【海堂学社】你的患者龈下刮治后牙酸吗？(下篇)

你的患者龈下刮治后

牙酸吗？(下篇)

再看敏感原理分析

1. The extent to which RDS remains a long-standing problem subsequent to periodontal therapy could only partly be addressed, as the data set was limited to a follow-up period of only 4 weeks.

牙周治疗后的RDS这一问题存在已久，由于本研究数据仅限于4周的随访期，尚无法对所有问题迎刃而解。

2. Indeed, a variety of emotional elements may influence the subjective interpretation of pain and anxiety, fear and depression are factors that are known to affect pain perception, and the subjects ability to identify coping methods. Thus, anxiety and stress may play important roles when assessing RDS. 

事实上，疼痛是一种主观描述，受到多种情绪因素的影响，如焦虑、恐惧和抑郁，都被确认为是影响疼痛感知的因素，另外受试者的自我认知也很重要。因此，焦虑和心理压力可能在评估RDS时有着重要影响。

3. The degree to which pathways in the central nervous system become sensitised is yet another mechanism that may explain different reports of pain associated with root dentin exposures. 

中枢神经系统通路敏感度也可能是一种相关机制，用以解释为何各种研究中，根面牙本质暴露与疼痛关系会有所不同。

4. The design of the present study was such that it allowed for sequential, repeated assessments of RDS in the treated quadrants. However, the repeated measurements over the 4-week period may have lead to adaptation to the pain provoking stimuli so that patients would give less scores to teeth tested late in the sequence.

本研究设计对受试象限连续、反复评估RDS。如是4周期间反复测量，患者可能适应了相关刺激，因此在试验后期，患者对受试牙评分较低。 

5. The decreased scores over time may hence represent a true reduction in RDS as an effect of the instituted oral hygiene measures. There is poor understanding of the etiologic background to the painful symptoms patients may suffer following exposures of root dentin to the oral environment for example as a sequel to gingival recession and periodontal therapy. 

在完善口腔卫生后，分数随时间推移下降，可能确实代表RDS在降低。牙龈退缩和牙周治疗，导致根面牙本质暴露，患者可能会出现疼痛症状，但目前我们对其病因学背景还知之甚少。

6. Nonetheless, the fact that root surfaces become sensitive to a variety of externally applied stimuli after periodontal instrumentation is not to be of surprise as opened dentinal tubules may become subject to hydrodynamic forces. Therefore, the painful conditions that may emerge should rather be considered a normal, physiologic response than one abnormal, at least initially. 

尽管如此，因为开放的牙本质小管可能会受到流体动力的影响，所以牙周器械治疗后，根面对各种外部刺激变得敏感，这不足为奇。正因如此，人们认为这种可能的疼痛，是一种正常的生理反应，起码最初大家都这么想的。

7. The fact that root dentin then may become non-sensitive appears to be related to a peripheral occlusion of the exposed dentinal tubules as non-sensitive dentin display much lower or hardly any dentinal tubules exposed to the oral environment. 

根面牙本质随后可能会变得不再敏感，这似乎与暴露的牙本质小管外围封闭有关，因为不敏感的牙本质，其牙本质小管很少或根本不暴露在口腔内。

8. Recently, Yates et al. noted, in a placebo controlled split mouth designed clinical trial of an active agent, reduction of dentin hypersensitivity among the placebo treated control teeth along with reduced plaque scores and, thus, observed a similar phenomenon as in the present study. Placebo effect, however, can be ruled out as a factor for the reported reduced pain scores in the present study as patients did not receive any medicament to alleviate emerging painful symptoms other than instruction to maintain oral hygiene. 

最近，Yates等人在一项活性药物与安慰剂对照，分口设计临床试验中发现，使用安慰剂的对照组牙本质过敏症减少，同时牙菌斑评分也有所降低，这与本研究的发现相似。然而，在本研究中，可以排除安慰剂效应，我们不认为它与患者的自评疼痛分数降低有关，因为患者仅遵照指导做口腔卫生维护，并未使用任何缓解疼痛的药物。

9. Yet, regression to the mean may be a factor to explain the reduced pain scores in those quadrants where plaque control alone was maintained. It would have been desirable to control for this effect by allowing a run-in period, where pain assessment was conducted without advice or treatment. For practical reasons, this was not possible to scheme. In clinical trials, however, where the objective is to assess the therapeutic effect of a given agent, run-in periods, where non-active agent is given to both test and control teeth should be exercised to control for both effects of placebo and regression to the mean.

不过，在仅做菌斑控制的象限，均值回归可能是造成疼痛评分降低的一个因素。理想状态应有一个导入期，在此期间不做任何治疗（包括给相关建议），就行疼痛评估，以排除均值回归效应。由于现实原因，未能实现。但要强调的是，在临床试验中，如果目的是评估某一药物的治疗效果，则应该设置导入期，给试验组和对照组的患牙同时使用无活性药物，这样可以排除安慰剂效果，和均值回归的影响。

词汇角

1. coping 

2. hydrodynamic

3. peripheral 

4. alleviate

5. regression 

以上词汇详见词汇角，

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