【作者】 陈玲；

【导师】 梅予锋；

【作者基本信息】 南京医科大学 ， 口腔临床医学， 2017， 硕士

【摘要】 目的:通过体外实验研究氟离子导入氟化乳牙釉质的效果;通过临床跟踪儿童乳牙患龋状况变化,观察氟离子导入预防乳牙龋病的效果,研究龋活跃程度对氟离子导入的影响,为选择合适的干预时机提供参考。方法:实验一:将54个离体乳切牙标本随机均分为9组,7个实验组用NF-Ⅱ型护齿仪在不同的工作条件下(NaF浓度、电流强度、导入时间)下进行氟离子导入处理,两个对照组分别用2%氟化钠和去离子水浸泡,将进行处理后的各组标本分别置入5 ml 0.1 mol/L乳酸中,48 h后用氟离子选择电极法测定各管溶液中氟离子浓度,并进行统计学分析。实验二:采用整群随机抽样方法,抽取张家港市12所幼儿园的3-4岁儿童进行口腔检查,采用一年两次的氟离子导入防龋技术,追踪随访两年,观察乳牙患龋率、龋均、新增dmft的变化。同时根据基线口腔检查的龋失补牙数(dmft),分为无龋组(dmft=0)、低龋组(1≤dmft<4)、高龋组(dmft≥4),两年后比较各组的新增dmf t。结果:实验一:氟离子导入组、氟化钠浸泡组、去离子水组中氟离子浓度的均值分别为(0.0940 ± 0.0200、(0.0554 ± 0.0147)及(0.0388 ± 0.0012)mg/L,氟离子导入组的氟含量明显高于氟化钠浸泡组,差异有统计学意义(P<0.05);在NaF浓度与氟化乳牙釉质关系的实验中,1%、2%、3%F-导入组中氟离子浓度的均值分别为(0.0925 ± 0.0123)、(0.0940 ± 0.0200)及(0.1025 ±0.0023)mg/L,3%F-导入组的氟含量高于1%和2%F-导入组,差异均有统计学意义(P<0.05)。在电流强度与氟化乳牙釉质关系的实验中,0.3 mA、0.4 mA、0.5 mA导入组中氟离子浓度的均值分别为(0.0928 ± 0.0098)、(0.0940 ±0.0200)及(0.1045 ± 0.0033)mg/L,0.5 mA导入组的氟含量高于0.3 mA、0.4 mA导入组,差异有统计学意义(P<0.05)。导入时间和氟化乳牙釉质关系的实验中,2min、3min、4min导入组中氟离子浓度的均值分别为(0.0933 ±0.0014)、(0.0940 ±0.0200)及(0.0952 ± 0.0016)mg/L,三组间氟离子浓度的差异无统计学意义(P>0.05)。实验二:1697名儿童在2013～2015年患龋率分别为50.83%、61.99%、68.00%;龋均分别为2.06 ± 3.03、3.06 ± 3.80、3.47 ± 3.90,三年间患龋率、龋均均呈逐年上升趋势,差异均有统计学意义(x2=113.567,P<0.05;F=69.730,P<0.05)。2014、2015年的新增dmft分别为1 01 ± 1.53、0.53 ± 0.97,2015年的新增dmft明显降低,两年间新增dmft的差异具有统计学意义(t=10.933,P<0.05)。两年后无龋组、低龋组、高龋组新增dmft分别为0.82 ±1.39、2.11 ±2.15、2.41 ± 2.10.三组间的差异有统计学意义(F=135.58,P<0.05),且任意两组之间的差异均有统计学意义(P<0.05)。结论:1.氟离子导入技术能够有效增加乳牙釉质氟含量,在本实验条件下,提高F-导入浓度和增加电流强度能使乳牙釉质氟含量增高。2.临床应用氟离子导入能预防乳牙龋病的发生,高龋活跃程度可降低氟离子导入的防龋效果,在乳牙未患龋之前进行干预效果最好。更多还原

【Abstract】 Objective:To evaluate the fluoridation of deciduous enamel after fluoride iontophoresis in vitro;To observe the changes of deciduous teeth caries and the prevention effect of the fluoride ioninfiltration;To researchthe prevention effect of the fluoride ion infiltration with different decay degrees of the deciduous teeth,providing reference for the selection of the appropriate timing of the intervention.Methods:Part1:54 deciduous incisors sample were used and randomly divided into nine groups.Seven experimental groupswere treated with fluoride iontophoresis under several conditions,other two control groups were soaked in 2%NaF solution and deionized water,respectively.After that,each sample was placed into 5ml 0.1 mol/L lactic acid solution,Fluoride concentrations were measured with fluoride ion-specific electrode 48h later,then statsiticanlyasis were performed.Part2:The children aged 3-4 year-old from 12 preschools in Zhangjiagang were selected with cluster random sampling method.They were selected for clinical examination annually and received a bi-annual fluoride ion infiltration application.Caries incidence、mean dmft、the increase dmft were calculated.Also they were divided into three groups according to the dmft calculated by the first oral examination:caries-free group(dmft=0)、low caries group(1≤dmft<4)、caries high caries group(dmft>4,and the increase dmft was compared in two years later.Results:Part1:The mean values of fluoride concentration in fluoride iontophoresis group,NaF group and the deionized water group was(0.0940± 0.0200)、(0.0554 ± 0.0147)and(0.0388 ± 0.0012)mg/L,respectively.The concentration of fluoride in the fluoride iontophoresis group was significantly higherthan that in the NaF group(P<0.05).In concentration-dependent test,the mean values of fluoride concentration in 1%,2%,3%fluoride iontophoresis group was(0.0925 ± 0.0123)、(0.0940 ± 0.0200)and(0.1025 ±0.0023)mg/L,respectively,The concentration of fluoride in the 3%fluoride iontophoresis group was significantly higher than that in 1%and 2%fluoride iontophoresis group(P<0.05).In current strength-dependent test,the mean values of fluoride concentration in the 0.3 mA、0.4 mA、0.5 mA fluoride iontophoresis group was(0.0928 ± 0.0098)、(0.0940 ± 0.0200)and(0.1045 ± 0.0033)mg/L,respectively.The concentration of fluoride in 0.5 mA fluoride iontophoresis group was significantly higher than that in 0.3 mA and 0.4 mA fluoride iontophoresis group(P<0.05).In time-dependent test,the mean values of fluoride concentration in the 2min、3min、4min fluoride iontophoresis group was(0.0933 ± 0.0014)、(0.0940 ±0.0200)and(0.0952 ± 0.0016)mg/L,respectively.The concentration of fluoride in three groups had no significant difference(P>0.05).Part2:It was found that from 2013 to 2015,the prevalence of dental caries was 50.83%、61.99%and 68.00%,respectively;The mean number of decayed,missed and filled teeth(dmft)was 2.06 ± 3.03、3.06 ± 3.80 and 3.47 ± 3.9,respectively.The prevalence of dental caries and mean dmft increased gradually as the children grew up.There was significant difference among 3 years(x2 =113.567,P<0.05;F =69.730,P<0.05).The increase dmft in 2014.2015 was 1.01 ± 1.53 and 0.53 ± 0.97,respectively.The increase dmft in 2015 was decreased and the difference between 2014 and 2015 was significantly(t=10.933,P<0.05).At the same time the increase dmft in two years later among carie-free group、low caries group、high caries group was 0.82 ± 1.39、2.U ± 2.15、2.41 ± 2.10,respectively(F=135.58,P<0.05),the difference between the three groups and every two groups was significantly(P<0.05).Conclusion:1.Fluoride iontophoresis is an effective way to increase the concentration of fluoride in deciduous enamel.This study showed that improve the concentration of fluoride and increase the current strength could enhance the concentration of fluoride in enamel effectively.2.Using the application of fluoride ion can prevent the occurrence of dental caries.The high caries activity may weaken the prevention effect of the fluoride ioninfiltration,The optimal timing of intervention is before the caries appeared.更多还原