Thylstrup A
Department of Cariology and Endodontics, Royal Dental College, Copenhagen, Denmark.
J Dent Res. 1990 Feb;69 Spec No:742-50; discussion 820-3. doi: 10.1177/00220345900690S144.
Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.
近期的临床和实验室证据表明，全身性氟化物在抑制龋齿方面所起的作用比之前认为的要小。本文根据对龋齿疾病的最新认识，综述了关于水氟化、氟化物局部应用和氟化物补充剂的临床数据。由于功能使用减少，正在萌出的牙齿往往会积累具有致龋潜力的牙菌斑。因此，从牙齿萌出到邻面接触建立和完全咬合的这段时间对龋齿的发生最为关键。临床数据分析表明，当牙齿萌出到离子氟浓度较低的环境中时，可获得最大程度的防龋保护。在水氟化研究和包括含氟牙膏在内的氟化物局部应用方案的长期研究中，龋齿减少情况的相似性表明，相对于更显著的萌出后效应，氟化物的萌出前效应的重要性处于临界水平。因此，水氟化和局部氟化物项目是社区层面控制龋齿的重要措施。对于个体而言，局部应用氟化物被视为旨在阻止龋齿进展的龋齿治疗的一个组成部分。因此，氟化物应用被认为是一种辅助治疗方法，与控制致龋牙菌斑相结合。从牙齿萌出开始每日使用含氟牙膏比从出生开始每日使用氟化物补充剂更有效。
