講義-氟化物於口腔保健之運用—新竹市校護

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1 耀慧 DDS, MDSc, FICD 台北醫學學臨床助理教授國防醫學院牙科公共衛碩國際牙醫學院台灣地區院美國德州衛科學院專科進修 1 1

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14 FLUORIDE THE MOST EFFECTIVE AND WIDELY USED APPROACHES FOR CARIES PREVENTION AND CONTROL in :Recommendations for using fluoride to prevent and control dental caries in the United State, MMWR CDC, Aug /50(RR14):PP

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16 GUIDELINE ON FLUORIDE THERAPY AAPD, 2014 Recommendations 1). There is confirmation from evidence-based reviews that fluoride use for the prevention and control of caries is both safe and highly effective in reducing dental caries prevalence From: American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. May

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18 氟是帶負電最強的化學元素, 通常以化合物形式存在為然界中第 17 常的元素體中以骨頭及牙齒含量最 18 18

19 食物空氣藥物空氣藥物食物 Data form: WHO, Fluorides and human health,

20 In Taiwan (US national Defense,1961) 0.1~1.1ppm, 公最 (1.1ppm) 台灣本島 ( 郭獻,1998) 中南部 (0.08~0.09ppm) 於北部 (0.04ppm) 或東部 (0.03ppm) 臺北來事業處,2003 ( 市長信箱信件編號 : ) 臺北地區 :0.06~0.07ppm 20 20

21 資料來源 : WHO, Fluorides and human health. Ch.2 The supply of fluoride to man. p.17-74,

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25 worldwide dentists are trying to convince the public that children are not getting enough fluoride,.. but the exact opposite is true: children and adults are exactly overdosing on fluoride 25 25

26 From: The Fluoride Education Project,Fluoride in food. poisonfluoride.com/pfpc/html/f-_in_food.html From: The Fluoride Education Project,Fluoride in food. poisonfluoride.com/pfpc/html/f-_in_food.html 26 26

Total fluoride intake 氟化物總攝取量東京科學, 2004 嬰兒每氟化物攝取量平均 : 0.

27 Total fluoride intake 氟化物總攝取量東京科學, 2004 嬰兒每氟化物攝取量平均 : mg/kg 建議標準值 : mg/kg (Ophagu et al, 1985) 27 27

28 British Dental Journal 2013; 214:

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31 From: K. Bailey et al, Fluoride in Drinking-water, WHO,

32 FLUORIDE CONCENTRATION OF TEA Authors Authors Authors Authors WHO,1970 NA NA 97( ) Ramsey,1975 England ( ) Striibig,1981 Germany ( ) Wei,1989 HK ( ) Chen,1996 US ( ) Beherndt,2002 Germany ( ) 農委會 Taiwan (90-350) Data from: fluoride and human health,1970, Caries Res 2002:36:405 & external/teais/index.html, Modified by: Dr. Yao-Hui Huang 32 32

33 FACTORS ASSOCIATED WITH FLUORIDE CONCENTRATION OF TEA Tea leaves Type Soil Time picked (older contain more F) Infusion time (Chen, 1996) Majority within 30 Continue until 120 綠茶 ( 鐵觀包種龍井 ) 烏龍茶 33 33

34 品名氟濃度值 PH 值 XX 山烏龍茶 ( 無糖 ) 0.5ppm 6.66 XX 烏龍茶 ( 無糖 ) 0.8ppm 6.23 XX 天霧烏龍茶 ( 無糖 ) 0.4ppm 6.19 YY 烏龍茶 ( 無糖 ) 0.7ppm 6.50 XX 烏龍 ( 無糖 ) 0.8ppm 6.45 XX 青烏龍茶 ( 無糖 ) 0.7ppm 6.33 XX 極品烏龍茶 ( 無糖 ) 1.15ppm 5.82 資料來源 : 國防醫學院牙科公衛研究室,

35 Q & A 哪些食物含有氟化物? 所有食物均含氟化物含氟量較的食物? 茶葉資料來源 :WHO, Fluorides, Environmental health criteria 227,

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37 Featherstone,

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41 Re-mineralization De-mineralization 41 41

42 擾細菌酵素的活性 Enolase: formation of acid Phosphoglucomutase: formation of polysaccharide 氟離抑制葡萄糖通過細胞壁 42 42

43 MESSAGE FROM NIH 2001, NIH Consensus Development Conference Statement The evidence for the benefit of applying fluoride varnish to permanent teeth is general positive Effective also to reverse or arrest early dental caries From: NIH, Diagnosis and management of dental caries throughout life. NIH Consensus Development Conference Statement, J Dent Educ 65:1162-8,

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(Rugg-Gunn,2013, by delivery method) Community preventive measures 社區防齲 Personal effort is NOT required 不需個努 Reduce inequalities in disease 降低疾病之不均勻勻分布 Community-bases

46 (Rugg-Gunn,2013, by delivery method) Community preventive measures 社區防齲 Personal effort is NOT required 不需個努 Reduce inequalities in disease 降低疾病之不均勻勻分布 Community-bases self-administered Professionally administered From: Andrew Rugg-Gunn, Dental caries: Strategies to control this preventable disease. Acta Medica Academica 2013;42(2):

47 資料來源 : WHO,1994 單位 : 百萬圖表製作 : 耀慧醫師 47 47

48 在此輸入名語錄 48 48

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51 % 2. 3% % 20-35% % % TOOTHPASTE TOOTHPASTE

52 Typical Composition Binders 0.0 2% Flavor 0.5 2% Abrasive 18 50% Sweetener 0.2 1% Surfactant 0.5 2% 80-90% Water 0 50% Humectants 20 65% Fluoride % 52 TOOTHPASTE TOOTHPASTE

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54 TOOTHPASTE AS BATHROOM SNACK CROLL,1992 (QUINTESSENCE INT.23(2):77-78) 54 54

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56 Correct Amount of Toothpaste for Young Children 56 56

57 Pea size amount of toothpaste 0.25~0.5 g (Villena, 2000) 57 57

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59 建議之牙膏使用方法橫擠式 From: Pediatr Dent, 22(4): , lower SD==> easier to be standardised 59 59

60 2010, Walsh 535 studies found, 75 were included. 71 contributed data to meta-analysis Effectiveness: 23 % (DMFS) for ppm 36 % for ppm No statistically significant effect: <550 ppm 低於 550 ppm 無預防蛀效果 Results on the deciduous dentition: equivocal 資料來源 :Walsh T et al, Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents..cochrane Database Syst Rev 2010; issue

61 2010, Walsh--- Conclusions confirms the benefits of using fluoride toothpaste..., but only statistically significantly at fluoride concentrations of 1000 ppm and above 有效預防蛀需 >1000 ppm 資料來源 :Walsh T et al, Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents..cochrane Database Syst Rev 2010; issue

FROM: JADA, 145(2):190-191, 2014 The ADA currently advises caregivers to brush <2

62 FROM: JADA, 145(2): , 2014 The ADA currently advises caregivers to brush <2 y/o- with water 2-6 y/o- pea-size F toothpaste But, from 2014 ADA recommend 62 62

63 FROM: JADA, 145(2): ,

64 From: B.H. de Oliveira et al, Children s Toothbrushing Practices Recommended on the Internet by Pediatric Dentistry Associations. Pediatr Dent 2016;38(7):

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66 should not produce unwanted effects on health, e.g. dental fluorosis No longer at risk of dental fluorosis From: Scottish Intercollegiate Guidelines Network (SIGN) Dental interventions to prevent caries in children. Edinburgh: SIGN;

67 From: Scottish Intercollegiate Guidelines Network (SIGN) Dental interventions to prevent caries in children. Edinburgh: SIGN;

68 From: Scottish Intercollegiate Guidelines Network (SIGN) Dental interventions to prevent caries in children. Edinburgh: SIGN;

69 From: Scottish Intercollegiate Guidelines Network (SIGN) Dental interventions to prevent caries in children. Edinburgh: SIGN;

70 2016 From: Marinho VCC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2016, Issue 7. Art.No.: CD

71 From: Marinho VCC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2016, Issue 7. Art.No.: CD

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73 British Dental Journal 2012; 212:

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75 Proposed Best Practices for Selfapplied Fluoride Administration From: Zero et al. Effective Use of Self-care Fluoride Administration in Asia. Adv Dent Res 24(1):16-21,

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80 From: 1 Weyant RJ, et al. Topical Fluoride for Caries Prevention: Executive Summary of the Updated Clinical Recommendations and Supporting Systematic Review. JADA 2013;144(11):

81 From: 1 Weyant RJ, et al. Topical Fluoride for Caries Prevention: Executive Summary of the Updated Clinical Recommendations and Supporting Systematic Review. JADA 2013;144(11):

82 Ministry of Health, New Zealand 2009 Experience of caries (including pre-cavitated lesions) in the past 3 years and health professional assessment of individual and/or family risk of caries 82 82

83 total F intake 40% by stomach excretion from urine, 10-25% 75-90% absorbed absorbed F retain in Ca-rich areas (bone & teeth) 35-50% by intestine urine excretion, 10-20% (nfants); 40% (adults) infants, 80-90% retained adults, 60% retained From: K. Bailey et al, Fluoride in Drinking-water p29-30, WHO,

84 Plasma fluoride levels after a small amount of fluoride ingested Reaches a peak within min followed by a rapid decline as a result of both uptake in calcified tissues and urine excretion Return to baseline levels within 3 4 h From: Victor R Preedy, Fluorine Chemistry, Analysis, Function and Effects,p56, The Royal Society of Chemistry

85 微量防蛀牙 (0.7 ppm) 過量中毒急性 ( ppm) 慢性 (dental >1.5 ppm; skeletal > 10 ppm) 85 85

86 Fluorosis=> 氟中毒?? fluorosis dental fluorosis skeletal fluorosis Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis Moderate amounts lead to dental effects, but long-term ingestion of large amounts can lead to potentially severe skeletal problems. => =>

87 Fluorosis=> 氟中毒?? Enamel fluorosis is not a disease but rather affects the way that teeth look

88 . there are some undesirable side-effects of excessive fluoride exposure. Experience has shown that it may not be possible to achieve effective fluoride-based caries prevention without some degree of mild enamel fluorosis, regardless of which methods are chosen. (Perterson, 2016) From: Poul Erik Petersen and Hiroshi Ogawa, Prevention of dental caries through the use of fluoride the WHO approach, Community Dental Health 33: 66 68,

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90 氟化物產品急性中毒劑量簡表 ( 以 20 公為例 ) 單次劑量 ( 毫克 ) 0.05% NaF 漱 (c.c.) 0.2% NaF 漱 (c.c.) 1000ppm 超氟牙膏 (200 克 / 條 ) 1mg 氟錠 1mg NaF 氟錠致死劑量條 1000 顆 2200 顆可能中毒條 100 顆 220 顆致死劑量 :ADA,1994 可能中毒劑量 :Bayless and Tinanoff, 1985(5mg/kg) 圖表製作 : 耀慧醫師 90 90

91 GUIDELINE ON FLUORIDE THERAPY AAPD, 2014 From: American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. May

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鼠　疫（Plague）

鼠　疫（Plague）鼠疫 (Plague) 一疾病概述 (Disease description) 存在囓齒類及其跳蚤的一種人畜共通傳染病, 並藉跳蚤傳染給各種動物及人類, 其最初反應為跳蚤咬傷部位臨近的淋巴腺發炎, 這就是腺鼠疫, 經常發生於鼠蹊部, 少發生於腋下或頸部,