Lussi A, Buzalaf M A R, Duangthip D, Anttonen V, Ganss C, João-Souza S H, Baumann T, Carvalho T S
Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
Eur Arch Paediatr Dent. 2019 Dec;20(6):517-527. doi: 10.1007/s40368-019-00420-0. Epub 2019 Feb 14.
Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH.
Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF can cause acid-resistant surface coatings and when Sn/F formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives.
Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn.
侵蚀性牙磨损（ETW）在临床上的相关性日益增加。据估计，全球范围内30%-50%的乳牙和20%-45%的恒牙受到影响。导致ETW的最重要营养因素之一是软饮料的过度饮用，但诸如胃食管反流或饮食失调等患者相关因素也可导致侵蚀性病变。酸是否会导致侵蚀性脱矿取决于其在实际pH值下相对于牙齿矿物质的饱和度。
钠氟化物或胺氟化物等氟化物对侵蚀的疗效似乎有限，主要原因是侵蚀过程中缺乏生物膜以及与细菌酸相比酸的pH值较低。这意味着要达到某种预防效果，有必要使用更高氟浓度的产品（这对幼儿不是一个合适的选择）和/或增加应用频率。此外，当氟化物与钛或亚锡离子结合时会产生有前景的效果，氟化物化合物在其中发挥了作用。TiF可形成耐酸表面涂层，当应用Sn/F配方时，Sn不仅存在于表面，还会融入牙釉质和牙本质中。这两种效果都使牙齿表面对酸脱矿更具抵抗力。已测试了不同的含氟载体来预防侵蚀/ETW，如牙膏、漱口水、凝胶和 varnishes（此处原文varnishes未明确释义，可能是某种涂剂之类，暂保留英文）。牙膏提供一定程度的保护，特别是含Sn的配方，但活性成分的效果有时会被磨料的存在所抵消。
检测相关因素并对其施加影响是阻止侵蚀性牙磨损的主要手段。此外，有牙齿侵蚀风险的患者应始终使用额外的氟源，最好是含Sn的。
