牙釉质发育缺陷性疾病的环境影响因素及临床管理

Enamel developmental defects:environmental factors and clinical management

牙釉质形成是有赖于多层机制协同调控的复杂生理过程,包括组织发生、形态发生、细胞分化等重要阶段,最终由牙源性上皮细胞定向分化为功能性成釉细胞,分泌基质并介导矿化。这一过程对各种局部和全身干扰因素非常敏感。牙发育与萌出过程始于胚胎阶段,持续至青春期甚至成年后这一漫长时期,各种干扰因素都可能使乳牙及恒牙的硬组织基质形成和矿化异常,导致牙釉质发育缺陷性疾病。其中,生命早期(从受精卵开始到8岁前)是对环境因素暴露最敏感的时期,同时也是乳牙及恒牙牙釉质发育的关键时期,这一时期的环境因素暴露往往导致不同程度的釉质发育缺陷。本文回顾了环境因素影响牙釉质发育缺陷性疾病的研究进展,概述了环境因素导致牙釉质发育缺陷性疾病的遗传学及表观遗传学机制,总结了针对该类疾病基于三级预防的临床管理策略,以期为从生命早期关键时间窗口预防牙发育异常,提供优生优育健康咨询及促进儿童口腔健康管理提供依据,通过前移儿童口腔疾病的预防关口,创建妇幼友好型社会,提高新生人口素质。

Enamel formation is a complex physiological process that depends on the coordinated regulation of multiple mechanisms.This process is quite sensitive to various local and systemic interference factors.Therefore,during the long period from the embryonic stage to adolescence or even adulthood,various interference factors may lead to enamel developmental defects.Among them,early life is the most sensitive stage to environmental factors exposure,while it is also the critical period of enamel development of deciduous and permanent teeth.Environmental factors exposure during this period often leads to varying degrees of enamel development defects.In this review,we generalize the research progress of environmental factors affecting enamel developmental defects,summarize the potential mechanisms of environmental factors leading to enamel developmental defects,and conclude the clinical management strategies based on tertiary prevention.This work hopes to provide a theoretical basis for preventing abnormal teeth development from the critical time window of early life,propose eugenics health consultation and promote children′s oral health management.