Ganss Carolina, Schulze Katja, Schlueter Nadine
Department of Conservative and Preventive Dentistry, Dental Clinic, Justus Liebig University, Giessen, Germany.
Monogr Oral Sci. 2013;23:88-99. doi: 10.1159/000350475. Epub 2013 Jun 28.
Dental erosion develops from the chronic exposure to non-bacterial acids resulting in bulk mineral loss with a partly demineralised surface of reduced micro-hardness. Clinical features are loss of surface structures with shallow lesions on smooth surfaces and cupping and flattening of cusps; already in early stages, coronal dentine often is exposed. Not only enamel, but also dentine is therefore an important target tissue for anti-erosion strategies. The main goal of active ingredients against erosion is to increase the acid resistance of tooth surfaces or pellicles. The challenge with toothpastes is that abrasives, otherwise beneficial in terms of cleaning properties, may counteract the effects of active ingredients. Fluoride toothpastes offer a degree of protection, but in order to design more effective formulations, active ingredients in addition to, or other than, fluorides have been suggested. Polyvalent metal cations, Ca/P salts in nano-form, phosphates, proteins, and various biopolymers, e.g. chitosan, are substances under study. The complex combined action of active ingredients and abrasives on the dental hard tissues, and the role of excipients of complex toothpaste formulations are not yet fully understood. Current evidence is flawed by the diversity of experimental designs, and there is no knowledge from clinical studies with patients so far. However, research results indicate that there is potential to develop effective toothpastes in this field. As the prevalence of initial erosive lesions particularly in younger age groups is high in some countries, such strategies would be of great importance for maintaining oral health.
牙侵蚀是由于长期接触非细菌性酸导致大量矿物质流失，表面部分脱矿且显微硬度降低而形成的。临床特征为表面结构丧失，光滑表面出现浅病变，牙尖杯状化和平坦化；在早期阶段，牙冠牙本质通常就已暴露。因此，不仅牙釉质，牙本质也是抗侵蚀策略的重要靶组织。抗侵蚀活性成分的主要目标是提高牙齿表面或牙菌斑的耐酸性。牙膏面临的挑战在于，尽管磨料在清洁性能方面有益，但可能会抵消活性成分的作用。含氟牙膏提供了一定程度的保护，但为了设计更有效的配方，人们提出了除氟化物之外或不同于氟化物的活性成分。多价金属阳离子、纳米形式的钙/磷盐、磷酸盐、蛋白质以及各种生物聚合物，如壳聚糖，都是正在研究的物质。活性成分和磨料对牙齿硬组织的复杂联合作用以及复合牙膏配方中辅料的作用尚未完全了解。目前的证据因实验设计的多样性而存在缺陷，而且迄今为止尚无来自患者临床研究的知识。然而，研究结果表明在这一领域开发有效牙膏具有潜力。由于在一些国家，尤其是年轻人群体中，初始侵蚀性病变的患病率较高，因此这类策略对于维持口腔健康至关重要。
