Newbrun E
Department of Stomatology, University of California, San Francisco 94143-0512, USA.
Adv Dent Res. 1996 Apr;10(1):29-34. doi: 10.1177/08959374960100010401.
Prevention of dental caries in patients with hyposalivation due to Sjögren's syndrome requires increasing host resistance and decreasing cariogenic organisms and their substrate. Although plaque control by scrupulous oral hygiene is important, particularly from a periodontal perspective, and restriction of dietary sucrose intake can limit caries, the most successful therapeutic and preventive measure has been the topical application of fluoride to the tooth surface, by the dentist, dental hygienist, dental auxiliary, and the patient. Studies on schoolchildren with normal salivary function who used fluoride dentifrices have shown that efficacy in caries prevention depends on (1) the concentration of fluoride used, (2) the frequency with which it is applied, and, to a certain extent, (3) the specific fluoride compound used. Controlled clinical studies are lacking, however, on patients with hyposalivation due to Sjögren's syndrome, and only limited data are available from patients with radiation-induced hyposalivation. Obviously it is not possible to run placebo control groups; nevertheless, there have been no head-to-head comparisons of fluoride rinses, or of stannous fluoride, acidulated phosphate fluoride, or sodium fluoride gels, and thus no single protocol can be recommended. Accordingly, different centers have used these products interchangeably--for example, selecting a rinse regimen if patients complain of gagging when using a gel applied in a tray, or if the cost of the tray is prohibitive. Recent innovations that show promise for treatment of high-caries-risk patients with hyposalivation are the use of fluoride rinses in combination with chlorhexidine rinses or gels and the professional application of high-concentration chlorhexidine varnishes to the teeth.
预防干燥综合征所致唾液分泌过少患者的龋齿，需要增强宿主抵抗力，减少致龋微生物及其底物。尽管通过严格的口腔卫生进行菌斑控制很重要，特别是从牙周角度来看，并且限制饮食中蔗糖的摄入量可以限制龋齿，但最成功的治疗和预防措施一直是由牙医、口腔保健员、口腔辅助人员以及患者对牙齿表面进行局部用氟。对使用含氟牙膏的唾液功能正常的学童进行的研究表明，预防龋齿的效果取决于：（1）所用氟化物的浓度；（2）使用频率，并且在一定程度上还取决于（3）所用的特定氟化物化合物。然而，目前缺乏针对干燥综合征所致唾液分泌过少患者的对照临床研究，仅有关于放射性唾液分泌过少患者的有限数据。显然，不可能设立安慰剂对照组；尽管如此，尚未对氟化物漱口水、氟化亚锡、酸性磷酸氟或氟化钠凝胶进行直接比较，因此无法推荐单一方案。相应地，不同中心交替使用这些产品——例如，如果患者在使用托盘装的凝胶时抱怨作呕，或者托盘成本过高，则选择漱口水方案。近期显示有望用于治疗高龋齿风险的唾液分泌过少患者的创新方法，是将氟化物漱口水与氯己定漱口水或凝胶联合使用，以及专业人员对牙齿应用高浓度氯己定清漆。
