Beltran E D, Burt B A
Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029.
J Public Health Dent. 1988 Fall;48(4):233-40. doi: 10.1111/j.1752-7325.1988.tb03204.x.
The widespread availability of fluoride from many sources is accepted as a major reason for the caries decline among children in developed countries. There is still controversy, however, about its principal mode of action. This article reviews the evidence on fluoride's preeruptive and posteruptive effects, and suggests reasons for its continuing role in the caries decline. Early fluoridation studies accepted that fluoride acted preruptively through incorporation into developing enamel; but further research could not explain why fluoride levels were not clearly higher in enamel exposed to fluoride, nor why there were no clear correlations between caries experience and enamel fluoride concentration. Instead, considerable evidence suggests that fluoride acts mainly, though not entirely, through posteruptive remineralization of demineralized enamel. Caries experience has declined in nonfluoridated as well as in fluoridated areas, though DMF scores are still consistently lower in fluoridated areas. Posteruptive remineralization effects are seen from fluoridated drinking water as well as with fluoride from other sources. The continuing caries decline, beyond the level suggested by early fluoridation field trials, can be attributed either to more efficient remineralization or to long-term, intraoral ecological change, or to both.
来自多种来源的氟化物广泛可得，这被认为是发达国家儿童龋齿率下降的主要原因。然而，关于其主要作用方式仍存在争议。本文回顾了有关氟化物在牙齿萌出前和萌出后作用的证据，并提出了其在龋齿率下降过程中持续发挥作用的原因。早期的氟化研究认为，氟化物通过结合到正在发育的牙釉质中在牙齿萌出前发挥作用；但进一步的研究无法解释为什么暴露于氟化物的牙釉质中氟含量没有明显更高，也无法解释为什么龋齿经历与牙釉质氟浓度之间没有明显的相关性。相反，大量证据表明，氟化物主要（但并非完全）通过对脱矿牙釉质的萌出后再矿化发挥作用。在未氟化地区和氟化地区，龋齿发生率都有所下降，不过氟化地区的恒牙龋失补牙面（DMF）得分仍然一直较低。从氟化饮用水以及其他来源的氟化物中都可以看到萌出后再矿化的效果。龋齿率持续下降，超过了早期氟化现场试验所表明的水平，这可能归因于更有效的再矿化或长期的口腔内生态变化，或者两者皆有。
