蔡騏駿 牙醫
台灣註冊牙科醫生
萬芳醫院齒顎矯正科總醫生
預防蛀牙,愛用『氟化物』
牙齒表面的琺瑯質,是人體全身最堅硬的結構,保護著內層的牙本質和牙髓神經,抵禦食物冷熱酸甜的刺激,接受各種軟硬食物的摩擦。如此堅硬的物質,究竟為何會發生蛀牙呢?
附著在牙齒表面的牙菌斑,含有多種細菌,其中轉糖鏈球菌(Streptococcus mutans)會把進入口腔的碳水化合物,尤其是糖類食物,發酵成為酸性物質,降低牙齒表面環境的酸鹼度。琺瑯質當中96%的成分是稱為氫氧磷灰石(hydroxyapetite)的礦物質,在酸性環境中會發生去鈣化作用(demineralization),又稱為脫鈣,使鈣質流失造成牙齒表面變軟並減少,形成了初期的蛀牙。堅硬的琺瑯質一旦有了缺陷,去鈣化作用再持續發生,就可能發展成更深更廣的蛀牙,影響到牙本質和牙髓神經。
圖 1.蛀牙四要素:碳水化合物(尤其糖類)、致齲菌、齒質、時間
預防蛀牙,可以從防治蛀牙四要素下手:1. 少吃精緻醣類、蔗糖,減少進食頻率,提高口腔酸鹼值; 2. 使用公筷公匙,減少口腔細菌傳遞; 3. 以氟化物強化齒質; 4. 每日做好口腔的清潔。
氟化物如何強化齒質呢?
氟化物是自然界存在的天然化合物,氟在口腔中可以取代氫氧磷灰石當中沒那麼穩定的氫氧部分,把琺瑯質表層變成氟化磷灰石,並且促進再鈣化作用(remineralization),強化琺瑯質表面的結晶結構。同時氟化物還有抑制細菌在牙齒表面生長,減低細菌酵素作用的效果。當再鈣化作用的速度大於去鈣化作用時,蛀牙的進展便會停止。
圖2. 再鈣化與去鈣化
發育中的兒童,牙醫會建議定期塗氟及服用氟錠,以讓發育中的琺瑯質獲得更多的氟。對於成年人而言,塗氟或氟錠的效果則不顯著,一般建議使用含氟牙膏以及含氟漱口水進行蛀牙預防。含氟牙膏需注意濃度,研究顯示含氟1000ppm 以上的牙膏,才具有較佳的防蛀效果。
漱口水選用則需注意使用說明及氟化物(NaF, 氟化鈉)濃度,濃度0.05%(約等於225ppm)的漱口水建議每日使用,每次口含約10 c.c., 上上下下、左左右右充分漱口一分鐘,用後30分鐘盡量避免飲食或漱口。臨床研究證實漱口水的防蛀效果,比單純物理性清潔可提昇30%,注意要持續長期使用,才能達到防蛀成效。
正在接受矯正治療、口中有固定裝置、接受口腔手術、或頭頸部放射線治療的患者,因為唾液減少及清潔死角增加,蛀牙機率提高,更需要以氟化物加強齒質預防蛀牙。
採用三步法
請記住,雖然漱口水能有效殺菌,但它只是全面口腔健康程序的其中一個補充部分,其餘部分包括使用含氟牙膏刷牙和使用牙線清潔。單靠刷牙是不足夠的……它僅能清理口腔的 25%。要保持整個口腔清潔,還需要使用李施德林抗菌漱口水沖洗。
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