早期釉质龋治疗的研究进展

在各种口腔疾病中,龋病发病率较高,能否将其控制在早期阶段并将其治愈,对维持口腔健康有重要意义。因此对早期釉质龋的治疗成为人们研究的一个焦点。目前临床研究显示:再矿化疗法、渗透树脂技术治疗早期釉质龋病具有非常好的疗效。再矿化疗法是将已脱矿及软化的釉质通过不同的处理方法使其发生再矿化,尽可能恢复其硬度,终止或修复早期釉质龋。氟化物、CPP-ACP被证实在抑制釉质的脱矿及促进脱矿釉质的再矿化方面有很好的效果,但氟化物的使用安全成为国内外研究人员争论的焦点。因此CPP-ACP相比于氟化物是一种更为安全的再矿化材料。渗透树脂技术是用微创的方法治疗早期釉质龋,一次完成治疗,能减少牙科恐惧症的发生,尤其适用于儿童。同时也受到越来越多牙体修复医师的关注。     

护牙素、柠檬烯和五倍子单宁酸联合BAG对正畸釉质再矿化影响的研究

目的:应用护牙素、天然产物柠檬精油提取物柠檬烯(LIM)以及五倍子单宁酸联合生物玻璃(BAG)分别处理托槽周围脱矿的釉质,在体外测试这三种试剂对正畸脱矿质牙釉质的再矿化作用。方法:将48颗已粘接好托槽的人离体牙随机等分四组,即人工唾液A组,护牙素B组,柠檬烯C组,五倍子单宁酸联合生物活性玻璃D组,进行脱矿处理后涂布各组试剂。用显微硬度仪分别于脱矿前、脱矿后及再矿化的第28天检测开窗实验区的维氏硬度值。结果:脱矿处理后的各组SMH值均小于脱矿前(P0.05),再矿化实验后四组SMH值较脱矿后均有增加,将各组SMH值进行单因素方差分析,A组与C组再矿化后SMH值无统计学差异(P0.05),B组与D组再矿化后SMH值无统计学差异(P0.05)。结论:护牙素与五倍子单宁酸联合BAG对脱矿釉质均具有较好的作用,且效果相当。柠檬烯不能促进脱矿釉质的再矿化。     

氟化泡沫与氟保护漆对离体乳牙釉质保护效果的比较

目的 比较局部使用氟化泡沫和氟保护漆对乳牙釉质脱矿的保护作用。方法 60颗牙冠完整的下颌乳切牙,在牙冠唇侧选定釉质处理区域,按照不同试剂处理分为A、B、C三组,A:氟化泡沫组,B:氟保护漆组,C:去离子水组。处理后的离体牙在脱矿液中浸泡72 h后用扫描电镜观察釉质表面形态结构差异;利用原子吸收分光光度计检测各组脱矿液中钙离子的溶出量。结果 A、B两组析出的Ca²⁺浓度均显著低于C组(P<0.05);B组析出的Ca²⁺浓度显著低于A组(P<0.05)。扫描电镜观察釉质表面显示C组较A、B两组脱矿明显,A、B两组的釉质表面可见再矿化物。结论 离体下颌乳切牙应用氟化泡沫及氟保护漆都可以增强其釉质的抗酸能力并促进再矿化,氟保护漆较氟化泡沫具有更强的保护作用。     

CPP-ACP与Duraphat对离体牙牙釉质再矿化的对比研究

目的观察可口可乐和冰红茶2种饮料对离体恒牙牙釉质的脱矿作用及使用酪蛋白磷酸钙复合体(CPP-ACP)与多氟乐(Duraphat)2种再矿化制剂对已脱矿离体牙牙釉质再矿化的影响。方法选取2015年6-9月在重庆医科大学附属口腔医院因正畸拔除的恒牙制备而成的牙块试件120个,随机分为可口可乐组与冰红茶组,每组60个,分别用可口可乐和冰红茶进行酸蚀处理,5d后从各组中随机取出40个试件,随机分为2个亚组,每个亚组20个试件,分别涂布CPP-ACP和Duraphat进行再矿化处理,后继续用原饮料酸蚀处理5d,每组剩余20个试件作为对照组继续酸蚀处理。分别测定初次酸蚀处理前后及再矿化处理后继续酸蚀5d时每组试件所浸泡饮料中的钙离子浓度。结果可口可乐中的钙离子浓度较高,为(0.913±0.142)mmol/L,冰红茶中的钙离子浓度较低,为(0.212±0.011)mmol/L,酸蚀处理后,2组饮料中的钙离子浓度均较处理前有所增加,差异有统计学意义(P0.05)。经再矿化处理后,可口可乐与冰红茶2组中CPPACP与Duraphat亚组饮料中的钙离子浓度均低于本组对照亚组,差异有统计学意义(P0.05);且CPPACP亚组饮料中的钙离子浓度均低于Duraphat亚组,差异有统计学意义(P0.05)。结论CPP-ACP与Duraphat均可以使已经发生脱矿的牙釉质发生再矿化,但CPP-ACP的再矿化作用较Duraphat略强。     

钙乐（Calar）光固化氢氧化钙盖髓剂软化牙本质再矿化效果实验研究

目的评价钙乐（Calar）光固化氢氧化钙盖髓剂软化牙本质的再矿化作用。方法用氧化锌、普通氢氧化钙、钙乐光固化氢氧化钙3种盖髓剂作为垫底材料，置于离体牙人工龋的龋面上，分别垫底1个月，用显微硬度计测量牙本质的硬度。结果钙乐（Calar）光固化氢氧化钙盖髓剂垫底组的显微硬度值与普通氢氧化钙组无统计学差异（P〉0．05），但前两者的显微硬度值与氧化锌组有统计学差异（P〈0．05）。结论钙乐（Calar）光固化氢氧化钙是一种具有良好再矿化作用的盖髓剂。     

掺锶纳米羟基磷灰石复合釉质粘结的体外研究

目的:体外检测掺锶纳米羟基磷灰石作为填料与釉质粘结剂复合后的粘结强度和再矿化作用。方法:将掺锶纳米羟基磷灰石按不同质量比(0%、8%、10%、12%、14%)、纳米羟基磷灰石按一定质量比(10%)与京津釉质粘结剂复合后分别粘结托槽,电子万能测试机检测托槽粘结强度,并计算ARI记分,对结果进行统计学处理与分析。用扫描电镜观察12%掺锶纳米羟基磷灰石粘结剂、10%纳米羟基磷灰石粘结剂和0%粘结剂对托槽周围脱矿釉质的再矿化情况。结果:12%掺锶纳米羟基磷灰石粘结剂剪切强度和拉伸强度均高于其他各组,与10%纳米羟基磷灰石粘结剂、0%粘结剂有显著差异(P0.05);各组ARI记分之间无显著差异(P0.05);12%掺锶纳米羟基磷灰石粘结剂再矿化效果优于其他各组。结论:12%掺锶纳米羟基磷灰石釉质粘结剂较其他各组具有良好的机械性和再矿化作用。     

深圳市小学生龋病流行特征分析

了解2015年深圳在校小学生龋病流行特征,为制定小学生口腔健康策略和开展口腔健康促进提供依据.方法 对深圳市公立小学169 918名在校学生进行口腔健康普查.通过深圳市学生口腔防治管理系统收集数据.结果 2015年深圳市小学生乳牙患龋率为49.5%,填充率为13.6%,龋均为(1.81±2.52),缺失率为4.6%;恒牙患龋率为16.4%,填充率为20.4%,龋均为(0.33±0.88),恒牙缺失率为0.2%,显著龋病指数(SiC)为(0.98±1.27).随着年龄增长乳牙患龋率及龋均呈下降趋势,恒牙患龋率及龋均呈上升趋势.12岁儿童恒牙患龋率为26.5%,龋均为(0.57±1.15),缺失率为0.4%,SiC为(1.72±1.42).女生恒牙患龋率(18.5%)高于男生(14.8%) (x2=431.38,P<0.01);女生恒牙龋均(0.38±0.94)也高于男生(0.29±0.82)(t=-20.84,P<0.01).原关外小学生的乳、恒牙患龋率(55.0%,18.3%)均高于原关内(46.0%,15.2%)(x2值分别为1 289.04,294.90,P值均<0.05),龋均(2.14±2.66,0.39±0.98)也高于原关内(1.61±2.40,0.29±0.80)(t值分别为-41.04,-23.26,P值均<0.01).结论 深圳小学生龋病流行处于较低水平,原关外新区情况尤为严重.需要重点加强口腔健康教育及干预措施.     

上海市浦东新区本地和外来务工子弟学校小学生患龋状况调查分析

目的掌握浦东新区本地和外来小学生患龋状况,比较本地和外来小学生在患龋方面的差异。方法采取分层随机抽样方法选择调查样本,按照WHO制定的龋齿诊断标准进行口腔检查。结果浦东新区本地和外来小学生乳牙患龋率分别为70.85%和65.68%,恒牙患龋率分别为28.36%和28.05%;本地和外来小学生乳牙龋均分别为3.00颗和2.74颗;恒牙龋均分别为0.49、0.44颗;女性小学生恒牙患龋率、龋均高于男性(P<0.01);郊区片小学生恒牙患龋率、龋均均高于市区片小学生(P<0.01)。结论浦东新区本地和外来小学生患龋严重程度基本相同;郊区片小学生患龋情况较严重,应加强郊区片小学生龋齿防治工作。     

西藏那曲地区藏族学生恒牙龋病现状调查

目的了解那曲地区藏族学生龋病患病情况,为当地制定口腔预防保健措施提供基线资料。方法采用单纯随机抽样方法,按照WHO 1997年的《口腔健康调查基本方法》,对12～17岁的471名藏族学生进行恒牙龋病检查。结果藏族学生恒牙总患龋率为56.7%,男生患龋率为53.9%,女生患龋率为59.1%,差异无统计学意义(χ2=1.258,P=0.262);龋均为(4.09±2.11),男生龋均为(4.04±2.10),女生龋均为(4.13±2.11),差异无统计学意义(t=-0.646,P=0.518)。结论那曲地区藏族学生恒牙龋病患病率较高、程度较重,预防治疗措施急需加强。     

年轻恒牙牙髓坏死应用根管内血运重建术治疗的手术方式及应用价值探究

目的分析年轻恒牙牙髓坏死应用根管内血运重建术治疗的手术方式及应用价值。方法选择2016年1—11月收治的78例年轻恒牙牙髓坏死患者作为研究对象,随机分为对照组和观察组各39例。对照组采取根尖诱导形成术进行治疗,观察组则应用根管内血运重建术治疗。比较两组年轻恒牙牙髓坏死治疗总有效率、牙骨样组织沉积率及干预前后患者牙根管长度和管壁厚度。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果观察组年轻恒牙牙髓坏死治疗总效率为94.87%,高于对照组的76.92%,差异有统计学意义(P0.05)。观察组牙骨样组织沉积率为(89.51±12.41),高于对照组的(64.39±12.13),差异有统计学意义(P0.05)。干预后,观察组牙根管长度和管壁厚度分别为(16.78±0.32)、(2.45±0.21)mm,均优于对照组的(15.29±0.69)、(2.21±0.15)mm,差异均有统计学意义(均P0.05)。结论年轻恒牙牙髓坏死应用根管内血运重建术治疗的手术方式应用价值高,可有效增加牙骨样组织沉积率,延长牙根管长度,提高管壁厚度,效果肯定,值得推广。     

酪蛋白磷酸肽钙氟磷复合体溶液对牙釉质缺损的再矿化作用

目的研究2%酪蛋白磷酸肽钙氟磷复合体(CPP-ACFP)溶液对釉质缺损的再矿化率与时间的关系.方法从人第三磨牙切取28块釉质片,于每片中制备两条釉质缺损.28块釉质片被随机分为4组,每组分别于再矿化液中浸泡1、3、5、10天,然后进行切片放射影像和矿物质含量测定.结果经1、3、5、10天后,矿化液分别取代矿物质缺失9.19%、14.27%、29.07%、38.45%,求得直线回归方程为(Y=6.8558+3.3451X;R2=0.9235),经统计学检验,此方程有意义(tr=4.91,P＜0.05).结论CPP-ACFP对牙釉质缺损的再矿化作用相当明显,可作为食物、牙膏添加剂,在龋病预防中将起重要作用.     

Bioactive properties of milk proteins with particular focus on anticariogenesis

Beyond nutrition, there is an increasing amount of data and information to demonstrate a bioactive role for dairy components in adults including a role in prevention of dental caries. Specifically, the casein fraction and hydrolysates thereof have been the focus of researchers investigating cariogenicity prevention. Tooth enamel is a polymeric substance consisting of crystalline calcium phosphate embedded in a protein matrix. Dental caries develop by acidic demineralization (calcium and phosphorus solubilization) of tooth enamel. Demineralization occurs directly (acidic food consumption) or indirectly (by fermentation products of dental plaque odontopathogenic bacteria growing on residual food particles between teeth or adhering to the plaque). Research efforts with milk derived bioactive peptides have focused on inhibition of cariogenic, plaque-forming bacteria, inhibition of tooth enamel demineralization, and subsequent enamel remineralization. Caseinophosphopeptides (CPP) and glycomacropeptide (GMP) have been patented for use in common personal hygiene products to prevent dental caries. Research has shown CPP and GMP to be growth inhibitory to the cariogenic bacteria Streptococcus mutans and other species. Additionally, CPP forms nanoclusters with amorphous calcium phosphate (AMP) at the tooth surface to provide a reservoir of calcium and phosphate ions to maintain a state of super saturation with respect to tooth enamel. This would buffer plaque pH, and also provide ions for tooth enamel remineralization. Glycosidic structures attached to GMP are important to numerous bioactive properties of the peptide including anticariogenicity. Like CPP, GMP has shown inhibitory activity to enamel demineralization and promotes tooth enamel remineralization.     

Cheese consumption and the development and progression of dental caries

Whereas research into the causes of dental decay has focused on the harmful relationship between dental plaque bacteria and foods, studies into the protective effects of foods have been infrequent and limited in number. Recent investigations showed that milk and cheese could reduce the effects of metabolic acids, and could help restore the enamel that is lost during eating. Postulated mechanisms involve buffering, salivary stimulation, reduction of bacterial adhesion, reduction of enamel demineralization, and/or promotion of remineralization by casein and ionizable Ca and P. Given this information, consumers may be motivated to use milk and cheese to reduce, or reverse the cariogenic effects of many other foods.     

Prevalence of dental erosion caused by sulfuric acid fumes in a smelter in Japan]

The effect of occupational sulfuric acid exposure and other factors on teeth was explored in a cross-sectional study with blind dental examinations. Among 350 male workers in a copper-smelter in Japan, 28 had mild dental erosion with silky-glazed opaque appearance of the enamel and/or shallow concavities on the enamel. While opaqueness was observed in 20 and concavities found in 11 workers, only 3 had both signs, suggesting that the concave lesions were often accompanied with enough remineralization to keep the dental surface gloss, possibly due to acid exposure at a low level. The cases had a history of working in an electrolytic refining plant (36%), significantly more than in the non-cases (14%, p < 0.05). Some significant differences were found between the cases and the non-cases: the cases were older, had less dental plaque, less gingivitis, and more frequent toothbrushing habits. No significant differences were observed in possibly related dietary habits such as several types of acidic drinks. It was concluded that the present cases with dental erosion were most probably associated with occupational acid exposure. The risk ratio of cross-sectional prevalence of dental erosion for those with a history of electrolytic refining plant work was 3.0 (95% CI: 1.3-6.7) compared with those without a history of acid exposure. Whether the present work environment can still develop new cases of dental erosion remains to be studied.     

Effect of starch on the cariogenic potential of sucrose

Since in vitro and animal studies suggest that the combination of starch with sucrose may be more cariogenic than sucrose alone, the study assessed in situ the effects of this association applied in vitro on the acidogenicity, biochemical and microbiological composition of dental biofilm, as well as on enamel demineralization. During two phases of 14 d each, fifteen volunteers wore palatal appliances containing blocks of human deciduous enamel, which were extra-orally submitted to four groups of treatments: water (negative control, T1); 2 % starch (T2); 10 % sucrose (T3); and 2 % starch+10 % sucrose (T4). The solutions were dripped onto the blocks eight times per day. The biofilm formed on the blocks was analysed with regard to amylase activity, acidogenicity, and biochemical and microbiological composition. Demineralization was determined on enamel by cross-sectional microhardness. The greatest mineral loss was observed for the association starch+sucrose (P<0.05). Also, this association resulted in the highest lactobacillus count in the biofilm formed (P<0.05). In conclusion, the findings suggest that a small amount of added starch increases the cariogenic potential of sucrose.     

Prevalence of enamel defects and the relationship to dental caries in deciduous and permanent dentition in Indaiatuba, São Paulo, Brazil

The aim of this study was to determine the prevalence of hypoplasia, demarcated opacity and dental fluorosis among schoolchildren with deciduous and permanent dentition. The association between enamel defects and dental caries was also verified. The sample consisted of 624 schoolchildren aged 5 and 309 aged 12. The dmft and DMFT indexes were used to assess dental caries prevalence, DDE to assess enamel defects, and Dean to assess fluorosis. Chi-squared test was used to test significance (p < 0.05) and odds ratio to analyze prevalence of dental caries and enamel defects. A positive association between dental caries and enamel defects (hypoplasia, demarcated opacity and dental fluorosis) was observed for schoolchildren aged 5. However, only hypoplasia and demarcated opacity were associated with caries experience in permanent dentition. The results of this study indicated that children had increased odds of dental caries when enamel defect was present, both in deciduous and permanent dentition; further studies are needed to give evidence to this association.     

茶抗龋的动物模型

方法：用变形链球菌Ｉｎｇｂｒｉｔ在Ｗｉｓｔａｒ大鼠上复制出龋齿动物模型，以０．０２１ｍｍｏｌ／Ｌ氟化钠水作为阴性对照，０．０５３ｍｍｏｌ／Ｌ氟化钠水作为阳性对照，给龋模型鼠饲以不同氟浓度（０．０２３ｍｍｏｌ／Ｌ，０．０４２ｍｍｏｌ／Ｌ，０．０５６ｍｍｏｌ／Ｌ）茶水，以Ｋｅｙｅｓ龋齿计分标准和光镜观察作为评价指标，并用扫描电镜，电子能谱观察了茶的抗龋和对釉质龋的再矿化作用。结果：不同浓度的绿茶水均可显著降低龋齿的计分（Ｐ＜０．０１），并对釉质龋有较明显的促进再矿化作用     

Morphological changes in dental enamel after fluoride gel application in vitro

INTRODUCTION: The investigations of in vitro models precede the clinical studies. Using these studied we can investigate the effect upon the enamel of different agents for local application. AIM: The purpose of this study was to investigate the ultrastructural changes in a normal and partially demineralized enamel after 0.42% fluoride gel application in vitro using scanning electron microscopy. MATERIAL AND METHODS: The experiment was performed on 20 premolars extracted for orthodontic indications. Symmetrical specimens were prepared, as one half served as a control, while the other one was treated with fluoride gel. The specimens were examined with electron microscope at different magnifications. RESULTS: The findings show that fluoride gel applications affect the processes of mineralization and remineralization. CONCLUSIONS: This gives us the ground for applying fluoride gel in the clinical practice for prevention and treatment of caries incipiens.     

氟化泡沫对学龄前儿童龋齿的预防效果及对乳牙患龋情况和龋面变化的影响

目的研究氟化泡沫对学龄前儿童龋齿的预防效果及对乳牙患龋情况、龋面变化的影响。方法选择2016年1-12月共200例3~4岁学龄前儿童,随机均分为两组,对照组给予常规防龋保健指导,观察组在对照组基础上采用氟化泡沫预防龋齿,每6个月干预1次,共干预治疗4次。观察比较两组的新增龋率、龋均、DMFT指数、浅龋再矿化率。结果两组干预前后龋坏率比较差异均无统计学意义(均P>0.05)。观察组新增龋率显著低于对照组,差异有统计学意义(P<0.05)。干预前,两组龋均比较差异无统计学意义(P>0.05)。干预后,观察组龋均显著低于对照组(P<0.05)。干预前,两组DMFT指数比较差异无统计学意义(P>0.05)。干预后,观察组DMFT指数显著低于对照组(P<0.05)。观察组浅龋再矿化率(36.0%,36例)显著高于对照组(23.0%,23例),差异有统计学意义(χ^2=4.06,P<0.05)。观察组应用氟化泡沫干预过程中,发生误吞4例,发生率为4.0%,无其他不良反应发生。对照组无不良反应发生。结论氟化泡沫对学龄前儿童龋齿的预防效果显著,能够有效控制乳牙患龋情况、龋面变化,从而保护乳牙。     

Socioeconomic factors, nutritional risk, and enamel defects in children from João Pessoa, Paraíba State, Brazil

This study focused on factors related to nutritional risk in children over one year of age from low-income families in Jo?o Pessoa, Paraíba State, Northeast Brazil, and the frequency of related enamel defects. The study included 117 children, 56 at nutritional risk and 61 with normal growth. Nutritional evaluation, clinical dental examination, and interviews with mothers were conducted at the homes. Gestational and birth records were examined in the maternity hospital. Data were analyzed using the chi-square, Fisher's exact tests, and logistic regression. Enamel defects were associated with nutritional risk after the first year of life. Nutritional risk was associated with per capita family income, birth weight, and intrauterine growth index. These are relevant factors for individual nutritional planning and formation of dental enamel.