NHNG SN PHM CHM SC RNG MING

MC LC

M U .......................................................................................................................................................2

1. Mi trng rng v ming...................................................................................................................2

2. Bnh rng ton cu ..............................................................................................................................8

3. Nc sc ming...................................................................................................................................37

4. K hoch nghin cu lm sng sn phm chm sc rng ming ...................................................37

5. Xu hng tng lai ............................................................................................................................38

6. Ti liu tham kho .............................................................................................................................38

M U
Mc d m phm vi mc ch lm p, lm thm, lm sch tn ti t thi xa
xa, nhng ch trong th k 20 vi s tin b ln v khoa hc v k thut nn sn
phm c a dng ha v mu m v chc nng, bn cnh yu cu s an ton
v bo v ngi tiu dng.
Hin nay, m phm khng ch l to mi m cn dng chm sc da, tc, hoc
rng..V cc ngun nguyn liu, khng ch c sn xut t thin nhin m n
cng c th c tng hp c th hoc thm ch sn xut t vi sinh vt ch tc gen.
Sau y xin cp ti mt trong nhng loi m phm l cc sn phm chm sc
rng ming.
1. Mi trng rng v ming
Ging nh cc loi ng vt c v khc, mi cuc i con ngi u c 2 b rng.
B u tin l rng sa, rng ny coi l tin v s rng, n xut hin tr s sinh
thi k 5-9 thng tui. Khi c mt tui ri n hai tui tr s mc 20 chic rng.
B rng th hai l rng vnh vin trong li sut t lc tr s sinh n tui dy th.
Nhng chic rng ny l nhng chic rng th, n s mc dn n lc nm tui, v
thay th chic rng sa. S c 32 chic rng. Trong sut cuc i con ngi khong
91% nhai bng 32 chic rng ny v chm sc chng. Trong s 32 chic nng, 16
nm hm trn hay hm rng vm l mt phn ca hp s v bt ng, 16 ci
khc nm trong vm rng hm di, ci thuc mt phn ca hm di v di chuyn
mt phn ca hp s. Mi loi rng c chia u gia hai vm rng.
Cc phn ca rng
Mi chic rng gm c 3 phn: Phn trn li l nhn thy c, phn di li
khng nhn thy, v phn sit gia 2 phn ny. Phn trn c bao ph 1 lp men
rng, phn di th lin kt vi xng trong hm. Phn gc chim 2/3 tng chiu
di ca rng.
 Cc m ca rng
Mi chic rng gm c 5 m vi chc nng ring bit khc nhau. Nhng bnh
trong mi lp m nh hng ti ton b rng, kt qu l b ph hy. Cc m l:
Hnh 1:

Men rng: Lp cng mu trng bao ph ton b rng trn, n bo v rng

khng b bt ra di p lc ca vic nhai. Thnh phn ch yu (96-98%) l
cc cht v c, ch yu canxi v phosphate.
Ng rng: Mt m xng mu vng di men, cung cp h tr v to thnh
phn ln cu trc rng, ko di gn n ton b chiu di rng. N c bao
ph bi lp men v c nh bi phn xng rng di. V thnh phn ha
hc, ng rng c bao gm 20% hu c v 75% cht v c, hoc collagen
v caxi photphat, 5% cn li ch yu l nc v cht khc.
Ty: Mt m mm nm trung tm cha dy thn kinh, mch mu v mch
bch huyt m to ng rng v cung cp dinh dng cho rng. Do ngun
cung cp phong ph ca mu v dy thn kinh, ty cng c chc nng nh
 mt h thng phng th chng li cuc xm hi ca vi khun v nh l mt
tn hiu cm gic tn thng bng cch gy ra au rng.
Xng rng: M xng mng bao ph ht phn chn rng v n gip gn
rng vo phn xung quanh xng.
Dy chng nha chu: Mt lp si lin kt m tri di gia xng rng v
xng kt ni cc chn rng n xng hm. N cng m rng khi nhng
p lc tc dng trong thi gian nhai.
Cc m nha chu
Cc m nha (t ting Hy Lp '' peri '' ). L mt h thng chc nng bao gm cc
m khc nhau bao quanh v h tr rng. H thng ny cng c gi l '' b my
gn '' hoc '' h tr m ca rng''. Gii phu hc, thut ng ny ch cp n cc
m lin kt gia cc rng v xng ca h.
Cc m to nn m nha chu bao gm nu, dy chng nha chu, cc xng rng, v
xng rng hoc xng hm. S khe mnh ca chng l rt quan trng cho sc
khe tng th ca ming v s sng cn ca rng.

Nu rng
Nu rng, thng gi l li, l phn quan trong nht ca b phn bao ngoi
rng. Nu rng bao gm cc si m dy xp mt vng gn cht quanh c rng v
lin kt vi m bao ph (m nim mc) to thnh ng ming.
Nu rng c cu to vng chc v khng b x dch khi cu trc c s ca n.
Nu rng c bao ph bi mt lp mng trn nhn, nhy, c mch mu, lp
mng ny nhy cm v d chy mu khi b m phi hoc b lm tn thng nh.
Nu rng cn bao ph ln rng cha mc v vic au nhc trong qu trnh mc
rng l do chic rng mi y lp m d b tn thng ny.
Trong lm sng, nu rng c chia thnh:
Hnh 2:
 Nu t do ngoi c h khong 1.5mm vi rng v to thnh lp da m
mm bao quanh rng. Rnh nng hp gia rng v nu t do c gi l
rnh nu. Rnh nu su khong 0.5mm, rng khong 0.15mm, v bao ph
tt c cc b mt ca rng. y ca rnh nu c to thnh t cc t bo
do cc biu m xp ni tip. Kch thc ca ti rnh ng vai tr rt quan
trng khi xc nh cc bnh v m nha chu v bn chc ca rng.
Nu dnh l nu bm cht vo b mt cng ca rng bng cch cun vng
quanh rng bi biu m chuyn dng c bit n l cc biu m gn ni
tip vi nhau. Nu dnh s c h vi rng ln dn theo tui v c th
thay i ng k gia ngi vi ngi, rng vi rng.
Cc t bo do cc biu m xp ni tip c ti to lin tc trong sut cuc
i con ngi v tc thay th l t 4 n 6 ngy. Kt qu ca vic ti to
trong m c tnh thm cao c li nh qu trnh to ra sn phm trao i cht
bi vi khun c trong khoang ming. Khu vc ny ng vai tr quan trng
trong vic duy tr sc khe rng ming.
Nu khe rng bin i khc nhau v chiu su v chiu rng, chim din
tch gia cc rng lin k nhau.
Dy chng nha chu v xng chn rng
Dy chng nha chu chim khng gian gia cc b mt chn rng v xng rng
hoc xng hm. Dy chng nha chu bao gm cc si m lin kt, mch mu, dy
thn kinh v cc t bo khc. Chc nng ca b phn ny l to lin kt gia cc
lp xng rng vi xng hm, rng vi nu, v gia mi chic rng vi khu vc
xung quanh chic rng . V mt gii phu, xng chn rng l mt b phn ca
rng, nhng v mt chc nng, xng chn rng li l b my h tr cho rng v
nu v dy chng nha chu c neo vo n.
Xng rng
Xng rng, cn c gi l xng hm, pht trin cng vi s hnh thnh ca
rng trong sut thi gian thai nghn v tip tc pht trin trong qu trnh mc rng
tr em. Ngi ta xc nh c ba loi xng rng: xng c, xng si v
bn thn xng rng. Xng si to cu trc h tr chnh cho rng v gm ch
yu l ty bo ngi ln.
Cc b phn khc trong khoang ming
Mt s vng khc trong khoang ming cng ng vai tr quan trng. Bao gm
li, vm ming, tuyn nc bt, v nim mc cht lt trong nha khoa ca ming
hoc chnh khoang ming.
Vm ming
Vm ming to thnh mi vm trong khoang ming v gm hai phn: vm cng
khu vc pha trc v nm sau hm rng trn, vm mm pha sau, nm trn li
vo hng hoc khu vc c hng.
Vm cng phn cch khoang ming v khoang mi, to mi cho ming v sn cho
mi. Vm mm gip cho vic nhai nut trong ming.
Li
Li l c quan chnh ca v gic v l b phn quan trng pht m. Li cng
h tr rng trong vic nhai v nut thc n.
Li nm sn ca khoang ming, ni vi cc c khc trong np thanh qun v
hng hay c hng. c bao ph bi cc mng nhy, nhiu tuyn nhy v tuyn
huyt thanh cng nh chi v gic. Bn trong, li bao gm cc si m, c, mch
mu v dy thn kinh.
Nc bt v tuyn nc bt
Nc bt l cht lng c cha nc, dch nhy, m, mui v cc enzyme. Nc
bt c hnh thnh v bi tit vo trong khoang ming bng ba cp tuyn nc
bt: tuyn di hm, tuyn di li (hay tuyn di hm di) v tuyn mang tai.
Cc tuyn nc bt di hm nm di sn ca khoang ming, bn trong hm.
Nc bt c tit ra t nhng tuyn ny vo trong khoang ming thng qua mt
ng dn hay ng m di ming c gi l ng ca Wharton. Tuyn di
li cng nm di sn khoang ming nhng gn gia v dn nc bt vo
trong khoang ming thng qua mt s ng dn nh ca Bartholin v cc ng dn
ca Rivinus. Cc tuyn mang tai nm pha di tai v dc theo cnh hm. Cc ng
dn t nhng tuyn ny i vo t pha trong m i din vi rng hm th hai
hm trn.
Tuyn nc bt cha c huyt thanh v t bo nhy. S tit nc bt t cc tuyn
huyt thanh th mng v cha nc trong khi t cc tuyn nhy v c cha dch
nhy m dy v nht hn.
Nhng tuyn ny c iu khin bi h thng thn kinh t tr (hay khng t
nguyn) v phn ng bng cch phn x li vi c kch thch trc tip ln gin tip.
V d nh, nc bt c tit ra t ng mt cch trc tip khi bn nht thc n
y ming nhng nc bt cng c tit gin tip khi bn ni chuyn hoc nhn
thy mt loi n no m bn c bit thch.
Nc bt c mt s chc nng quan trng sau:
H tr qu trnh tiu ha thc n.
Chun b thc n cho qu trnh nut bng cch bin i chng v mt dng
nht qun.
 Lm m v bi trn mi, ming.
Lm sch rng ming khi cc mnh vn thc n v cc cht bn ngoi khc.
Bi tit cc cht hu c v v c t c th.
c bit, chc nng cui cng ca nc bt l c th khc phc chng vim
nim mc ming ( cht lt nha khoa trong ming) v li nghim trng.
Nim mc ming cht lt nha khoa trong ming
Nim mc ming hay mng nhy cht lt nha khoa trong ming cng c chc
nng c bit quan trng vi rng ming. Nim mc ming mng, cht lt nha khoa
c th di chuyn t do gm cc lp t bo biu m. Cc t bo ny thuc cng mt
loi vi t bo c tm thy trn cc lp ngoi ca da v c tc dng nh mt lp
bo v. Tuy nhin, trong khoang ming, lp bao ph ny nm trn mt lp mng
nhy dy, ni tit ra cht nhy.
Nh nhc bn trn, vt liu nhy cha mt loi protein c gi l dch nhy,
cht m c hnh thnh trong t bo cht ca cc t bo biu m ny. V dch nhy
tch ly, cc t bo tr nn sng phng cho n khi v ra, gii phng cc cht bn
trong ln b mt ming. Cc lp nhy trng ln b mt biu m c tc dng nh
mt lp bo v chng li cc cht gy hi trong khoang ming hoc c vai tr nh
mt phng php lu gi li cc ht nh bn ngoi xm nhp vo khoang
ming.
Vic sn xut ra cht nhy c th tng ln rt nhiu bi s kch thch do b nhim
trng, d ng hoc do nhit . Tt c chng ta u quen thuc vi vic gia tng sn
xut cht nhy do cm lnh hoc au hng. Thng thng, au do lnh hoc au
do l lot, bnh m c nhng vt lot nh trn nim mc ming xut hin trong
sut thi gian b m. Do nim mc ming cng c th c s dng nh mt
tm gng phn nh sc khe chung ca c th.
2. Bnh rng ton cu
Bnh v rng bao gm su rng , cao rng , vim nu (vim li), v nha chu (mt
m h tr rng) l nhng vn ton cu. Chi ph hng nm chm sc nha khoa
M vt qu 37 t , trong c khong 6 t c dnh sa cha s tn ph
ca su rng (1). Tuy nhin, chi ph ca bnh rng ming khng th n gin c
o bng tin. Cc yu t khc cng cn phi c xem xt; V d, vic mt rng
dn n kh nng nhai km, li ni vn , v nhng thay i trong thm m
khun mt, c th gy bi ri. nim hnh phc ca mt ngi cng c th b tn hi
do lin quan n au rng,nkhng c kh nng nhai ng, v cc nhim trngc
kh nng ly lan t ming n cc b phn khc ca c th (2). Hin nay, phn ln
thi gian ca cc nha s v v sinh vin l lm sch rng v cc cu trc lin
quan ngn nga bnh rng ming. Phng php thay th ngn nga cc bnh
rng ming, c th c s dng bi dn s ni chung ag c pht trin
gimn s lng thi gian dnh cho cc chuyn gia nha khoa.
Cc yu t nh hng n cng sut ca hot ng trong ming
Trc khi tho lun v sn phm cng ngh c th phng nga v iu tr bnh
v rng ming, chng ta cn phi hiu c nhng nguyn tc chung l c s
tnh hiu lc v cng sut ca cc tc nhn tr liu trong khoang ming (Hnh. 3).
Vic s dng hiu qu ca cc hot cht trong cc sn phm ng ung l ph
thuc vo nhiu yu t; mt s nhng yu t c m t bng s trong hnh
8. Thng thng mt kem nh rng iu tr hoc nc sc ming c cha mt
hot cht hoc thuc phi ha tan trong h thng. Nc xc ming trn th trng
l dung dch nc da trn cng thc, nhng cha nhiu thnh phn khc, trong
phi tng thch vi loi thuc ny. Kh nng tng tc khng mong mun gia
cc thnh phn l mt mi quan tm ln ca formulators v nh sn xut. Mt s
tng tc c thit k c bit, chng hn nh tng kh nng ha tan ca thuc
trong nc (v d, triclosan) bng cch thm vo cc cht hot ng b mt v cc
thnh phn khc to thnh mt th sa. Tuy nhin, cc thnh phn khng tng
thch i khi v tnh c s dng, c bit l trong cc cng thc phc tp, ni c
mt s hiu bit khng y v tnh cht ha hc (3).
Cc vt liu ng gi cng c th l mt ngun gc ca vn tng thch. Bt k
h s tng tc c th c th nh hng trc tip hoc gin tip, s sn c ca
thuc trong h thng. iu ny thng c th c nh gi trong cc phng th
nghim trn mu mi v tui ca sn phm.
Thuc c to phc vi cc nguyn liu khc, mc d tan trong cng thc, c th
biu hin gim sinh kh dng trn c th ngi. Thut ng '' kh dng sinh hc ''
thng c s dng th hin mt mi quan h thi gian ca nng thuc t
do ti v tr mc tiu. Trong trng hp ny, sau khi sc ming hoc s dng kem
nh rng, sinh kh dng l nng ca mt loi thuc t do trong mi trng ca
cc v tr mc tiu v s nhanh chng m ti n bin mt.
Hnh 3:

iu ny c th c xc nh, cung cp v tr c th c ly mu v nng

thuc o c trong mi trng tip xc vi cc v tr mc tiu (Tc l, nc bt,
dch mng bm, v cht lng crevicular).
Thi gian tip xc c th quan trng. V hu ht cc liu trong sn phm ung c
khc nh, thi gian n s nm trong ming nn di cho vic lu gi ti u ca
thuc. iu ny c xc nh qua ming i vi mt s thuc thuc st trng
nh chlorhexidine v triclosan. Ni chung, 30-45 giy thng l .
Khi a vo mi trng ming qua kem nh rng / gel / sc ming, thuc cn li
phi khuch tn trong nc bt trc khi n c th tip cn v tr d nh hot ng
ca n. Trong nc bt, thuc c gii phng sau tng tc vi cc thnh phn
nc bt trc khi n b mt rng ming. V l thuyt, ch c thuc dng t do
mi c hiu lc c th tng tc ti u vi v tr mc tiu. Cc v tr ny bao gm
cc mng bm, men, rnh nu, m nu, v mng nhy.
Lng thuc c gi li trn b mt rng ming sau khi s dng cng c coi l
quan trng, nh gii hp tip theo ca thuc vo vi mi trng ca v tr mc tiu
c th cung cp hiu ng bn vng. iu ny s c xc nh ch yu bi cc
danh t ha ca loi thuc c bit c s dng. Bi v trong nhng khong thi
gian di liu thng c thc hnh vi cc sn phm (mt ln hoc hai ln mt
ngy), thuc tn ti lu c th c mt li th khc bit v s hin din ca n cn
trong khoang ming. Thm vo l qu trnh gii phng khong trng bnh thng
bi l cht loi b khi b mt rng ming ca dng nc bt. Mt loi thuc
ko di c th c gi li trong mi trng ca cc v tr mc tiu trong hnh thc
hot ng, c hi tt hn l gy mt hiu qu iu tr.
S pht trin ca cng ngh trong sn phm chm sc ming
Trong lch s, thuc nh rng hoc kem nh rng c pht trin gi cho
rng sch v g ra khi cc vt bn. Cc thnh phn thit yu ca kem nh rng
l: mt cht lm c, mt tc nhn mi mn lm sch, b mt, cht gi m, hng
v, v hot ng iu tr tch cc cc tc nhn. Mt trong nhng loi kem nh rng
u tin cha mt cht mi mn (kt ta canxi cacbonat) v mt lng nh x
phng bt. Kem nh rng ny gy kh chu n cc m ca ming v pH l
tng i cao do lng x phng ca n (4). Sau khi Chin tranh th gii th hai,
nhiu cng ty tin hnh nghin cu khoa hc pht trin thuc nh rng, m du
hn, nh nhng hn, v cng c tnh nng phng bnh. Thay v x phng, cht ty
ra-sodium lauryl sarcosinate- c gii thiu trong kem nh rng. Bn cnh
vic ngn nga kch ng, cc cht ty ra tng hp ci thin hng v v cng
c by t kim sot axit mng bm gy su rng. Hnh 4 cung cp mt ci
nhn tng quan v s pht trin ca cng ngh trong cc sn phm ng ung. Cc
loi c thc y bi nhng tin b khoa hc v li ch ca ngi tiu dng
c phn loi rng ri nh l mt n ci tt (Hnh. 4).
Kem nh rng loi b vt bn v lm trng
C hai loi vt bn trn rng: (a) vt trn rng (bn ngoi vt) v (b) vt trong
rng (vt ni ti). Cc vt bn bn ngoi c th bt ngun t cht crom trong thc
phm hay ung; Trong khi cc vt ni ti c th c gy ra bi iu tr ti ch,
chng hn nh tetracycline, hoc tip xc vi cht fluoride qu mc trong thi gian
pht trin rng (di nm tui). Mt s nh nghin cu nghin cu c ch hnh
thnh vt bn v cc phng php loi b vt rng pht trin (Hnh. 5) (5)

S pht trin ca cng ngh lm trng trong kem nh rng v gel c miu t
trong hnh 5. Th tc thng c s dng nht loi b cht bn trn rng l s
dng cht mi mn nh l Silicon dioxide, dicalcium phosphate dehydrate (DCPD),
v mui Alumin nh l Canxi Alumina. Tt c nhng cht ny c s dng trong
vic kt hp vi cht ty lm sch cht bn. Trong u nhng nm 80, Canxi
Alumin hoc cc enzyme c (hoc khng c) cht iu chnh mng bm nh l
pyrophosphate c thm vo. Mt thi gian sau, cc cht chun b fouride nh l
hydrogen peroxide, urea peroxide hoc calci peroxide c thm vo loi b
ng thi cht bn ni ti v khng ni ti. nh gi hiu nng, mt vi kim tra
trong phng th nghim c pht trin nhng khng c ci no tng quan vi
vic loi b cht bn in-vivo trn rng. Do , cc chng lm sng l tt nht
nh gi vic loi b cht bn. Kt qu t cc nghin cu in-vivo c miu t
bng 1.

Table 1: In Vivo Stain Reduction Six Weeks Postbrushing

Dentifrice treatment Stain reduction (%)
SiO2/NaF toothpaste No change
SiO2/NaF/tripolyphosphate 14.0
SiO2/Calcined Alumina/Pyrophosphate 49.0
C th thy rng s thm vo ca Canci Alumin vi pyrophosphate mang n kh
nng loi b cht bn tt trong thc th. Mt phng php khc loi b cht bn
ni ti l bi hnh 5 s pht trin ca cng ngh lm sch / lm trng rng. Hnh 4
s pht trin ca cng ngh trong cc sn phm rng ming. 536 Gaffar phn nh
quang ph s dng Minolta chromameter. S thay i mu sc c o bi E (khc
bit mu). Gi tr dng cng cao th rng cng trng. S dng E trong thc th c
th t c E t 2 ti 4 vi cng ngh trn (trong mi v). Nu mt ci b sung
peroxide, gi tr c th cao n mc 6. tham kho, mt cch iu tr ni tr bi
nha s s cung cp E t 7 n 8 theo mt phng php trong 2 tun.

Sn phm lm trng rng ti nh

Lm trng rng l mt vn sc khe quan trng v v li ch hnh thc bi v
rng bn c th gy ra s kh chu v nh hng ti cht lng cuc sng. Mt du
hiu ca sc khe tt l n ci sng. Vy th vic lm trng bi c hai quy nh
chuyn nghip v sn phm gim nh v sn phm ngoi tr thnh ngnh kinh
doanh ng gi 500 triu USD M.
Mt cht c bn lm trng rng l peroxide, hydrogen peroxide, carbamide
peroxide, v percarbonate. Phng php iu tr ni tr chun c hng dn bi
vic bc rng vi mng mng m c bo ha vi 20-25% peroxide vi hoc
khng c n si. T khi s tp trung cao ca peroxide l n mn v c th t
m nu, rng phi c c lp bi cao su. on cui ca ty rng rng, rng
c xoy trit bi nc v c nh bng. Nhiu cuc hn s c yu cu
t c mu rng mong mun.
Gn y hn, iu tr lm trng ti nh s dng peroxide trong sn trng hay lm
mn tr nn thng dng. Cht sn c bao gm polymer hnh thnh film, nh l
polyox hay hn hp carbomer vi 6% peroxide hoc bao gm lm mn ca
polyethylene tr gip vi 6% peroxide gel c s dng i tr cho lm trng ti
nh. Nhng iu ny dng nh mang li hiu qu tng ng nhng khng tt
bng iu tr ni tr

Thuc nh rng lm gim hi th kh chu

Mi hi ming c gy ra bi nha khun phn ng vi protein nc bt hnh
thnh hn hp sulfur hi (VSC). Tonzetich ch ra rng hydrogen sulfide, methyl
mercaptan, v dimethyl sulfide 9H2S, CH3SH, v (CH3)2S, tng ng) l yu t
chnh gy hi mnh. Mt phng php dng chromatographic c pht trin o
lng mt cch hng i tng trc tip vo VSC t hi th nh l phng php
cm bin hay t nhin. Phng php ny c, trong chiu ngc li, c php iu
tra nghin cu trong nhiu lnh vc lin quan ti mi hi ming.
C hai phng php hin ti dng nh gi mc mi hi. u tin l cch
tip cn da trn cm bin hay cm quan, th hai l phng php s dng cng c
chromatograph. Mt nghin cu c thc hin xc nh s tng quangia hai
phng php trong nghin cu nha khoa. Mt s lin quan tuyt vi (r 0.78)
c cng b gia phng php dng cng c v c tnh da vo cm bin. S
dng k thut phn tch, hiu qu ca kem nh rng trong x l mi hi mic
c nh gi nhiu lmsng khc nhau. Mt ng c s c c vo bui
sng. Mt i tc sau c chi vi gi dc hoc kem nh rng hot ng,
bng mt S gim cht bn trong thc th vi 6 tun nh rng trc lm gim (%)
SiO2/NaF kem nh rng khng thay i SiO2/NaF/tripolyphosphate 14.0
SiO2/Calcined Alumina/Pyrophosphate 49.0 Oral Care Products 537 v sau
c s dng 3 hoc 12 gi iu tr trc nh gi hiu qu. Mt kem nh rng
cha khng khun bacterial triclosan v mt copolymer polyvinyl methyl ether
maleic acid (PVM/MA) c pht trin. iu ny gip gim chu ng vi mi hi
ming.Cc kt qu lm sng c tng hp hnh 6:
Phim hi th ming
Mt s b sung gn y cho vn lm sch hi th l phim th. l mt phim
ha tan c gn vi dc cht lm mt v to mi tp trung cao, i khi, c cc
hot cht b sung. Tm phim ha tan ngay lp tc trong li v gii phng mt
lung hng thm v hot cht lm sch hi th. Tm phim c lm thnh cc
ming nh, mi ming di 100 mg v mng hn 100 mm. Cc tm phim thng
c gi nh v ri, ng gi tin li. Hnh thc c bit ny chng t s thch hp
vi khch hng cho tc dng nhanh ca n, tin s dng, v mi l. N c bit
ph bin gii tr. T khi c gii thiu th trng M vo thng 10 2001, th
loi ny c tri nghim v thc s pht trin. Tng sn phm bn ra rong nm
2002 t gn 250 triu USD M, tng ng mt na th trng lm sch hi
th ton cu.

Thnh phn c bn ca phim th l polymer film, hng liu, cht to mt, plastic,
cht nh ha v to ngt. Thm vo , cht hnh thnh phim, cht iu chnh cu
trc, ph gia, to mu thng c s dng lm tng c tnh v h tr x l
cho tm phim. Polymer c s dng hnh thnh film l polymer t nhin hoc
sn phm lin quan nh l pullulan, hydroxyalkyl cellulose, alginates, gelatin,
starches v tng t. Vic sn xut cng nghip sn phm ny ang tng trng.
Phn ln phim c sn xut bi qu trnh khun ha tan thng thng. Thng
th, hn hp lng ca tt c nguyn liu c c trn mt cht nn di chuyn
hnh thnh phim m thng qua mt thit b iu chnh dy phim. Cht nn mang
li phim m thng qua mt lm kh v mt phim kh c a ra t mt ovan
khc cui. Trong sut qu trnh, phn ln nc v lng hng liu b mt i.
Vic kim sot lp mng lun kh thong c th gy nh hng ln ti tnh cht
ca n. Lp mng c 3 tnh cht vt l quan trng l s phn hy, mdun n hi,
v bn ko t. Qu trnh phn hy ca lp mng phi nhanh v sch s m
bo ngi dng khng cm thy nht trong ming. Mt lp mng vi mdun n
hi cao c xu hng cng hn v do t b un. bn sc cng ca lp mng
phi ln chu ng s x l sn phm ra, bao gm c s thot hi cht nn,
chuyn ha v s ng gi mng. p ng cc tiu ch ny, 1 lp mng polime
thch hp trc y l s la chn ng. Mt v d l vic s dng cc hydropropyl
metyl xenlulozo nh lp mng trc y.
Cc chc nng chnh ca lp mng trn th trng ngy nay l lm trong sch hi
th. Hu ht cc lp mng t c chc nng ny bng cch s dng 1 nng
cao ca mi thm che y mi hi ming. tuy nhin, hiu qu lun lun khng
k lng v mang tnh tm thi. Trong 1 s trng hp,thnh phn nc sc
ming,nh tinh du v ion kim loi l nhng hp cht c tc dng khng khun v
trung ha cc hp cht lu hunh d bay hi. Vi s chp nhn gia tng ca sn
lng ny bi khch hng, c kh nng nhng lp mng vi li ch rng ming
c ci thin v mong mun trong tng lai. Thm na, nhng lp mng ha tan
c cng ang c khm ph mang li li ch ngoi vic chm sc rng
ming , chng hn nh y t v dinh dng.
 Thuc nh rng iu tr
Thuc nh rng kim sot su rng
Ta bit rng s hnh thnh ca su rng l kt qu ca s tng tc gia cc men
rng , mi trng (nc bt), cht lng bm mng v ch n cha cacbohydrat.
Nhng tng tc ny cng rt quan trng trong vic hnh thnh cc mng bm trn
rng. Mng bm rng ng 1 vai tr quan trng trong vic hnh thnh su rng v
n l mng bm vi khun sn xut axit t ng. Tuy nhin vic sn xut cc axit
t cc mng bm vi khun v s phn hy tip theo ca men rng khng phi l 1
qu trnh lin tc. Thay vo , n xut hin theo chu k. Vo 1 thi gian nht nh,
mng bm axit tn cng b mt men rng v lm cn kit cc khong cht ca n,
gy ra 1 tn thng nh trn b mt. Nhng khu vc ny c gi l chm su
rng hay cc m trng v xy ra lu trc khi su rng c th c pht hin bi
cc nha s hoc cc chuyn vin v sinh. Nu khng c kim sot,qu trnh ny
s dn n ph hy rng. V su rng khng phi l 1 qu trnh lin tc , nhng tn
thng ban u sm c th khc phc qua cc tng tc ca cc yu t khc nhau
trong mi trng ming, l s qu bo ha i vi canxi photphat trong nc
bt, fluoride, v pH ca mng bm lng(8).
Men rng khng phi 1 b mt khng thm mn, thay vo l xp v hin nhin
thiu st ca cc hot ng trn b mt c th che giu cc hot ng thc t di
y. to ra tn thng su rng, cc axit phi thm nhp vo cc cu trc men
rng, trong bao gm cc tinh th hydroxyapatite(HA) bao quanh bi 1 cht nn
hu c gm c nc, protein, v cc cht lipit v iu ny c thc hin bng
cch loi b 1 s cht khong t cc thanh tinh th bn di b mt ca rng. S
kh khong ny lm suy yu cu trc v nu khng c kim sot, cui cng dn
n tn thng di b mt thng c gi l 1 m trng, bn ngoi trng nh
phn v trng hn b mt xung quanh rng bnh thng.
Tip tc ca cc kt qu ca qu trnh kh khong trong vic hnh thnh cc l
hng. iu ny xy ra khi cc khong cht c ti to vo men rng b suy yu
do vi khun axit. S b cht khong c th, do , ch din ra khi c s mt cu
trc rng thng qua kh khong. Do , s kh khng v s b cht khong l cc
qu trnh lin tc vi s mt mt v thay th cc khong cht vo mentrong mi
trng ming. Hu ht cc khong ha tan trong rng c thay th bi
canxiphotphat khng ha tan, nh DCPD. Nu mi trng giu DCPD, qu trnh
b cht khong xy ra. Qu trnh ny c tng cng rt nhiu bi ion fluoride,
m chuyn i DCPD thnh fluorohydroxyapatite, theo hnh thc trn , v bn
trong, rng tng sc khng vi cc axit tn cng.
Fluoride lm tng vic ti to khong ha bng cch tng tc ca tinh th ,
nhng khi phc cu trc rng, s qu bo ha ca canxiphotphat trong mi
trng cng l cn thit. Qu trnh b cht khong c chng minh kim
sot bi s c mt ca fluoride v s qu bo ha ca canxi v photphat trong cc
mng bm lng. Nh vy, rng v mi trng ang trong 1 trn chin qua li.
Trong iu kin khe mnh khi s qu bo ha cao v mng bm axit t, lng
canxi photphat xung quanh trong dch mng bm l duy tr men rng khe
mnh . Khi nhng thch thc su rng ln v mng bm c sn xut ra nhiu
hn axit.S qu bo ha i vi DCPD gim v s kh khong xy ra. Fluoride c
ch s hnh thnh tn thng bng cch tng cng qu trnh b cht khong, v s
tng cng ny chu nh hng rt nhiu bi s qu bo ha ca nhng mng bm
lng i vi HA.
Thuc nh rng c cha Fluoride c kh nng b sung thm khong cht( s b
cht khong) vt qua thng tn su rng. Qu trnh ny c th c o trong c
th bng cch s dng m hnh ca s b cht khong bn trong ming. Mt c
trng cho tc dng ca fluoride c trnh by trong hnh 12, cho thy t l phn
trm tng khong cht trong men hoc ng rng sau 2 tun s dng 1100ppm F t
MFP hoc Natriflorua, NaF. C 2 u cho florua vo h thng m rng cng mc
s khong ha vi nng bng nhau. Cc nghin cu lm sng ca con ngi
trong vic phng chng bnh h rng ( l hng ) i hi 3 nm ti liu anticaries
c hiu lc. Trong nhng nghin cu , gim trung bnh trong bnh h rng bin
i t 25% n 40% ph thuc vo dn s s dng trong nghin cu cho florua vo
nc nga su rng. Dng tng cng ch lm vic l tng 1000 n
1500ppm florua trong thuc nh rng vi vic s dng cc cht ph gia nh
xylitol, ng nonfermentable, hoc triclosan dit khun. Cc cht ph gia ny
c nu ra lm tng hiu qu ca flo trong kem nh rng. (hnh 7,8) (10)
Hnh 7: T l thay i khong cht trung bnh cho men v ng rng
Fluoride (ppm)
Hnh 8: Phn ng ca Flo cho kem nh rng MFP v NaF.
Cng ngh Anticalculus v anticavity
Si tch t trn rng l 1 vn ton cu. Trong gn 5000 nm k t thi ca ngi
sumer , si c coi nh yu t quan trng trong nguyn nhn ca bnh nha chu.
Mc d n khng l 1 nguyn nhn gy ra ngun gc ca bnh nha chu ngy
nay,si l 1 ng gp quan trng trong s hnh thnh cc mng bm rng, m lin
quan n bnh nha chu. Ti 1 thi im nht nh, hng trm, thm ch hng ngn
chuyn vin v sinh trn ton th gii ang loi b si tch t bng cch tuyn chn
c hc . Nhng phng thc ny s dng rt nhiu lao ng v gy ra rt nhiu kh
chu cho bnh nhn.
Mc v t l ca si, ti Hoa K ni chung c trng by trong 1 cuc iu
tra s khe rng ming ton din bi cc vin nghin cu nha khoa(11). Cc d
liu hin th trong hnh 14 v 15 cho thy t l mc si . Si c quan st thy
34% tr em tui i hc. ngi ln, 25% n 30% c si tch t trn l nu.
ngi cao tui cho thy 1 t l cao hn. Mc ca si trong dn s cho thy nhu
cu pht trin 1 phung tin ha hc hiu qu nhng an ton ngn chn si tch
t trn rng. iu ny c bit quan trng i vi cc nc ni m cc nha s v
chuyn vin v sinh khng c sn 1 cch d dng. Do , s pht trin ca cng
ngh ngn chn si l rt quan trng trn ton th gii t quan im y t cng
ng.
Hnh 9:d liu t Sc khe rng ming ca U.S. Adulth NIDR, 1985
% Tng s ngi

Khng c Trn nu Di nu
Biu 10: Tnh trang cao rng ngi dn M (Sc khe rng ming ca ngi
M trng thnh, NIDR, 1985)
Thnh phn ha hc ca si nha khoa trn rng v vt liu nha khoa

Cao rng nha khoa bao gm c cc thnh phn hu c v v c. Phn hu c l s

kt hp ca cc biu m t bo, bch cu, vi sinh vt v polysaccarid . Phn v c
ch yu l mui canxi phosphat, trong bao gm: carbonat hydroxyapatid (CHA),
DCPD, v octacanxi phosphat (OCP). Cc tia X-quang, quang ph hp th hng
ngoi ca cao rng con ngi, cc mu thu c t hm rng gi v cc b mt
rng cho thy thnh phn v c ca cao rng t rng gi ch yu l CHA, trong khi
cc cht t
b mt rng l mt hn hp canxi phosphat -TCPC (Mg-thay th), CHA,
v OCP. Cc cht lng ng ch yu l canxi base v cc mui phosphat (12).

Cng ngh phng chng s hnh thnh cao rng

Phng php chung ca vic loi b cao rng l bng phng php c hc. Cc
phng php c hc ny c s can thip su v au n. Mt gii php khc l pht
trin mt phng php ha hc ngn nga s hnh thnh cc giai on c bn ca
canxi phosphat. Mt lng ln cc cht ha hc c xut lm chm s
hnh thnh ca cao rng trn cc b mt rng. Cc cht ha hc thng l cc hp
cht, c ch s hnh thnh ca mui canxi phosphat giai on kt tinh. Trong ,
nhng cht c ch hiu qu nht l pyrophosphat, pyrophosphat thm polymer v
cc mui km. Ni chung, cc cht ha hc thng hot ng thng qua mt hiu
ng b mt. Cc cht c ch hp th cc thnh phn hnh thnh (canxi phosphat)
tinh th v chng lm gim s hnh thnh giai on kt tinh, cho php canxi
phosphat tn ti dng v nh hnh. Ni chung, c hai trong s cc hnh thc th
nghim c s dng nh gi cc cht c ch. Mt th nghim theo hng
t hnh thnh ca HA. (Hnh 11) s dng mi trng qu bo ha, kch thch dch
mng bm. Th nghim th hai l pht trin cc mm tinh th cho s hnh thnh
HA trong s dng iu kin tng ng vi mi trng nc bt (Hnh. 12).
Thng qua s dng cc th nghim, cc gi tr tng i th hin hiu qu ca cc
thuc c ch c tm tt v th hin trong Bng 2. N cho thy cht c ch mnh
nht l pyrophosphat. S kt hp ca pyrophosphat, copolymer ca pyrophosphat
v copolymer (PVM / MA) cng cho ta mt hiu qu tng cng. Cc mui km,
xt theo mt khc, i hi mt nng c c hn, cao hn cho hiu qu. Hiu
qu lm sng tng i ca cc cht ha hc trong thuc nh rng khc nhau c
tm tt trong Bng 3. D liu sn c t cc hp cht ca mt s nghin cu lm
sng ch ra rng c ch cao rng vi cc pyrophosphat v natri fluorid kt hp t
xp x 26%; vi copolymer / pyrophosphat (t 1,3% pyrophosphate tan n 3,3%)
gim cao rng trong phm vi cao n 50%; cc mui km i hi nng c c
hn cho hiu qu 2% hoc cao hn. Vi nng thp (0,5%), hiu qu chng li s
hnh thnh cao rng trn b mt nu l rt km (13).
Ml thuc th (Biu 11: S hnh thnh HAP)

Thi gian (Pht)

C ch hot ng ca cc cht ha hc c ch cao rng

C ch c ch s hnh thnh cao rng ca cc cht c ch c biu din trn s

minh ha. Canxi v phosphate t nc bt hoc t mng bm s lm kt ta cht
lng t giai on tin tinh th pht trin n giai on tinh th khi khng c mt
cht c ch. Khi c s hin din ca cht c ch, pha v nh hnh n nh v vic
chuyn i sang pha tinh th b tr hon. y r rng l iu hin nhin khi quan st
trn nh hin vi in t ca cao rng, c hnh thnh trong iu kin hin din v
vng mt cc cht c ch. Trong s vng mt ca cht c ch, kch thc tinh th l
rt ln v c xc nh; trong s hin din ca cht c ch, cc cht lng ng l
rt nh v c hnh thi hc ca canxi phosphat v nh hnh (Hnh. 13).
Cc cng ngh hin nay c s dng c ch s hnh thnh cao rng
cng cha fluorid. Khi ng dng, mt cht c ch mnh s hnh thnh tinh th
canxi v phosphat s cng tn ti vi fluorid, mt tc nhn thc y s hnh thnh
tinh th, chng ta cn phi hiu chng hot ng cng nhau nh th no. Cc cht
c ch ngn nga s hnh thnh ca HA, nhng lm th no hai tc nhn cng tn
ti trong mt h thng v pht huy tc dng tng ng? D liu ban u ca chng
ti ch ra rng cc cht c ch tng trng tinh th lm vic trn b mt rng, trong
khi ion fluorid hot ng bn trong rng. Kt qu c th c gii thch bi thc t
l cc cao rng xy ra trn rng ( trn), trong khi kh khong xy ra khu vc bn
di b mt ca men (di mng mng). S hin din ca lp mng mng trn
rng cho php vn chuyn c chn lc fluorid v cc cht c ch. C ch ny
c lm sng t bi nhng nghin cu ca cc cht c ch t nhin n s pht
trin tinh th trong nc bt. Nghin cu ch ra rng tc dng c ch s tng
trng tinh th ca cht c ch t nhin c th c khc phc bng vic b sung
cc cht fluorid. Hiu ng ny khng phi l thay th mt cht c ch hp ph
bng fluorid, cng khng phi hot ha cc cht th cp pht trin bn cnh. Thay
vo , cc hiu ng c gii thch trn c s ca vic tng lc tc ng vo
kt ta v v tr pht trin tinh th b tc nghn, khng hnh thnh c trn c
s hiu ng khng gian. iu ny c xc nhn bi cc nghin cu in vivo
(cc nghin cu trn cc c th sng).
Bng 2: Cng ngh kim sot cao rng: Hiu qu tng i

Ha cht Nng c ch (ppm)

Pyrophosphat 4.0
Pyrophosphat + Copolymer 3.0
Km 60.0

Bng 3: Hiu qu lm sng ca thuc nh rng trn ngi

Thuc nh rng Gim bt cao rng trung bnh vi cht v hi (%)

3.3% pyrophosphat + NaF 26
3.3% pyrophosphat +1% 50
PVM/MA/NaF
3.3% pyrophosphat +1.5% 47
PVM/MA/NaF
0.5% km citrate + MFP 14
2% km + sodium fluorid 38-50

Tm tt: PVM/MA, copolymer polyvinylmethyl maleic acid

Ngun: t Ref. 13.
Cng ngh Gim but rng

S pht trin sau ca kem nh rng cha cht ha hc c m rng nh l

mt cch ngn chn au nhc rng do rng nhy cm; tc l, qu mn. Nhy
cm men rng c nh ngha l mt s au but rng cc b p ng vi
nhit, xc gic, hay lung hi kch thch ln cc b mt men rng khng c bao
ph. Thng thng, chn rng c bao ph bi nu hoc m nu nhng khi
nu tt xung, b mt chn rng b l ra. Khi khng c bao ph, theo thi gian,
s try xc v mi mn s loi b cc lp mng ca xng rng, do l ra
men rng vi nhng l nh li ti.
Biu 12: S pht trin ca cc tinh th

Thi gian(pht)

Hnh 13 C ch pyrophosphate / copolymer / NaF hnh thnh cao rng.

B mt n king hay vi khun a - xt c th vch trn ng rng l chn lng hoc
ng ti b mt.N bit l tip xc vi ng rng v s hin din ca ng m trn b
mt c lin quan n tng nhy cm.ng ng rng cha dch.
Hn hp ha cht, kch thch lnh nng hoc c th lm cho dch ny m rng hoc
thu nh li,kch thch dy thn kinh ty tim n dn n au.Hin nay mui ca
kali sn sng so vi liu php phng nga trong kem nh rng OTC.Cc i l
khc chng hn nh nitrat kali c cho l gy ra gim thn kinh hot ng bng
cch thay i ngng kch thch dy thn kinh ty.Nhng cch tip cn ny
c kt hp trong mt kem nh rng duy nht c cha kali nitrat v cht ng
trng hp tun theo b mt rng.Hnh 14B cho thy s tc c th l do t trong ng
nghim iu tr ng rng vi kem nh rng.Tht khng may , liu php ny yu
cu 2-3 tun iu tr trc khi quan st gim nhy.Do cn c mt loi vt
liu tt ngay lc ny c th phn ng nhanh trong kem nh rng c th nhanh
chng lm gim nhy cm ca ng rng (14).
Cng ngh Multibenefit trong kem nh rng
S pht trin tip theo trong cng ngh kem nh rng l kt hp khng khun i
l vi florua v gim hp cht cao rng.
Vi sinh vt ca nha khao mng bm rng: sc khe v dch bnh.

Hnh 14 (A) ng ng m (B) tc ng ng

Hnh 15 vi sinh vt (y t vi bnh tt)
 Hnh 16 chin lc iu tr cho cc i l antiplaque

Nghin cu c bn trong 30 nm qua r rng thnh lp vai tr ca rng mng ti

giao din ca rng / nu l nguyn nhn chnh yu ca vim li rng, m c th
cui cng dn n bnh nha chu. Cc nghin cu trc y bi Lo et al (15) v
nghin cu tip theo ca Syed v Loesche ( 16 ) cho thy c ngng mc vi
khun, l tng thch vi sc kho li rng ( hnh. 15 v 16 ). Khi ngng mc
vi khun tng t nht l 2 hoc 3 n t hng ca cc cng , sau vim nu
c khi xng. Do , mc ch chnh ca i l antiplaque ho cht l mang
h vi thc vt n mc tt cho sc kho ti b mt ca li rngli rng,ch yu do
gim tng khi lng ca h vi sinh vt trn b mt , hoc bng cch gim tng
khi lng ca cc mm bnh b mt (hnh 17 v 18).Mng bm rng ch yu
bao gm cc vi sinh vt n l hp l dit khun dng gim hoc ngn nga
to thnh mng.L do l cc khng khun s hoc lm c ch vi khun trong mng
bm sn c hay phng nga l nng - zation.Tuy nhin, nghin cu ban u cho
thy r rng rng vi khun trong khoang ming phi b git c ch ngn to
thnh mng cho ch trong su gi, vi iu kin l mt ngy phi nh rng 2
ln.Nh khoang ming l mt h thng m ,c hi tip tc ti nhim l lun lun
hin din. Da trn cc nghin cu gn y, c im chung ca tc nhn dit
khun hu ch cho nh hng antiplaque c th tm tt trong Bng 4.i vi mt
khng khun antiplaque c hiu qu,mt hot ng ph rng chng li bng ming
vi l cn thit,v cc thnh phn sinh ca mng bm rt phc tp. Vi cationic tc
nhn dit khun, nng c ch ti thiu ( MIC ) trong lot 0.1-0.5 mg / ml chng
li mm bnh rng ming c ghi nhn. Tuy nhin, hin nay hiu bit v dc
tnh ca cc tc nhn khng khun antiplaque ch ra rng c nhng yu t khc
ngoi tnh khng khun trong vic xc nh antiplaque bn vng nh hng trn
rng. Nhng yu t ny bao gm vic lu gi v gii phng cc khng khun trn
b mt rng ming cng nh hiu qu vi s c mt ca mi trng nc bt. Hn
na, quan trng l khng khun cho chng nh hng n v, nu khng ph hp
vi bnh nhn th hn rt ngho.Mt xem xt s dng sn phm ng ung l
kh nng tng thch vi cc tc nhn nh bng b mt, v c 2 thnh phn ny
u rt quan trng kim sot vt trn rng cng nh nh ha du hng v,
c kt hp cht ch trong sn phm v sinh rng ming cho ph hp.Cc lu
quan trng khc l c c tnh thp v tim nng ti thiu lm xo trn h sinh
thi vi khun rng ming thng thng(17).
Cationic tc nhn dit khun
Trong s cc i l cc tc nhn khng khun nh chlorhexidine digluconate (
CHDG ), clo - rua benzethonium ( BTC ), v clo - rua cetyl pyridium( CPC ).
CHDG hiu qu hn l BTC hoc CPC v c duy tr cao hn trong mi trng
ming. H cng khc nhau i vi phn ng ca h vi protein nc bt, l mt
thng s quan trng cho vic lu gi khng khun cation trn b mt rng ming;
tng duy tr sn xut mt phin bn ko di nng hot ng chng li tc nhn
gy bnh rng ming.

Hnh 17 Nghin cu tnh kh thi ca cc mng bm thng qua xc nh mt k

thut nhum hunh quang
Hnh 18 C ch duy tr cc cht triclosan trn b mt rng ming bi cht ng
trng hp. Cc nhm ha tan (methyl ether) by triclosan / b mt mixen trong khi
nhm tp tin nh km (COOH) lin kt vi canxi trong mt lp cht lng dnh trn
giao din rng / men.
Bng 4.c im ca khng khun cho hiu ng cc mng bm
Ph rng hot tnh khng khun.
Substantivity cc b mt rng ming
Ngon ming.
Tng thch vi cc thnh phn kem nh rng.
c tnh thp.
Khng c s xo trn v sinh thi hc bng ming.

Cc nghin cu lm sng di hn chng minh hiu qu ca khng khun cation

chng li vi mng bm, vim nu v mng bm. Tuy nhin, cc thuc ny gy ra
khng th chp nhn nhum rng v s gia tng trong vic hnh thnh si. Do ,
vic s dng chng trong cc sn phm v sinh rng ming r rng l gii hn (17).
i l khng khun Noncationic
Gn y (trong 10 nm qua), c s quan tm to ln trong khng khun
noncationic , trong cung cp cc li ch nh mng bm, vim li, tnh ton, v
gim su rng. iu ny ch yu da trn mt i l khng khun nonionic, cht
triclosan, trong c ph rng hot tnh khng khun chng li cc vi khun gram
dng v gram m. i vi cht triclosan c hiu qu, mt h thng phn phi l
cn thit tng thi gian c tr ca n trong khoang ming. Mt cht ng trng
hp ca polyvinyl metyl ete (PVM) v axit maleic (MA) c hin th thc
hin iu . cht ng trng hp ny l rt thch hp ci thin vic cung cp
cc cht triclosan, k t PVM / MA c chng minh phn ng vi cc b
mt cng v mm trong khoang ming. Trong mt nghin cu ngn hn ko di
bn ngy ca de novo hnh thnh mng bm, chng ti nh gi mt lot cc tc
nhn khng khun khc nhau. Chng ti thy rng cht triclosan thc s cn mt h
thng phn phi c ci thin, ch yu l mt cht ng trng hp, tng cng
lu gi ca c hai rng v b mt biu m ming (18).
Mt trong nhng nguyn tc quan trng pht trin l gi cho mi gia nhp khng
phi l yu t duy nht trong hot ng antiplaque; nng gi li phi l hot tnh
sinh hc. chng minh nguyn tc ny, chng ti tin hnh mt lot cc
nghin cu hiu c bao nhiu cht triclosan c gi li postbrushing.
Trong mt nghin cu, chng ti so snh ba cng thc cht triclosan, tng c mt
h thng Tng cng khc nhau (Bng 5). Nh c th nhn thy (Bng 6), thm ch
sau 14 gi, mt s lng ng k c gi li trong mng bm, c nng cao hn
MIC ca triclosan cho vi khun ng ming (MIC l 0,3-4 mg / ml). Cc bc
quan trng tip theo l xc nh liu ny c gi li lng l hot tnh sinh hc.
Mt tm bng tnh kh thi kho nghim c s dng, trong chng ta tip
xc vi cc mng bm hai thuc nhum hunh quang phn bit i x gia cc
vi khun sng v cht bng cch o t l ca mu xanh l cy pht hunh quang
mu . Trong nghin cu ny, mt s lng c th o t s v xc nh xem liu
cc s c li l hot tnh sinh hc. Trong mt nghin cu in hnh th hin
y, nh rng vi kem nh rng gi dc cho mt s gim mng bm tnh kh
thi; h thng cht triclosan cht ng trng hp gim cao nht trong kh nng
tn ti, v cc h thng khc, chng hn nh cht triclosan / pyrophosphate v cht
triclosan / mui km ca axit nitric, khng khc bit ng k.
Bng 5: Tc nhn khng khun khng cation: Nghin cu so snh s c ch mng
vi khun bng phng php trong ng nghim In Vivo

iu tr Trung bnh P trn tt c cc b Nhm SNK

mt + S.D.
Gi dc placebo 1.46 + 0.12 A
0.12% CHDG 0.53 + 0.17 B
0.2% SnF2 (Rinse) 1.10 + 0.16 C
0.06 Triclosan 1.00 + 0.14 C
S0.06 Triclosan + Gantrez 0.72 + 0.17 B
0.06 Triclosan + PVPA 0.67 + 0.16 B
Cc t vit tt: Gantrez: PVM/MA, PVPA, polyvinylphosphonic acid; SNK,
phng php kim nghim Student-Newman-Keuls.
T gi dc placebo (Hnh. 18). Nhng kt qu ny c chng thc bi mt
nghin cu lm sng c lp trong su thng ca Renvert v Birkhed (Bng 6) (19).
C ch vic copolymer tng cng cung cp cc triclosan c lm sng t
(Hnh. 23). Cc polymer c hai nhm : mt l nhm gn kt v nhm khc l nhm
ha tan. Nhm ha tan gi triclosan trong cc b mt mixen v nhm gn kt to
phn ng vi cc b mt rng ming thng qua canxi trong cht lng lp mng
bm.
Triclosan thot ra t t sau , thng qua s tng tc vi mi trng nc bt.
Trong cc th nghim lm sng di hn, cng ngh ny c nh gi trn ton
th gii trong 6 thng qua 12 nghin cu mng bng/ vim nu rng, ba nghin
cu vi rng, ba th nghim lm sng su rng, v nm nghin cu di hn gim
st s vi khun ng ming. Kt qu ca tt c nhng nghin cu trn ch ra rng
cng ngh ny c hiu qu chng li cc mng bm, vim li, vi rng v su rng.
Khng c tc dng ph ca s mu rng hoc tng vi rng c ghi nhn. V
cng khng c s xo trn sinh thi hc ca cc vi khun ng ming.
Mt trong nhng kha cnh th v nht ca triclosan l tc dng hiu qu nhn
i ca n. Khng khun ny khng ch tiu diu vi khun m cn v hiu ha cc
sn phm ca vi khun, nhng th lm tng kh nng vim nu. Chng ti ch
ra rng triclosan l mt cht c ch mnh bng hai con ng cyclo-oxygenase v
lipoxygenase. N khng ch c ch cc enzym ny trong ng nghim m cn c
ch s to thnh cc sn phm ca chng ( pros- taglandins (cc axit bo khng bo
ha cc m) v leukotrienes) trong t bo si nu c kch thch bi cc t bo
bch cu 1-. Nhng d liu ny c khng nh lm sng trong mt nghin cu
ch ra chng ti ngn chn c vi khun vi troclosan nhng vn duy tr tc
dng chng vim ca n. Nh vy, triclosan c tc dng hiu qu nhn i- c
khng khun v chng vim. Tnh nng c o ny khng c cung cp cho n
nay bi nhng cht khng khun v chng vim khc (20). Thut ng ny c
th nghim trong nghin cu lm sng di hn gim s tn cng v pht trin
ca bnh nha chu (21,22).

Bng 6: Mc bm triclosan sau khi nh rng (mg/ml)

Bi nh rng 0.3% Triclosan/ 0.3% Triclosan/ 0.3% Triclosan/1%

(hr) copolymer n=12 pyrophosphate n=12 zinc n= 12
2 38.83 + 18.28a 20.90 + 14.14 30.60 + 13.6

14 4.14 + 1.72 2.74 + 2.11 3.95 + 1.79

P=0.05, so snh vi kem nh rng gi dc placebo.

a

Ngun: T phn 23.

Bng 7: Nc sc ming tr liu

Nc sc ming Tnh nng Gim tnh c th trong cc

bnh l so vi gi dc
Fluoride rinses 225 ppm F Gim 50% su rng tr
em (3 tui)
Cao rng + Vi rng 1% anion pyrophosphate; 100 Gim 30-35 % s hnh
ppm F cng vi mt thnh cao rng sau khi s
copolymer ca PVM / MA dng su thng
(0,5%)
Chng mng/ Chng 0.030.06 Triclosan + 1% Gim 20-30 % trong mng
vim nu copolymer PVM/MA + F bm / vim li sau ba thng
s dng

3. Nc sc ming
Cc loi nc sc ming trn th trng ang c xy dng vi nng thp hn
so vi kem nh rng. V d dn s ni chung s dng kem nh rng 1 g hoc 1
cc ln bn chi, nhng c s dng nc sc trong 10-15 cc v mt s nng
thp hn ca hot tnh c kt hp. Cng v vy m nc sc ming khng cha
cc tc nhn lm c v lm trng rang. Mt ln s dng sc ming in hnh cha
hot tnh b mt, v , i l hot ng, v nc. Cc nguyn tc chung v hot ng
c nu trn cng c ch ra cch phn phi cc i l phn chia trong nc
sc ming. Bng 7 tm tt vic thc hin lm sng in hnh so vi mt gi dc
ra ca iu tr ra nh sau.
4. K hoch nghin cu lm sng sn phm chm sc rng ming
nh gi tin lm sang Nghin cu th im Nghin cu kim sot Th
nghim.
ti liu hiu qu ca cc sn phm ung so vi cc bnh rng ming, k hoch
nghin cu lm sng c nu trong biu trn. Cc nghin cu tin lm sang
bao gm phng th nghim v ng vt th nghim. V d, i vi uoride efcacy
mt ln kim tra s bao gm s hp th ca flo trong rang hoc HA. Lm gim men
ha tan sau khi iu tr bng flo, sau c kim tra bng axit. Hiu qu chut
bang cch bi them dung dch flo vo rng trong vic lm gim su rng, cc l t
thng rng, v s hp th flo cc mng bm rng v nc bt. Cc th nghim
ngm ha vi tr em ( 1000 nhm) trong thi hn 3 nm nh gi hiu qu pht
trin. phng nga mng bm v hnh thnh vim li. Cc th nghim c tin
hnh trong su thng. Cc th nghim lnh tnh ton gim flo cng c ngm ho
cho mt khong thi gian su thng. th nghim flonh vy l song song / hai im
m thit k.
5. Xu hng tng lai
Nhu cu ton cu i vi cng tc phng chng bnh rng ming c th c p
ng bi s pht trin ca ngun ti nguyn kin thc trong hc vin v ngnh cng
nghip v cc ng dng tip theo ca n. Vi mt s hiu bit tt hn v qu trnh
xy ra trong ming, chng ta s c th to ra hot ng tt hn v h thng phn
phi i l hot ng cho vic kim sot cc bnh v ming, nh hng n sc
khe ni chung. Cc xu hng cng ngh ang dn u hng ti mc tiu
'' ming khe mnh / c th khe mnh. ''
6. Ti liu tham kho
1. Dental Spending Hits$37 Billion. Am Dent Assoc News 1992 (Jan 6).
2. Periodontal aspects of systemic health. Symposium Proceedings. Comp Cont
Edu 1998(Fall).
3. Gaffar A, Afflitto, J. General principles for delivery of active agents for
mouthrinses. Int Dent J 1996; 42(4):251256.
4. Fishman SL. Hares teeth to fluorides, historical aspects of dentifrice use. In:
Emery G, Rolla G, eds. Clinical and Biological Aspects of Dentifrice. Oxford
University Press, 1972:17.
5. Nathoo SA, Gaffar A. Studies on dental stain induced by antibacterial agent and
rational approaches for bleaching dental stains. Adv Dent Res 1995; 9(4):462470.
6. Solis-Gaffar M, Niles HP. Instrumental evaluation of mouth odor in a human
clinical study. J Dent Res 1977; 54:851857.
7. Niles HP, Gaffar A. Relationship between sensory and instrumental evaluation
of mouth odor. J Soc Cos Chem 1993; 44:101107.
8. Gaffar A, Blake-Haskins J, Mellberg J. In vivo studies with dicalcium phosphate
dihydate/MFP system for caries prevention. Int Dent J 1993; 63(1):8190.
9. Sullivan RJ, Fletcher R, Barchman R, Legeros RZ. Intra-oral comparison and
evaluation of the ability of dentifrices to promote remineralization of caries-like
lesions in dentin and enamel. J Clin Dent 1995; 6:135138.
10. Gaffar A, Blake-Haskins J, Sullivan RJ, Simone A, Saunders F. Cariostatic
effects of axylitol/NaF dentifrice in vivo. Int Dent J 1998; 48:3239.
11. Mandel ID. Rinses for the control of supragingival calculus formation. Int Dent
J 1992; 42:270285.
12. Gaffar A, Legeros RZ, Gambogi RS, Afflitto J. Inhibition of formation of
calcium phosphate deposits on teeth and dental materials: Recent advances. Adv
Dent Res 1995; 9(4):419426.
13. Volpe AR, Petrone M, Davies RM. A review of calculus clinical efficacy
studies. J Clin Periodont 1993; 4(3):7181.
14. Miller S, Gaffar A, Sullivan RJ, Truong T, Stranick M. Evaluation of new
dentifrice for treatment of sensitive teeth. J Clin Dent 1994; 5:7179.
15. Loe H, Theilde E, Jensen SB. Experimental gingivitis in man. J Periodont
1970; 36: 177187.
16. Syed SA, Loesche WJ. Bacteriology of experimental gingivitis: effect of
plaque. Info Immun 1978; 21:821829.
17. Gaffar A, Volpe AR, Lindhe J. Recent advances in plaque/gingivitis control. In:
Emery G, Rolla G, eds. Chemical Biological Aspects of Dentifrices. Oxford
University Press, 1992:229247.
18. Gaffar A, Afflitto J, Herles S, Nabi N. Recent advances in plaque, gingivitis,
tartar and caries prevention. Int Dent J 1994; 44:6370.
19. Renvert St, Birkhed D. Comparison of three triclosan dentifrices on plaque,
gingivitis and salivary microflora. J Clin Periodont 1995; 23:6370. 552 Gaffar
20. Gaffar A, Scherl D, Afflitto J, Coleman EJ. The effects of triclosan on the
mediators of gingival inflammation. J Clin Periodont 1995; 22:280284.
21. Rosling B, Wannfors B, Volpe AR, Furuichi Y, Ramberg P, Lindhe J. The use
of a triclosan/copolymer dentifrice may retard progression of periodontitis. J Clin
Periodont 1997; 24:873880.
22. Elwood RP, Worthington HV, Blinkhorn AB, Volpe AR, Davies RM. Effect of
triclosan/copolymer dentifrice on incidence of periodontal attachment loss in
adolescence. J Clin Periodontol 1998; 25:363367.
23. Mandel ID. Chemotherapeutic mouthrinses for control of oral disease. Int Dent
J 1992; 42(4):251285.