{"id":19299,"date":"2023-04-13T19:56:49","date_gmt":"2023-04-13T12:56:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19299"},"modified":"2023-04-17T14:41:59","modified_gmt":"2023-04-17T07:41:59","slug":"co-che-sau-rang-benh-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/co-che-sau-rang-benh-sinh\/","title":{"rendered":"C\u01a1 ch\u1ebf s\u00e2u r\u0103ng – B\u1ec7nh sinh."},"content":{"rendered":"

V\u1ea5n \u0111\u1ec1 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh s\u00e2u r\u0103ng t\u1eeb l\u00e2u \u0111\u00e3 \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 quan t\u00e2m nghi\u00ean c\u1ee9u, c\u00f3 r\u1ea5t nhi\u1ec1u thuy\u1ebft nh\u1eb1m c\u1ee7ng c\u1ed1 \u0111\u1ec3 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a s\u00e2u r\u0103ng. C\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn nh\u01b0 “Thuy\u1ebft h\u00f3a h\u1ecdc c\u1ee7a Miller”, “Thuy\u1ebft Davies trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng”, “Thuy\u1ebft ti\u00eau protein c\u1ee7a Gottlieb”, “Thuy\u1ebft Protein ph\u1ee9c v\u00f2ng c\u00e0ng” hay quan tr\u1ecdng nh\u1ea5t l\u00e0 “Thuy\u1ebft \u0111\u1ed9ng h\u1ecdc trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng” – thuy\u1ebft \u0111\u1eb7t ra n\u1ec1n t\u1ea3ng \u0111\u1ec3 gi\u1ea3i th\u00edch c\u0103n nguy\u00ean b\u1ec7nh sinh s\u00e2u r\u0103ng. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y nh\u1eb1m cung c\u1ea5p ki\u1ebfn th\u1ee9c v\u00e0 hi\u1ec3u bi\u1ebft cho nha s\u0129 v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh li\u00ean quan \u0111\u1ebfn b\u1ec7nh n\u00e0y.<\/strong><\/p>\n

1. Thuy\u1ebft ho\u00e1 h\u1ecdc c\u1ee7a Miller (1881)<\/h2>\n

Miller l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean d\u00f9ng ph\u01b0\u01a1ng ph\u00e1p th\u1ef1c nghi\u1ec7m \u0111\u1ec3 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh b\u1ec7nh s\u00e2u r\u0103ng. \u00d4ng \u0111em ng\u00e2m r\u0103ng \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1ed5 v\u00e0o m\u1ed9t h\u1ed7n h\u1ee3p b\u00e1nh m\u00ec, th\u1ecbt v\u00e0 n\u01b0\u1edbc b\u1ecdt, sau \u0111\u00f3 quan s\u00e1t c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ti\u00eau calci c\u1ee7a r\u0103ng. Qua k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u n\u00e0y \u00d4ng k\u1ebft lu\u1eadn l\u00e0 \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a acid, m\u00f4 c\u1ee9ng c\u1ee7a r\u0103ng b\u1ecb m\u1ea5t ch\u1ea5t v\u00f4i. Trong giai \u0111o\u1ea1n n\u00e0y men r\u0103ng b\u1ecb ph\u00e1 hu\u1ef7 ho\u00e0n to\u00e0n. Sang giai \u0111o\u1ea1n hai, m\u00f4 h\u1eefu c\u01a1 c\u1ee7a ng\u00e0 b\u1ecb ph\u00e1 hu\u1ef7 b\u1edfi qu\u00e1 tr\u00ecnh l\u00ean men c\u1ee7a vi khu\u1ea9n l\u00e0m ti\u00eau protein.<\/p>\n

2. Thuy\u1ebft Davies trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng<\/h2>\n

C\u01a1 ch\u1ebf g\u00e2y s\u00e2u r\u0103ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch nh\u01b0 sau:<\/p>\n

Men vi khu\u1ea9n + glucid \u2014> l\u00ean men \u2014> acid \u2014> ti\u00eau Calcium \u2014> s\u00e2u r\u0103ng.<\/p>\n

3. Thuy\u1ebft ti\u00eau protein c\u1ee7a Gottlieb trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng (1946)<\/h2>\n

Gottleib v\u00e0o n\u0103m 1946 \u0111\u00e3 \u0111\u1ecbnh ngh\u0129a r\u1eb1ng: “S\u00e2u r\u0103ng l\u00e0 qu\u00e1 tr\u00ecnh ti\u00eau protein do vi khu\u1ea9n, c\u00e1c tinh th\u1ec3 men b\u1ecb bong ra.” Tuy nhi\u00ean thuy\u1ebft ti\u00eau protein c\u1ee7a Gottlieb kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c ph\u1ea7n n\u00e0o c\u01a1 ch\u1ebf c\u1ee5 th\u1ec3 c\u1ee7a s\u00e2u r\u0103ng l\u00e0 do vi khu\u1ea9n, \u0111i\u1ec1u m\u00e0 \u0111\u1ebfn ng\u00e0y nay \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u1ed9ng r\u00e3i, tr\u1edf th\u00e0nh \u0111\u00fang \u0111\u1eafn.<\/p>\n

4. Thuy\u1ebft protein ph\u1ee9c v\u00f2ng c\u00e0ng<\/h2>\n

Theo Martin (1956), cho r\u1eb1ng c\u1ea3 hai th\u00e0nh ph\u1ea7n h\u1eefu c\u01a1 v\u00e0 v\u00f4 c\u01a1 g\u1ea7n nh\u01b0 c\u00f9ng b\u1ecb ti\u00eau m\u1ed9t l\u00fac. \u0110\u1ea7u ti\u00ean l\u00e0 ti\u00eau protein \u1edf th\u00e0nh ph\u1ea7n h\u1eefu c\u01a1 men r\u0103ng, ch\u1ea5t sinh ra th\u00e0nh ph\u1ee9c h\u1ee3p v\u00f2ng c\u00e0ng v\u00e0 ph\u1ee9c h\u1ee3p n\u00e0y l\u00e0m ti\u00eau calci.<\/p>\n

5. Thuy\u1ebft \u0111\u1ed9ng h\u1ecdc trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng<\/h2>\n

Nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y ng\u01b0\u1eddi ta gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf g\u00e2y s\u00e2u r\u0103ng l\u00e0 do qu\u00e1 tr\u00ecnh h\u1ee7y kho\u00e1ng chi\u1ebfm \u01b0u th\u1ebf h\u01a1n t\u00e1i kho\u00e1ng do vai tr\u00f2 chuy\u1ec3n h\u00f3a carbohydrate c\u1ee7a vi khu\u1ea9n tr\u00ean m\u1ea3ng b\u00e1m b\u1ec1 m\u1eb7t r\u0103ng.<\/p>\n

S\u1ef1 h\u1ee7y kho\u00e1ng: C\u00e1c hydroxyapatite v\u00e0 Fluorapatite \u2013 th\u00e0nh ph\u1ea7n ch\u00ednh c\u1ee7a men, ng\u00e0 \u2013 b\u1ecb ho\u00e0 tan khi pH gi\u1ea3m d\u01b0\u1edbi m\u1ee9c pH t\u1edbi h\u1ea1n, pH t\u1edbi h\u1ea1n c\u1ee7a hydroxyapatite l\u00e0 5,5 v\u00e0 pH t\u1edbi h\u1ea1n c\u1ee7a fluorapatite l\u00e0 4,5.<\/p>\n

S\u1ef1 t\u00e1i kho\u00e1ng: Qu\u00e1 tr\u00ecnh t\u00e1i kho\u00e1ng ng\u01b0\u1ee3c v\u1edbi qu\u00e1 tr\u00ecnh h\u1ee7y kho\u00e1ng, x\u1ea3y ra khi pH trung t\u00ednh, c\u00f3 \u0111\u1ee7 ion Calcium v\u00e0 Phosphate, trong m\u00f4i tr\u01b0\u1eddng. N\u01b0\u1edbc b\u1ecdt c\u00f3 vai tr\u00f2 cung c\u1ea5p c\u00e1c ion Calcium v\u00e0 Phosphate \u0111\u1ec3 kho\u00e1ng ho\u00e1.<\/p>\n

H\u1ee7y kho\u00e1ng v\u00e0 t\u00e1i kho\u00e1ng l\u00e0 2 hi\u1ec7n t\u01b0\u1ee3ng sinh l\u00fd lu\u00f4n di\u1ec5n ra b\u00ecnh th\u01b0\u1eddng trong t\u1ed5 ch\u1ee9c c\u1ee9ng c\u1ee7a r\u0103ng, n\u1ebfu h\u1ee7y kho\u00e1ng > t\u00e1i kho\u00e1ng th\u00ec s\u1ebd sinh ra b\u1ec7nh s\u00e2u r\u0103ng. T\u00f3m t\u1eaft qu\u00e1 tr\u00ecnh sinh l\u00fd b\u1ec7nh s\u00e2u r\u0103ng theo s\u01a1 \u0111\u1ed3 White (1975)<\/p>\n

\"co-che-sau-rang\"
S\u01a1 \u0111\u1ed3 White (1975)<\/figcaption><\/figure>\n

B\u1ec7nh c\u0103n v\u00e0 b\u1ec7nh sinh b\u1ec7nh s\u00e2u r\u0103ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong s\u01a1 \u0111\u1ed3 White (1975) v\u00e0 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch qua s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7 v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y m\u1ea5t \u1ed5n \u0111\u1ecbnh.<\/p>\n

Qu\u00e1 tr\u00ecnh h\u00ecnh th\u00e0nh t\u1ed5n th\u01b0\u01a1ng s\u00e2u r\u0103ng<\/p>\n

\u2013 Giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh s\u00e2u r\u0103ng l\u00e0 s\u1ef1 h\u1ee7y kho\u00e1ng v\u00e0 h\u00f2a tan c\u1ea5u tr\u00fac r\u0103ng do gi\u1ea3m pH khu tr\u00fa c\u1ee7a m\u1ea3ng b\u00e1m v\u00e0 h\u1ee7y kho\u00e1ng men r\u0103ng.<\/p>\n

\u2013 \u1ede pH < 5,5, c\u00e1c ch\u1ea5t kho\u00e1ng c\u1ee7a r\u0103ng ho\u1ea1t \u0111\u1ed9ng nh\u01b0 m\u1ed9t ch\u1ea5t \u0111\u1ec7m, gi\u1ea3i ph\u00f3ng c\u00e1c ion calci v\u00e0 phosphat v\u00e0o trong m\u1ea3ng b\u00e1m. Kh\u1ea3 n\u0103ng \u0111\u1ec7m c\u1ee7a r\u0103ng duy tr\u00ec ph t\u1ea1i ch\u1ed7 \u1edf m\u1ee9c 5,0 v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00ecnh th\u00e0nh c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc \u0111i\u1ec3n h\u00ecnh c\u1ee7a s\u00e2u r\u0103ng. \u1ede pH 5,0, b\u1ec1 m\u1eb7t men kh\u00f4ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng cho t\u1edbi khi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng m\u1ea5t kho\u00e1ng d\u01b0\u1edbi b\u1ec1 m\u1eb7t. C\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1edbi ch\u1edbm n\u00e0y, gi\u1edbi h\u1ea1n \u1edf m\u00f4 men, \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t b\u1ec1 m\u1eb7t men c\u00f2n nguy\u00ean v\u1eb9n \u1ea3o, nh\u01b0ng l\u1edbp d\u01b0\u1edbi b\u1ec1 m\u1eb7t x\u1ed1p. L\u1ed7 sau ch\u1ec9 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh khi c\u00e1c t\u1ed5n th\u01b0\u01a1ng men x\u1ed1p d\u01b0\u1edbi b\u1ec1 m\u1eb7t hu\u1ef7 kho\u00e1ng nhi\u1ec1u t\u1edbi m\u1ee9c s\u1eadp l\u1edbp men b\u1ec1 m\u1eb7t.<\/p>\n

\u2013 Tr\u00ean l\u00e2m s\u00e0ng, c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1edbi ch\u1edbm n\u00e0y c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c khi th\u1ed5i kh\u00f4 b\u1ec1 m\u1eb7t r\u0103ng. Khi c\u00e1c t\u1ed5n th\u01b0\u01a1ng men x\u1ed1p d\u01b0\u1edbi b\u1ec1 m\u1eb7t \u0111\u01b0\u1ee3c hydrat ho\u00e1 r\u1ea5t kh\u00f3 ph\u00e1t hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng v\u00ec men x\u1ed1p l\u00fac n\u00e0y tr\u1edf n\u00ean trong su\u1ed1t. C\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1edbi ch\u1edbm c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i kho\u00e1ng h\u00f3a v\u00e0 h\u1ed3i ph\u1ee5c.<\/p>\n

\u2013 C\u00e1c l\u1ed7 s\u00e2u tr\u00ean b\u1ec1 m\u1eb7t men l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng h\u1ed3i ph\u1ee5c v\u00e0 n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00ec m\u00f4 ng\u00e0 s\u1ebd b\u1ecb ph\u00e1 hu\u1ef7 nhanh, ph\u00e1 v\u1ee1 c\u1ea5u tr\u00fac r\u0103ng.<\/p>\n

 <\/p>\n

Ngu\u1ed3n:<\/em><\/p>\n

1. Nguy\u1ec5n D\u01b0\u01a1ng H\u1ed3ng (1979), “B\u1ec7nh h\u1ecdc s\u00e2u r\u0103ng” R\u0103ng H\u00e0m M\u1eb7t, T\u1eadp 1. Nh\u00e0 xu\u1ea5t b\u1ea3n Gi\u00e1o d\u1ee5c.<\/em>
\n2. A.T. Hara, C. Silami de Magalhaes et al (2002), “effect of fluoride-containing restorative systems associated with dentifrices\u00a0on root dentin”. Journal of Dentistry, 30:205-212.<\/em>
\n3. C.-Y.S. Hsu, T.H. Jordan et al (2000). “Effects of low-energy co2 laser irradiation and the organic matrix on inhibition of enamel demineralization” Journal of Dental Research, 79:1725-1730.<\/em>
\n4. Gilberto Minostroza H., (2009),” Dental caries, 3th edition, Ripano book<\/em>
\n5. James B., William R., Thomas J. Et al (2006), “Fundamentals of Operative<\/em>
\ndentistry” 3th edition, Quintessent\u00a0book.<\/em>
\n6. Luciana B., AubreyS., Marcelo B. (2008), “The association of dental caries with social factors and nutritional status in Brazilian preschool children”, Eur J Oral Sci, 116: 37-43 Printed in Singapore.<\/em>
\n7. M. Lenander-Lumikari. V. Loimaranta (2000), “Saliva and Dental Caries” Adv Dent Res 14:40-47.<\/em>
\n8. Moun G., Hume W., (2009), “Prervation and restoration of tooth structure”, 2nd edition, Mosby, 1998.<\/em>
\n9. National Institutes of Health Office of the Director (2001). “Diagnosis and Management of Dental Caries Throughout Life” Volume 18, Number 1.<\/em>
\n10. Samuel Akpata (2011), “Dental Caries,, eighth edition, Mosby.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

V\u1ea5n \u0111\u1ec1 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh s\u00e2u r\u0103ng t\u1eeb l\u00e2u \u0111\u00e3 \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 quan t\u00e2m nghi\u00ean c\u1ee9u, c\u00f3 r\u1ea5t nhi\u1ec1u thuy\u1ebft nh\u1eb1m c\u1ee7ng c\u1ed1 \u0111\u1ec3 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a s\u00e2u r\u0103ng. C\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn nh\u01b0 “Thuy\u1ebft h\u00f3a h\u1ecdc c\u1ee7a Miller”, “Thuy\u1ebft Davies trong c\u01a1 ch\u1ebf s\u00e2u r\u0103ng”, […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[3],"yoast_head":"\nC\u01a1 ch\u1ebf s\u00e2u r\u0103ng - B\u1ec7nh sinh. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y nh\u1eb1m cung c\u1ea5p ki\u1ebfn th\u1ee9c v\u00e0 hi\u1ec3u bi\u1ebft cho nha s\u0129 v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh li\u00ean quan \u0111\u1ebfn b\u1ec7nh s\u00e2u r\u0103ng. 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