本文转自“海堂学社 Malus Wisdom”
你的患者龈下刮治后
牙酸吗？(上篇)
1. The successful treatment of periodontal disease depends on the effective removal of bacterial deposits from the tooth surfaces. This can be accomplished by thorough daily oral hygiene measures achieved by the patient. A large number of dentinal tubules will, thus, be exposed, leading to direct avenues to the pulp for bacteria and bacterial elements present in the oral environment. As a result, the patient may experience increased sensitivity of the exposed root surfaces to thermal, tactile, evaporative and osmotic stimuli.
成功的牙周治疗仰赖于有效地去除牙菌斑。这需要患者每日彻底地清洁口腔。但这又可能导致大量牙本质小管暴露，牙髓将直接受到口内细菌及其产物的刺激。最终，患者根面暴露，对温度刺激、机械刺激、吹气刺激和渗透压变化的敏感度将增加。
2. This pain condition, when severe, has in the literature been termed dentin hypersensitivity (DH), which is a well-known ailment to the clinician. The prevalence of DH has been assessed in epidemiological studies employing questionnaires, clinical assessments and questionnaires and clinical assessments in combination. The prevalence has been reported to vary between 15% and 84% depending on the patient population examined.
当疼痛反应严重时，术语称为牙本质过敏症（DH）。临床医生对此已司空见惯。流行病学研究中，常采用问卷调查、临床检查以及两者相结合的方法，评估DH的患病率。不同的被检人群，DH患病率在15%至84%之间。
3. It is not clear whether already sensitive teeth are at risk to become more sensitive or even hypersensitive after scaling and root planing. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops root dentin sensitivity (RDS). Throughout the study the term RDS is used to designate a painful response of a particular tooth to professionally applied stimuli on the root surface.
原本敏感的牙齿，在洁刮治和根面平整后，是否会变得更敏感，或罹患牙本质敏感症？这仍为不解之谜。本次临床试验的目的是研究接受非手术牙周治疗的患者，发生根面牙本质敏感（RDS）的程度。本研究中，RDS特指：特定牙受到专业的人为刺激后，根面产生的疼痛反应。
4. Alterations in RDS was followed in 35 patients (29–65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. All tentative experimental teeth were tested for pulpal vitality. Prior to the initiation of the trial, the patients were subjected to a comprehensive periodontal examination by one of the authors. Plaque was recorded at all treatment sessions and follow-up examinations using the criteria described by Quigley & Hein (1962) after disclosure with a solution of erythrocine.
随访35例（29-65岁）中重度牙周病患者非手术治疗后RDS的变化情况。所有试验牙均作牙髓活力测试。试验开始前，由作者之一全面检查患者的牙周。所有治疗和随访中均用龙胆碱溶液显示菌斑，并用Quigley & Hein （1962）指数评分。（译者注：详情见推文《初识Quigley-Hein菌斑指数（1962）》）。
5. Tests for painful responses were carried out on the buccal surface of each tooth included in the study. RDS was first determined with a scratch test using a pressure-sensitive probe (0.45 N and a blunt terminal tip of 0.4 mm diameter). On testing, the probe was held perpendicular to the root surface and was run vertically and horizontally in order to cover at best the entire buccal surface. After stimulation, the patient was asked to score the discomfort according to a visual analogue scale (VAS; see below).
在所有受试牙颊面作疼痛反应测试。首先，用压力感应探针(0.45 N，直径为0.4 mm的钝头探针)轻划牙面测定RDS。检查时，探针垂直于根面握持，作垂直和水平向运动，并尽量涵盖整个颊面。随后，患者根据视觉模拟量表自行评分（译者注：VAS评分具体方法欢迎关注海堂学社明日推文）。
6. Following the scratch test a rest period of approximately 20 min was allowed before the test with air-blast pain stimuli was performed. An air-blast (60psi 22℃) derived from a dental syringe was directed to the root surface for 1 s. The syringe was held perpendicularly, 2–3 mm from the root surface. During testing the dentist’s gloved fingers shielded the neighbouring teeth.
在轻划牙面行探痛测试后，让患者休息20分钟，然后做吹气疼痛测试（直接吹冷气）。垂直根面放置气水枪，并在距离2-3mm处向根面吹气（60psi 22℃）1秒。测试时，医生应戴手套，用手指保护邻牙免受影响。
7. The study was extended to include a total of 4 weeks of observation. After baseline recordings, the subjects received oral hygiene instruction according to the standardised treatment protocol. Subsequently, one of the available quadrants was scaled and root planed (S/RP) by a dental hygienist, using hand and/or ultrasonic instrumentation. Polishing was then performed with a rubber cup and polishing paste. At each subsequent week a new quadrant was treated, following the test procedure described above.
连续观察4周。在基线记录后，受试者接受标准化口腔卫生指导。随后，由牙科卫生士在其中一个象限完成手动和超声洁刮治，根面平整。然后用橡胶杯和抛光膏抛光。之后每周按上述方法处理其他象限，每周一项限。
8. There was a statistically significant reduction in mean VAS-scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth.
随着时间的推移，在仅做有效控制菌斑的象限中，VAS平均评分显著降低；而器械治疗后，VAS评分显著增高（p<0.001）。并且，器械治疗后，自评VAS高分的受试者百分比也有所增加。VAS平均评分的变化不大，只有9名患者有3颗或更多的牙齿VAS评分增加大于2cm。
9. A statistically significantly higher increase of RDS was observed for initially sensitive teeth(VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged.
与基线无敏感的牙齿相比，原本就敏感的牙齿（VAS>0）RDS明显增加（p<0.001）。虽然在洁刮治后4周随访期间，RDS有所降低，但敏感牙齿百分比保持不变。
10. The high quality of plaque control was confirmed by an observed reduced number of root surfaces carrying plaque of which less than 15% showed visible plaque at the follow-up examinations. The observation that RDS decreased following improvement in oral hygiene contradicts the opinion that plaque control results in an increase of RDS.
如果在随访中，检出（视诊）菌斑的根面数量少于15%，则认定为菌斑控制良好。本研究结果显示，口腔卫生改善后，RDS有所降低，这与之前提出的观点相悖。该观点认为菌斑控制会增加RDS。
11. In the current study dentin sensitivity increased, on the other hand, following scaling and root planing. This applied to the intensity of RDS, the number of patients reporting sensitivity as well as the frequency of sensitive teeth. The latter finding is in line with prevalence studies observing RDS to be a particularly prevalent complication in patients previously exposed to either non-surgical or surgical periodontal therapy.
而在本研究中，洁刮治和根面平整后，牙本质敏感度增加。RDS程度、出现敏感的患者数，以及发生敏感的频率也有所增加。这些发现与先前的流行病学研究一致。该研究观察到，在既往接受过牙周治疗的患者中，无论是非手术还是手术治疗，RDS都是一种非常普遍的并发症。
词汇角
1. ailment
2. tentative
3. perpendicular
4. intensity
5. contradict
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MALUS WISDOM
