龋病预防的研究进展：从再矿化到微生态调控

Research progress in dental caries prevention: From remineralization to microecological regulation

摘要

龋病是由产酸病原体引起的口腔微生物失衡，是一种导致牙体硬组织发生阶段性脱矿与再矿化的动态性疾病。因此，龋病管理的重点在于有效恢复口腔微生态平衡以及脱矿与再矿化平衡。本文总结了调控“双平衡”的策略，在促进再矿化方面，包括传统的氟化物以及酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）、纳米羟基磷灰石及自组装肽P11-4等；而在调节微生态平衡方面，则包括益生菌、L-精氨酸、赖氨酸乙酰化修饰及真菌干预等。本文还介绍了其他龋病诊断及防治方法的新进展，认为将再矿化与微生态调控联合是未来龋病预防的发展方向，以期促进龋病的主动管理以及个性化预防，降低龋病的发生率。

Abstract

Dental caries is an oral microbial dysbiosis driven by acidogenic pathogens, representing a dynamic disease process characterized by alternating phases of demineralization and remineralization of dental hard tissues. Consequently, the cornerstone of caries management lies in the effective restoration of two interrelated equilibria: The oral microbial ecological balance and the balance between demineralization and remineralization. This review summarizes current strategies for modulating this "dual balance." To begin with, strategies aimed at promoting remineralization are discussed, including conventional fluoride agents, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, and the self-assembling peptide P11-4. Second, approaches for regulating microbial ecological balance are considered, such as probiotics, L-arginine, lysine acetylation modification, and fungal intervention. Third, recent advances in other diagnostic, preventive, and therapeutic modalities for caries are highlighted. On the whole, this review proposes that the integration of remineralization-promoting measures with microecological regulation represents a promising direction for future caries prevention, with the goal of facilitating active management and personalized prophylaxis, thereby reducing the overall incidence of dental caries.

关键词

龋病 / 微生态调控 / 再矿化 / 自组装肽 / 益生菌 / 精准预防

Key words

Dental caries / Microecological regulation / Remineralization / Self-assembling peptide / Probiotics / Precision prevention

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基金资助

甘肃省青年人才项目（个人项目）(2026QNGR010)

甘肃省自然科学基金项目(24JRRA360)