含氟牙膏及含氟漱口水使用後唾液中氟離子變化情形

研究背景：由於含氟牙膏及含氟漱口水在預防齲齒方面的成效不錯，價格低廉、使用方便、己與口腔衛生習慣結合在一起，而且無不悅的味道，因此以含氟牙膏刷牙是目前任何年齡最常見的預防齲齒的方法。而含氟漱口水己成為台灣全體小學生進行牙科公共衛生計畫最廣泛被使用來預防和控制齲齒的製劑。然而使用含氟牙膏及含氟漱口水之後，究竟有多少氟離子在唾液中，有無達到保護牙齒的最低濃度，值得我們探討。研究目的：使用含氟牙膏或含氟漱口水前、後，唾液中氟離子的經過時間變化並比較兩者間之差異。研究方法：選取某國中，研究對象為一年級學生共三十四名。解釋研究計畫，在研究進行前執行，告知研究內容及注意事項，徵得受測者之家長及受測者同意進行檢測。餐後一到二小時後各以低氟0.5g(500 ppm F-)、中氟1 g(1000 ppm F-) 、高氟1.5 g (1500 ppm F-)之含氟牙膏，刷牙時間三分鐘接著以20ml蒸餾水漱口10秒。含氟漱口水則以0.2% NaF（1000 ppm F-）、0.05% NaF（250 ppm F-）含氟漱口水10ml漱口一分鐘。在一分鐘、五分鐘、十五分鐘、三十分鐘、四十五分鐘、一小時及二小時之時間點收集唾液樣本。以試管收集唾液，使用專用氟電極測氟離子濃度，以進行統計分析。結果：進行實驗之前，唾液氟離子在基礎線平均值為0.06±0.04 ppm 。在使用含氟牙膏低氟、中氟及高氟濃度後，經過時間的變化，唾液氟離子濃度有顯著的上昇（p＜0.0001），使用高氟的含氟牙膏，較中氟及低氟有較高的氟離子濃度，以含氟牙膏低氟濃度刷牙後2小時，唾液中的氟離子回到基礎線、以含氟牙膏高氟濃度、中氟濃度刷牙後2小時，唾液中的氟離子仍然高於基礎線。在使用含氟牙膏低氟、中氟及高氟濃度刷牙後二小時，口中唾液氟離子大於0.04 ppm，均能維持氟離子抗齲之有效濃度。唾液氟離子濃度，在使用含氟漱口水漱口後1分鐘達到最大值，用0.05% NaF是0.2% NaF含氟漱口水後的1/3。唾液中氟離子濃度在使用含氟漱口水後平均2小時遠高於基礎線。在使用0.05%NaF、0.2% NaF含氟漱口水後二小時，唾液中氟離子濃度遠大於0.08 ppm，均大於0.04 ppm抗齲之有效濃度，故評估齲齒進行的風險非常低。本研究證實含氟漱口水比含氟牙膏更能增加唾液中的氟離子濃度且可維持二小時以上。結論：使用含氟牙膏或含氟漱口水後唾液中的氟離子減少分兩期： 1.開始的快速減少期：在使用後1分鐘左右達到最大值，5分鐘內快速減少，大約持續30－60分鐘，因人而異。 2.緩慢減少期：氟離子緩慢減少約持續數小時。

關鍵字

含氟牙膏；含氟漱口水；唾液氟離子滯留變化

並列摘要

Research background: Fluoridated toothpastes and mouthrinses are now widely used for the prevention and control of dental caries in the dental public health plan and homecare. because of it’s effectiveness, low price,easily use and without unpleasant odor, It deserves us to explore whether the oral fluoride retention in saliva could reach the minimal concentration to protect the process of dental caries after usage of fluoridated toothpaste and mouthrinse. Study Objective: Oral fluoride retention in saliva, before and after fluoridated toothpastes or mouthrinses administration,and compare the difference between them. Methods: The samples included 34 students in the junior high school who were agreed by their parents and themselves to get the informed consents. After lunch, toothbrushing for 3 minutes was by using 0.5g〈500ppm F-〉, 1g〈1000ppm F-〉,or 1.5g〈1500ppm F-〉respectively, then,rinsed with 20 ml distilled water for 10 seconds. 0.2%NaF〈1000ppm F-〉 mouthrinse and 0.05%〈250ppm F-〉 mouthrinse were dispensed into 10 ml aliquots and the students instructed to rinse for one minute. Rinsing with water was not permitted following administration of the mouthrinse. Saliva samples were collected in test tube immediately prior and then at 1,5,15,30,45min and 1 and 2hr after toothbrushing and rinsing. The fluoride content of the saliva was determined using an ion-specific electrode for further statistical analysis. Results: Mean baseline salivary fluoride value was 0.06±0.04 ppm before the experiments. Brushing with 500 ppm fluoridated toothpaste, salivary fluoride level returned to baseline after two hours. Brushing with 1000 ppm and 1500 ppm fluoridated toothpastes, salivary fluoride levels remained above baseline after two hours. The retention rate of salivary fluoride from toothpastes or mouthrinses used was proportional to the concentration of fluoride ion in the original preparation. The concentration of salivary fluoride was higher than 0.04ppm in all experimental groups for more than two hours which was the minimal caries preventive concentration. Conclusion: Three different concentration of toothpastes and two different concentration of mouthrinses were applied to children and then salivary fluoride concentration was calculated. The results showed that the salivary fluoride concentration was more than 0.04ppm for more than two hours which was the minimal caries protective concentration. Mean salivary fluoride clearance curve decreased in two distinct phases: 1. The first phase(fast decreasing phase), the peak fluoride levels occurred 1 minute after brushing and then rapidly decreased in the next 5 minutes, which lasted for 30~60 minutes depending on the individual. 2. The second phase(slow decreasing phase), which decreased slowly and lasted for hours.