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局部氟化 (Topical Fluoridation)






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局部氟化 (Topical Fluoridation). 陳弘森 副教授 高雄醫學大學 牙醫學系 TEL: 07-3121101 轉 7008, 7020 E-mail: hosech@kmu.edu.tw. 學習目標. 氟化物與牙齒面的作用機轉 局部氟化與牙科公衛 局部氟化的種類與使用方式 局部氟化的風險 學習資源: Murray JJ: Appropriate use of fluoride for human health. WHO, Geneva, 1996. Topical fluoridation. Introduction
局部氟化 (Topical Fluoridation)

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Topical fluoridation l.jpgSlide 1

局部氟化(Topical Fluoridation)

陳弘森 副教授

高雄醫學大學 牙醫學系

TEL: 07-3121101轉7008, 7020

E-mail: hosech@kmu.edu.tw

Slide2 l.jpgSlide 2

學習目標

  • 氟化物與牙齒面的作用機轉

  • 局部氟化與牙科公衛

  • 局部氟化的種類與使用方式

  • 局部氟化的風險

  • 學習資源:

    • Murray JJ: Appropriate use of fluoride for human health. WHO, Geneva, 1996

Topical fluoridation5 l.jpgSlide 5

Topical fluoridation

  • Introduction

  • Mechanism of topical fluoride

  • Topical fluoride in dental public health

  • Topical fluoride in dental clinic

  • Risk of topical fluoride

  • Conclusion

Introduction l.jpgSlide 6

Introduction

Mechanism of topical fluoride l.jpgSlide 10

Mechanism of topical fluoride

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化學結構

Ca10(PO4)6 (OH)2+2F- → Ca10(PO4)6F2 + 2(OH)-

enamel hydroxyapatite + fluoride fluorapatite + hydroxyl

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Dental Mineral = carbonated apatite

Ca10-XNAX(PO4)6-y(CO3)z(OH)2-u(F)u

Most soluble in acid

Fig. 2. Schematic representation of the acid solubility ranking of dentally relevant minerals (18).

Ca10(PO4)6(OH)2 = hydroxyapatite

Less soluble

Ca10(PO4)6(F)2 = fluorapatite

Least soluble

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HF

HF

H+ +F-

H+ +F-

Bacterial Cell

pH7 H+ +F-HF

Fig. 6. Schematic representation of fluoride entering a bacterial cell in the form of HF at lower pH values, dissociating, and thereby providing H+ and F- ions inside the cell.

pH4.5 H+ +F-HF

Topical fluoride in dental public health l.jpgSlide 16

Topical fluoride in dental public health

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Topical fluoride in dental clinic

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Recommended application technique

  • Paint – on technique

  • Tray technique

  • Topical electrolytic application

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  • 2% neutral sodium fluoride

    (0.9% fluoride ion)

  • 8% stannous fluoride

    (2% fluoride ion)

  • 2.8% acidulated phosphate fluoride

    (1.23% fluoride ion)

Risk of topical fluoride l.jpgSlide 38

Risk of topical fluoride

Danger l.jpgSlide 39

Danger

  • The acute lethal dose is about 50mg/kg.

  • The average 5 years child B.W. 20kg 3mg/kg early symptoms

Symptoms of fluoride toxicology l.jpgSlide 40

Symptoms of fluoride toxicology

  • Chemical burn (ulceration / necrosis)

  • Inhibit enzyme (protoplasmic poison)

  • Binds calcium (nerve action)

  • Hyperkalemia (cardiotoxicity)

Treatment l.jpgSlide 41

Treatment

  • Immediate treatment

  • Induced vomiting

  • Protection of stomach

  • Maintaince of blood calcium

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1ppm[F-] = 1 mgF/l

= 1mgF/kg

= 1x10─4 %F

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Conclusion

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氟化物製品之種類、濃度及用法

目前常用之氟化物製品有下列幾種,依濃度

  • 局部塗氟 (濃度 10,000 ~ 50,000 ppm)

  • 家用局部塗氟 (1,000 ~ 5,000 ppm)

  • 含氟牙膏 (800 ~ 1500 ppm)

  • 自用含氟漱口水 (濃度 250 ~ 1,000 ppm)

  • 專供發育中孩童長期服用之氟錠。

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結論

  • 評量局部氟化在臨床上的重要性

Thank you for your listening l.jpgSlide 48

Thank You For Your Listening!

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ACID

Calcium phosphate +Fluoride

Remineralization

Fig. 4. Schematic representation of demineralization and Remineralization processes

which lead to remineralized crystals with surfaces rich in fluoride and of low solubility

Fluoride mouth rinses l.jpgSlide 56

Fluoride mouth rinses

  • 1946 Bibby et al. Early trials

  • 1962 Torell and Siberg 0.2% Fluorol

  • 1965 Torell and Ericsson 0.05% Fluorol

Fluoride application in dentistry l.jpgSlide 58

Fluoride application in dentistry

Sodium fluoride l.jpgSlide 59

Sodium fluoride

  • 1942 Bibby was first to use

  • 1948 Knutson 2% was used

Stannous fluoride l.jpgSlide 60

Stannous fluoride

  • 1950 Muhler & his workers

  • 1959 Jordan et al. & Gish et al.

    8% SnF2

    SnF2 are acidic, with a pH 2.4 – 2.8

    Application : once every 6 months.

Acidulated phosphate fluoride apf l.jpgSlide 61

Acidulated Phosphate Fluoride (APF)

  • 1963 Brudevola et al. found APF

  • APF systems consist sodium fluoride, hydrofluoric acid, and phosphoric acid (1.23% fluoride 0.98% phosphoric acid & pH 3 – 3.5)

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表二、國內近年來推廣氟化物使用之重要記事:

Duraphat fluoride varnish l.jpgSlide 72

Duraphat®Fluoride varnish

  • The outstanding preparation for topical caries prophylaxis and treatment of hypersensitive necks of teeth

Fda ada accepted office fluoride application systems l.jpgSlide 73

FDA/ADA-Accepted Office Fluoride Application Systems

Topical electrolytic application l.jpgSlide 74

電離子游動應用法(Topical electrolytic application)

  • 利用電離子游動儀器(Galvafluor)及電導印模皿(Impression support conductor)促進氟離子(F-)之滲透入琺瑯質。

  • 原理:手握正極,使身體及牙齒成正極,口咬負極之電導印模皿。則 gel 之帶正電之鈉離子等移向負極之印模皿,而帶負電之氟離子(F- )移向正極之牙齒,如此氟之滲透入琺瑯質更為加強。

Slide78 l.jpgSlide 78

附表 – 口腔保健用品含氟量和急性氟中毒劑量的比較(以20kg小孩為例)


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