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本文为作者原创翻译，未经授权禁止转载AAPD.ClassificationofPeriodontalDiseasesforInfants,Children,Adolescents,andIndividualswithSpecialHealthCareNeeds.PediatricDentistry,. 者：周双双极橙儿童齿科校 对：代微微极橙儿童齿科
审 阅：汪 鹭极橙儿童齿科
目的PURPOSE美国儿牙协会(AAPD)认为，虽然在儿童和青少年中，破坏性牙周病的患病率较低，但这一人群可能会发生几种常与潜在的系统性或免疫性疾病相关的牙周疾病。1-4此外，目前和早期的研究表明，牙龈炎在四、五岁的人群中占一半的发病率，在青春期达到顶峰，发病率接近%。3在儿童时期，牙龈炎的发病率可能与龋齿相似，甚至更高。1然而，与龋齿相比，儿童牙龈炎的长期影响受到的 i.牙周袋periodontalpockets;
ii.牙科修复dentalrestorations;
iii.牙根解剖结构rootanatomy;
iv.牙位toothposition;
v.拥挤rowding.
b.全身影响因素systemicmodifyingfactors
i.宿主免疫功能hostimmunefunction;
ii.全身健康systemichealth;
iii.遗传学genetics.
3.环境因素environmentdeterminants
a.吸烟smoking;
b.药物medications;
c.压力stress;
d.营养nutrition.
为了达到或维持临床牙周健康，临床医师不应低估每个患者的诱发因素和影响因素，并应认识到这些因素何时能得到能充分控制。易感因素是导致牙菌斑积累的所有因素或条件(如牙齿解剖、牙齿位置、修复体情况)，而影响因素是改变个体对龈下菌斑累积反应方式的因素或条件(如吸烟、全身情况、药物治疗)。许多因素是可以控制的(如，去除充填体悬突，戒烟，良好的糖尿病控制)，而有些因素则不能(如，遗传，免疫状况，关键药物的使用)。21
Inordertoattainormaintainclinicalperiodontalhealth,cliniciansshouldnotunderestimatepredisposingandmodifyingfactorsforeachpatientandshouldrecognizewhenthesefactorscanbefullycontrolledornot.Predisposingfactorsareanyagentorconditionthatcontributestotheaccumulationofdentalplaque(e.g.,toothanatomy,toothposition,restorations),whilemodifyingfactorsareanyagentorconditionthataltersthewayinwhichanindividualrespondstosubgingivalplaqueaccumulation(e.g.,smoking,systemicconditions,medications).Manyfactorsaredeterminedcontrollable(e.g.,removalofoverhangs,smokingcessation,gooddiabetescontrol)whileothersarenot(e.g.,genetics,immunestatus,useofcriticalmedications).21牙龈健康Gingivalhealth牙龈健康(GH)通常与炎症浸润和宿主反应的相对稳定平衡相关。21牙周组织完整的牙龈健康患者诊断依据为：(1)探诊性无附着丧失，(2)放射学检查无骨吸收(RBL)，(3)PPD3mm，(4)BoP10%。11牙龈炎和牙周炎治疗后可恢复牙龈健康。11牙龈炎治疗后牙龈健康的诊断标准与上述相同。牙周组织减少，在成功治疗牙周炎后，也可观察到相同的临床特征。当前牙龈健康但有过牙周治疗史牙周情况稳定的患者，仍会增加牙周炎复发的机率。因此，应密切监测以确保最佳的疾病管控。11Gingivalhealth(GH)isusuallyassociatedwithaninflammatoryinfiltrateandhostresponseinrelativelystableequilibrium.21GHinapatientwithintactperiodontiumisdiagnosedby(1)noprobingattachmentloss,(2)noradiographicboneloss(RBL),(3)3mmofPPD,and(4)10percentBoP.11GHcanberestoredfollowingtreatmentofgingivitisandperiodontitis.ThediagnosticcriteriaforGHinapatientfollowingtreatmentofgingivitisarethesameasthosejustmentioned.Thesesameclinicalfeaturesalsoareobservedonareducedperiodontiumfollowingsuccessfultreatmentofperiodontitis.ApatientwithacurrentGHstatuswhohasahistoryofsuccessfullytreatedandstableperiodontitisremainsatanincreasedriskofrecurrentperiodontitis;therefore,thepatientshouldbemonitoredcloselytoensureoptimaldiseasemanagement.牙龈疾病和牙龈状态Gingivaldiseasesandconditions牙龈炎是一种可逆的疾病，其特征是牙龈发生炎症，但不会导致临床附着丧失(CAL)。牙龈炎是发展为牙周炎、进行性结缔组织附着丧失和骨丧失的必要前提，在儿童和青少年中非常普遍。6,22,28控制牙龈炎症被认为是牙周炎的首要预防策略，也是牙周炎复发的次要预防策略。即使牙龈发炎的位点容易发生附着丧失，但并非所有受影响的地方都肯定会发展成牙周炎。这是因为健康牙龈、牙龈炎和牙周炎之间的相互关系高度依赖于宿主的易感性和免疫炎症反应。然而，在对所有年龄、有或无没有牙周病史的患者管理中，临床医生必须了解它们的关键作用。牙龈疾病大致可分为两类:牙菌斑生物膜诱发的牙龈炎和非牙菌斑诱发的牙龈疾病。Gingivitisisareversiblediseasecharacterizedbyaninflammationofthegingivathatdoesnotresultinclinicalattachmentloss(CAL).30Gingivitisishighlyprevalentamongchildrenandadolescents11,21andanecessaryprerequisiteforthedevelopmentofperiodontitisandprogressiveconnectivetissueattachmentandboneloss.6,22,28Controllinggingivalinflammationisconsideredtheprimarypreventivestrategyforperiodontitis,aswellasthesecondarypreventivestrategyforrecurrenceofperiodontitis.Eventhoughthereisapredilectionofattachmentlosstooccuratinflamedsitesofthegingiva,notallaffectedareasaredestinedtoprogresstoperiodontitis.Thisisbecausetheinter-relationshipbetweenhealth,gingivitis,andperiodontitisishighlydependentonthehost’ssusceptibilityandimmune-inflammatoryresponse.Nevertheless,cliniciansmustunderstandtheircrucialroleinongoingmanagementofgingivitisfortheirpatientsofallageswithand/orwithoutahistoryofperiodontaldisease.Therearebroadlytwocategoriesofgingivaldiseaseandconditions:dentalplaquebiofilminducedgingivitisandnon-dentalplaque-inducedgingivaldisease.牙菌斑生物膜诱发的牙龈炎Dentalplaquebiofilm-inducedgingivitis在年世界牙周和种植周围疾病分类研讨会上，年修订的牙菌斑引起的牙龈疾病系统分类5包括以下四个部分：(1)牙龈炎症的范围和严重程度的描述；(2)牙龈肿胀的范围和严重程度的描述；(3)简化牙龈疾病分类；(4)讨论轻度局限性牙龈炎是否应被视为一种疾病或健康的转变。22这四个部分将在本文中讨论。DuringtheWorldWorkshopontheClassificationofPeriodontalandPeri-implantDiseasesandConditions,revisionsoftheclassificationsystem5fordentalplaque-inducedgingivaldiseasesincludedfour