Caries tuaj qhov twg thiab nws puas tuaj yeem swb?

2024 Tus sau: Seth Attwood | [email protected]. Kawg hloov kho: 2023-12-16 16:06

Cov hniav lwj yog ib qho kab mob uas yuav luag txhua tus neeg nyob hauv peb lub ntiaj teb tau kis nrog niaj hnub no. Raws li kws kho mob kis kab mob, txawm tias nyob rau hauv Nruab Nrab Hnub nyoog, qhov tshwm sim ntawm caries hauv Tebchaws Europe yog peb zaug tsawg dua li niaj hnub no. Yog vim li cas rau lub peb hlis ntuj yeej ntawm kev kho hniav yog feem ntau nyob rau hauv lub fact tias peb noj.

Hniav qauv Nyuaj tab sis yooj yim Cov enamel uas tsim cov yas ntawm cov hniav yog cov khoom hnyav tshaj plaws hauv tib neeg lub cev. Txawm li cas los xij, nws tsis tuaj yeem tiv thaiv cov tshuaj tua kab mob ntawm cov khoom pov tseg ntawm S. mutans streptococci.

Qhov tseeb tias cov hniav raug tawm tsam los ntawm kev pheej hmoo thiab nyuaj rau kev rhuav tshem cov kab mob yog ib feem rau kev liam rau tib neeg nws tus kheej.

Niaj hnub no, cov kws kho hniav feem ntau ua raws li cov qauv uas cov kab mob cariogenic - Streptococcus mutans - tsiv mus rau hauv lub qhov ncauj kab noj hniav los ntawm lub plab 10-15 txhiab xyoo dhau los, thaum thawj pab pawg neeg ntawm peb cov poj koob yawm txwv hloov mus rau kev ua liaj ua teb thiab nyuj yug me nyuam, tso tseg kev yos hav zoov, thiab pib. noj cov protein tsawg (nqaij) thiab ntau carbohydrates (cereals, zaub, thiab khoom noj siv mis). Kuj ceeb tias, qhov kis kab mob ntawm caries tau ntseeg tau tsim tsawg dua li ib nrab xyoo dhau los.

Cov kab mob ua lub luag haujlwm rau kev txhim kho cov txheej txheem carious tau txheeb xyuas thaum pib ntawm lub xyoo pua 20th. Tab sis, ntxiv rau qhov pib ntawm thawj theem ntawm caries, S. mutans, ntawm cov kws tshawb fawb "provocateurs" tom qab pom ob peb lwm hom streptococci thiab lactobacilli, txuas ntxiv cov txheej txheem, thiab, ntxiv rau, hom actinomycetes lub luag haujlwm rau cov hniav. kab mob caries.

Qhov tseeb tias streptococci yog qhov ua rau tus kab mob tsis kaj siab yog qhov laj thawj heev. Microbes ntawm cov genus no tau muaj nyob rau hauv lub plab zom mov ntawm tib neeg thiab tsiaj txhu rau ntau txhiab xyoo, feem ntau tsis ua rau muaj kev phom sij.

Txhawm rau tswj hwm lawv tus kheej lub neej, streptococci siv cov carbohydrates los ntawm peb cov zaub mov, decomposing lawv ntawm cov ntaub ntawv tus nqi piv rau lwm cov kab mob, thiab tom qab ntawd, tawm hauv cawv, aldehydes lossis acids.

Nrog rau qhov tshwm sim ntawm cov nroog loj thiab cov khoom noj khoom haus, cov kab mob carious coj ntau thiab ntau lub qhov ncauj, thiab Streptococcus ua tiav nws txoj kev vam meej tom qab kev lag luam kiv puag ncig, thaum refined qab zib, dej qab zib thiab lwm yam khoom noj uas muaj sucrose - zoo tagnrho rau ceev ceev carbohydrate fermentation - los ua pheej yig thiab pheej yig. Nws yog thaum ntawd cov quav hniav los ua ib qho chaw zoo tagnrho rau cov kab mob cab rau cov kab mob cariogenic.

Kev puas tsuaj mechanism

Yuav kom nkag siab yuav ua li cas caries tshwm, thawj zaug koj yuav tsum paub tias cov hniav enamel yog li ntawm 95% muaj cov ntxhia - calcium hydroxyapatite Ca10 (PO4) 6 (OH) 2. Nws cov hexagonal crystals sib xyaw ua prisms thiab muab lub zog rau cov pob txha thiab cov hniav. Lub enamel ntawm tsuas yog ib qho incisor muaj txog 5 lab ntxhia prisms.

Zoo li tag nrho cov hydroxyl ("alkaline") cov zaub mov, hydroxyapatite yog degraded los ntawm acids. Qhov no tshwm sim vim qhov ua txhaum ntawm qhov tsis zoo ntawm cov kua qaub-puag tshuav, paub rau txhua tus neeg los ntawm kev tshaj tawm cov pos hniav.

Thaum cov kua qaub nkag mus rau hauv lub qhov ncauj, piv txwv li nrog ib khob ntawm caw, peb lub cev sim ua kom nws tsis zoo, thiab calcium los ntawm cov enamel tsiv mus rau hauv cov qaub ncaug. Thiab tsis muaj calcium, ntxhia prisms vau zoo li lub tsev ntawm daim npav. Yog tias cov txheej txheem rov ua dua, cov kua qaub tawm tsam cov dentin nyob hauv qab enamel. Tom qab ntawd cov kab noj hniav carious tshwm hauv cov hniav - kab noj hniav.

Cov organic acids yooj yim xws li acetic, lactic thiab citric acids tshwj xeeb tshaj yog "ntshai". Yog li ntawd, thaum peb haus cawv los yog noj txiv kab ntxwv, enamel ntawm peb cov hniav yog doomed rau ib feem puas. Tab sis acids tshwm nyob rau hauv lub qhov ncauj txawm tsis muaj txiv kab ntxwv.

Plaque streptococci pub rau cov carbohydrates uas peb noj, thiab aggressive acids yog cov khoom los ntawm lawv cov fermentation. Qhov yooj yim dua cov carbohydrates, qhov ceev cov kua qaub yog tsim los ntawm nws. Qhov no txhais tau tias ntau zaus peb noj cov carbohydrates yooj yim (glucose, fructose, sucrose), caries ntau zuj zus.

Cov enamel uas tsim cov hniav ntawm cov hniav yog cov khoom hnyav tshaj plaws hauv tib neeg lub cev. Txawm li cas los xij, nws tsis tuaj yeem tiv thaiv cov tshuaj tua kab mob ntawm S. mutans streptococcus pov tseg cov khoom.

Kwv yees li ntawm cov txheej txheem ntawm kev txhim kho tus kab mob no tau piav qhia los ntawm Asmeskas kws tshawb fawb-tus kws kho hniav Willoughby Miller thaum kawg ntawm lub xyoo pua 19th, hu nws txoj kev xav tshuaj-parasitic. Qhov no txhais tau hais tias, ntawm ib sab, cov tsos ntawm caries yog cov txheej txheem tshuaj, tab sis tsis muaj microbes-parasites nws yuav tsis yog li loj-scale los yog yuav tag nrho neutralized.

Raws li tus thawj coj ntawm lub tuam tsev tiv thaiv kab mob caries ntawm MGSU Edith Kuzmina, peb lub laj thawj yog vim li cas rau qhov tshwm sim ntawm caries: cov quav hniav nrog cov kab mob, cov zaub mov carbohydrate thiab tsis zoo ntawm cov hniav enamel.

Qhov no txhais tau hais tias tsuas muaj peb txoj hauv kev los tua cov hniav lwj: noj ob peb cov suab thaj yooj yim (yooj yim fermented carbohydrates) raws li qhov ua tau, ua rau cov hniav enamel tiv taus ntau dua, thiab, thaum kawg, tshem koj cov hniav ntawm cov quav hniav, uas streptococci zais..

Qab zib qhov tseeb

Tau kawg, tib neeg paub ntev ntev tias "qab zib ua rau lawv cov hniav lwj", tab sis nws muaj peev xwm ua pov thawj lub luag haujlwm ntawm kev noj zaub mov hauv qhov tshwm sim ntawm caries tsuas yog thaum, nyob rau hauv chav kawm ntawm ntau yam kev sim ywj pheej, nws tau pom tias muaj streptococci. nyob rau hauv cov hniav plaque thiab nyob rau hauv cov neeg tsis muaj caries.

Thawj kauj ruam hauv kev ua pov thawj qab zib "kev ua txhaum" tau coj los ntawm Danish xibfwb Frederik von der Fehr ntawm Royal College of Dentistry hauv Aarhus. Xyoo 1970, von der Fehr tau ua ib qho kev sim uas ib pawg neeg tuaj yeem pab dawb nrog cov mob zoo ntawm cov hniav enamel tsis suav nrog kev tu lub qhov ncauj - lawv tsis txhuam lossis yaug lawv cov hniav tom qab noj mov. Ib nrab ntawm lawv kuj tau yaug lawv lub qhov ncauj nrog 50% sucrose tov ob peb zaug hauv ib hnub.

Tsis muaj kev tu cev ntau ntxiv cov kab mob hauv cov quav hniav, tab sis thaum muab piv rau cov kab mob ntawm cov hniav ntawm cov hniav uas ntxuav lawv lub qhov ncauj nrog cov tshuaj qab zib, nrog rau pawg tswj hwm, pom pom pom pom pom pom pom pom ntau dua ntawm cov kab mob caries - demineralization ntawm enamel thiab cov tsos. ntawm stains ntawm nws.

Yog tias ua ntej, piv txwv li, nyob rau hauv lub xyoo pua 18th tsis nyob deb, qab zib yog ib qho khoom kim heev thiab tsis yog txhua tus tau tshwm sim hauv kev noj haus, tam sim no, raws li kev soj ntsuam hniav, feem ntau cov neeg hauv Russia thiab ntau lub teb chaws noj cov khoom qab zib txhua hnub. Raws li Edith Kuzmina sau tseg, nws tsis yog ntau npaum li cas qab zib noj ib lub sij hawm tseem ceeb, tab sis qhov zaus ntawm nws noj.

Qhov zoo tshaj plaws, cov kws kho hniav qhia kom noj cov khoom qab zib kom tsawg li sai tau thiab hloov cov suab thaj fermentable - qabzib, sucrose thiab fructose - nrog sorbitol, mannitol thiab xylitol. Cov polyhydric cawv no muaj qab zib thiab feem ntau siv los ua cov khoom qab zib (piv txwv li, hauv ntshav qab zib), thiab carious streptococci tsuas yog siv tsis tau.

Ntuj xylitol muaj nyob rau hauv strawberries thiab carrots. Thiab yog tias koj tseem tsis tuaj yeem tsis kam qab zib, ces nws yog qhov zoo dua los noj nws tsis yog "ib leeg", tab sis ua ke nrog lwm cov khoom noj - qhov no txo cov cariogenicity. Tib lub txiv apples, piv txwv li, yuav tsum muaj ntau qhov sib cais ntawm cov qaub ncaug, thiab nws dilutes thiab, muaj cov tshuaj tiv thaiv alkaline, ib nrab neutralizes acid tsim nyob rau hauv lub qhov ncauj tom qab fermentation ntawm sucrose thiab qabzib.

Ob lub ntsej muag fluoride

Yog hais tias thawj txoj kev sib ntaus sib tua caries - muab cov khoom qab zib - tsis haum rau txhua leej txhua tus, ces nws yog yooj yim npaum li cas rau cov hniav enamel ntau resistant rau acids. Niaj hnub no, tib qho kev lees paub thoob ntiaj teb thiab txoj hauv kev zoo tshaj plaws los txhawb cov enamel tseem yog fluoridation.

Thawj thawj zaug, cov tshuaj fluoride tau ntxiv rau cov mis nyuj ntau heev rau kev tiv thaiv kab mob hauv cov tsev kawm ntawv thiab cov tsev kawm qib kindergarten hauv Switzerland xyoo 1953. Tom qab 60 xyoo, 95% ntawm lub ntiaj teb cov tshuaj txhuam hniav muaj fluoride. Yog tias koj nyeem cov tshuaj txhuam hniav muaj pes tsawg leeg, koj yuav pom muaj sodium fluoride, monofluorophosphate, lossis aminofluoride hauv nws.

Los yog tej zaum yuav muaj ob peb fluorides. Lub tshuab uas tag nrho cov tshuaj no pab tiv thaiv cov hniav los ntawm cov hniav lwj yog yooj yim heev. Fluorine ions tau nkag mus rau hauv cov iav siv lead ua ntawm cov pob zeb hauv av enamel prisms, tom qab ntawd nws cov solubility hauv cov kua qaub txo qis.

"Hmoov" tshuaj hormone

Niaj hnub no, nws yog tsim nyog hais tias qhov ntau ntawm caries ntawm cov txiv neej yog, raws li txoj cai, qis dua ntawm cov poj niam. Qhov no yog vim kev sib raug zoo ntawm cov tshuaj estrogen hauv cov ntshav thiab cov microbial microflora ntawm qhov ncauj kab noj hniav.

Thawj qhov kev sib raug zoo hauv kev sim nrog nas tau txais nyob rau hauv nruab nrab ntawm lub xyoo pua xeem ntawm Indiana University. Tom qab ntawd cov kws tshawb fawb pom tias qhov kev loj hlob ntawm caries nce nrog nce qib ntawm cov tshuaj estrogen hauv cov txiv neej, ovariectomized (tsis muaj zes qe menyuam) thiab cov poj niam ib txwm muaj.

Nyob rau tib lub sij hawm, theem ntawm cov txiv neej cov tshuaj hormones - androgens - tsis qhia ib yam dab tsi cuam tshuam rau tus mob ntawm cov hniav. Txij thaum ntawd los, ntau qhov kev tshawb fawb tau ua tiav uas tau lees paub qhov kev sib raug zoo ntawm qib ntawm poj niam cov tshuaj hormones thiab qhov tshwm sim ntawm kev tsim cov hniav lwj. Cov txheej txheem tseeb uas cov tshuaj estrogens cuam tshuam rau kev kho hniav tseem tsis tau kawm, tab sis cov qaub ncaug xav tias muaj cov tshuaj estrogen-sensitive immunoreactive proteins uas tswj cov naj npawb ntawm cariogenic microbes hauv lub qhov ncauj.

Ntawm qhov tod tes, nws yog vim muaj cov tshuaj fluorides uas tau pom zoo kom siv cov tshuaj txhuam hniav me me, ntau dua li cov hnyuv ntxwm-ntev ntev ntawm cov txhuam hniav, raws li qhia hauv TV tshaj tawm. Lub ntsiab yog vim li cas rau qhov no yog qhov txaus ntshai ntawm fluorosis, los yog supersaturation ntawm enamel nrog fluorine.

Qhov ua kom yuam kev ntawm fluoride yog tias muaj ntau dhau ntawm nws, nws hloov cov hydroxyapatite ntawm cov enamel mus rau lwm qhov, cov ntxhia tsis yooj yim dua, thiab cov hniav pib tawg.

Hauv qhov no, cov tshuaj fluorides tuaj yeem nkag mus rau hauv lub cev tsis yog nrog cov tshuaj txhuam hniav nkaus xwb - koj tsuas yog yuav tsum tau nqus lawv.

Piv txwv li, hauv cov neeg nyob ze cov hluav taws kub hluav taws xob thiab cov chaw tsim khoom uas tsim cov hydrofluoric acid, fluorosis tshwm sim peb zaug ntau dua: cov tshauv volcanic thiab cov khib nyiab muaj fluoride. Thawj zaug, tus kws sau paj huam Roman Mark Marziall tau hais txog qhov tshwm sim ntawm "overdose" ntawm fluorine, piav txog cov hniav ntawm tus poj niam ntawm Alexander lub Great li "speckled".

Txhawm rau khaws cov hniav thiab zam lawv qhov kev puas tsuaj los ntawm cov tshuaj fluoride ntau dhau, nws tsuas yog ua raws li "pea txoj cai" thiab tsis txhob txhuam koj cov hniav ntau dhau - ob lossis peb zaug hauv ib hnub yog txaus. Fluoridation muaj ardent tw, uas sib cav hais tias cov tshuaj txhuam hniav thiab fluoride-fortified mis nyuj - koj muaj peev xwm yuav nws nyob rau hauv Russia - ua rau tag nrho cov kab mob txaus ntshai, nrog rau cov qog malignant.

Tab sis cov lus thov no tsis tau txais kev txhawb nqa los ntawm cov ntaub ntawv ntseeg tau. Yog lawm, fluoride thiab nws cov ntsiab lus yog cov tshuaj lom tiag tiag.

Tab sis ntawm no nws yog txhua yam hais txog kev muaj zog: txawm tias Paracelsus (Philip Aureol Theophrastus Bombast von Hohenheim), tus kws kho mob zoo thiab kws kho tsiaj ntawm Renaissance, tsim ib qho aphorism uas tsis tau poob nws qhov cuam tshuam rau tsib centuries dhau los: Txhua yam yog tshuaj lom thiab txhua yam yog tshuaj.; Nws tsuas yog koob tshuaj uas ua rau nws ib txoj kev lossis lwm qhov”.

Kev lom tshuaj fluoride yuav tsum tau noj ob peb lub raj tshuaj txhuam hniav txhua hnub. Raws li rau cov mis nyuj nrog sodium fluoride, nws qhov yuav tsum tau ua txhua hnub yog ib khob (200 ml), raws li qhia hauv pob.

Txawm li cas los xij, cov tshuaj txhuam hniav fluoride muaj lwm txoj hauv kev. Ua ntej tshaj plaws, cov tshuaj fluoride-dawb pastes uas ntxiv dag zog rau cov enamel vim yog calcium los yog tag nrho cov ntxhia molecules - dag hydroxyapatite, npaj rau cov menyuam yaus uas nquag nqos cov tshuaj, thiab cov neeg muaj kev pheej hmoo.

Tshuaj tiv thaiv kab mob hniav

Txhawm rau tsim cov tshuaj tiv thaiv kab mob caries, yuam lub cev tua cov kab mob streptococci, yog kev npau suav ntawm ntau tus kws tshawb fawb.

Suav cov kws tshawb fawb los ntawm Lub Tsev Haujlwm ntawm Virology hauv Wuheng tau los ze tshaj plaws rau kev rhuav tshem tib neeg ntawm lub suab ntawm kev xyaum. Hauv xyoo 2011, lawv tau tshaj tawm qhov kev sim ua tiav nas ntawm cov tshuaj tiv thaiv DNA ua ke.

Nws cov ntsiab lus yog tias ntxiv rau DNA ntawm streptococcus nws tus kheej, nws kuj muaj cov nucleic acid ntawm lwm cov kab mob - salmonella. Lub cev tiv thaiv kab mob reacts rau salmonella ntau nquag, ncaj tib lub sij hawm nrog cariogenic streptococcus.

Tab sis txawm tias cov tshuaj tiv thaiv kab mob caries tshwm nyob rau hauv arsenal ntawm kws kho hniav, peb tsis tuaj yeem hnov qab txog kev txhaws thiab hniav hniav. Raws li ib tus kws tshaj lij kis mob thoob ntiaj teb, Daniel Smith ntawm Boston Forsyth Institute, piav qhia, cov tshuaj tiv thaiv tsuas yog siv tau tiag tiag yog tias nws raug txhaj rau cov menyuam yaus hnub nyoog ib thiab ob xyoos - thaum thawj cov hniav tshwm sim, tab sis cov quav hniav - a zej zog cov kab mob - tseem tsis tau muaj sij hawm tsim….

Muaj lwm qhov tsis muaj zog hauv cov tshuaj tiv thaiv kab mob hniav.

Txawm hais tias nws tswj kom kov yeej ib hom kab mob streptococcus, uas ua rau thawj cov tsos mob ntawm tus kab mob, lwm yam kab mob uas cuam tshuam nrog cov hniav lwj ntawm ntau theem kuj yuav zoo rov qab ua cov neeg pib.

Yog li ntawd, cov kws kho hniav hu caries ib tug insidious kab mob, uas muaj peev xwm thiab yuav tsum tau tawm tsam nrog ib txwm txoj kev: ua raws li kev noj haus thiab tsis tu ncua mus ntsib kws kho hniav. Tseeb tiag, tsis zoo li sharks, uas tuaj yeem txuas ntxiv ntau txhiab tus hniav thaum lawv lub neej, peb tib neeg poob cov hniav muaj nuj nqis mus ib txhis.