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维持牙釉质表面的完整性:牙菌斑、唾液及预防剂在牙釉质脱矿与再矿化中的作用

Maintaining the integrity of the enamel surface: the role of dental biofilm, saliva and preventive agents in enamel demineralization and remineralization.

作者信息

García-Godoy Franklin, Hicks M John

机构信息

Bioscience Research Center, College of Dental Medicine, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, FL 33328, USA.

出版信息

J Am Dent Assoc. 2008 May;139 Suppl:25S-34S. doi: 10.14219/jada.archive.2008.0352.

Abstract

BACKGROUND

Dental caries is an infectious disease, and it affects 90 percent of late adolescents and young adults in the United States. It is a complex disease that occurs along the interface between the dental biofilm and the enamel surface.

RESULTS

Many components in saliva are taken up by dental biofilm and protect the enamel surface. On the other hand, newly erupted teeth depend on the enamel pellicle for posteruption maturation of acid-susceptible substituted hydroxyapatite. When Streptococcus mutans colonizes dental biofilm, it depends on vertical transmission, horizontal transmission or both. These acidogenic, aciduric bacteria are considered to be the primary organisms responsible for enamel caries. The ability of the biofilm to sequester calcium, phosphate and fluoride from the saliva, as well as from sources outside the oral cavity allows enamel to undergo remineralization after demineralization. Optimal remineralization depends on the enamel surface's being exposed to low concentrations of calcium, phosphate and fluoride for prolonged periods. Outside sources of bioavailable calcium, phosphate and fluoride can alter dental biofilm's cariogenicity.

CLINICAL IMPLICATIONS

The use of sugar alcohols, povidone-iodine, delmopinol, triclosan and chlorhexidine may modulate the caries process. In addition, studies involving probiotics and molecular genetics have provided results showing that these methods can replace and displace cariogenic bacteria with noncariogenic bacteria, while maintaining normal oral homeostasis.

摘要

背景

龋齿是一种传染病,在美国影响着90%的青少年晚期和年轻成年人。它是一种沿着牙菌斑与牙釉质表面之间的界面发生的复杂疾病。

结果

唾液中的许多成分被牙菌斑摄取并保护牙釉质表面。另一方面,新萌出的牙齿在酸敏感的替代羟基磷灰石萌出后成熟过程中依赖于釉小皮。当变形链球菌在牙菌斑中定植时,它依赖垂直传播、水平传播或两者兼而有之。这些产酸、耐酸的细菌被认为是导致牙釉质龋的主要微生物。牙菌斑从唾液以及口腔外来源螯合钙、磷和氟的能力,使得牙釉质在脱矿后能够再矿化。最佳再矿化取决于牙釉质表面长时间暴露于低浓度的钙、磷和氟。生物可利用的钙、磷和氟的外部来源可以改变牙菌斑的致龋性。

临床意义

使用糖醇、聚维酮碘、地莫匹醇、三氯生和氯己定可能会调节龋齿过程。此外,涉及益生菌和分子遗传学的研究已经提供结果表明,这些方法可以用非致龋细菌替代和取代致龋细菌,同时维持正常的口腔内环境稳定。

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