多乐氟、护牙素及含氟牙膏促进釉质再矿化的体外研究

目的:比较多乐氟、护牙素和含氟牙膏促进脱矿釉质再矿化的效果。方法:将40个牛牙釉质块人工龋试样随机分为4组(n=10),A组(对照组)置于人工唾液中浸泡12 d;B组(多乐氟组)釉质表面涂覆多乐氟涂膜,12 h后去除涂膜,置于人工唾液中浸泡12 d;C组(护牙素组)釉质表面涂覆护牙素1 min后,置于人工唾液中浸泡12 d;D组(含氟牙膏组)分别于每天早、晚将样本浸泡于含氟牙膏浆3 min,其余时间浸泡于人工唾液中,共12 d。脱矿前及处理前后,用硬度计测定各组釉质表面的显微硬度,计算其表面硬度恢复率(SMHR%);SEM观察表面结构。结果:SEM观察发现,B、C、D组再矿化处理前后釉质表面有新形成的羟基磷灰石晶体沉积。A、B、C、D组的SMHR(%)分别为20.43±5.91、60.55±14.05、67.69±11.74、52.82±3.61;除B、C组无统计学差异(P>0.05),其他各组间两两相比均有统计学差异(P<0.05)。结论:含氟材料或亚稳定无定形磷酸钙材料(护牙素)均可显著促进脱矿釉质的再矿化,护牙素的效果最好。     

氟纳米羟基磷灰石对早期釉质龋再矿化影响的研究

目的:研究氟纳米羟基磷灰石对早期釉质龋再矿化的影响,比较它与纳米羟基磷灰石、氟化钠和人工唾液的再矿化效果。方法:选取新鲜拔出的牛切牙40颗,制成人工龋模型,露出唇侧面,其余部分涂布双层指甲油。置于盛有脱矿液的容器中37℃脱矿3d,使用显微硬度仪测量脱矿后釉质的显微硬度。扫描电镜下观察脱矿后的釉质表面的平滑状态。然后随机分为4组。用软毛刷将相应试剂涂刷在釉质表面,3次/d,3～4min/次。人工唾液组直接将釉质块浸泡其中。10d后进行显微硬度和扫描电镜观察。实验前后统计采用配对t检验。结果:氟纳米羟基磷灰石组的显微硬度较脱矿后和对照组硬度值增加,有统计学意义(P<0.05),扫描电镜观察釉质表面变平滑。结论:氟纳米羟基磷灰石对早期釉质龋的再矿化效果较好。     

含氟牙膏对釉质脱矿影响的体外研究

目的：探讨国内常见市售含氟牙膏对完整釉质及脱矿釉质的作用。方法：测定市售的3种含氟牙膏的氟含量,并选取釉质完好的牛牙及人工龋脱矿的牛牙,用3种含氟牙膏和不含氟牙膏刷洗釉面后,乳酸处理1min,用原子吸收光谱仪测定溶出的钙量。结果：含氟牙膏组和不含氟牙膏组均能使完整奥质的溶钙量明显降低,与空白对照组相比差异有显著性;含氟牙膏组和不含氟牙膏组均能使人工龋脱矿釉质的溶钙量明显下降,并且两组间有显著性差异。结论：含氟牙膏可以增强完整釉质及人工龋脱矿釉质的抗酸溶钙能力,且效果与其氟浓度相关,氟浓度为52.63umol/L时可显著提高牙齿抗酸力。     

渗透树脂治疗乳牙釉质早期龋的体外研究

目的：探讨渗透树脂治疗人工脱矿乳牙釉质早期龋对其釉质显微硬度的影响。方法：选取5～7岁儿童因滞留拔除的无龋下颌乳中切牙21颗,制备人工脱矿釉质模型后,随机将其分为空白对照组、脱矿组、渗透树脂治疗组,每组7个样本,采用显微硬度测试仪测量各组牙釉质显微硬度,观察釉质显微硬度的变化。结果：空白对照组、渗透树脂治疗组牙釉质表面显微硬度明显高于脱矿组,差异具有统计学意义（P＜0．01）;渗透树脂治疗组显微硬度低于空白对照组,差异具有统计学意义（P＜0．01）。结论：乳牙釉质脱矿后牙釉质表面显微硬度降低,渗透树脂治疗釉质脱矿可提高牙釉质表面的显微硬度。     

ICON渗透树脂修复人工釉质龋白斑的效果研究

目的：评价ICON渗透树脂修复人工釉质龋白斑的效果。方法：选取因正畸而拔除的前磨牙28颗,制备人工釉质龋后,随机分为实验组和对照组,实验组采用ICON渗透树脂修复人工釉质龋白斑,对照组采用涂氟处理,测量并比较釉质龋白斑修复后的表面微硬度和龋白斑面积减少百分比,最后采用SPSS17．0软件进行统计分析。结果：治疗修复后实验组釉质龋的表面微硬度值显著高于对照组,差异具有统计学意义（P＜0．05）;修复后实验组龋白斑所占面积百分比低于对照组,差异具有统计学意义（P＜0．05）。结论：ICON渗透树脂能提高人工釉质龋白斑表面的微硬度,并能大大降低龋白斑的面积百分比,推荐临床使用。     

缓释氟粘贴片体内防治龋齿效果的评价

目的评价缓释氟粘贴片体内防治龋齿的作用。方法受试者7例,无氟期(唾液单独作用)和有氟期(唾液与氟片共同作用)戴右侧上颌舌侧和左侧下颌颊侧装置各一,每装置有正常和4小时人工龋釉质标本各1块。有氟期氟片置于上颌中切牙前庭沟处的粘膜表面,每天一次,一次一片。实验后将正常釉质块放入37℃酸胶中48小时。观察两期人工龋表面硬度值的改变、表面沉积物的情况和实验后釉质抗酸能力的变化。结果有氟期人工龋表面硬度值增加量(上下颌分别为73.9±6.3kg/mm2和35.1±8.9kg/mm2,P<0.5)高于无氟期(上下颌分别为55.9±8.3kg/mm2和31.1±14.5kg/mm2,P>0.5),上颌硬度值增加最多,P<0.5。有氟期人工龋釉质表面有小而致密的矿物盐沉积,无氟期的沉积物大而疏松。有氟期正常釉质经酸处理后脱矿程度低于无氟期。结论缓释氟粘贴片能提高唾液对早期龋的再矿化作用,增进正常釉质的抗酸能力。     

恒磨牙窝沟釉质矿化程度分析

目的:通过对未萌、初萌、成年恒磨牙的咬合面窝沟侧壁釉质剖面显微硬度值的测定,比较三者窝沟侧壁釉质的矿化程度.方法:用激光龋牙探测仪和显微放射照相法选择无龋的未萌牙10个、初萌牙11个、成年牙15个,由窝沟开口至底部,分别测定上、中、下三个部分及颊面釉质的浅层(表面下50μg)和深层(表面下100μm)的显微硬度.结果:成年牙、初萌牙窝沟上部釉质浅层的显微硬度与其窝沟下部有显著性差异(P<0.05),前者明显大于后者;成年牙、初萌牙、未萌牙三者窝沟下部釉质浅层的显微硬度无显著性差异(P>0.05).成年牙和初萌牙窝沟上部釉质浅层的显微硬度显著大于未萌牙的相应部位(P<0.05).成年牙、初萌牙和未萌牙窝沟上部釉质深层的显微硬度无显著性差异(P>0.05).结论:在牙齿萌出后,咬合面窝沟上部釉质表层的显微硬度得到提高,窝沟下部釉质在萌出后无明显变化.     

氟化物与镧、钼协同应用抑制牙釉质脱矿过程的研究

目的 :明确氟化物与镧、钼协同应用的防龋效果 ,为其应用研究提供实验依据。方法 :体外建立人工龋模型 ,氟离子、镧离子、钼离子分别应用及协同应用预处理后形成的人工龋 ,经扫描电镜和显微硬度测量研究表明 ,氟与钼、镧协同应用预处理形成的牙釉质人工龋 ,其脱矿深度较用同样浓度单独含镧、钼或氟预处理液处理者浅 ,釉质脱矿最轻 ,形成的人工龋深度最浅。釉质表面形成的覆盖物最厚、致密 ,呈块状和片状结晶 ,晶粒大、与下方釉质结合紧密。显微硬度高 ,它在抗酸实验中显示了较强的抗酸性。协同应用的防龋机理亦被探讨。结论 :氟、钼、镧协同应用防龋效果最好     

纳米无定形磷酸钙对渗透树脂显微硬度及抛光性能的影响

目的:探讨渗透树脂中加入纳米无定形磷酸钙后对树脂显微硬度及抛光性能的影响。方法:通过脱矿液建立人工龋模型,分别使用渗透树脂及加入纳米无定形磷酸钙的渗透树脂对龋模型进行渗透,使用显微硬度测试仪计算努氏硬度,利用扫描电子显微镜观察釉质抛光表面探究无定形磷酸钙加入渗透树脂后对树脂显微硬度及抛光性能的影响。结果:显微硬度测试后发现,渗透树脂组(C组)与脱矿组(B组)相比,显微硬度提高(P<0.05),但较正常釉质组(A组),硬度值存在统计学差异(P<0.05),纳米无定型磷酸钙渗透树脂组(D组)与正常釉质组(A组)相比,无统计学差异。扫描电镜观察显示,渗透树脂组(C组)及纳米无定形磷酸钙渗透树脂组(D组)经过相同步骤的抛光后,渗透树脂组(C组)表面光滑,孔隙小而少,有少量细滑痕,纳米无定形磷酸钙渗透树脂组(D组)表面不规整,孔隙较大,较C组显粗糙。结论:渗透树脂虽然可以较好恢复脱矿釉质表面的显微硬度,但与正常釉质存在差异,纳米无定形磷酸钙的加入,可以较好弥补渗透树脂这一缺点,但是会影响树脂的抛光性能。     

人氟斑牙早期龋再矿化的初步研究

目的研究离体氟斑牙早期龋模型经再矿化处理后,釉质表面显微硬度及微观形貌的变化。方法应用离体氟斑牙制备釉质样本40个,经酸蚀凝胶人工龋实验脱矿后,1.0%酪蛋白磷酸肽-磷酸钙（CPP-CP）再矿化液再矿化。采用显微硬度计测定各样本脱矿前后及再矿化后的显微硬度值。采用体视显微镜、偏光显微镜、透射显微镜以及扫描电镜观察釉质表面微观形貌。结果脱矿前,釉质表面显微硬度值为（241.53±21.31）kHV;脱矿后,表面显微硬度下降到（175.76±24.99）kHV（P＜0.05）。其表面硬度损失百分比（%SMHD）为（27.23±4.79）％,表现为类似早期龋的表层下脱矿;再矿化后,表面显微硬度提高到（210.17±21.48）kHV（P＜0.05）,其表面显微硬度恢复的百分比（%SMHR）为（52.32±4.23）％,主要表现为表层下再矿化。结论再矿化处理对治疗氟斑牙早期龋有较好的临床效果。     

Estimation of the fraction of an ingested dose of fluoride excreted through urine in pre-school children

OBJECTIVE: To determine the fraction of an ingested fluoride dose of 1 mg in 50 mL orange juice that is excreted through the urine (FUEF) of children aged 3-5 years. METHODS: Eighty-eight controlled determinations involving 24-hour urinary collections from a total of 48 children were carried out during consecutive control and test days. Net fluoride urinary excretion due to the ingested dose was calculated as the difference between the total amount of fluoride excreted by each child on test and control days. RESULTS: Excretion of the fluoride ingested from the single fluoride dose presented an average value of 30.7% (95% CI: 28.9-32.5%). No significant associations were found between individual FUEF values with either anthropometrical variables or urinary pH values. The average FUEF value found in the present study lies between previously reported values for infants and young adults. The epidemiological usefulness of the FUEF values in estimating daily fluoride dose in pre-school children is discussed.     

Review of the Anticaries Effectiveness of Professionally Applied and Self -applied Topical Fluoride Gels

Of the five types of topical fluoride gel products available in the United States, two have not been clinically tested in randomized double blind clinical trials. For those tested, the averaged results of clinical trials involving schoolchildren in fluoride-deficient communities indicate a caries reduction of approximately 26 percent from either a professional or self-administered program. A similar relative reduction can be expected from programs conducted in fluoridated communities, but the absolute caries inhibition is less. Twice-a-year professional applications are more effective than once-a-year applications, and self-applications using trays are more effective than applying the gel on a toothbrush. For subjects beyond school age, there are few clinical studies of either self-applied or professionally applied gels; however, current epidemiological evidence does not indicate a need for public health caries preventive programs for healthy employed adults. For medically compromised patients, especially those exhibiting rampant caries associated with radiation-induced xerostomia, a variety of topical gel procedures appear to be effective in limiting caries.     

Acute Fluoride Toxicity from Ingesting Home-use Dental Products in Children, Birth to 6 Years of Age

Objectives : This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. Methods : Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. Results : Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF₂ gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. Conclusion : Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.     

Patterns of fluoride intake from birth to 36 months

OBJECTIVES: Dental fluorosis prevalence has increased in the United States, Canada, and other nations due to the widespread availability of fluoride in many forms, with fluoride ingestion during the first three years of life appearing most critical in fluorosis etiology. With few contemporary studies of fluoride ingestion in this age group, the purpose of this paper is to describe patterns of estimated fluoride ingestion from birth to 36 months of age from water, dentifrice, and dietary fluoride supplements and combined. METHODS: Repeated responses to separate series of questions about water intake, use of fluoride dentifrice, and use of fluoride supplements were collected by questionnaire as part of the longitudinal Iowa Fluoride Study and used to estimate fluoride intake. Estimated intake is reported by source and combined at different ages. Effects of subject age and other covariates on fluoride intake were assessed using regression methods appropriate for the analysis of correlated data. RESULTS: For most children, water fluoride intake was the predominant source, especially through age 12 months. Combined daily fluoride intake increased through 9 months, was lower at 12 and 16 months, and increased again thereafter. Mean intake per unit body weight (bw) was about 0.075 mg F/kg bw through 3 months of age, 0.06 mg F/kg bw at 6 and 9 months, 0.035 mg F/kg bw at 12 and 16 months, and 0.043 mg F/kg bw from 20-36 months. Depending on the threshold chosen (e.g., 0.05 or 0.07 mg F/kg bw), variable percentages of the children exceeded the levels, with percentages greatest during the first 9 months. Regression analyses showed fluoride intake (mg F/kg bw) from 1.5-9 months to decrease with increasing child's age, mother's age, and mother's education, with a complex three-way interaction among these factors. From 12-20 months, fluoride intake increased with increasing child age and decreased with increasing mother's age. No statistically significant relationships were found for fluoride intake from 24-36 months. CONCLUSIONS: There is considerable variation in fluoride intake across ages and among individuals. Longitudinal studies may be necessary to fully understand the relationships between fluoride ingestion over time and development of fluorosis.     

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本文主要对专业人员使用的局部用氟措施的适应证、应用方法和频率、临床效果进行回顾。专业人员使用的局部用氟措施通常在口腔临床和社区口腔健康项目中应用,其主要适用于高龋危险性的儿童、青少年和成年人。应用频率取决于个体对龋的敏感性,一般推荐每半年应用1次。氟化凝胶、泡沫和含氟涂料都能有效预防儿童乳、恒牙龋的发生,但对6岁以下儿童不推荐使用氟化凝胶。另外高浓度含氟涂料还具有明显抗牙本质敏感的作用。     

儿童使用APF凝胶和氟化泡沫氟的作用量及摄入量比较

目的检测中国儿童氟化泡沫使用量、滞留量并与含氟凝胶比较。方法研究对象为成都市、小学1年级学生（年龄6～7岁）105人，55人使用氟化泡沫、50人使用含氟凝胶。将含氟凝胶或泡沫放置在已称重的托盘后再称总重，按常规操作程序应用于实验对象。使用后收集唾液、托盘及盘中剩余药物。取出托盘2min及10min后，用事前称重塑料试管继续收集唾液2min。实验室检测采用盲法，使用氟离子电极检测样本氟浓度并计算回收的总氟量。结果6～7岁儿童平均使用0．52±0．10g的氟化泡沫和2．61±0．43g含氟凝胶。滞留的氟量氟化泡沫为1．76±0．72mg，含氟凝胶为6．75±4．56mg。氟化泡沫的用量为含氟凝胶重量的19．92％，吸收量为含氟凝胶的26．07％。结论　氟化泡沫有明显减少病人氟使用量的优点。     

饮料茶氟含量研究

本研究用氟离子选择电极、微量扩散、高温气化分离、气相色谱方法分别测定日本东京市售 30种罐装饮料茶 ,其结果 :红茶饮料是 1.0 2 ug/ml、乌龙茶是 0 .91ug/ml、杜仲茶是 0 .0 2 9ug/ml、绿茶是0 .6 9ug/ml、大麦茶饮料茶是 0 .0 0 5ug/ml。氟离子选择电极方法能在多种离子共存的条件下对氟离子特异反应 ,该方法广泛应用于牙科领域、气相色谱、微量扩散、高温气化分离方法也能够测定氟     

Overview of the history and current status of fluoride supplementation schedules

Clinical trials of dietary fluoride supplements began in the 1940s in an effort to bring the benefits of fluoride to those who did not receive it through their drinking water. Following the early success of these trials, the Council on Dental Therapeutics of the American Dental Association (ADA) published its first recommendations for fluoride supplementation in 1958. The American Academy of Pediatrics (AAP) followed with its own recommendations in 1972. During the 1970s a variety of alternative schedules appeared in the literature, most in reaction to the findings of unexpectedly high levels of enamel fluorosis in children being supplemented with the AAP schedule. In 1979 the ADA and AAP agreed on essentially identical schedules. During the 1980s, however, the prevalence of enamel fluorosis continued to increase, and fluoride supplements were found in some studies to be a risk factor for fluorosis. This finding prompted another round of dosage schedule recommendations in the early 1990s. This paper presents a history of fluoride dosage recommendations and reviews the recent proposals for reducing supplement dosage.