市售包裝飲料含漱前後對唾液酸鹼值之影響探討

研究背景食物的致齲性曾被廣泛的研究過，但大部分偏向固體食物，僅有少數研究提到流體食物的致齲性。目前流體飲料食用頻率日漸增加，經常攝取含糖飲料和高齲齒率有關，研究飲料的致齲性，以建議大眾選擇低致齲性飲料，有預防牙醫學的價值。研究目的： 1.對市售包裝飲料標示成分之分析 2.探討市售包裝飲料含漱前後對唾液酸鹼值之影響研究方法：本研究乃針對高雄縣某一所國中七年級學生喜好之市售包裝飲料進行調查，並對飲料中標示成分先行分析，並選取DMFT index 3.0以下，無全身性疾病及未長期服用藥物和無嚴重牙齦炎者學生34名，先進行前測後再以含漱市售包裝飲料一分鐘後收集2，5，10，15，30，45及60分鐘之唾液進行分析。結果：本研究結果顯示四種飲料皆能使唾液酸鹼值在2分鐘內降至低於起始值，乳酸飲料下降量最大，柳橙汁下降最少且最早回復致起始值。致酸性大小：以乳酸飲料最大、5%葡萄糖水次之、可樂再次之、柳橙汁最小。結論：本研究實驗結果不若先前Stephan curve中pH值降至脫鈣臨界值，其原因可能與現今衛生條件、口腔衛生習慣較以前改善許多，及本研究依正常生活常規，未限制停止口腔衛生行為，故無法累積牙菌斑亦有相關，且口腔中影響唾液酸鹼值之因素很多，唾液流速、細菌種類及數目、食物、個人口腔衛生習慣等皆可能影響唾液中酸鹼值。雖然研究發現甜食對齲齒之影響已不如預期大，但也不表示常喝含糖飲料是安全的，若是攝取甜飲頻率增加仍有致齲之危險，依本研究結果顯示飲用甜飲在2分鐘內唾液酸鹼值降至最低值，若長時間持續飲用時將會使酸鹼值繼續下降，故建議飲用甜飲應在2分鐘內飲用完畢，以免形成牙齒之齲蝕，若能減少食用甜飲將更有助齲齒之預防；但要減少學生對甜食之誘惑實不易，建議應從教育著手，將健康飲食及衛生習慣灌輸予學生，建立正確之飲食觀念，減少甜食及飲料之攝取，以降低齲齒罹患率增加口腔防治之成效。

關鍵字

齲齒；唾液酸鹼值；市售包裝飲料；牙菌斑

並列摘要

Background: There have been many studies on the cariogenicity of solid foods using plaque pH, but information on the effect of plaque pH value for soft drinks is limited. The consumption of sweetened beverages is on the rise, and high incidence of dental caries has been associated with frequent consumption of sweetened beverages. Therefore, from the dental public health point of view, educating people to choose less cariogenic beverages is a valuable strategy for dental caries prevention. Study Objective: 1. To compare the ingredients of commercially packaged soft drinks. 2. To study the effects of packed beverage consumption on salivary pH values. Methods: Questionnaires were given to a group of the seventh grade students in a country junior high school in Kaohsiung to determine the favorite commercially packaged soft drinks among the students. The ingredients were compared based on the information given in the labels. Thirty four healthy students, not on any medication, or with any long-term history of severe gingivitis were selected for participation in this study. After the baseline salivary pH values were measured, the subjects were instructed to rinse with 10 ml of the test drinks and to hold it in their mouths for one minute. Salivary pH value measurements were taken at 2,5,10,15,30,45 and 60 minutes after rinse and the collected data were analyzed by SPSS statistics package. Results: All the beverages tested lowered the salivary pH value below the pre-rinse baseline salivary pH value. Lactate was found to result in the greatest pH drop. Orange juice resulted in the least pH drop and it took the least time to return to the baseline. The acidogenicity of the tested beverages in descending order are lactate, 5% glucose, carbonated drink and orange juice. Conclusion: The results of the present study indicate that the salivary pH value is not as critical as previously found in other studies. Possible explanations for the discrepancies may include: increased awareness of public health and personal oral hygiene, and the fact that the subjects were not restricted from maintaining their regular level of personal oral hygiene, thus preventing the accumulation of plaque. Moreover, the salivary pH value can be affected by various factors including choices of foods, types of bacteria, rates of salivary flow and the level of personal oral hygiene maintenance. Although the results of the present study indicate that the effect of sweetened food on dental caries is less influential than previously thought, we find that all the test drinks in our study have similar acidogenicity and frequent consumption of sweetened drinks could lead to an increased risk of dental caries. Based on our finding that the salivary pH value drops to its lowest point within two minutes of taking in sweetened beverages and that continuous and long time consumption of such drinks causes the salivary pH value to drop below the critical value, we advise that one should either finish the sweetened beverage within two minutes, stop drinking the sweetened beverage after two minutes, or simply cut down on the intake of sweetened beverage to minimize the risk of getting dental caries. Furthermore, emphasizing public education for oral health, instilling in students the knowledge of well-balanced diet and importance of personal oral hygiene, and cutting down on consumption of soft drinks will result in better caries prevention.