氟化物涂膜后唾液中氟浓度变化和牙釉质抗酸溶解性的研究
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摘要
前言
Dean等人在早期的研究中，发现了氟与龋病之间的关系，肯定了氟化物的防龋作用。近年来，国内外对氟化物涂膜研究认为，氟化物涂膜的作用在于增强牙釉质的抗龋能力，氟化物涂膜涂在牙齿表面上，自然干燥后形成一层含氟薄膜，其中氟化物释放出来，对牙釉质表面起到保护作用，氟化物涂膜的使用为局部氟化物防龋又开辟了一条新途径。
本研究在国内首次进行在活体内局部氟化物涂膜后唾液氟浓度变化的研究，同时结合氟化物涂膜后牙釉质表层钙溶出量的检测，评价氟化物涂膜对牙釉质抗酸溶解性作用的效果，为实际临床应用提供科学依据。
实验材料
1．2％氟化钠涂膜和2％氟化钠溶液的配制
1．1 2％氟化钠涂膜：取8gNaF加入400ml天然树脂无水乙醇溶液中，配制成2％NaF涂膜。
1．2 2％氟化钠溶液：取8gNaF加入400ml去离子水中，配制成2％NaF溶液。
2．主要试剂
要求使用去离子水，优级纯试剂。
2．1 镧液
2．2 TISAB液
3．主要仪器
3．二 低温高速离心机：Sorvall suPer ’121，美国 DUPONT公司
3．2 氟离子选择性电极：中国长沙半导体材料厂
3．3 pH计：PHSJ C型精密酸度计，上海雷磁仪器厂
3．4 原子吸收分光光度计：AA－670，日本岛津株式会社
实验方法
1．实验对象
随机选取某中学15－17岁无龋学生20名（男10名，女10
名）作为实验对象。分成实验和对照两组，每组各10人，均为男
生5人，女生5人。实验组接受氟化钠涂膜处理，对照组接受氟化
钠溶液处理。
2．唾液中氟浓度的测定
采集所有受试者唾液样品。于上午9点，令受试者低头让唾
液自行流人 sml的试管内。将样品立即低温离心问，一4℃）
30Inin，取lml上清液于一20T保存备用。按照上述方法分别采集
实验组和对照组接受氟处理后1小时J小时在小时＊ 小时、24
小时和36小时的唾液样品。将样品恢复至室温，加人0．10ml TI－
SAB，采用标准曲线法以氟离子选择性电极测定氟浓度。
3．牙釉质表面钙溶出量的测定
采集所有受试者牙釉质表层钙溶出量样品。经三次涂氟后，
分另在1上J个月采集所有受试者牙釉质表层钙溶出量样品。采
用日本产AA－670原子吸收分光光度计测定钙溶出量。
4．数据处理
采用SPSS附分析软件用t检验进行显著性分析。
·2·
实：验结果
1．实验组用氟后唾液中氛浓度与用氟前基线值比较，二小时。
3小时，显著高于用氟前u＜0．01人而且用氟后1小时实验组显
著高于对照组瞩＜o对门，用氟后3小时实验组高于对照组汗＜
0．05）。
2．实俄用氟后牙釉质钙溶出量与用氟前基线值相比较，二
个月在个月J个月，显著低于用氟前（P＜o．01人对照组用氟后
3个月与用氟前相比较，无显著性差异（P＞o．05人涂氟后二个
月，实验组低于对照组（P＜o．05卜2个月J个月，实验组显著低
于对照组u＜o0Q。
本 论
1．氟化物涂膜和其他局部使用氟化物方法，如含氟剂漱口、
氟化牙膏刷牙、含氟凝胶等相比，它能明显地延长氟化物和牙釉质
表面两者的接触时间和接触浓度。Castioni等人通过对许多研究
结果分析推论出：应用含有高浓度的专业氟制剂后唾液中氟水平
要高于应用低浓度的氟制剂。Twetlnan等观测局部使用三种涂膜
后唾液氟浓度变化情况，发现使用涂膜后升高的氛浓度持续不超
过6小时，且升高的唾液氟浓度与涂膜中的含氟量相关。
本研究使用二％氟化钠涂膜后，唾液氟浓度快速升高，但是升
高的氟浓度持续不超过 6 ，J’时。同 Twetman等人的报道相一致。
而使用氟化钠溶液后，升高的氟浓度持续较短，不超过3小时。实
验、对照两组比较，说明使用氟化钠涂膜与氟化钠溶液相比，氟化
物涂膜具有快速凝固和缓慢释放氟的特性，使其在唾液中持久释
放氟的浓度较高，有利于氟离子与牙釉质接触和反应。
·3·
2．局部用氟后，在牙釉质中除了形成氟磷灰石外，还产生大
量氟化钙。当口腔局部环境pH值下降时沉积于釉质表面的氟化
钙物质缓慢释放出氟元素，有助于抑制牙釉质磷灰石晶体的溶解，
提高抗酸脱钙能力，并能起到促进再矿化作用。氟化钙不会立即
溶解消失，可持续数周、数月。大量研究表明，氟的主要通过局部
作用，要获得较好的防龋效果就必须在牙齿周围的液体中有低浓
度的氟持续存在。本研究采用活体牙釉质进行研究，检测钙溶出
量的结果，能客观反映氟化钠涂膜对牙釉质的抗酸溶解性作用。
实验组使用氟化钠涂膜后l在＊个月牙釉质表层钙溶出量随时间
的增加而增高，但均明显低于用氟前K＜o．01人而对照组使用
氟化钠溶液后1在J个月牙釉质表层钙溶出量虽然低于用氟前，
但是3个月时钙溶出量显著增高，接近用氟前的基线值（P＞
0．05人我们认为使用涂膜后沉积于釉质表面的氟化钙物质缓慢
释放出氟
Preface
In the early studies, Dean and his colleagues found the relation of fluoride and dental caries, and were sure of the caries - preventive effects of fluoride. Recently, much researchers consider that fluoride varnish can enhance the anticaries effect of dental enamel. Fluoride varnish films on the surface of dental enamel after topical application of fluoride varnish. F - ions release from the film, and then protect dental enamel. Now, topical application of fluoride varnish inaugurate new approach for the prevention of dental caries.
In the present study, we i nvestigate the fluoride concentrations in whole saliva after topical application of fluoride varnish in vivo before all other researchers in China. At same time, with the analysis of the dissoved Ca from enamel after topical application of fluoride varnish , we assess effect on anti - acid solubility of fluoride varnish with dental enamel, in order to provide science foundation for clinical practice.
Material
1. 2% NaF varnish and 2% NaF solution
2. Primary reagent
2.1 Lan liquid
2.2 TISAB liquid
3. Primary instrument
3.1 Centrifuge :Sorvall super T21, DUPONT Inc. ,USA 3. 2 Fluoride - sensitive electrode: Changsha semiconductor Inc. , China
3.3 pH;PHS-3 C, Shanghai leici instrument Inc. , CHIN A
3.4 Atomic absorption spectrometry: AA - 670, Shimadzu, Japan
Methods
1. Subjects
20 caries - free students (10 Boys and 10 girls ) ranged in age from 15 to 17 years were selected and divided into NaF varnish and NaF solution groups.
2. Analysis of fluoride concentration in saliva
The samples of unstimulated whole saliva were collected at baseline before a single topical application of NaF varnish or NaF solution and 1, 3, 6, 12, 24, 36h after a single topical application of NaF varnish or NaF solution. The concentration of fluoride in saliva samples was determined with a fluoride - sensitive electrode.
3. Analysis of dissoved Ca from enamel
The samples of dissoved Ca from enamel were collected at before a single topical application of NaF varnish or NaF solution and 1,2,3 month after a single topical application of NaF varnish or NaF solution. The dissoved Ca from enamel was analysed with atomic absorption sectrophotometry( A A -670 Japan).
4. Statistical methods
The data were processed using the t test by SPSS7.
Results
1. Compared with baseline value and the values of salivary fluoride concentrations after topical application of fluoride varnish, the values after Ih, 3h were significantly higher than baseline( P <0. 01). Compared between fluoride varnish group and fluoride solution group, the values of fluoride varnish g;roup were significantly higher than fluoride solution group after lh(P<0.01); the values of fluoride varnish group were higher than fluoride solution group after 3h(P<0.05).
2. Compared with baseline value and the values of dissoved Ca from enamel after topical application of fluoride varnish, the values after 1, 2, 3 months were significantly lower than baseline( P <0.01). Compared with baseline value and the values of dissoved Ca from enamel after topical application of fluoride solution, there were no significant differences between the values after 3 months and baseline ( P > 0.05 ). Compared between fluoride varnish group and fluoride solution group, the values of fluoride varnish group were lower than fluoride solution group after 1 month(P<0.05) ; were lower than fluoride solution group after 2, 3 months( P <0.01).
Discussion
1. According to the majority of studies, comparing with other topical fluoride products such as dentifrices or mouthrinses, fluoride varnish can prolong the time of its contact and reaction with enamel. Castioni et al. analysed the data of the concentrations of fluoride found in saliva after a single topical application have been investigated in many studies, and reasoned out that professionally applied products, containing high fluoride concentrations, lead to higher salivary levels as compared to self - applied p
Dean等人在早期的研究中，发现了氟与龋病之间的关系，肯定了氟化物的防龋作用。近年来，国内外对氟化物涂膜研究认为，氟化物涂膜的作用在于增强牙釉质的抗龋能力，氟化物涂膜涂在牙齿表面上，自然干燥后形成一层含氟薄膜，其中氟化物释放出来，对牙釉质表面起到保护作用，氟化物涂膜的使用为局部氟化物防龋又开辟了一条新途径。
本研究在国内首次进行在活体内局部氟化物涂膜后唾液氟浓度变化的研究，同时结合氟化物涂膜后牙釉质表层钙溶出量的检测，评价氟化物涂膜对牙釉质抗酸溶解性作用的效果，为实际临床应用提供科学依据。
实验材料
1．2％氟化钠涂膜和2％氟化钠溶液的配制
1．1 2％氟化钠涂膜：取8gNaF加入400ml天然树脂无水乙醇溶液中，配制成2％NaF涂膜。
1．2 2％氟化钠溶液：取8gNaF加入400ml去离子水中，配制成2％NaF溶液。
2．主要试剂
要求使用去离子水，优级纯试剂。
2．1 镧液
2．2 TISAB液
3．主要仪器
3．二 低温高速离心机：Sorvall suPer ’121，美国 DUPONT公司
3．2 氟离子选择性电极：中国长沙半导体材料厂
3．3 pH计：PHSJ C型精密酸度计，上海雷磁仪器厂
3．4 原子吸收分光光度计：AA－670，日本岛津株式会社
实验方法
1．实验对象
随机选取某中学15－17岁无龋学生20名（男10名，女10
名）作为实验对象。分成实验和对照两组，每组各10人，均为男
生5人，女生5人。实验组接受氟化钠涂膜处理，对照组接受氟化
钠溶液处理。
2．唾液中氟浓度的测定
采集所有受试者唾液样品。于上午9点，令受试者低头让唾
液自行流人 sml的试管内。将样品立即低温离心问，一4℃）
30Inin，取lml上清液于一20T保存备用。按照上述方法分别采集
实验组和对照组接受氟处理后1小时J小时在小时＊ 小时、24
小时和36小时的唾液样品。将样品恢复至室温，加人0．10ml TI－
SAB，采用标准曲线法以氟离子选择性电极测定氟浓度。
3．牙釉质表面钙溶出量的测定
采集所有受试者牙釉质表层钙溶出量样品。经三次涂氟后，
分另在1上J个月采集所有受试者牙釉质表层钙溶出量样品。采
用日本产AA－670原子吸收分光光度计测定钙溶出量。
4．数据处理
采用SPSS附分析软件用t检验进行显著性分析。
·2·
实：验结果
1．实验组用氟后唾液中氛浓度与用氟前基线值比较，二小时。
3小时，显著高于用氟前u＜0．01人而且用氟后1小时实验组显
著高于对照组瞩＜o对门，用氟后3小时实验组高于对照组汗＜
0．05）。
2．实俄用氟后牙釉质钙溶出量与用氟前基线值相比较，二
个月在个月J个月，显著低于用氟前（P＜o．01人对照组用氟后
3个月与用氟前相比较，无显著性差异（P＞o．05人涂氟后二个
月，实验组低于对照组（P＜o．05卜2个月J个月，实验组显著低
于对照组u＜o0Q。
本 论
1．氟化物涂膜和其他局部使用氟化物方法，如含氟剂漱口、
氟化牙膏刷牙、含氟凝胶等相比，它能明显地延长氟化物和牙釉质
表面两者的接触时间和接触浓度。Castioni等人通过对许多研究
结果分析推论出：应用含有高浓度的专业氟制剂后唾液中氟水平
要高于应用低浓度的氟制剂。Twetlnan等观测局部使用三种涂膜
后唾液氟浓度变化情况，发现使用涂膜后升高的氛浓度持续不超
过6小时，且升高的唾液氟浓度与涂膜中的含氟量相关。
本研究使用二％氟化钠涂膜后，唾液氟浓度快速升高，但是升
高的氟浓度持续不超过 6 ，J’时。同 Twetman等人的报道相一致。
而使用氟化钠溶液后，升高的氟浓度持续较短，不超过3小时。实
验、对照两组比较，说明使用氟化钠涂膜与氟化钠溶液相比，氟化
物涂膜具有快速凝固和缓慢释放氟的特性，使其在唾液中持久释
放氟的浓度较高，有利于氟离子与牙釉质接触和反应。
·3·
2．局部用氟后，在牙釉质中除了形成氟磷灰石外，还产生大
量氟化钙。当口腔局部环境pH值下降时沉积于釉质表面的氟化
钙物质缓慢释放出氟元素，有助于抑制牙釉质磷灰石晶体的溶解，
提高抗酸脱钙能力，并能起到促进再矿化作用。氟化钙不会立即
溶解消失，可持续数周、数月。大量研究表明，氟的主要通过局部
作用，要获得较好的防龋效果就必须在牙齿周围的液体中有低浓
度的氟持续存在。本研究采用活体牙釉质进行研究，检测钙溶出
量的结果，能客观反映氟化钠涂膜对牙釉质的抗酸溶解性作用。
实验组使用氟化钠涂膜后l在＊个月牙釉质表层钙溶出量随时间
的增加而增高，但均明显低于用氟前K＜o．01人而对照组使用
氟化钠溶液后1在J个月牙釉质表层钙溶出量虽然低于用氟前，
但是3个月时钙溶出量显著增高，接近用氟前的基线值（P＞
0．05人我们认为使用涂膜后沉积于釉质表面的氟化钙物质缓慢
释放出氟
Preface
In the early studies, Dean and his colleagues found the relation of fluoride and dental caries, and were sure of the caries - preventive effects of fluoride. Recently, much researchers consider that fluoride varnish can enhance the anticaries effect of dental enamel. Fluoride varnish films on the surface of dental enamel after topical application of fluoride varnish. F - ions release from the film, and then protect dental enamel. Now, topical application of fluoride varnish inaugurate new approach for the prevention of dental caries.
In the present study, we i nvestigate the fluoride concentrations in whole saliva after topical application of fluoride varnish in vivo before all other researchers in China. At same time, with the analysis of the dissoved Ca from enamel after topical application of fluoride varnish , we assess effect on anti - acid solubility of fluoride varnish with dental enamel, in order to provide science foundation for clinical practice.
Material
1. 2% NaF varnish and 2% NaF solution
2. Primary reagent
2.1 Lan liquid
2.2 TISAB liquid
3. Primary instrument
3.1 Centrifuge :Sorvall super T21, DUPONT Inc. ,USA 3. 2 Fluoride - sensitive electrode: Changsha semiconductor Inc. , China
3.3 pH;PHS-3 C, Shanghai leici instrument Inc. , CHIN A
3.4 Atomic absorption spectrometry: AA - 670, Shimadzu, Japan
Methods
1. Subjects
20 caries - free students (10 Boys and 10 girls ) ranged in age from 15 to 17 years were selected and divided into NaF varnish and NaF solution groups.
2. Analysis of fluoride concentration in saliva
The samples of unstimulated whole saliva were collected at baseline before a single topical application of NaF varnish or NaF solution and 1, 3, 6, 12, 24, 36h after a single topical application of NaF varnish or NaF solution. The concentration of fluoride in saliva samples was determined with a fluoride - sensitive electrode.
3. Analysis of dissoved Ca from enamel
The samples of dissoved Ca from enamel were collected at before a single topical application of NaF varnish or NaF solution and 1,2,3 month after a single topical application of NaF varnish or NaF solution. The dissoved Ca from enamel was analysed with atomic absorption sectrophotometry( A A -670 Japan).
4. Statistical methods
The data were processed using the t test by SPSS7.
Results
1. Compared with baseline value and the values of salivary fluoride concentrations after topical application of fluoride varnish, the values after Ih, 3h were significantly higher than baseline( P <0. 01). Compared between fluoride varnish group and fluoride solution group, the values of fluoride varnish g;roup were significantly higher than fluoride solution group after lh(P<0.01); the values of fluoride varnish group were higher than fluoride solution group after 3h(P<0.05).
2. Compared with baseline value and the values of dissoved Ca from enamel after topical application of fluoride varnish, the values after 1, 2, 3 months were significantly lower than baseline( P <0.01). Compared with baseline value and the values of dissoved Ca from enamel after topical application of fluoride solution, there were no significant differences between the values after 3 months and baseline ( P > 0.05 ). Compared between fluoride varnish group and fluoride solution group, the values of fluoride varnish group were lower than fluoride solution group after 1 month(P<0.05) ; were lower than fluoride solution group after 2, 3 months( P <0.01).
Discussion
1. According to the majority of studies, comparing with other topical fluoride products such as dentifrices or mouthrinses, fluoride varnish can prolong the time of its contact and reaction with enamel. Castioni et al. analysed the data of the concentrations of fluoride found in saliva after a single topical application have been investigated in many studies, and reasoned out that professionally applied products, containing high fluoride concentrations, lead to higher salivary levels as compared to self - applied p
引文
1．岳松龄主编．现代龋病学．北京医科大学·中国协和医科大学联合出版社，1993：176
2. Schmidt HIM. Ein neues touchierungsmittel mit besonders lang anhahendem intensivem Fluoridierungseffekt. Stoma, 1964; 17:14
3. Arends J, Schuthof J. Fluoride content on human enamel after fluoride application and washing. An in vitro study. Caries Res, 1975;9:363
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5. Arends J Christoffersen J. The nature of early carious lesions in enamel. J Dent Res 1986;65:2
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12． Duckworth RM, Morgan SN. Oral fluoride retention after use of fluoride dentifrices. Caries Res 1991 ;25(2) :123
13． Duckworth RM,Stewart D,Effect of mouthwashes of variable NaF concentration but constant NaF content on oral fluoride retention. Caries Res 1994;28:43
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15． Stookey Gk. Critical evaluation of the composition and use of topical fluorides. J Dent Res 1990 ;69:805
16． Fejerskov O, Ekstrand J, Burt BA. Fluoride in Dentistry. 2nd e-dition. Copenhagen: Munksgard, 1996:252
17． 刘鲁川，岳松龄。氟以及表面活性剂对牛牙釉质脱矿的影响。口腔医学纵横, 1997; 13:201
18． Ogaard B,Seppa L,Rolla G. Professional topical fluoride applications: Clinical efficacy and mechanism of action. Adv Dent Res. 1994;8:190
19． Saxegaard E,Rolla G. Kinetics of acquisition and loss of calcium fluoride by enamel in vivo. Caries Res 1989; 23:406
20． Bruun C, Givskov H. Formation of CaF2 on sound enamel and in caries-like enamel lesions after different froms of fluoride applications in vitro. Caries Res 1991; 25:96
21． Cruz R, Ogaard B, Rolla G. Uptake of KOH-soluble and KOH-insoluble fluoride in sound human enamel after topical application of a fluoride varnish ( Duraphat) or a neutral 2 % NaF solution in vitro. Scand J Dent Res 1992; 100:154
22． Daschner H,Uchtmann H,Daschner HA. Primary reactions of fluoride with outmost layers of enamels. J Dent Res 1990; 69 (Spec Iss):825
23． Larsen MJA,Richard A. CaF2 formation on human enamel in a salivary film. Caries Res 1998;32(30) :269
24． Margolis HC, Moreno EC. Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides. J Dent Res 1990;69:606
25． Page DJ. A study of the eifect of fluoride delivered from solution and dentifrices on enamel demineraliation. Caries Res 1991; 25: 251
26． Featherstone JDB. Prevention and reversal of dental caries:role of low level of fluoride. Community Dent Oral Epidemiol 1999; 27: 31
27． Schiffner U. Giilzow HJ. Influnce of firmly and loosely bound fluoride on enamel demineralization in vitro. Caries Res 1998; 32 (3) :283
28． Relief DH,et al. Enamel fluoride uptake distribution and retention from topical fluoride agents. Caries Res 1983; 17:44
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9. Grobler SR, et al. Fluoride untake and retention by sound enamel after in vivo Duraphat application. Tydskr Tandheelkd Ver S Afr 1983;38:55
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11． Castioni NV, Baehni PC, Gurny R. Current status in oral fluoride pharmacokinetics and implications for the prophylaxis against dental caries. Eur J Pharm Biopharm 1998 ;45(2) :101
12． Duckworth RM, Morgan SN. Oral fluoride retention after use of fluoride dentifrices. Caries Res 1991 ;25(2) :123
13． Duckworth RM,Stewart D,Effect of mouthwashes of variable NaF concentration but constant NaF content on oral fluoride retention. Caries Res 1994;28:43
14． Dawe C, Weatherell JA. Kinetics of fluoride in the oral fluids. J Dent Res 1990; 69:638
15． Stookey Gk. Critical evaluation of the composition and use of topical fluorides. J Dent Res 1990 ;69:805
16． Fejerskov O, Ekstrand J, Burt BA. Fluoride in Dentistry. 2nd e-dition. Copenhagen: Munksgard, 1996:252
17． 刘鲁川，岳松龄。氟以及表面活性剂对牛牙釉质脱矿的影响。口腔医学纵横, 1997; 13:201
18． Ogaard B,Seppa L,Rolla G. Professional topical fluoride applications: Clinical efficacy and mechanism of action. Adv Dent Res. 1994;8:190
19． Saxegaard E,Rolla G. Kinetics of acquisition and loss of calcium fluoride by enamel in vivo. Caries Res 1989; 23:406
20． Bruun C, Givskov H. Formation of CaF2 on sound enamel and in caries-like enamel lesions after different froms of fluoride applications in vitro. Caries Res 1991; 25:96
21． Cruz R, Ogaard B, Rolla G. Uptake of KOH-soluble and KOH-insoluble fluoride in sound human enamel after topical application of a fluoride varnish ( Duraphat) or a neutral 2 % NaF solution in vitro. Scand J Dent Res 1992; 100:154
22． Daschner H,Uchtmann H,Daschner HA. Primary reactions of fluoride with outmost layers of enamels. J Dent Res 1990; 69 (Spec Iss):825
23． Larsen MJA,Richard A. CaF2 formation on human enamel in a salivary film. Caries Res 1998;32(30) :269
24． Margolis HC, Moreno EC. Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides. J Dent Res 1990;69:606
25． Page DJ. A study of the eifect of fluoride delivered from solution and dentifrices on enamel demineraliation. Caries Res 1991; 25: 251
26． Featherstone JDB. Prevention and reversal of dental caries:role of low level of fluoride. Community Dent Oral Epidemiol 1999; 27: 31
27． Schiffner U. Giilzow HJ. Influnce of firmly and loosely bound fluoride on enamel demineralization in vitro. Caries Res 1998; 32 (3) :283
28． Relief DH,et al. Enamel fluoride uptake distribution and retention from topical fluoride agents. Caries Res 1983; 17:44