Comparison of the Therapeutic Effects of Two Methods for Removing Black Tooth Stain in Children
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摘要:
目的 比较采用赤藓糖醇喷砂法和矽粒子旋转抛光法治疗儿童外源性牙面黑色素沉着（extrinsic black tooth stain，EBS）的临床疗效。 方法 筛选符合纳入标准的3～12岁儿童48名，通过改良Lobene色斑指数记录色素水平，采用自身半口对照，随机将左右侧分为试验组和对照组，试验组用赤藓糖醇喷砂法，对照组用矽粒子旋转抛光法清除牙齿唇颊面EBS，记录操作时间，进行治疗感受评分，评价治疗安全性，采用“色素积分（score）除以操作时间（second）”计算清洁效率（S/s），随访治疗后3个月和6个月色素再附着水平，通过SPSS 23.0软件分析试验结果。 结果 治疗前唇颊面左右两侧色素得分差异无统计学意义，舌腭面色素得分大于唇颊面，牙面不同分区的色素得分有统计学差异。试验组的效率高于对照组[（0.06±0.05） S/s vs （0.04±0.02） S/s，P < 0.001]。8例（16.7%）研究对象对喷砂治疗感到紧张，7例（14.6%）研究对象喷砂治疗过程中出现牙龈出血。治疗前、治疗后3个月、6个月试验组和对照组色素水平差异无统计学意义（P > 0.05）。 结论 虽然赤藓糖醇喷砂更容易导致牙龈出血，使儿童紧张，但其清除色素效率更高，值得临床推广。 Abstract:Objective To compare the clinical efficacy of using erythritol air-polishing and silica particle polishing for treating extrinsic black tooth stain （EBS） in children. Methods 48 children aged 3-12 years who met the inclusion criteria were selected. The Lobene stain index was used to record the pigment level, and a self-half-mouth control was used to randomly divide the left and right sides into the experimental group or control group. The experimental group was treated with erythritol air-polishing, and the control group was treated with silica particle air-abrasion to remove EBS on the labial and buccal surfaces of the teeth. The operation time, treatment experience score, and safety were recorded, and the cleaning efficiency （S/s） was calculated using the “pigment score divided by operation time” formula. The pigment reattachment level was followed up at 3 and 6 months after treatment using SPSS 23.0 software for analysis. Results There was no significant difference in pigment scores between the left and right sides before treatment, but the pigment score on the lingual and palatal surfaces was higher than that on the labial and buccal surfaces, and there was a statistically significant difference in pigment scores among different areas of the teeth. The efficiency of the experimental group was higher than that of the control group [（0.06±0.05） S/s vs （0.04±0.02） S/s, P < 0.001]. 8 （16.7%） of the study subjects felt nervous during air-polishing treatment, and 7 （14.6%） had gum bleeding during the process. There was no difference in pigment levels between the experimental and control groups before treatment, at 3 months, or at 6 months after treatment. Conclusion Although erythritol air-polishing may cause more gum bleeding and nervousness in children, its pigment removal efficiency is higher and it is worth promoting clinically. -
表 1 改良儿童治疗感受评定标准
Table 1. Modified scale for treatment experience in children
评分 表情 表现 1（不紧张） 
能迅速、准确回答医生的问题，表情淡定自然。 2（有点紧张） 
愿意并能准确回答医生问题，但面部表情不自然，手脚不自然放置，不自觉举手、抬脚。 3（比较紧张） 
能够回答问题，但声调和语速受紧张影响而改变，身体不自然扭动，举手、
抬脚等动作增加，但比较受控，有时叫停，不影响医生的操作。4（非常害怕） 
想要拒绝治疗，哭叫，手常抬起，想要阻止医生操作，需要强硬的语气命令
才能配合，操作受到影响。5（特别害怕） 
持续哭闹，身体不停扭动，需要助手辅助控制身体才能继续治疗，治疗非常困难。 
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表 2 治疗前唇颊面左右侧色素得分[（
$\bar x \pm s$ ），分]Table 2. Comparison of stain scores of the left and right side of buccal surface [（
$\bar x \pm s$ ），score]唇颊面分区 左侧 右侧 t P 色素得分 4.99 ± 2.36 5.19 ± 2.27 1.462 0.151
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表 3 治疗前牙面不同分区色素得分[（
$ \bar x \pm s $ ），分]Table 3. Comparison of stain scores in different surface zones [（
$ \bar x \pm s $ ），score]牙面分区 G B M D O F P 色素得分 1.60 ± 0.62 1.35 ± 0.53 1.30 ± 0.56 1.13 ± 0.56 0.92 ± 0.77 8.301 < 0.001* *P < 0.05。
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表 4 治疗前唇颊面和舌腭面色素得分[（
$\bar x \pm s $ ），分]Table 4. Comparison of stain scores in tongue and buccal surfaces [（
$ \bar x \pm s $ ），score]牙面分区 唇颊面 舌腭面 t P 色素得分 5.11 ± 2.27 5.65 ± 2.06 −2.024 0.049* *P < 0.05。
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表 5 受试者对赤藓糖醇喷砂法和矽粒子慢速旋转抛光法的治疗感受（n）
Table 5. Subjects’ treatment experience of erythritol air polishing and silica particle polishing （n）
评分 试验组 对照组 Z P 1 40 47 −2.333 0.020* 2 7 1 3 1 0 *P < 0.05。
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表 6 试验组和对照组治疗前、治疗后3个月、6个月色素水平比较（
$\bar x \pm s $ ）Table 6. Comparison of buccal EBS status between test group and control group before treatment，3 months and 6 months after treatment （
$\bar x \pm s $ ）治疗时间 试验组 对照组 t P 基线 5.56 ± 2.21 5.38 ± 2.10 0.986 0.330 治疗后3个月后 2.10 ± 2.23 2.02 ± 2.04 0.453 0.653 治疗后6个月后 1.88 ± 1.85 1.67 ± 1.58 1.401 0.168
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