儿童龋病口腔微生态失衡及防治策略研究进展

Research Progress on Oral Microbial Dysbiosis and Prevention Strategies in Childhood Dental Caries

摘要: 儿童龋病尤其是幼儿龋病是影响儿童口腔健康的重要公共卫生问题。传统病因学多强调特定致龋菌的作用，但近年来越来越多研究表明，儿童龋病的发生发展更符合口腔微生态失衡的理论框架。在频繁摄糖、菌斑滞留等持续环境压力作用下，口腔微生态可由相对稳定的动态平衡状态逐渐转向以产酸菌和耐酸菌富集为特征的失衡状态，并伴随群落多样性下降。在功能层面，龋病相关菌群表现为糖代谢活跃、产酸和耐酸能力增强以及产碱缓冲能力减弱。本文围绕儿童龋病相关口腔微生态失衡的主要特征、影响因素及防治策略进行综述，以期为儿童龋病的早期风险评估和微生态导向干预提供参考。

Abstract: Childhood dental caries, especially early childhood caries, is a major public health problem affecting children’s oral health. Traditional etiological theories have mainly focused on the role of specific cariogenic bacteria. However, increasing evidence suggests that the development of childhood dental caries is better understood within the framework of oral microbial dysbiosis. Under persistent environmental pressures such as frequent sugar intake and plaque retention, the oral ecosystem gradually shifts from a relatively balanced state to a dysbiotic state characterized by the enrichment of acidogenic and aciduric bacteria, reduced microbial diversity, and structural remodeling. At the functional level, caries-associated microbial communities show enhanced carbohydrate metabolism, increased acid production and acid tolerance, and reduced alkali-generating capacity. These changes promote the maintenance of a low-pH microenvironment and continuous demineralization of dental hard tissues. In addition, frequent sugar intake, poor oral hygiene, host-related factors, and early microbial colonization all contribute to the initiation and maintenance of this dysbiosis. Current prevention and control strategies are gradually shifting from traditional environmental intervention to function-oriented modulation and precise microbiome-based intervention. This review summarizes the structural and functional characteristics, influencing factors, and prevention strategies related to oral microbial dysbiosis in childhood dental caries, with the aim of providing a reference for early risk assessment and microbiome-directed intervention.