牙釉质发育缺陷介导的儿童龋齿加速进展、 精准预防与微创治疗研究进展

Research Progress on Accelerated Caries Progression, Precision Prevention, and Minimally Invasive Treatment in Children Mediated by Developmental Defects of Enamel

摘要: 牙釉质发育缺陷(developmental defects of enamel, DDE)可被视为儿童龋齿加速进展的关键介导因素。系统评价显示，DDE儿童早期龋风险为正常儿童的1.94倍，釉质发育不全者高达5.45倍。以磨牙–切牙矿化不全(molar incisor hypomineralisation, MIH)为代表的釉质矿化不良全球患病率为2.4%~40.2%，第二乳磨牙矿化不全(hypomineralised second primary molar, HSPM)可使其风险升高10.90倍。DDE通过降低釉质密度、增加表面孔隙率，并富集Selenomonas sputigena形成高毒力蜂窝状生物膜，驱动龋损快速穿透釉牙本质界；获得性釉质膜保护性蛋白缺失进一步加剧易感性。诊断方面，定量光诱导荧光(quantitative light-induced fluorescence, QLF)与光学相干断层扫描(optical coherence tomography, OCT)联合深度学习模型可精准鉴别DDE与早期龋(受试者工作特征曲线下面积 > 0.97)。预防与治疗强调分层管理：专业涂氟、窝沟封闭及38%氟化二氨银(silver diamine fluoride, SDF)联合氟化钠清漆适用于中轻度病损；渗透树脂、非创伤修复治疗(atraumatic restorative treatment, ART)及化学机械去腐等微创技术可最大限度保存牙体组织。DDE患儿需建立全周期管理及多学科协作。将DDE明确定位为龋病加速介质，推动“筛查–预警–预防–微创–随访”主动管理模式，是降低儿童龋病负担的关键方向。

Abstract: Developmental defects of enamel (DDE) can be regarded as key mediators of accelerated caries progression in children. A systematic review showed that children with DDE have a 1.94-fold higher risk of early childhood caries, and those with enamel hypoplasia have a 5.45-fold higher risk. Molar incisor hypomineralisation (MIH), a representative subtype of enamel hypomineralisation, has a global prevalence ranging from 2.4% to 40.2%. The presence of hypomineralised second primary molars (HSPM) increases the risk of MIH by 10.90-fold. DDE reduces enamel density, increases surface porosity, and enriches Selenomonas sputigena to form a highly virulent honeycomb-like biofilm, driving rapid caries penetration through the dentinoenamel junction. Loss of protective proteins in the acquired enamel pellicle further increases susceptibility. For diagnosis, quantitative light-induced fluorescence (QLF) and optical coherence tomography (OCT), combined with deep learning models, can accurately distinguish DDE from early caries (area under the curve >0.97). Preventive and therapeutic strategies emphasise a stratified approach: professional fluoride application, fissure sealing, and 38% silver diamine fluoride (SDF) combined with sodium fluoride varnish are suitable for mild‑to‑moderate lesions; minimally invasive techniques such as resin infiltration, atraumatic restorative treatment (ART), and chemomechanical caries removal preserve tooth structure to the greatest extent. Children with DDE require whole‑life‑cycle management and multidisciplinary collaboration. Identifying DDE as a key accelerator of caries and promoting the proactive management model of “screening - risk warning - prevention - minimally invasive treatment - long-term follow-up” are essential directions for reducing the burden of childhood caries.