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局部氟化 (Topical Fluoridation)

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

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局部氟化 (Topical Fluoridation)

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  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

  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

  3. Topical fluoridation • Introduction • Mechanism of topical fluoride • Topical fluoride in dental public health • Topical fluoride in dental clinic • Risk of topical fluoride • Conclusion

  4. Introduction

  5. Mechanism of topical fluoride

  6. 化學結構 Ca10(PO4)6 (OH)2+2F- → Ca10(PO4)6F2 + 2(OH)- enamel hydroxyapatite + fluoride fluorapatite + hydroxyl

  7. 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

  8. 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

  9. Topical fluoride in dental public health

  10. Topical fluoride in dental clinic

  11. Recommended application technique • Paint – on technique • Tray technique • Topical electrolytic application

  12. 2% neutral sodium fluoride (0.9% fluoride ion) • 8% stannous fluoride (2% fluoride ion) • 2.8% acidulated phosphate fluoride (1.23% fluoride ion)

  13. Risk of topical fluoride

  14. Danger • The acute lethal dose is about 50mg/kg. • The average 5 years child B.W. 20kg 3mg/kg early symptoms

  15. Symptoms of fluoride toxicology • Chemical burn (ulceration / necrosis) • Inhibit enzyme (protoplasmic poison) • Binds calcium (nerve action) • Hyperkalemia (cardiotoxicity)

  16. Treatment • Immediate treatment • Induced vomiting • Protection of stomach • Maintaince of blood calcium

  17. 1ppm[F-] = 1 mgF/l = 1mgF/kg = 1x10─4 %F

  18. Conclusion

  19. 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。

  20. 結論 • 評量局部氟化在臨床上的重要性

  21. Thank You For Your Listening!

  22. 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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