牙本质过敏症治疗进展

牙本质过敏症是口腔科的常见症状之一 ,其发生率为8%～ 30 % ,牙本质过敏症的发生机制有多种学说 ,目前大多数学者普遍接受的是液体流动力学说 ,即外界刺激引起牙本质小管内液流动 ,激发牙髓神经感受器 ,引起疼痛。因此 ,牙本质过敏症的治疗目的主要是封闭牙本质小管和镇痛牙髓神经。临床上治疗牙本质过敏症的方法较多 ,疗效不一 ,但随着治疗方法的改进以及新方法的使用 ,脱敏疗效也正在逐步提高。本文就近年来治疗牙本质过敏症的现状进行综述。一、药物脱敏法1 氟化物　有多种形式的氟化物用于牙本质过敏症的治疗。氟能与羟磷灰石结合形成…     

Systemp脱敏剂治疗牙本质过敏症的研究

目的观察Systemp脱敏剂治疗牙本质过敏症的效果.方法牙本质过敏症患牙240颗,实验组120颗,使用Systemp脱敏剂,对照组120颗使用30%草酸钾溶液.离体牙30颗,磨除牙冠颈1/3区牙釉质,暴露牙本质,分3组,第1组涂布Systemp,第2组涂布草酸钾溶液,第3组不作任何处理,进行扫描电镜观察.结果实验组与对照组的疗效存在显著性差异,各组内随着时间的推移,疗效出现下降且存在显著性差异.电镜下可见,经Systemp处理后牙本质表面的牙本质小管基本被封闭,开口不显现,并有"树脂突"样结构深入牙本质小管约50μm.结论Systemp能有效地封闭牙本质小管,治疗牙本质过敏症效果明显,持续性较佳,是一种较为理想的牙本质脱敏剂.     

TM光固化脱敏涂料的临床疗效和作用机理研究

目的：试验TM光固化脱敏涂料对牙本质过敏症的治疗效果,并初步研究其脱敏的作用机理。方法：将115名牙本质过敏症患者的239颗患牙随机分为两组,实验组和对照组分别用TM光固化脱敏涂料和GLUMA脱敏剂脱敏,比较两组的即刻和三月后疗效;并制作离体牙标本,通过扫描电镜观察TM光固化脱敏涂料对牙本质小管的封闭作用。结果：两组的即刻和三月后疗效无显著差异;TM固化脱敏涂料产生的“树脂突”牙深入牙本质小管30－50μm。结论：TM光固化脱敏涂料对牙本质过敏症有较好的治疗效果。     

All—Bond脱敏剂治疗牙本质过敏症的护理体会

Ａｌ－Ｂｏｎｄ脱敏剂治疗牙本质过敏症的护理体会广东省口腔医院（５１０２６０）潘彩霞牙本质过敏症的治疗方法较多，但效果都不很理想。Ａｌ－Ｂｏｎｄ脱敏剂治疗牙本质过敏症，经临床观察，效果肯定，现将护理体会总结如下：一、病例选择：有咬合面磨损或牙颈部暴露的...     

Prime&Bond(R)NT粘接剂治疗牙本质过敏症的临床观察

目的探讨有效治疗牙本质过敏症的方法。方法将120例患者的356颗牙本质过敏牙随机分为实验组和对照组,每组178颗。实验组用Prime＆BondNT粘接剂脱敏,对照组用脱敏糊剂脱敏。观察两组牙齿脱敏治疗的即刻、3个月后和半年后的临床效果。结果在脱敏治疗的即刻、3个月后和半年后,实验组患牙牙本质过敏症的治疗效果都优于对照组,实验组治疗牙本质过敏症的有效率超过94%。结论Prime＆BondNT粘接剂是一种治疗牙本质过敏的理想脱敏剂。     

激光治疗牙本质过敏症的护理配合

牙本质过敏症是指牙在受到外界刺激,如温度(冷、热)、化学物质(酸、甜)以及机械作用(摩擦或咬硬物)等所引起的酸痛症状。激光脱敏是目前临床使用有效的一种脱敏方法,其治疗原理是通过激光瞬间产生的高温使牙本质间质和牙本质小管成熔融状,使开放的牙本质小管口封闭,刺激传导中断而达到脱敏的目的。但由于激光对组织的穿透力强,遇反光物体易折射,治疗时稍有操作不当,极易损伤人体正常组织,给患者或医务人员造成不必要的伤害。严格的防护和细致的护理不仅能防止治疗过程中差错事故的出现,而且能节省治疗时间,提高工作质量和效率。本文通过对128例用脉冲Nd：YAG激光行牙脱敏治疗患者的护理,总结出以下护理经验。     

口腔脱敏糊剂治疗牙本质过敏症疗效分析

目的观察口腔脱敏糊剂治疗228例牙本质过敏症患者的疗效。方法用双盲法将228例出现牙本质过敏症的患者随机分成2组,分别用口腔脱敏糊剂和普通牙膏刷牙,记录使用牙膏前及使用牙膏后2、4周的牙齿敏感指数,观察其疗效,、结果和普通牙膏相比,口腔脱敏糊剂在治疗牙本质过敏症的患者时疗效有显著性差异。结论口腔脱敏糊剂对牙本质过敏症有较好的治疗效果,且使用方便。     

Prime&Bond(R)NT粘接剂治疗牙本质过敏症的临床观察

目的 探讨有效治疗牙本质过敏症的方法.方法 将120例患者的356颗牙本质过敏牙随机分为实验组和对照组,每组178颗.实验组用Prime&Bond(R)NT粘接剂脱敏,对照组用脱敏糊剂脱敏.观察两组牙齿脱敏治疗的即刻、3个月后和半年后的临床效果.结果 在脱敏治疗的即刻、3个月后和半年后,实验组患牙牙本质过敏症的治疗效果都优于对照组,实验组治疗牙本质过敏症的有效率超过94%.结论 Prime&Bond(R)NT粘接剂是一种治疗牙本质过敏的理想脱敏剂.     

牙本质敏感的概述

牙本质敏感是口腔临床上常见的疾病之一,在成年人中普遍存在,患病率为29.7%。目前最为广泛接受的发病机制是流体动力学说。牙本质敏感的治疗是封闭或部分封闭牙本质小管来减少牙本质小管内的液体流动和阻断牙本质小管内神经传导。临床上常见的脱敏方法为药剂、激光、材料充填及冠修复等多种方法。     

ALL—BOND脱敏剂治疗牙本质过敏症的临床观察

ＡＬＬ－ＢＯＮＤ脱敏剂治疗牙本质过敏症的临床观察广州市第一人民医院（５１０１８０）桂平徐英亿治疗牙本质过敏的方法主要是应用各种脱敏剂脱敏，如氟化钠糊剂、碘化银、氨硝酸银、硝酸钾涂布，药物离子导入法等，方法甚多但效果都不确切，个体疗效差异大。近几年来一...     

Clinical correlations of dentin structure and function

Dentin, a porous, fluid-filled mineralized tissue, may provide critical mechanical support to overlying enamel. Once the enamel or cementum surface seals are lost by disease or trauma, the same organization that provided critical mechanical support then becomes a liability, offering millions of fluid-filled diffusion channels from the periphery directly to the pulp. If restorative materials placed in cavities do not seal the dentin, there is a fluid-filled continuum from the cavosurface margins, around gaps between the restorative material and the tooth, to dentin surfaces, then through dentin via its tubules to the pulp. Under most conditions these channels permit bidirectional diffusion of exogenous and endogenous substances across dentin. Occasionally, hydrodynamic stimuli will produce transient, rapid movement of dentinal fluid that will induce pain. The tubules are sometimes so close together in deep dentin that their intrinsic wetness interferes with the bonding of adhesive resins. This permits the formation of gaps, microleakage, dentin sensitivity, and, occasionally, pulpal irritation. Many clinical problems such as poor dentin bonding, microleakage, dentin sensitivity, and pulpal irritation have a common denominator in the structure and function of dentin.     

Sensitivity of dentin to chemical stimuli

Abstract Numerous chemical stimuli have been used to click pain from exposed dentin. Most of the effective chemicals share a common denominator; they arc all very hypertonic. Dentin surfaces covered with a smear layer are much less responsive to hypertonic solutions than dentin devoid of a smear layer. These observations support the hydrodynamic theory of dentin sensitivity. The most important variables influencing the efficacy of chemical stimuli include: ionic composition, presence or absence of calcium, sodium or potassium, pH and osmolality (tonicity). Although hypertonic solutions of sucrose or CaCl₂ can be useful qualitative stimuli, the theoretical objections to using them for quantitative evaluation of dentinal sensitivity seem to far out-weight their advantages.     

Mechanisms of dentin sensitivity

This article reviews dentin sensitivity from a mechanistic perspective beginning with short treatments of pulpal innervation, the hydrodynamic considerations of dentin, and how various stimuli may cause pain. Speculation is raised about the contribution of bacteria and their products on dentin sensitivity and how dentin might become truly hypersensitive, especially following periodontal therapy. Wherever possible, the clinical considerations of basic research is stressed.     

Dentin hypersensitivity: etiology and methods of treatment]

This work presents review on etiology of dentinal hypersensitivity and mechanisms of dentin desensitization. The main theories on dentin sensitivity are discussed in details. Particularly are stressed hydrodynamic and transducer theories. Two main approaches to the dentin desensitization by tubule occlusion and blocking pulpal nerve activity by altering the sensory nerves excitability are presented. The aim of dentin desensitization is to apply various agents that occlude dentinal tubules and so decrease dentin sensitivity or to apply agents that reduce nerve excitability. Between many different agents in use the most wide use and best results in decreasing dentin sensitivity have topical application of oxalate salts and application of unfilled resins. Different toothpaste with strontium chloride or potassium nitrate as active ingredients have been commonly used as very effective desensitizing agents.     

Effect of a new liner/base on human dentin permeability

Objectives

Resin-modified glass ionomers (RMGI) have demonstrated clinical success in their ability to minimize post-operative sensitivity of restorations. RMGIs have been recently introduced as paste-liquid systems for convenience of clinical usage. The objective of this study was to measure the ability of a new paste-liquid RMGI liner/base to reduce fluid flow through human dentin.

Methods

Dentin permeability was measured on human crown sections on etched dentin, using etched dentin as a model for the exposed tubules typical of root sensitivity, and permitting measurement of the maximum permeability. In the one group, the etched dentin was coated with the RMGI, and pre- and post-treatment permeability was measured on the coated dentin. In the second group, a smear layer was created on the dentin with sandpaper, then the samples were coated with the RMGI; permeability was measured on the smeared and coated dentin. Samples from each group were sectioned and examined via scanning electron microscopy (SEM).

Results

The new paste-liquid RMGI liner/base significantly reduced fluid flow through dentin, and exhibited excellent seal on dentin with either a smear layer or open tubules. SEM images show evidence that the RMGI infiltrated the smear layer with resin during placement, penetrated dentin tubules, and formed resin tags in acid-etched dentin.

Conclusions

Based on these results, combined with previous research on adhesion and microleakage, it is concluded that the new RMGI liner/base should minimize post-operative sensitivity in restorations.     

Amalgam restorations: postoperative sensitivity as a function of liner treatment and cavity depth

The purpose of this clinical study was to assess the sensitivity reported by patients following the insertion of class 1 or class 2 amalgam restorations in the treatment of primary carious lesions of different depths. Ninety subjects with previously untreated teeth requiring restorations due to caries lesions were selected: 32 teeth had lesions that were clinically and radiographically judged to be located in the outer one-third of dentin, 30 were located in the middle one-third of dentin, and 28 were located in the inner one-third of dentin. Four different lining regimens were employed: Group 1--no linear; Group 2--two coats of Copalite liner; Group 3--a dentin adhesive resin liner (Scotchbond Multi-Purpose); Group 4--a resin-modified glass ionomer (Fuji Bond LC). Patients were contacted on days 2 and 7 postoperatively and questioned regarding the presence or absence of sensitivity, the stimuli that created the sensitivity, if any, the duration of any sensitivity, and the intensity of any sensitivity using a rating from None to Severe. If sensitivity was experienced on day 7, patients were also contacted on days 14, 30, and 90 to assess the sensitivity at those intervals. The chi-square test of independence showed no significance at the 0.05 level between the different dentin treatments and cavity depths. By day 2, 19% of lesions located in the outer one-third, 27% of lesions located in the middle one-third, and 29% of lesions located in the inner one-third of dentin were sensitive. On day 30, four teeth were still sensitive, two located in the middle one-third and two located in the outer one-third of dentin. On day 90 all teeth were without sensitivity.     

活髓预备牙的临时性保护

目的介绍活髓预备牙的临时性保护措施和效果。方法局麻下对活髓牙进行规范的牙体预备，414颗预备牙表面涂脱敏剂、底胶或牙本质粘结剂，用Protemp^IM、自凝树脂Quick Resin或Unifast，通过间接法或直接法制作临时性修复体，再用Procem^TM或丁香油氧化锌糊剂进行粘固。对应用临时性冠桥的牙齿情况、数目分布，修复体件数、使用情况等进行了总结。结果736件临时性修复体中，用直接法、间接法制作的分别为341件和395件。就位困难、咬合高是试戴过程中经常出现的问题，发生率分别为16．39％和13．11％。通过临床观察发现，术后最多见的并发症就是牙本质过敏，发生率为3．91％。牙髓炎发生率为0．38％。涂脱敏剂、底胶或粘结剂组和不涂组，牙髓并发症的发生率分别为1．93％和8．18％。结论制作和粘固临时性树脂冠桥能够保护基牙，防止基牙移位、牙龈增生，暂时性发挥修复功能。活髓预备牙表面涂脱敏剂、底胶或粘结剂可以减少术后牙髓并发症的发生率，以应用脱敏剂效果最好。     

The effect of fluoride and strontium application on dentin: in vivo and in vitro studies.

The effectiveness of topical 2% sodium fluoride applied with and without 10% strontium chloride pretreatment was compared in patients complaining of tooth hypersensitivity. In addition the radiopacity of 2% sodium fluoride and 25% strontium chloride treated dentin was studied in vitro. Reduction of sensitivity to cold and mechanical stimuli was evaluated during a period of 3 months by pain scoring in the exposed cervical dentin of homologous teeth on the two sides of the jaws. There was a significant decrease in the sensitivity of the exposed cervical dentin after treatment with sodium fluoride solution with or without pretreatment with strontium chloride solution. At the end of the experimental period the combined strontium and fluoride treatment was found to be more effective than that of fluoride alone in reducing sensitivity to cold. The increase in radiodensity of dentin samples immersed in strontium chloride was statistically significant, while there was no significant increase in density for the samples immersed in sodium fluoride solutions. A mineralization process is possibly the effective means by which fluoride or strontium diminishes sensitivity of dentin.     

Dentin permeability. Effects of desensitizing dentifrices in vitro

Patients using placebo dentifrices in clinical trials usually show a significant decrease in dentin sensitivity over a 2- to 4-week period. If their sensitivity were due to hydrodynamic fluid movement, then the results suggest that there was a decrease in their dentin permeability. This hypothesis was tested in vitro by measuring the ease with which fluid could flow (i.e., hydraulic conductance) across dentin discs before and after brushing the discs with a variety of dentifrices, including most of the marketed densensitizing dentifrices. All dentifrices decreased the hydraulic conductance of dentin. An experimental dentifrice containing oxalate as the active ingredient was far more effective than any of the marketed dentifrices. The results tend to support the hypothesis that, at least part of the reduction in clinical sensitivity in patients with hypersensitive dentin is due to the abrasive action of the dentifrice.