歯周疾患における剥離細胞学的研究

炎症の程度と剥離細胞および組織像との対比

抄録

A comparison between macroscopic evaluation and cytological findings in the labial gingiva of maxillae and mandible. Histopathological findings were also examined, including the therapeutic course was made on periodontal diseases of 81 patients selected randomly. Macroscopic evaluation was made on four items, reddening, swelling, bleeding, pus discharge by a predetermined standard. The overall results were determined as the inflammation grade (IG). In classifying exfoliative cytology, exofoliative epithelium were divided in terms of positional morphology into 4 types, deep layer type (Dt), intermediate layer type (It), nucleated superficial layer type (S₁t), non-nucleated superficial layer type (S₂t). According to the staining attitude, they were divided into blue type (Bt), red-blue mixed type (RBt), red type (Rt), yellow type (Yt).
Additionally, an all type (At), blue type seen in the intermediate layer type (ItBt) were added. As a result of the examination, the following results were obtained.
(1) As the inflammation grade increases, Dt or Bt increases, whereas S₂t or Yt decreases. It, irrespective of the inflammation grade, occupied the majority of the exfoliative epithelium.
(2) Changes by inflammation grade is obscure excepting that turbidity, poor staining tendecy, indistinctness of the border, small vacuole and large vacuole become conspicuous at inflammation grade 8 as changes in the cytoplasm.
Nuclear changes show a tendency towards hyperchromatosis or hypochromasia, and karyosome increases as inflammation grade increases.
(3) In all inflammation grade, no change was seen on cytoplasm-nucleus ratio (long axis).
(4) As inflammation grade increase, appearance of leukocytes and bacteria tends to increase.
(5) The observation of the course using various local treatments showed a decrease both Dt and Bt from the second week and a tendency towards recovery was seen. Bacteria attachment decreased in the first week in periodontal curettage, gingivectomy and flap operation. Subsequently the same condition was maintained.
(6) The appearance of cells in each type according to positional morphology and staining attitude corresponding to inflammation grade, and changes of epithelial layer were confirmed histologically.
The above results demonstrate that the exfoliative cytological examination can express morphological changes of the pocket epithelium in the periodontal diseases to a considerable degree. Consequently, it is of use to accurately grasp the fluctuation in the disease process.