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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: [email protected] 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

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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: [email protected]


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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


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Topical fluoridation

  • Introduction

  • Mechanism of topical fluoride

  • Topical fluoride in dental public health

  • Topical fluoride in dental clinic

  • Risk of topical fluoride

  • Conclusion




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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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F

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




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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)



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Danger

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

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


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Symptoms of fluoride toxicology

  • Chemical burn (ulceration / necrosis)

  • Inhibit enzyme (protoplasmic poison)

  • Binds calcium (nerve action)

  • Hyperkalemia (cardiotoxicity)


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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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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



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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


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Fluoride mouth rinses

  • 1946 Bibby et al. Early trials

  • 1962 Torell and Siberg 0.2% Fluorol

  • 1965 Torell and Ericsson 0.05% Fluorol



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Sodium fluoride

  • 1942 Bibby was first to use

  • 1948 Knutson 2% was used


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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.


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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:表二、國內近年來推廣氟化物使用之重要記事:


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Duraphat表二、國內近年來推廣氟化物使用之重要記事:®Fluoride varnish

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


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FDA/ADA-Accepted Office Fluoride Application Systems表二、國內近年來推廣氟化物使用之重要記事:


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電離子游動應用法表二、國內近年來推廣氟化物使用之重要記事:(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。


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附表 表二、國內近年來推廣氟化物使用之重要記事:– 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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