目的 探讨聚维酮碘（povidone-iodine,PVP-I）漱口水对青少年正畸患者口腔菌群α多样性与牙龈炎发生的影响,并与氯己定（chlorhexidine,CHX）漱口水及氯化钠（NaCl）漱口水进行对比,评估其在正畸患者口腔卫生管理中的临床可行性与优势。方法 纳入2020年1月至2025年1月在四川大学华西医院营山医院口腔科接受口腔正畸治疗的青少年患者174例,按所使用漱口水种类分为NaCl组（n=76）、CHX组（n=52）和PVP-I组（n=46）。所有患者均接受统一的口腔卫生宣教,并连续使用指定漱口水4周。分别于基线、治疗后1周、4周、12周评估牙菌斑指数（plaque index,PLI）、牙龈指数（gingival index,GI）、牙龈沟出血指数（sulcus bleeding index,SBI）、简化口腔卫生指数（simplified oral hygiene index,OHI-S）、主观感受量表评分及牙龈沟液炎症标志物[肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素（interleukin,IL）-1β、IL-6、IL-17],同时评估口腔菌群α多样性变化。结果 三组患者基线各项指标差异无统计学意义（P>0.05）。治疗1周与4周后,CHX组和PVP-I组的PLI、GI、SBI、OHI-S均较NaCl组明显降低;菌群多样性分析显示,CHX与PVP-I组的Shannon和Simpson指数显著下降;炎症因子方面,PVP-I组在第4周时TNF-α、IL-1β、IL-6、IL-17水平均显著低于NaCl组;PVP-I组患者在主观感受上得分最高,口感、清新感、黏膜舒适度和总体满意度优于CHX组。结论 PVP-I漱口水在控制菌斑、减轻牙龈炎及降低炎症反应方面与CHX疗效相当,且患者耐受性更佳,可作为其理想的临床替代选择。
Abstract
Objective To explore the effects of povidone-iodine (PVP-I) mouthwash on the α diversity of oral flora and the occurrence of gingivitis in adolescent orthodontic patients, and to compare it with chlorhexidine (CHX) mouthwash and sodium chloride (NaCl) mouthwash, and to evaluate its clinical feasibility and advantages in the oral hygiene management of orthodontic patients. Methods A total of 174 adolescent patients undergoing orthodontic treatment at the department of stomatology of Yingshan Hospital, West China Hospital of Sichuan University, from January 2020 to January 2025, were enrolled and divided into three groups according to the type of mouthwash used: NaCl group (n=76), CHX group (n=52), and PVP-I group (n=46). All patients received standardized oral hygiene education and used the assigned mouthwash for four consecutive weeks. Plaque index (PLI), gingival index (GI), sulcus bleeding index (SBI), simplified oral hygiene index (OHI-S), subjective scores, and gingival crevicular fluid inflammatory markers (TNF-α, IL-1β, IL-6, IL-17) were evaluated at baseline and 1, 4, and 12 weeks post-treatment, along with changes in oral microbiota α-diversity. Results At baseline, no significant differences were found among the three groups. After 1 and 4 weeks of treatment, PLI, GI, SBI, and OHI-S were significantly lower in the CHX and PVP-I groups than in the NaCl group. Microbiota diversity analysis showed significantly lower Shannon and Simpson indices in the CHX and PVP-I groups. Inflammatory factor analysis revealed that at week 4, TNF-α, IL-1β, IL-6, and IL-17 levels were significantly lower in the PVP-I group than in the NaCl group. Moreover, PVP-I group patients had the highest subjective scores for taste, freshness, mucosal comfort, and overall satisfaction, outperforming the CHX group. Conclusion PVP-I mouthwash has comparable efficacy to CHX in controlling plaque, alleviating gingivitis and reducing inflammatory responses, and has better patient tolerance. It can be used as an ideal clinical alternative.
关键词
口腔正畸 /
聚维酮碘 /
氯己定 /
牙龈炎
Key words
orthodontics /
povidone-iodine /
chlorhexidine /
gingivitis
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基金
南充市应用技术研究与开发专项项目“右美托咪定与丙泊酚联合地佐辛在口腔舒适化治疗中的应用”（20YFZJZC0024）
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