical and mental state.更多还原