Başlangıç Mine Lezyonlarına Tedavi Yaklaşımları
Özet
Başlangıç mine lezyonlarının tedavisinde temel yaklaşım; biyofilmin kontrolü, demineralizasyonun azaltılması ve remineralizasyonun desteklenmesidir. Bu kapsamda ilk basamak, etkili ağız hijyeni ve plak kontrolüdür. Düzenli ve doğru teknikle yapılan diş fırçalama, diş ipi kullanımı ve gerektiğinde antimikrobiyal ajanlardan yararlanılması lezyonların ilerlemesini önlemede kritik rol oynar. Diyetin düzenlenmesi, özellikle ekstrinsik şeker tüketiminin azaltılması, çürük riskinin kontrolünde önemli bir diğer faktördür. Florür, çürüklerin önlenmesinde altın standart ajan olarak kabul edilmekte; demineralizasyonu azaltma, remineralizasyonu artırma ve antibakteriyel etki mekanizmalarıyla etki göstermektedir. Sistemik (su, tuz, süt florürlemesi ve takviyeler) ve topikal (diş macunu, gargara, vernik, jel, gümüş diamin florür) uygulamalar mevcuttur. Florürün etkinliğini artırmak amacıyla kalsiyum fosfat bazlı sistemler (DCPD, β-TCP, CPP-ACP/CPP-ACFP), polifosfatlar gibi ajanlar geliştirilmiştir. Ayrıca biyomimetik yaklaşımlar (8DSS ve P11-4 peptidleri, nHAP), ozon, klorheksidin glukonat, arjinin, ksilitol, kitosan ve bazı doğal ürünler çürük yönetiminde destekleyici alternatifler olarak araştırılmaktadır. Sonuç olarak, başlangıç mine lezyonlarının yönetimi multidisipliner, minimal invaziv ve kanıta dayalı yaklaşımlarla; bireysel çürük riskine göre planlanmalıdır.
The fundamental approach to the management of initial enamel lesions involves the control of the biofilm, reduction of demineralization, and promotion of remineralization. Within this framework, the first step consists of establishing effective oral hygiene and adequate plaque control. Proper toothbrushing, the use of dental floss, and antimicrobial agents when necessary help prevent lesion progression. Reducing extrinsic sugar intake is also important for controlling caries risk. Fluoride is regarded as the gold standard agent in caries prevention; it exerts its effects by inhibiting demineralization, enhancing remineralization, and reducing bacterial activity. Both systemic (water, salt, and milk fluoridation, as well as supplements) and topical (toothpastes, mouthrinses, varnishes, gels, and silver diamine fluoride) applications are available. To enhance the efficacy of fluoride, calcium phosphate–based systems (such as DCPD, β-TCP, and CPP-ACP/CPP-ACFP) and polyphosphates have been developed. In addition, biomimetic strategies (including 8DSS and P11-4 peptides and nano-hydroxyapatite), as well as ozone, chlorhexidine gluconate, arginine, xylitol, chitosan, and natural products, are being investigated as supportive alternatives in caries management. In conclusion, the management of initial enamel lesions should be planned according to individual caries risk, employing multidisciplinary, minimally invasive, and evidence-based approaches.
Referanslar
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Gunsolley JC. Clinical efficacy of antimicrobial mouthrinses. Journal of dentistry. 2010;38:S6-S10.
Gallagher A, Sowinski J, Bowman J, Barrett K, Lowe S, Patel K, et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. American Dental Hygienists' Association. 2009;83(3):111-6.
Asadoorian J. Tooth brushing. Canadian journal of dental hygiene. 2006;40:1-14.
González-Cabezas C, Fernández C. Recent advances in remineralization therapies for caries lesions. Advances in Dental Research. 2018;29(1):55-9.
Mobley CC. Nutrition and dental caries. Dental clinics. 2003;47(2):319-36.
Ccahuana-Vásquez R, Tabchoury C, Tenuta L, Del Bel Cury A, Vale G, Cury J. Effect of frequency of sucrose exposure on dental biofilm composition and enamel demineralization in the presence of fluoride. Caries Research. 2006;41(1):9-15.
O'mullane D. Can prevention eliminate caries? Advances in Dental Research. 1995;9(2):106-9.
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Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. The Cochrane database of systematic reviews. 2013(12):Cd003809.
Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews. 2003(1):Cd002278.
Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews. 2015(6):Cd002280.
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Shahid M. Regular supervised fluoride mouthrinse use by children and adolescents associated with caries reduction. Evidence-based dentistry. 2017;18(1):11-2.
Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monographs in oral science. 2011;22:97-114.
O'Mullane DM, Baez RJ, Jones S, Lennon MA, Petersen PE, Rugg-Gunn AJ, et al. Fluoride and Oral Health. Community dental health. 2016;33(2):69-99.
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Rozier RG, Adair S, Graham F, Iafolla T, Kingman A, Kohn W, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2010;141(12):1480-9.
Bibby BG. A test of the effect of fluoride-containing dentifrices on dental caries. Journal of dental research. 1945;24(6):297-303.
Pessan JP, Toumba KJ, Buzalaf MAR. Topical use of fluorides for caries control. Fluoride and the Oral Environment. 2011;22:115-32.
Bibby B, Zander H, McKelleget M, Labunsky B. Preliminary reports on the effect on dental caries of the use of sodium fluoride in a prophylactic cleaning mixture and in a mouthwash. Journal of dental research. 1946;25(4):207-11.
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Meyers RJ, Kingman A. A comparison of the anticaries effectiveness of daily and weekly rinsing with sodium fluoride solutions: final results after three years Stanley B. Heifetz, DDS, MPH. 1982.
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Ercan E, Baglar S, Colak H. Diş hekimliğinde topikal florür uygulama metotları. Cumhuriyet Dental Journal. 2010;13(1):27-33.
Dijkman GE, de Vries J, Lodding A, Arends J. Long-term fluoride release of visible light-activated composites in vitro: a correlation with in situ demineralisation data. Caries research. 1993;27(2):117-23.
Howe PR. A method of sterilizing and at the same time impregnating with a metal affected dentinal tissue. Dent Cosmos. 1917;59:891-904.
Yamaga R. Diamine silver fluoride and its clinical application. J Osaka Univ Dent Sch. 1972;12:1-20.
Rosenblatt A, Stamford T, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. Journal of dental research. 2009;88(2):116-25.
Gao S, Zhao I, Hiraishi N, Duangthip D, Mei M, Lo E, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clinical & Translational Research. 2016;1(3):201-10.
Crystal YO, Marghalani AA, Ureles SD, Wright JT, Sulyanto R, Divaris K, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatric dentistry. 2017;39(5):135E-45E.
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Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries research. 2019;53(3):284-95.
Amaechi BT, Van Loveren C. Fluorides and non-fluoride remineralization systems. Toothpastes. 23: Karger Publishers; 2013. p. 15-26.
Zhang YP, Din CS, Miller S, Nathoo SA, Gaffar A. Intra-oral remineralization of enamel with a MFP/DCPD and MFP/silica dentifrice using surface microhardness. The Journal of clinical dentistry. 1995;6(2):148-53.
Sullivan RJ, Masters J, Cantore R, Roberson A, Petrou I, Stranick M, et al. Development of an enhanced anticaries efficacy dual component dentifrice containing sodium fluoride and dicalcium phosphate dihydrate. American journal of dentistry. 2001;14 Spec No:3a-11a.
Karlinsey RL, Mackey AC, Walker ER, Frederick KE. Preparation, characterization and in vitro efficacy of an acid-modified beta-TCP material for dental hard-tissue remineralization. Acta biomaterialia. 2010;6(3):969-78.
Karlinsey RL, Pfarrer AM. Fluoride plus functionalized β-TCP: a promising combination for robust remineralization. Advances in dental research. 2012;24(2):48-52.
Amaechi BT, Karthikeyan R, Mensinkai PK, Najibfard K, Mackey AC, Karlinsey RL. Remineralization of eroded enamel by a NaF rinse containing a novel calcium phosphate agent in an in situ model: a pilot study. Clinical, cosmetic and investigational dentistry. 2010;2:93-100.
Mensinkai PK, Ccahuana-Vasquez RA, Chedjieu I, Amaechi BT, Mackey AC, Walker TJ, et al. In situ remineralization of white-spot enamel lesions by 500 and 1,100 ppm F dentifrices. Clinical oral investigations. 2012;16(4):1007-14.
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Referanslar
Marsh PD, Bradshaw DJ. Dental plaque as a biofilm. Journal of industrial microbiology and biotechnology. 1995;15(3):169-75.
Gunsolley JC. Clinical efficacy of antimicrobial mouthrinses. Journal of dentistry. 2010;38:S6-S10.
Gallagher A, Sowinski J, Bowman J, Barrett K, Lowe S, Patel K, et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. American Dental Hygienists' Association. 2009;83(3):111-6.
Asadoorian J. Tooth brushing. Canadian journal of dental hygiene. 2006;40:1-14.
González-Cabezas C, Fernández C. Recent advances in remineralization therapies for caries lesions. Advances in Dental Research. 2018;29(1):55-9.
Mobley CC. Nutrition and dental caries. Dental clinics. 2003;47(2):319-36.
Ccahuana-Vásquez R, Tabchoury C, Tenuta L, Del Bel Cury A, Vale G, Cury J. Effect of frequency of sucrose exposure on dental biofilm composition and enamel demineralization in the presence of fluoride. Caries Research. 2006;41(1):9-15.
O'mullane D. Can prevention eliminate caries? Advances in Dental Research. 1995;9(2):106-9.
National Institute for Dental and Craniofacial Research, The Story of Fluoridation https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation 2018 [
Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. The Cochrane database of systematic reviews. 2013(12):Cd003809.
Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews. 2003(1):Cd002278.
Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews. 2015(6):Cd002280.
Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. The Cochrane database of systematic reviews. 2016;7(7):Cd002284.
Shahid M. Regular supervised fluoride mouthrinse use by children and adolescents associated with caries reduction. Evidence-based dentistry. 2017;18(1):11-2.
Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monographs in oral science. 2011;22:97-114.
O'Mullane DM, Baez RJ, Jones S, Lennon MA, Petersen PE, Rugg-Gunn AJ, et al. Fluoride and Oral Health. Community dental health. 2016;33(2):69-99.
Ziegler E. Milk fluoridation. Bulletin der Schweizerischen Akademie der Medizinischen Wissenschaften. 1962;18:379-91.
Bánóczy J, Rugg-Gunn A, Woodward M. Milk fluoridation for the prevention of dental caries. Acta medica academica. 2013;42(2):156.
Mariño R, Villa A, Guerrero S. A community trial of fluoridated powdered milk in Chile. Community dentistry and oral epidemiology. 2001;29(6):435-42.
Legett JB, Garbee W, Gardiner J, Lancaster D. The effect of fluoridated chocolate-flavored milk on caries incidence in elementary school children: two and three-year studies. ASDC journal of dentistry for children. 1987;54(1):18-21.
Rozier RG, Adair S, Graham F, Iafolla T, Kingman A, Kohn W, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2010;141(12):1480-9.
Bibby BG. A test of the effect of fluoride-containing dentifrices on dental caries. Journal of dental research. 1945;24(6):297-303.
Pessan JP, Toumba KJ, Buzalaf MAR. Topical use of fluorides for caries control. Fluoride and the Oral Environment. 2011;22:115-32.
Bibby B, Zander H, McKelleget M, Labunsky B. Preliminary reports on the effect on dental caries of the use of sodium fluoride in a prophylactic cleaning mixture and in a mouthwash. Journal of dental research. 1946;25(4):207-11.
Aurlene N, Manipal S, Prabu D, Sindhu R. Topical fluoride as a panacea for dental caries: A Review. Journal of Pharmaceutical Sciences and Research. 2019;11(9):3320-5.
Meyers RJ, Kingman A. A comparison of the anticaries effectiveness of daily and weekly rinsing with sodium fluoride solutions: final results after three years Stanley B. Heifetz, DDS, MPH. 1982.
Spencer A. The use of fluorides in Australia: guidelines. 2006.
Weyant RJ. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review (vol 144, pg 1279, 2013). JOURNAL OF THE AMERICAN DENTAL ASSOCIATION. 2013;144(12):1335-.
CİVELEK A, Emre Ö, ÇILDIR ŞK. Diş Hekimliğinde Topikal Florür Uygulamaları. Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2004;5(2).
Ercan E, Baglar S, Colak H. Diş hekimliğinde topikal florür uygulama metotları. Cumhuriyet Dental Journal. 2010;13(1):27-33.
Dijkman GE, de Vries J, Lodding A, Arends J. Long-term fluoride release of visible light-activated composites in vitro: a correlation with in situ demineralisation data. Caries research. 1993;27(2):117-23.
Howe PR. A method of sterilizing and at the same time impregnating with a metal affected dentinal tissue. Dent Cosmos. 1917;59:891-904.
Yamaga R. Diamine silver fluoride and its clinical application. J Osaka Univ Dent Sch. 1972;12:1-20.
Rosenblatt A, Stamford T, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. Journal of dental research. 2009;88(2):116-25.
Gao S, Zhao I, Hiraishi N, Duangthip D, Mei M, Lo E, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clinical & Translational Research. 2016;1(3):201-10.
Crystal YO, Marghalani AA, Ureles SD, Wright JT, Sulyanto R, Divaris K, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatric dentistry. 2017;39(5):135E-45E.
Fluoride Therapy. Pediatr Dent. 2018;40(6):250-3.
Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries research. 2019;53(3):284-95.
Amaechi BT, Van Loveren C. Fluorides and non-fluoride remineralization systems. Toothpastes. 23: Karger Publishers; 2013. p. 15-26.
Zhang YP, Din CS, Miller S, Nathoo SA, Gaffar A. Intra-oral remineralization of enamel with a MFP/DCPD and MFP/silica dentifrice using surface microhardness. The Journal of clinical dentistry. 1995;6(2):148-53.
Sullivan RJ, Masters J, Cantore R, Roberson A, Petrou I, Stranick M, et al. Development of an enhanced anticaries efficacy dual component dentifrice containing sodium fluoride and dicalcium phosphate dihydrate. American journal of dentistry. 2001;14 Spec No:3a-11a.
Karlinsey RL, Mackey AC, Walker ER, Frederick KE. Preparation, characterization and in vitro efficacy of an acid-modified beta-TCP material for dental hard-tissue remineralization. Acta biomaterialia. 2010;6(3):969-78.
Karlinsey RL, Pfarrer AM. Fluoride plus functionalized β-TCP: a promising combination for robust remineralization. Advances in dental research. 2012;24(2):48-52.
Amaechi BT, Karthikeyan R, Mensinkai PK, Najibfard K, Mackey AC, Karlinsey RL. Remineralization of eroded enamel by a NaF rinse containing a novel calcium phosphate agent in an in situ model: a pilot study. Clinical, cosmetic and investigational dentistry. 2010;2:93-100.
Mensinkai PK, Ccahuana-Vasquez RA, Chedjieu I, Amaechi BT, Mackey AC, Walker TJ, et al. In situ remineralization of white-spot enamel lesions by 500 and 1,100 ppm F dentifrices. Clinical oral investigations. 2012;16(4):1007-14.
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