Lynch R J M, Smith S R
GlaxoSmithKline Oral Healthcare, Weybridge, United Kingdom.
Adv Dent Res. 2012 Sep;24(2):63-7. doi: 10.1177/0022034512454295.
This is a review of the need for better remineralization and of the status of calcium-based remineralizing agents for use in anti-caries toothpastes. Use of fluoride toothpastes has markedly reduced caries. However, the decline may be over or in reverse. There is a limit to what fluoride alone can do; complementary agents are needed. Using plaque as a reservoir for calcium-based agents holds promise. Plaque fluid is already supersaturated with respect to relevant calcium phosphates at neutral pH; extra calcium may lead to surface-blocking and sub-optimal lesion consolidation. However, at cariogenic pH, lesions may be more porous to the ingress of mineral, leading to fuller consolidation, and controlled release of calcium should reduce undersaturation with respect to enamel and accelerate deposition of fluorhydroxyapatite. Clinical data to validate in vitro screening models are scarce. Direct progression to in situ models may often be appropriate. The spectrum of lesion types, from softening to relatively advanced subsurface, and lesion activity should be considered. Far from being 'marketing hype', progress with calcium-based remineralizing agents is both encouraging and scientifically sound. Clinical evidence exists for the efficacy of some agents, but further unequivocal clinical data are needed before these agents might be considered 'effective' when delivered from toothpaste.
本文综述了更好地进行再矿化的必要性以及用于防龋牙膏的钙基再矿化剂的现状。使用含氟牙膏已显著减少龋齿。然而，这种下降可能已经结束或出现逆转。仅靠氟化物所能起到的作用是有限的；需要补充剂。将牙菌斑作为钙基制剂的储存库具有前景。在中性pH值下，菌斑液相对于相关磷酸钙已经过饱和；额外的钙可能导致表面阻塞和病变巩固效果欠佳。然而，在致龋pH值下，病变可能对矿物质的侵入更具多孔性，从而实现更充分的巩固，并且钙的控释应减少相对于牙釉质的不饱和状态并加速氟羟磷灰石的沉积。用于验证体外筛选模型的临床数据稀缺。直接进入原位模型通常可能是合适的。应考虑病变类型的范围，从软化到相对较深的牙面下病变，以及病变的活性。钙基再矿化剂的进展绝非“营销炒作”，而是既令人鼓舞又有科学依据的。一些制剂的疗效已有临床证据，但在这些制剂从牙膏中递送时被认为“有效”之前，还需要进一步明确的临床数据。
