控制牙齿酸蚀症的研究进展

牙齿酸蚀症是指在没有细菌参与的情况下,由化学因素引起的牙体硬组织慢性、不可逆性破坏的疾病。此疾病在人群中普遍存在。控制酸蚀症的发生和发展是口腔临床工作的难点,正日益受到研究者的关注。本文就酸蚀症的早期诊断、风险评估及预防策略的研究进展作一综述。     

酸蚀症患牙腭侧瓷贴面修复的临床观察

牙科酸蚀症是由酸溶解引起不可逆的牙体硬组织丧失,可以导致牙齿折断、临床牙冠丧失及咬合功能紊乱。早期诊断、及时阻断酸性物质的破坏,并根据牙体缺损情况进行相应修复是口腔医师的一项挑战。本文报道一例腭侧瓷贴面修复早期酸蚀症导致的牙体缺损,以微创配合粘接修复达到保护和修复余留牙体组织的目的。     

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1牙体粘接修复术1.1定义借助于牙体硬组织表面处理,使材料与牙体粘接的方法。1.2牙釉质的粘接目前对釉质的粘接主要采用酸蚀技术,即通过酸蚀刻釉质表层,获得树脂修复体的微机械固位,从而增强复合树脂与釉质的粘接强度。     

磷酸酸蚀和Er:YAG激光处理牙釉质和牙本质来面对粘结性能的影响

研究表明,Er:YAG激光能够粗化牙体硬组织表面,并能提高表面的抗酸性,还具有无痛、不振动、不产热等优点。但Er:YAG激光酸蚀能否取代传统的磷酸酸蚀技术,作为临床粘结的常规表面处理方法尚无定论。本研究目的是将磷酸酸蚀和Er:YAG激光处理牙体硬组织表面的抗张粘结强度和粘结界面的扫描电镜形态进行对照研究。 材料和方法 选择人离休的健康前磨牙92颗。80颗用于测定抗张粘结强度,分4组:37％磷酸酸     

复合树脂直接粘接修复Ⅰ.基本原理与临床应用

龋齿、牙体组织慢性病损(楔状缺损、磨损、酸蚀等)、发育性缺陷和外伤是造成牙体硬组织缺损的主要原因.对于缺损部分的修复既要考虑功能和美观两大需求,同时还要保证修复体不能对正常组织和功能有损害.     

视神经炎患者激素治疗引起牙酸蚀症1例

牙酸蚀症是指牙齿受到不涉及细菌的化学物质侵蚀使得牙齿硬组织发生进行性破坏的一种疾病。病因包括内在因素和外在因素，内在因素如暴食、厌食、胃肠道疾病、药物等导致的胃食管反流而引起的牙齿酸蚀，外在因素则主要包括饮食、药物、职业因素等。本文介绍了1位患者，因诊断为视神经炎而接受糖皮质激素治疗，从而引起胃食管反流症状，出现全口牙齿尤其是上颌牙列的重度酸蚀破坏。本文主要就视神经炎激素治疗与牙酸蚀症发生的机制进行了探讨。     

临床病例报告：用复合树脂修复神经性贪食患者的酸蚀牙

神经性贪食对于牙体组织具有损伤作用。胃酸不仅可以酸蚀牙釉质和牙本质，而且会进行性地破坏牙齿的美学表现及生理功能。对于这种病症．传统的修复理念是对息牙进行根管治疗后全冠修复。这种治疗需花费大量金钱和时间并影响牙齿生理功能。随着复合树脂及粘结剂的发展，该类患牙修复时可以尽可能减少牙体预备量。本文介绍一例神经性贪食症并发牙齿酸蚀造成重度牙体组织丧失的患者行复合树脂直接修复的过程。对所有余留牙均只行少量预备并保存牙髓活力，继而以纳米树脂进行修复。该过程不涉及技工室操作部分。经过短期观察，修复后所有牙的生理功能、美学状态均可达到要求。     

牙齿酸蚀症实验室评估技术的研究进展

牙齿酸蚀症是指在无细菌参与的情况下,仅由化学作用而导致的牙齿硬组织不可逆性丧失。近年来,由于饮食结构的改变和各种饮料的流行,牙齿酸蚀症的发病率明显提高,因此,牙齿酸蚀症也越来越受到关注,而且有多种研究技术被用于牙齿酸蚀症的评估。本文就牙齿酸蚀症实验室评估技术的研究进展作一综述。     

苹果酸对羟基磷灰石脱钙和化学吸附的研究

目的　研究苹果酸对牙体硬组织的酸蚀作用及其对羟基磷灰石 (HA)的化学吸附作用。方法　 (1) 15 %苹果酸水溶液 10 78ml和 4 0 0 0mgHA混合 ,4 8h后分离固体生成物和滤液并反复冲洗固体 ,真空干燥 ,用傅里叶变换红外光谱法 (FTIR)进行定性和差错分析。 (2 )用 15 %苹果酸溶液酸蚀牙齿硬组织 15、30、6 0、12 0s后 ,干燥、喷金 ,扫描电镜观察表面形态。结果　苹果酸与HA反应后生成苹果酸钙盐有两种结构 ,一种溶解性较大 ,对HA有脱钙作用 ;另一种可溶性较小 ,可化学吸附于HA表面。延长酸蚀时间易生成沉积物阻塞牙本质小管。结论　苹果酸对HA具有脱钙 -吸附作用 ,延长酸蚀时间可生成阻塞牙本质小管的沉积物。     

酸蚀对Dyract与牙齿密合度的影响

目的：评价酸蚀对Dyract与牙体硬组织之间密合度的影响。方法：离体牙制备成V类洞，经酸浊和未酸蚀处理，Dyract常规充填，应用扫描电镜观察。结果：低倍镜下，Dyract在使用和未使用酸蚀剂时均与牙釉质、牙本质之间的密合度良好；高倍镜下，Dyract在未使用酸蚀时，与牙釉质间的混合层内有时可见0．8－1．4μm的微缝隙；使用酸蚀剂后Dyract与牙釉质间的界面见充填材料与牙釉质直接粘结。无论酸蚀与否，Dyract与牙本质密合度好。结论：酸蚀剂的使用可改善Dyract与牙釉质之间的密合度。     

北京市12岁人群牙侵蚀症患病情况及酸性饮料危险性分析

目的 调查北京市12岁人群牙侵蚀症(又称牙酸蚀症)的患病情况,并进行酸性饮料危险性分析.方法 采取多阶段分层等容量(多级、分层、等额)随机抽样方法抽取北京市12岁人群共844人进行酸性饮料摄人情况问卷调查,并应用适合我国青少年牙侵蚀症流行病学调查分级标准进行评估.结果 共获得有效问卷844份,其中有522人患牙侵蚀症.本组人群牙侵蚀症患病率为61.8%(522/844),其中1级(轻度牙釉质病损)占74.1%(387/522),2级(重度牙釉质病损)占24.9%(130/522),3级(轻度牙本质病损)为1.0%(5/522).结论 大量饮用碳酸饮料和果汁是牙侵蚀症的危险因素,应重视青少年人群牙侵蚀症患病情况并加强饮食指导.     

An in vitro assessment of the role of Tooth Mousse in preventing wine erosion

BACKGROUND: The recommendation that Tooth Mousse (TM), an anticariogenic remineralizing agent, is effective for controlling dental erosion in professional wine tasters is not evidence-based. The aim of this in vitro study was to determine the effectiveness of TM in reducing erosion of coronal enamel and radicular dentine/cementum simulating a typical wine judging session. METHODS: Enamel and dentine/cementum from buccal halves (experimental sample) and palatal halves (control sample) of human maxillary premolar teeth were subjected to 1500 one-minute exposures (cycles) to white wine (pH = 3.5). TM was applied every 20 cycles to the experimental sample, but not to the control sample. Paired t-tests were used to determine whether there were significant differences in erosion depths between the experimental and control samples. RESULTS: Mean erosion depths were significantly shallower in the experimental sample than the control sample for both enamel (34.4 microm versus 49.2 microm, respectively) (p < 0.05) and dentine/cementum (143.2 microm versus 203.7 microm, respectively) (p < 0.01). CONCLUSIONS: TM may have significant role in the management of wine erosion, which is under-recognized as an occupational hazard by the Australian wine industry. Future studies are needed to compare the relative benefits of TM and other remineralizing agents, when used individually or in combination, in preventing dental erosion.     

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牙齿酸蚀症是一种常见的口腔疾病,随着人们生活水平的提高,其发病率在逐年增长.牙釉质在酸性环境下会发生羟基磷灰石溶解反应,磷酸钙盐被溶出,并扩散至牙齿表面,这个过程称之为脱矿.釉质脱矿一旦发生,大部分不可逆转,常会影响到牙齿的健康和美观.防治牙齿酸蚀成为近几年国内外学者研究的热点,而氟化亚锡对牙齿的保护作用也受到学者们的重视.本文对氟化亚锡防治牙齿酸蚀的机制,应用的局限性和安全性,以及验证其防酸蚀效应的实验影响因素进行综述.     

Severe and rapid erosion of dental enamel from swimming: a clinical report

The diagnosis and treatment of a patient with excessive and rapid erosion of enamel is presented. Although the Center for Disease Control and the dental literature have reported on dental enamel erosion resulting from swimming pool chlorination, the awareness of such etiology among dental professionals may be limited. Common findings in these reports include cold sensitivity, a distinctive appearance resembling laminate veneer preparations of the facial surfaces of anterior teeth, occurrence of diastemas, and at times, a rough or gritty texture of the remaining tooth structure. Clinical presentations of erosive lesions can be diagnosed and the best course of treatment determined.     

Common dental conditions associated with dental erosion in schoolchildren in Australia

PURPOSE: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia. METHODS: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index. RESULTS: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002). CONCLUSIONS: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.     

Dental erosion caused by silent gastroesophageal reflux disease

BACKGROUND: Gastroesophageal reflux disease, or GERD, is a relatively common condition, in which stomach acid may be refluxed up through the esophagus and into the oral cavity, resulting in enamel erosion. Symptoms such as belching, unexplained sour taste and heartburn usually alert the patient to the condition. In silent GERD, however, these symptoms do not occur, and enamel erosion of the posterior dentition may be the first indication of GERD. CASE DESCRIPTION: A 30-year-old man came to a dental clinic with enamel erosion on the occlusal surfaces of his posterior teeth and the palatal surfaces of his maxillary anterior teeth. He reported no history of gastrointestinal disease or heartburn. CLINICAL IMPLICATIONS: Enamel erosion may be a clinical sign of silent GERD that allows the dentist to make the initial diagnosis. Referral to a physician or gastroenterologist is necessary to define the diagnosis; however, dental expertise may be essential in distinguishing between differential diagnoses such as bulimia, attrition and abrasion. Successful treatment of this medical condition is necessary before dental rehabilitation can be initiated successfully.     

An in vitro investigation of the effect of some analgesics on human enamel

The sale of over-the-counter pain relief medication has increased dramatically in recent years, and typically amounts to several hundred thousands of pounds per year in the UK. Many soluble analgesic preparations contain citric acid, and it has been suggested that these formulations may cause dental erosion. The aim of this study was to investigate the effect of some over-the-counter analgesics on tooth surface loss from human enamel. Six commonly available analgesics were chosen for this study and the effect of immersing unerupted human enamel was examined using non-contact optical profilometry. Two of the six analgesics investigated caused no detectable erosion (Boots soluble aspirin and Anadin Extra). Three caused statistically significant enamel erosion, but this was very slight and is thought to be clinically insignificant (Alka Seltzer, Panadol and Solpadeine). Only one analgesic caused possible potentially clinical significant enamel erosion. Further studies are needed to determine whether Aspro causes clinically significant enamel erosion.     

Dental erosion in deciduous teeth--an in vivo and in vitro study

OBJECTIVE: The aims of this study were to report on severe dental erosion and its associated etiological factors in deciduous teeth of Saudi children (n=16, X macro=6.5 years, R=5--8) in vivo, and to confirm (or reject) the clinical diagnosis by scanning electron microscopy (SEM). Another aim was to study progression of erosion in vitro using extracted healthy deciduous and permanent teeth. METHOD: For the in vivo study, a questionnaire and clinical examination was completed, medical history obtained and exfoliated eroded teeth (n=8) examined by SEM. For the in vitro study, enamel specimens were prepared from Saudi (n=21) and Finnish (n=19) deciduous teeth as well as Finnish permanent teeth (n=20), immersed in 2% citric acid for 5--30 min, microhardness measurements performed, and the specimens studied by SEM. RESULTS: The in vivo investigation showed that high intake of acidic drinks and fruits, upper respiratory tract problems and frequent medications may constitute possible etiological and/or aggravating factors for severe dental erosion in Saudi children. Deciduous tooth enamel was softer than permanent tooth enamel. SEM showed no clear differences in the ultrastructure of the enamel specimens amongst the three groups. The clinical diagnosis of severe dental erosion in those cases studied was reliable as verified by SEM. CONCLUSIONS: The presence of dental erosion in children is likely to be associated with a number of general health and dietary factors but is also aggravated by the relatively more rapid progression of erosion in the deciduous teeth.     

Pathogenesis and modifying factors of dental erosion

Dental erosion is caused by acidic solutions which come into contact with the teeth. Because the critical pH of dental enamel is approximately 5.5, any solution with a lower pH value may cause erosion, particularly if the attack is of long duration, and repeated over time. Saliva and salivary pellicle counteract the acid attacks but if the challenge is severe, a total destruction of tooth tissue follows. Ultrastructural studies have shown that erosive lesions are seen in prismatic enamel as characteristic demineralization patterns where either the prism cores or interprismatic areas dissolve, leading to a honeycomb structure. In aprismatic enamel the pattern of dissolution is more irregular and areas with various degrees of mineral loss are seen side by side. In dentin the first area to be affected is the peritubular dentin. With progressing lesions, the dentinal tubules become enlarged but finally disruption is seen also in the intertubular areas. If the erosion process is rapid, increased sensitivity of the teeth is the presenting symptom. However, in cases with slower progression, the patient may remain without symptoms even though the whole dentition may become severely damaged. Regarding the role of causative agents, present data does not allow the ranking of different acids with regard to their potential of causing erosion. Neither is there consensus as to how effective fluorides are in preventing the progression of erosive lesions, or how the chemical and structural factors of tooth tissue in general might modify this pathological process.     

北京某大学学生志愿者牙侵蚀症患病情况及相关因素调查

目的 对北京某大学学生牙侵蚀症（又称牙酸蚀症）患病情况进行初步调研，分析其相关因素。方法对179名北京某大学在校学生志愿者，采用问卷方式调查牙侵蚀症相关因素，并用van Rijkom改良标准进行临床评估。结果该组人群牙侵蚀症患病率为45．8％，均为牙釉质病损。好发牙面为前牙唇面。牙侵蚀症的发生与碳酸饮料、果汁、冲饮饮料和香蕉等酸性饮食因素相关。结论应对我国青年人群牙侵蚀患病情况加以重视，加强口腔卫生教育和饮食指导。