Cephalometric Assessment in Anterior Open Bite Patients Treated with and Without Mini-Implant Anchorages

● Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages

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∫√√≥“∏‘°“√ A 4 “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ MAHIDOL DENTAL JOURNAL « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 Original article Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages

Penprapa Chiewcharat Abstract Postgraduate Student of Orthodontic Objective: The aims of this study were to determine pre- and posttreat Residency Training Programme Department of Orthodontics, ment of cephalometric measurements in the skeletal anterior open bite Faculty of Dentistry, Mahidol University patients with and without mini-implant anchorages (MIAs), and to compare Suwannee Luppanapornlarp the measurements between both groups. The hypothesis is that there B.Sc., D.D.S., M.Sc. (Orthodontics), are differences of treatment changes between groups. A.B.O., Tha.B.O., Ph.D. (Dental Sciences) Assistant Professor, Materials and methods: A retrospective study was performed in fifteen Department of Orthodontics, skeletal anterior open bite patients. The MIAs were used to intrude molars Faculty of Dentistry, Mahidol University in six patients (mean age of 25±8.1 years). Another nine patients (mean Supatchai Boonpratham age of 24.3 2.6 years) were treated without MIAs and served as a D.D.S., Ph.D. (Dental Sciences) ± Department of Orthodontics, control group. Paired t-test and Mann-Whitney U test were used to Faculty of Dentistry, Mahidol University determine changes within and between groups, respectively (P<0.05). Pongstorn Putongkam Results: There were no significant differences of skeletal and soft tissue D.D.S., M.Sc., Dip. Thai Board profile changes between the 2 groups, except LL-E plane. For dental (Orthodontics) Department of Orthodontics, changes, both groups show successful open bite correction with significant Faculty of Dentistry, Mahidol University treatment changes of U1-NA, overbite, overjet (P<0.05). It was found that the upper first molars in the MIAs group were more intruded significantly when compared with the control group (P<0.05). Upper incisors in the control group seem to be more extruded but not significantly. Conclusion: Molar intrusion using MIAs could be another choice of treatment for skeletal anterior open bite patients with minimal patient cooperation. Key words: cephalometric, mini-implant anchorages, open bite, orthodontic treatment Correspondence author: Suwannee Luppanapornlarp Assistant Professor Department of Orthodontics, Faculty of Dentistry, Mahidol University 6 Yothi Street, Rachathewi, Bangkok 10400, Thailand Tel: 02-203-6431-2 Fax: 02-203-6430 E-mail: [email protected] Research grant: - Received: 15 August 2011 Accepted: 16 December 2011

Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages 121 Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 MAHIDOL DENTAL JOURNAL ∫∑«‘∑¬“°“√ §à“‡´ø“‚≈‡¡μ√‘°„πºŸâªÉ«¬øíπÀπâ“ ∫‡ªî¥∑’Ë®—¥øíπ√à«¡°—∫ °“√„™â·≈–‰¡à„™âÀ¡ÿ¥¬÷¥∑“ß∑—πμ°√√¡®—¥øíπ

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122 Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Introduction often chosen to intrude posterior teeth and to decrease Anterior open bite occurs when there is no the total facial height. However, if the patients are incisor contact and no vertical overlap of the upper unwilling to undergo surgical treatment, an alternative and lower incisors. The etiology of this type of malocclu- method must be considered to treat the anterior open sion is reported to be multifactorial. It can be influ- bite.16-17 enced by genetic and environmental factors.1-2 Anterior Mini-implant anchorages (MIAs) are now fre- open bite has been divided into 2 categories: skeletal quently used for establishing absolute anchorage for and dental anterior open bites. Dental anterior open orthodontic tooth movement which extends the range bite is often related to recessive dentoalveolar height of tooth movement and lessens invasive treatment in the anterior teeth region, while skeletal open bite options. Many reports of MIAs show the possibility is commonly related to excessive dentoalveolar height to orthodontically intrude posterior teeth with the especially in the posterior teeth region.3-4 accompanying changes in occlusal plane, mandibular Anterior open bite malocclusion especially the plane, lower anterior face height, and anterior skeletal type is thought to be more difficult to correct, dental overbite in order to close the patientûs open because of their high relapse tendencies. Therefore bite.18-21 most of the cases are considerably treated with The objectives of this study were to evaluate orthognathic surgery.5 Numerous treatment options dental and skeletal effects of the treatment and to have been introduced based on the neuromuscular compare cephalometrically changes in anterior open and morphologic features and on the etiologic and the bite patients treated with and without MIAs. environmental factors.6-7 In general, extrusion or eruption of anterior teeth is a common method of bite Materials and Methods closure. However, correcting an anterior open bite This retrospective study had been approved by with anterior teeth extrusion might compromise the the Ethic Committee of Mahidol University (COA. No. esthetics. Such methods to extrude upper and lower MU-IRB 2010/336.0912). The selection criteria of anterior teeth are extrusion arches, vertical elastics in the samples in this study were: (1) non-growing compliance patient, multiloop edgewise archwire patients (ages ranging from 17 to 33 yrs), (2) appliance or MEAW, and etc.6, 8-12 anterior open bite with skeletal type I and II tendency Another treatment strategy for closing the and open configuration (MP-PP : 24-38 degrees), anterioropen bite is to intrude posterior teeth and allow (3) no orthognathic surgery in the treatment, (4) the mandible to auto-rotate. For every 1 millimeter of premolars extraction for the orthodontic treatment molar intrusion, approximately 3 millimeters of open plan, (5) the use of conventional technique or bite is reduced.13 Some devices were developed to MIAs to intrude molars, (6) good quality of the intrude the posterior regions such as high pull headgear cephalograms to identify landmarks for all measure- with transpalatal arch and posterior bite block.13-15 It ments. MIAs were recently used in the orthodontic has been thought that this method is difficult to clinic at the Faculty of Dentistry, Mahidol University decrease the posterior dentoalveolar height. Moreover, and many incomplete document records were exclu- most cases resulted in reciprocal extrusion of the ded from the study. Finally, charts of 15 anterior anchor teeth instead. Thus, a surgical approach is open bite patients were used in this study.

Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages 123 Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

The samples were divided into 2 groups accord- statistically changes occurring in the same groups ing to the treatment procedure. The MIAs were used (pre- and post-treatment). When the data was not to intrude molars in 6 patients (mean age, 25±8.1 in normal distribution from the Kolmogorov-Smirnov years). Nine patients treated without MIAs (mean age, test, then Mann-Whitney U test was used to deter- 24.3±2.6 years) were evaluated and served as a mine statistically changes occurring among the two control group. Pre- and post-treatment cephalograms groups. The level of probability for statistical signifi- of all samples were traced and evaluated. cance was set at P value <0.05. Each lateral cephalometric radiograph was Errors of measurement were examined for traced on a 0.03 inch acetate paper, with a sharp intra-examiner reliability. Ten radiographs were black pencil (diameter 0.3 mm.) on a view box with selected by random technique and then retraced and a background illumination. The location of each land- remeasured after 3 weeks intervals. The differences mark was indicated by a single fine pencil dot. When between the first and the second times of measure- bilateral structure gave rise to double images, the ments were determined by paired t-test (P<0.05) and midpoint by estimation or construction was chosen. the results show no significant differences in all mea- The lateral cephalograms used in this study had been surements. obtained from the same x-ray machines. All radiographs were traced and measured by one investigator and Results checked by an experienced orthodontist (Luppana- There were no significant differences in any pornlarp S.). The pre- and post-treatment tracings variables of pre-treatment cephalograms between the from each patient were superimposed and evaluated control and MIAs groups (Table1). Comparison of the treatment changes using anatomic best fit tech- pre- and post-treatment measurements of both nique.22 All cephalometric variables were measured groups was shown in Table 2. In the control group, it and calculated. showed that there were no significant differences in In order to determine whether all measurements skeletal changes. For the dental changes, the upper are reproducible, errors of measurement were and lower incisors were retracted significantly (P< examined for intra-examiner reliability. Ten randomly 0.05). The overbite was increased significantly for selected cephalograms from both groups were retraced an average of 4.61±1.69 mm The upper incisors and remeasured 3 weeks after the first tracing. were extruded significantly for an average of 1.67± Paired t-test showed there was no significant 1.66 mm and lower incisors were also extruded for difference in all measurements between the first and 1.11±1.45 mm but not significantly (P value=.051). the second times (P>0.05). The upper molars were also slightly extruded significantly for an average of 0.61±.65 mm. The lower lips Statistical analysis to E-plane were significantly decreased for 2.50±1.79 Statistical analysis was performed using the mm. Statistical Package for Social Sciences (Version 17.0, In comparison of the pre- and post-treatment SPSS Inc, Chicago, Illinois USA). Data distributions evaluation of the MIAs group, there were no significant were reported using means and standard deviations differences in skeletal changes and the upper incisors for each group. Paired t-test was used to determine were retracted significantly. The lower incisors were

124 Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 slightly retracted nonsignificantly. The overbite was molars were slightly extruded but not significantly. increased significantly for an average 4.25±1.70 mm From Table 3, there were no significant differ- without significant elongation of the upper incisors. ences in skeletal changes between the control and The upper molars were significantly intruded for an the MIAs groups. However, there were slightly more average 1.50±1.04 mm. The lower incisors and increasing in skeletal vertical changes of the control

Table1 Comparison of the pre-treatment measurements between the control and the MIAs groups Control MIAs Variable Norm SD Mean SD Mean SD P value Skeletal SNA 84 3.58 83.94 3.28 81.08 4.01 0.15 SNB 81 3.59 79.11 4.53 75.67 3.45 0.21 ANB 3 2.50 4.72 2.96 5.42 3.26 0.40 SN-Pg 82 3.09 79.28 4.76 75.67 3.67 0.21 SN-MP 30 5.61 37.00 9.43 39.75 5.46 0.67 SN-PP 9 3.03 7.33 2.99 6.58 1.50 0.38 MP-PP 21 5.25 29.67 7.67 33.17 4.71 0.38 FH-FO 9 4.38 13.67 4.97 13.17 4.70 0.86 NS-Gn 68 3.29 70.94 4.02 73.17 3.76 0.32 (PFH/AFH)x100% 65 2.88 62.95 6.54 61.82 3.78 0.95 Facial index 81 6.54 77.45 6.47 77.99 4.55 0.68 Dental U1 to NA 22 5.94 28.94 0.67 28.67 4.76 0.76 U1 to NA (mm) 5 2.13 7.22 2.21 6.33 1.97 0.33 L1 to NB 30 5.61 38.94 7.39 33.58 1.97 0.37 L1 to NB (mm) 7 2.22 10.06 3.00 8.00 2.28 0.36 L1 to MP 97 5.97 102.28 8.37 97.42 7.88 0.31 Overbite 2 1.06 -2.83 1.48 -2.33 1.17 0.51 Overjet 3 0.62 3.33 2.06 5.17 2.14 0.10 U1 to PP (mm) 28 2.64 31.61 2.77 32.67 2.88 0.63 U6 to PP (mm) 22 2.13 26.28 1.72 26.67 3.01 0.85 L1 to MP (mm) 41.40 13.43 45.56 2.96 0.36 L6 to MP (mm) 36.61 2.47 35.33 3.01 0.25 Soft tissue 91 7.98 93.17 11.72 94.50 15.57 0.86 Nasolabial angle 14 3.83 13.89 4.04 12.33 5.64 0.45 H-angle 2 2.03 4.72 2.54 2.42 3.07 0.18 Lower lip to E-plane

Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages 125 Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Control MIAs

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

Comparison of pre- and post-treatment measurements of the control and the MIAs groups

<.05

Variable Norm SD Pre-treatment Post-treatment Difference Pre-treatment Post-treatment Difference

Skeletal SNA 84 3.58 83.94 3.28 84.22 3.59 0.28 1.00 81.08 4.01 81.25 4.13 0.17 0.26 SNB 81 3.59 79.11 4.53 79.00 4.00 -0.11 1.52 75.67 3.45 75.17 3.72 -0.50 1.41 ANB 3 2.50 4.72 2.96 5.22 2.53 0.50 1.30 5.42 3.26 6.08 2.22 0.67 1.33 SN-Pg 82 3.09 79.28 4.76 79.61 4.39 0.33 1.84 75.67 3.67 75.92 3.85 0.25 0.61 SN-MP 30 5.61 37.00 9.43 38.50 6.94 1.50 4.05 39.75 5.46 39.92 6.67 0.17 1.81 SN-PP 9 3.03 7.33 2.99 7.33 2.95 0.00 1.66 6.58 1.50 6.83 1.83 0.25 0.88 MP-PP 21 5.25 29.67 7.67 31.06 5.66 1.39 3.22 33.17 4.71 33.42 6.30 0.25 2.32 FH-FO 9 4.38 13.67 4.97 13.17 6.03 -0.50 3.77 13.17 4.70 14.17 5.45 1.00 2.17 NS-Gn 68 3.29 70.94 4.02 71.06 3.75 0.11 1.76 73.17 3.76 73.33 3.89 0.17 1.29 (PFH/AFH)x100% 65 2.88 61.82 3.78 60.58 4.92 -1.25 1.90 62.95 6.54 63.20 6.33 0.25 0.79 Facial index 81 6.54 77.99 4.55 75.64 4.79 -2.36 4.61 77.45 6.47 77.34 5.84 -0.11 3.53 Dental U1 to NA 22 5.94 28.94 6.67 15.00 7.16 -13.94* 6.42 28.67 4.76 13.67 5.05 -15.00* 4.94 U1 to NA (mm) 5 2.13 7.22 2.21 1.72 3.33 -5.50* 2.75 6.33 1.97 3.50 2.19 -2.83* 2.50 L1 to NB 30 5.61 38.94 7.39 28.78 8.57 -10.17* 8.02 33.58 7.32 32.58 6.65 -1.00 6.76 L1 to NB (mm) 7 2.22 10.05 3.00 6.56 2.96 -3.50* 2.29 8.00 2.28 8.17 2.25 0.17 1.81 L1 to MP 97 5.97 102.27 8.37 92.11 8.73 -10.17* 6.05 97.42 7.88 96.92 6.20 -0.50 6.12 Overbite 2 1.06 -2.83 1.48 1.78 0.71 4.61* 1.69 -2.33 1.17 1.92 0.86 4.25* 1.70 Overjet 3 0.62 3.33 2.06 2.33 0.43 -1.00* 2.25 5.17 2.14 2.25 0.42 2.92* 1.86 U1 to PP (mm) 28 2.64 31.61 2.77 33.28 2.77 1.67* 1.66 32.67 2.88 33.50 3.79 0.83 1.03 U6 to PP (mm) 22 2.13 26.28 1.72 26.89 1.67 0.61* 0.65 26.67 3.01 25.17 2.79 -1.50* 1.04 L1 to MP (mm) 45.56 2.96 46.67 2.87 1.11 1.45 45.56 2.96 45.33 3.88 0.17 1.94 L6 to MP (mm) 36.61 2.47 37.67 2.06 1.06* 1.07 35.33 3.01 36.17 2.86 0.83 1.33 Soft tissue Nasolabial angle 91 7.98 93.17 11.72 97.61 10.12 4.44 7.56 94.50 15.57 99.33 17.01 4.83 5.60 H-angle 14 3.83 13.89 4.04 12.33 4.63 -1.56 2.11 12.33 5.64 12.25 6.60 -0.08 2.89 Lower lip to E-plane 2 2.03 4.72 2.54 2.22 2.37 -2.50* 1.79 2.42 3.07 1.58 3.14 -0.83 0.93

Table 2

126 Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 group than in the MIAs group but not significant of the lower lips to E-planes. The upper and lower differences. Comparison of the dental changes between incisors were more extruded in control group but not the control and the MIAs groups showed that the significant difference. The upper molars were signifi- lower incisors were significantly more retracted in the cantly more intruded in the MIAs group (1.5±1.04 mm). control group which resulted in more retruded position There were no significant differences in overbite

Table 3 Comparison of the treatment changes between the control and the MIAs groups Control MIAs Variable Mean SD Mean SD P-value Skeletal SNA 0.28 1.00 0.17 0.26 0.86 NS SNB -0.11 1.52 -0.50 1.41 0.60 NS ANB 0.50 1.30 0.67 1.33 0.86 NS SN-Pg 0.33 1.84 0.25 0.61 0.38 NS SN-MP 1.50 4.05 0.17 1.81 1.00 NS SN-PP 0.00 1.66 0.25 0.88 0.68 NS MP-PP 1.39 3.22 0.25 2.32 0.86 NS FH-FO -0.50 3.77 1.00 2.17 0.52 NS NS-Gn 0.11 1.76 0.17 1.29 0.77 NS (PFH/AFH)100% -1.25 1.90 0.25 0.79 0.06 NS Facial index -2.36 4.61 -0.11 3.53 0.32 NS Dental U1 to NA -13.94 6.42 -15.00 4.94 0.95 NS U1 to NA(mm.) -5.50 2.75 -2.83 2.50 0.11 NS L1 to NB -10.17 8.02 -1.00 6.76 0.02 * L1 to NB(mm.) -3.50 2.29 0.17 1.81 0.01 * L1 to MP -10.17 6.05 -0.50 6.12 0.01 * Overbite 4.61 1.69 4.25 1.70 0.77 NS Overjet -1.00 2.25 -2.92 1.86 0.08 NS U1 to PP (mm.) 1.67 1.66 0.83 1.03 0.14 NS U6 to PP(mm.) 0.61 0.65 -1.50 1.04 0.00 * L1 to MP (mm.) 1.11 1.45 1.17 1.94 0.77 NS L6 to MP(mm.) 1.06 1.07 0.83 1.33 0.86 NS Soft tissue Nasolabial angle 4.44 7.56 4.83 5.60 0.95 NS H-angle -1.56 2.11 -0.08 2.89 0.22 NS Lower lip to E-plane -2.50 1.79 -0.83 0.93 0.01 * *P<.05, NS = Not significant

Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages 127 Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

correction between the two groups. These treatments in the MIAs group. The elongation from extrusion of were both effective in correcting anterior open bite upper incisors and lower incisors in the control group with approximately 4 mm increase in overbite. was approximately 1.67±1.66 mm and 1.11±1.45 mm respectively, while the MIAs group shows 0.83±1.03 Discussion mm and 1.17±1.94 mm. Many studies have reported In this study, no skeletal and dental variables that retraction of incisors would result in uprighting showed significant differences between the control and relative extrusion of incisor crown.23-25 and the MIAs groups at start of treatment. This implied From previous studies16,18-21,25, MIAs were used that the pre-treatment characteristics of the two to intrude the posterior teeth which resulted in groups were similar. The patients had skeletal type I counterclockwise rotation of the mandible and and type II tendency (ANB = 4.72±2.96 degrees in decrease in anterior facial height. In this study, open the control group and 5.42±3.26 degrees in the bite of the MIAs group was apparently corrected by MIAs group) with anterior open bite (2.83±1.48 mm; intrusion of the upper molars (1.50±1.04 mm) 2.33±1.17mm, respectively) and were tendency high without significant elongation of the upper incisors, angle cases (MP-PP: 24-38 degrees). The upper while in the control group upper molars were slightly incisors were protruded, and lower incisors were also extruded (0.61±0.65 mm). However, the lower molars slightly protruded in both groups. Moreover, the soft of the control and the MIAs groups were extruded by tissue profile was found to be in the normal range. mean of 1.06±1.07 mm and 0.83±1.33 mm respec- Slightly protruded lower lips to E-plane were found in tively, but significantly only in the control group. The the control group but not significantly. extrusion of lower molars might be a result of class II Because the objectives to correct the open bite mechanic with intermaxillary elastics, or might be malocclusion usually include proper vertical dimension because, in this study, the MIAs had been used only in of the maxillary and mandibular plane together with the maxillary arch. the positioning of the upper and/or lower incisors, The comparison of treatment changes between therefore conventional biomechanical techniques the control and the MIAs groups showed that there commonly involve with various devices such as a was a decrease in posterior facial height/anterior high-pull chin cup, an utility intrusion arch, the use facial height proportion (PFH/AFH) in the control of MEAW and etc.6, 11-12, 15, 24 In this study, the control group. In contrast, an increase in this measurement group was treated with a combination of those of the MIAs group was found. This may imply that methods including intermaxillary elastics. In the the increase in the anterior facial height was found MIAs group, all patients selected the orthodontic plan in the control group but not found in the MIAs group. of using MIAs to intrude molars. In this study, we In addition, there was more decrease in facial index found that there were no significant differences in the variable of the control group, which means that the skeletal characteristics of both groups when compared lower anterior facial heights of control group were the post-treatment with the pre-treatment variables. more increased than the MIAs group. However, these For the dental changes, the overbite of both groups treatment changes were not significantly different was significantly corrected by extrusion and retraction when compared between groups. It might be because of the upper and lower incisors, more in the control than the amount of molar intrusion might not be large

128 Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 enough to cause skeletal changes. Moreover, the without the significant extrusion of the upper incisors. sample size in this study might not be able to result in Therefore, using MIAs could be another choice of the significant difference of skeletal vertical changes treatment for these types of patients. This study implies or show counterclockwise rotation of mandible. The that the MIAs were effective for molar intrusion, functional occlusal planes related to Frankfurt correction of anterior open bite with minimal patient horizontal plane (FH-FO) were slightly decrease in cooperation. the control group and slightly increase in the MIAs group but not significant differences in comparison between References the two groups. 1. Isaacson JR, Isaacson RJ, Speidel TM, Worms For dental changes, the upper incisors were re- FW. Extreme variation in vertical facial growth and tracted in both groups, but not significantly when associated variations in skeletal and dental rela- compared between groups. In contrast, the lower tions. Angle Orthod 1971; 41: 219-29. incisors were significantly more retracted in the control 2. Nahoun HI, Horowitz SL, Benedicto EA. Varieties of group which may be resulted from slightly more pro- anterior open bite. Am J Orthod 1972; 61: 486- truded position of the lower incisors before treatment. 92. This may caused the lower molars to be more protracted 3. Cangialosi TD. Skeletal morphologic features of in the MIAs group and the wedging effect occurred anterior open bite. Am J Orthod 1984; 85: to close the bite. Kuhn et al6 suggested that for every 28-36. 1 millimeter of molar intrusion, approximately 3 milli- 4. Arat ZM, I eri H, Arman A. Differential diagnosis of meters of open bite is reduced. In this study, the skeletal open bite based on sagittal components of result of this study was consistent with this previous the face. World J Orthod 2005; 6: 41-50. study. The mean of molar intrusion was 1.5±1.04 mm 5. YI Chang, SC Moon. Cephalometric evaluation of and the overbite was reduced by 4.25±1.7 mm. the anterior open bite treatment. Am J Orthod However, the limitation of this study was a small Dentofacial Orthop 1999; 115: 29-38. sample size. Further research on a larger sample group 6. Kuhn RJ. Control of anterior vertical dimension and is needed. proper selection of extraoral anchorage. Angle Orthod 1968; 38: 340-9. Conclusions 7. Iscan HN, Akkaya S, Koralp E. The effect of the From this study, correction of skeletal anterior spring-loaded posterior bite-block on the maxillo- open bite treated with or without MIAs could be facial morphology. Eur J Orthod 1992;14:54-60. achieved. Both treatment strategies produced 8. Speidel TM, Isaacson RJ, Worms FW. Tongue- satisfactory and similar results. However, there were thrust therapy and anterior dental openbite: a some different treatment effects between both groups. review of new facial growth data. Am J Orthod To correct the open bite using conventional technique 1972; 62: 287-95. without MIAs, extrusion and retraction of the upper and 9. Tuenge RH, Elder JR. Posttreatment changes lower incisors were found more than in the MIAs group. following extraoral high-pull traction to the maxilla The use of MIAs to intrude molars was found to be of Macaca mulatta. Am J Orthod 1974; 66: 618- useful in correction of skeletal anterior open bite 44.

Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages 129 Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

10. Fields HW, Proffit WR. Facial pattern differences in 18. Kanomi R. Mini-implant for orthodontic anchorage. long faced children and adults. Am J Orthod J Clin Orthod 1997; 31: 763-7. 1984; 85: 217-23. 19. Sherwood KH, Burch JG, Thompson WJ. Closing 11. Kim YH. Anterior openbite and its treatment with anterior open bites by intruding molars with tita- multiloop edgewise archwire. Angle Orthod 1987; nium miniplate anchorage. Am J Orthod Dentofacial 57: 290-321. Orthop 2002; 122: 593-600. 12. Isaacson RJ, Lindauer SJ. Closing anterior open 20. Erverdi N, Keles A, Nanda R. The use of skeletal bites: The extrusion arch. Semin Orthod 2001; anchorage in open bite treatment: a cephalometric 7: 34-41. evaluation. Angle Orthod 2004; 74: 381-90. 13. Schudy FF. The control of vertical overbite in 21. Sugawara J, Daimaruya T, Umemori M, et al. Distal clinical orthodontics. Angle Orthod 1968;38: movement of mandibular molars in adult patients 19-39. with skeletal anchorage system. Am J Orthod 14. Pearson LE. Vertical control through use of man- Dentofacial Orthop 2004; 125: 130-8.

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130 Cephalometric assessment in anterior open bite patients treated with and without mini-implant anchorages Penprapa Chiewcharat Suwannee Luppanapornlarp Supatchai Boonpratham Pongstorn Putongkam “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ MAHIDOL DENTAL JOURNAL « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 ∫∑«‘∑¬“°“√ ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘

®‘πμπ“ “√–∫√√®ß ∫∑§¥¬— Õà ∑.∫., ª.∫—≥±‘μ («‘∑¬“‡ÕÁπ‚¥¥Õπμå) °≈ÿà¡ß“π∑—πμ°√√¡ «—μ∂ÿª√– ß§å: ‡æ◊ËÕ»÷°…“ª√– ‘∑∏‘¿“æ°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ ‚√ßæ¬“∫“≈‡®√‘≠°√ÿßª√–™“√—°…å ‡™◊ÈÕ·∫§∑’‡√’¬∑’Ëæ∫‰¥â„π§≈Õß√“°øíπ∑’Ëμ‘¥‡™◊ÈÕ 2 ™π‘¥ ∏π‘¬“ À¡«¥‡™’¬ß§– «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“: π”‚ª√æÕ≈‘ (‚°≈∫Õ≈ μ“√å‚ª√æÕ≈‘ ) ´÷Ëß «∑.¡. ( “∏“√≥ ÿ¢»“ μ√å) ª√–°Õ∫¥â«¬‚ª√æÕ≈‘ ≈–≈“¬„πμ—«∑”≈–≈“¬‚¡‚π‚æ√‰æ≈’π‰°≈§Õ≈ „π ¿“§«‘™“®ÿ≈™’««‘∑¬“™àÕßª“° §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ª√‘¡“≥ 1:1 ‚¥¬πÈ”Àπ—° ‡μ√’¬¡ “√≈–≈“¬‚ª√æÕ≈‘ ®“°‚ª√æÕ≈‘ ¢â“ßμâπ ‚¥¬‡μ‘¡¥’‡ÕÁ¡‡Õ ‚Õ√âÕ¬≈– 5 §‘¥‡ªìπ “√≈–≈“¬μ—Èßμâπ¢Õß‚ª√æÕ≈‘ 515 ¡‘≈≈‘°√—¡μàÕ¡‘≈≈‘≈‘μ√ ®“°π—Èπ‡®◊Õ®“ß¥â«¬πÈ”°≈—Ëπ„Àâ‰¥â “√≈–≈“¬‚ª√æÕ≈‘ §«“¡‡¢â¡¢âπ 103, 20.6 ·≈– 4.12 ¡‘≈≈‘°√—¡/¡‘≈≈‘≈‘μ√ ∑¥ Õ∫§«“¡ “¡“√∂ „π°“√¬—∫¬—Èß‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ¥â«¬«‘∏’¥‘ §å¥‘øøî«™—Ëπ ‚¥¬¡’§≈Õ√å‡Œ°´‘¥’π√âÕ¬≈– 0.2 ‡ªìπμ—«§«∫§ÿ¡∫«° ·≈–À“§à“§«“¡‡¢â¡¢âπ¢Õß‚ª√æÕ≈‘ ∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë¡’º≈∑”≈“¬‡™◊ÈÕ∑—Èß 2 ™π‘¥ ¥â«¬«‘∏’∫√Õ∏‰¥≈Ÿ™—Ëπ º≈°“√»÷°…“: ‚ª√æÕ≈‘ “¡“√∂¬—∫¬—Èß·≈–∑”≈“¬‡™◊ÈÕ·∫§∑’‡√’¬∑—Èß 2 ™π‘¥‰¥â ‚¥¬§à“§«“¡‡¢â¡¢âπ¢Õß‚ª√æÕ≈‘ ∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë¡’º≈∑”≈“¬‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ §◊Õ 34.33 ·≈– 3.22 ¡‘≈≈‘°√—¡ μàÕ¡‘≈≈‘≈‘μ√ μ“¡≈”¥—∫ ∫∑ √ÿª: ‚ª√æÕ≈‘ “¡“√∂¬—∫¬—Èß·≈–∑”≈“¬‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ·μà¡’ª√– ‘∑∏‘¿“æπâÕ¬°«à“§≈Õ√å‡Œ°´‘¥’π √âÕ¬≈– 0.2 √À— §”: §à“§«“¡‡¢â¡¢âπ¢Õß “√∑¥ Õ∫∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë¡’º≈¬—∫¬—Èß‡™◊ÈÕ, §à“§«“¡ ‡¢â¡¢âπ¢Õß “√∑¥ Õ∫∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë¡’º≈∑”≈“¬‡™◊ÈÕ, ª√– ‘∑∏‘¿“æ°“√μâ“π‡™◊ÈÕ ·∫§∑’‡√’¬, ‚ª√æÕ≈‘ μ‘¥μàÕ‡°’Ë¬«°—∫∫∑§«“¡: ®‘πμπ“ “√–∫√√®ß °≈ÿà¡ß“π∑—πμ°√√¡ ‚√ßæ¬“∫“≈‡®√‘≠°√ÿßª√–™“√—°…å 8 ∂.‡®√‘≠°√ÿß ‡¢μ∫“ß§Õ·À≈¡ °√ÿß‡∑æœ 10120 ‚∑√»—æ∑å: 02-289-7049 ‚∑√ “√: 02-289-7649 Õ’‡¡≈å: [email protected] ·À≈àß‡ß‘π∑ÿπ: - «—π∑’Ë√—∫‡√◊ËÕß: 15 ‘ßÀ“§¡ 2554 «—π¬Õ¡√—∫μ’æ‘¡æå: 26 ∏—π«“§¡ 2554

ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 131 ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 MAHIDOL DENTAL JOURNAL Original article Antimicrobial Efficacy of Propolis against Enterococcus faecalis and Porphyromonas gingivalis

Jintana Sarabunchong Abstract D.D.S., Cert. in Endodontics Objective: To evaluate antimicrobial efficacy of propolis against two species Dental Department, Charoenkrung Pracharak Hospital of bacteria found in endodontic infections. Thaniya Muadcheingka Materials and methods: Propolis (Global star propolis) which composed of M.Sc. (Public Health) 50% propolis and 50% monopropylene glycol (w/w) was dissolved in Department of Oral Microbiology, 5% DMSO to obtain the concentration of 515 mg/ml as the working Faculty of Dentistry, Mahidol University solution. Then this solution further was diluted in distilled water to obtain the concentration of 103, 20.6 and 4.12 mg/ml. The antimicrobial activities of propolis on Enterococcus faecalis and Porphyromonas gingivalis were tested by the disc diffusion technique, using 0.2% chlorhexidine as a positive control. Minimal bactericidal concentrations were determined by using the broth dilution method. Results: Propolis was effective against Enterococcus faecalis and Porphyromonas gingivalis. Minimal bactericidal concentrations of propolis were 34.33 mg/ml for Enterococcus faecalis and 3.22 mg/ml for Porphyromonas gingivalis. Conclusion: Propolis was effective against Enterococcus faecalis and Porphyromonas gingivalis but less efficient than 0.2% chlorhexidine. Key words: antimicrobial efficacy, minimal bactericidal concentration, minimal inhibitory concentration, propolis .

Correspondence author: Jintana Sarabunchong Dental Department, Charoenkrung Pracharak Hospital 8 Charoenkrung Road Bangkholaem, Bangkok, 10120 Thailand. Tel: 02-289-7049 Fax: 02-289-7649 E-mail: [email protected] Research grant: - Received: 15 August 2011 Accepted: 26 December 2011

132 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

∫∑π” πÕ°®“°π’È¬—ßÀ“‰¥âßà“¬·≈–√“§“∂Ÿ° ·μà¡’§«“¡‡ªìπæ‘…μàÕ °“√μ‘¥‡™◊ÈÕ·∫§∑’‡√’¬„π§≈Õß√“°øíπ‡ªìπ “‡Àμÿ ‡´≈≈å ·≈–∑”Õ—πμ√“¬μàÕ‡π◊ÈÕ‡¬◊ËÕ„π·≈–‡π◊ÈÕ‡¬◊ËÕ√Õ∫ª≈“¬ À≈—°¢Õß°“√Õ—°‡ ∫∫√‘‡«≥ª≈“¬√“°øíπ1 ‚¥¬Õ“®æ∫‡™◊ÈÕ √“°øíπ¡“°7,8,9,10 ¡’√“¬ß“π«à“‚´‡¥’¬¡‰Œ‚ª§≈Õ‰√∑å∑”„Àâ ‰¥âμ—Èß·μà 1-12 ™π‘¥ „π§≈Õß√“°øíπ∑’Ë‡ªìπ°“√μ‘¥‡™◊ÈÕ ‡°‘¥Õ“°“√·∑√°´âÕπ‡¡◊ËÕπÈ”¬“∂Ÿ°¥—πÕÕ°‰ªπÕ°ª≈“¬ §√—Èß·√° (primary infection) ‡™◊ÈÕ∑’Ëæ∫¡—°‡ªìπ™π‘¥ √“°øíπ√–À«à“ß°“√≈â“ß§≈Õß√“°øíπÀ√◊Õ√—Ë«ºà“π·ºàπ¬“ß ·∫§∑’‡√’¬°√—¡∫«°·≈–°√—¡≈∫„π —¥ à«π„°≈â‡§’¬ß°—π ·≈– °—ππÈ”≈“¬ ‚¥¬ºŸâªÉ«¬®–‡°‘¥Õ“°“√ª«¥Õ¬à“ß√ÿπ·√ß ¡’°“√ ‡ªìπ‡™◊ÈÕ™π‘¥∑’Ë∑πÕÕ°´‘‡®π‰¡à‰¥â (obligate anaerobe) ∫«¡¢Õß‡π◊ÈÕ‡¬◊ËÕ√Õ∫Ê ‡°‘¥°“√μ“¬¢Õß‡π◊ÈÕ‡¬◊ËÕ ¡’‡≈◊Õ¥ ‰¥â·°à ‡™◊ÈÕ„π°≈ÿà¡æÕ√åøî‚√‚¡·π (porphyromonas) ‚¥¬ ÕÕ°„μâº‘«Àπ—ß·≈–‡¬◊ËÕ∫ÿ ºŸâªÉ«¬∫“ß√“¬‡°‘¥°“√∑”ß“π∑’Ë ‡©æ“–æÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ (Porphyromonas º‘¥ª°μ‘¢Õß‡ âπª√– “∑∑’Ë¡“‡≈’È¬ß„∫Àπâ“ πÕ°®“°π—Èπ gingivalis) ´÷Ëß‡ªìπ·∫§∑’‡√’¬°√—¡≈∫ ‡™◊ÈÕπ’Èæ∫‰¥âª√–¡“≥ ºŸâªÉ«¬Õ’°√“¬Àπ÷Ëß¬—ß‡°‘¥Õ“°“√∫«¡¢Õßæ◊Èπª“° (floor of √âÕ¬≈– 28 ®“°μ—«Õ¬à“ß‡π◊ÈÕ‡¬◊ËÕ„π (pulp) ∑’Ëμ“¬·≈â«2,3,4 the mouth) ∑”„Àâªî¥°—Èπ∑“ß‡¥‘πÀ“¬„®10,11,12 πÈ”¬“Õ’° à«π‡™◊ÈÕ„π§≈Õß√“°øíπ∑’Ë≈â¡‡À≈«®“°°“√√—°…“§≈Õß ™π‘¥Àπ÷Ëß∑’Ëπ”¡“„™â≈â“ß§≈Õß√“°øíπ§◊Õ §≈Õ√å‡Œ°´‘¥’π √“°øíπ·≈–μâÕß‰¥â√—∫°“√√—°…“§≈Õß√“°øíπ´È” (retreat- (chlorhexidine) ´÷Ëß¡’º≈„π°“√μâ“π∑“π‡™◊ÈÕ·∫§∑’‡√’¬ ment) ¡—°æ∫™π‘¥¢Õß‡™◊ÈÕπâÕ¬°«à“ à«π„À≠à‡ªìπ ∑’Ë∑πÕÕ°´‘‡®π‰¡à‰¥â (anaerobic bacteria) ¥’°«à“‚´‡¥’¬¡ ·∫§∑’‡√’¬°√—¡∫«° ·≈–‡ªìπ·∫§∑’‡√’¬∑’Ë‡®√‘≠‰¥â∑—Èß¿“«– ‰Œ‚ª§≈Õ‰√∑å ·≈–¡’§«“¡‡ªìπæ‘…μàÕ‡´≈≈åπâÕ¬°«à“ ·μà ∑’Ë¡’·≈–‰¡à¡’ÕÕ°´‘‡®π (facultative anaerobic) ‡™àπ §≈Õ√å‡Œ°´‘¥’π‰¡à “¡“√∂≈–≈“¬‡π◊ÈÕ‡¬◊ËÕ„π∑’Ëμ“¬·≈â« ·≈– ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°‰§ (enterococci) ·≈– ‡μ√Á∫‚μ§Õ°‰§ ¡’º≈μàÕ‡™◊ÈÕ·∫§∑’‡√’¬°√—¡≈∫πâÕ¬°«à“·∫§∑’‡√’¬°√—¡∫«°8,9 (streptococci) ‚¥¬„π°≈ÿà¡‡ÕÁπ‡∑Õ‚√§Õ°‰§ æ∫‡™◊ÈÕ ‚ª√æÕ≈‘ (propolis) ‡ªìπ à«πº ¡¢Õß¢’Èº÷Èß·≈– ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ (Enterococcus faecalis) ¡“° ‡√´‘π (resin) ∑’Ë‰¥â®“°º÷Èß “¬æ—π∏ÿå‡Õæ‘ ‡¡≈≈‘‡øÕ≈“ ∑’Ë ÿ¥ ´÷Ëß‡ªìπ‡™◊ÈÕ∑’Ë¡—°∑πμàÕ “√μâ“π®ÿ≈™’æ„π§≈Õß√“°øíπ (Apis mellifera) ´÷Ëß‡ªìπº÷Èß„π´’°‚≈°μ–«—πμ° √«∫√«¡ (intracanal medicament)2,5,6 ®“°æ◊™À≈“¬™π‘¥‚¥¬‡©æ“–®“°¥Õ°‰¡â √Õ¬·μ°¢Õß ‡™◊ÈÕ·∫§∑’‡√’¬„π§≈Õß√“°øíπ‰¡à‰¥âÕ¬Ÿà‡©æ“– ‡ª≈◊Õ°‰¡â·≈–μ“„∫ „π¢—ÈπμÕπ°“√√«∫√«¡‡√´‘π º÷Èß®– „π§≈Õß√“°À≈—° ·μà¬—ßæ∫‰¥â„π∑àÕ‡π◊ÈÕøíπ (dentinal º ¡‡ÕÁπ‰´¡å®“°πÈ”≈“¬º÷Èß·≈–¢’Èº÷Èß≈ß‰ª¥â«¬ º÷Èßπ” tubules)3 ª≈“¬√“°øíπ∑’Ë¡’°“√·μ°·¢πß (apical canal ‚ª√æÕ≈‘ ¡“„™âªî¥√Õ¬·μ°¢Õß√—ß·≈–∑”„Àâ∑“ß‡¢â“√—ß ramification) √Õ¬§Õ¥ (isthmus) ·≈–≈—°…≥–∑’Ëº‘¥ª°μ‘ ‡≈Á°≈ß ‡æ◊ËÕªÑÕß°—πºŸâ√ÿ°√“π ·≈–„™âÀàÕÀÿâ¡´“° —μ«å∑’Ëμ“¬ ¢Õß√“°øíπÕ◊ËπÊ ´÷Ëß„π°“√√—°…“§≈Õß√“°øíπ ‡§√◊ËÕß¡◊Õ ¿“¬„π√—ß·≈–„À≠à‡°‘π°«à“∑’Ëº÷Èß®–‡Õ“ÕÕ°®“°√—ß‰¥â‡æ◊ËÕ ¢¬“¬®–‰¡à “¡“√∂‡¢â“‰ª¢¬“¬‡Õ“‡π◊ÈÕ‡¬◊ËÕ„π ·∫§∑’‡√’¬ ªÑÕß°—π‡™◊ÈÕ‚√§ πÕ°®“°π—Èπ¬—ß„™âªî¥™àÕß∑’Ë«“ß‰¢à‡æ◊ËÕ ·≈– ‘Ëß °ª√°„π∫√‘‡«≥¥—ß°≈à“«ÕÕ°‰¥â4 ®÷ß®”‡ªìπμâÕß ªÑÕß°—π°“√μ‘¥‡™◊ÈÕ¢Õßμ—«ÕàÕπ13 ≈—°…≥–¢Õß‚ª√æÕ≈‘ „™âπÈ”¬“≈â“ß§≈Õß√“°øíπ√à«¡°—∫°“√¢¬“¬§≈Õß√“° ‡æ◊ËÕ ®–ÕàÕπ ·≈–‡Àπ’¬«¡“°‡¡◊ËÕÕÿ≥À¿Ÿ¡‘ Ÿß°«à“ 20 Õß»“- ™à«¬∑”§«“¡ –Õ“¥„π§≈Õß√“°øíπ„Àâ¥’¬‘Ëß¢÷Èπ3,4,7,8 πÈ”¬“ ‡´≈‡´’¬ ·μà‡¡◊ËÕÕ¬Ÿà„πÕÿ≥À¿Ÿ¡‘∑’ËμË”°«à“π—Èπ®–·¢Áß·≈– ≈â“ß§≈Õß√“°øíπ∑’Ë¥’ §«√¡’ƒ∑∏‘Ï„π°“√∑”≈“¬·∫§∑’‡√’¬ ‡ª√“– à«π ’∑’Ëæ∫®–¡’ ’‰¥âμ—Èß·μà ’‡À≈◊ÕßÕàÕπ ’‡¢’¬« ‰¥âÕ¬à“ß°«â“ß¢«“ß “¡“√∂≈–≈“¬‡π◊ÈÕ‡¬◊ËÕ„π∑’Ëμ“¬·≈â« ®π∂÷ß ’πÈ”μ“≈‡¢â¡ ·≈–Õ“®æ∫≈—°…≥–„ ¥â«¬ ‚¥¬ ’ ∑”≈“¬æ‘…„π§≈Õß√“°øíπ ™à«¬°”®—¥™—Èπ ‡¡’¬√å (smear °≈‘Ëπ·≈–§ÿ≥ ¡∫—μ‘∑“ß¬“ ¢÷Èπ°—∫·À≈àß¢Õß‡√´‘π·≈– layer) ·≈–‰¡à‡ªìπÕ—πμ√“¬μàÕ‡π◊ÈÕ‡¬◊ËÕ√Õ∫ª≈“¬√“°øíπ ƒ¥Ÿ°“≈13,14,15 à«πª√–°Õ∫¢Õß‚ª√æÕ≈‘ ¢÷Èπ°—∫™π‘¥ ´÷Ëß„πªí®®ÿ∫—π¬—ß‰¡à¡’πÈ”¬“μ—«„¥∑’Ë¡’≈—°…≥–∑’Ë¥’¥—ß°≈à“« ¢Õßæ◊™∑’Ëº÷Èß‡°Á∫√«∫√«¡¡“ ª°μ‘ª√–°Õ∫¥â«¬ ‡√´‘π·≈– πÈ”¬“≈â“ß§≈Õß√“°øíπ∑’Ëπ‘¬¡„™âÕ¬à“ß·æ√àÀ≈“¬ §◊Õ ¬“ßÀÕ¡ (balsam) √âÕ¬≈– 50 ¢’Èº÷Èß√âÕ¬≈– 30 πÈ”¡—π ‚´‡¥’¬¡‰Œ‚ª§≈Õ‰√∑å (sodium hypochlorite) ‡æ√“–¡’ ÀÕ¡√–‡À¬ (essential and aromatic oil) √âÕ¬≈– 10 §≥ ¡∫ÿ μ— ∑‘ ¥’Ë „π°“√∑”≈“¬‡™’ Õ·∫§∑◊È ‡√’ ¬’ ≈–≈“¬‡πÕ‡¬◊È Õ„π◊Ë ≈–ÕÕß‡° √√âÕ¬≈– 5 ·≈– “√Õ◊ËπÊ ‡™àπ«‘μ“¡‘π·≈–·√à∏“μÿ

ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 133 ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Õ’°√âÕ¬≈– 514 ´÷Ëß„π‡√´‘π à«π„À≠à¡’ à«πª√–°Õ∫ ´ß “√∑÷Ë ¡’Ë º≈μ’ “π‡™â Õ·∫§∑◊È ‡√’ ¬·≈–‡™’ Õ‰«√◊È §— Õø≈“‚«πÕ¬¥◊ å ∑“ß‡§¡’§◊Õø≈“‚«πÕ¬¥å (flavonoid) °√¥øï‚π≈‘§ (flavonoid) °√¥Õ‚√¡“μ‘§ (aromatic acid ) ·≈–‡Õ ‡∑Õ√å ·≈–‡Õ ‡∑Õ√å (phenolic acid and ester)13 ¡’°“√„™â (ester)24 à«π “√∑’Ë¡’º≈μàÕ§«“¡‡ªìπæ‘…¢Õß‡´≈≈å¡–‡√Áß ‚ª√æÕ≈‘ ¡“‡ªìπ‡«≈“π“π°«à“ 300 ªï °àÕπ§√‘ μ°“≈ §◊Õ´’‡Õæ’Õ’ (CAPE, caffeic acid phenyl ester) πÕ°®“° ®π∂÷ßªí®®ÿ∫—π ‚¥¬™“«°√’°·≈–‚√¡—π„™â√—°…“μÿà¡ÀπÕß∑’Ë π’È‚ª√æÕ≈‘ ¬—ß¡’ƒ∑∏‘Ïμâ“π°“√Õ—°‡ ∫ ‚¥¬æ∫«à“ “√∑’Ë∑”„Àâ º‘«Àπ—ß Õ’¬‘ªμå‚∫√“≥„™â‡ªìπ¬“ à«π™“«Õ—ø√‘°—π„™â‡ªìπ¬“ ¡’º≈π’È§◊Õ´’‡Õæ’Õ’·≈–ø≈“‚«πÕ¬¥14,25å ‡™àπ°—π πÕ°®“°π—Èπ¬—ß„™â¬÷¥°≈Õß ªî¥√Õ¬·μ°„π¿“™π– ø≈“‚«πÕ¬¥åæ∫‰¥â„π‡´≈≈åæ◊™∑’Ë —ß‡§√“–Àå· ß ‡¡◊ËÕ „ àπÈ”·≈–‡√◊Õ·§πŸ ·≈–‡ªìππÈ”¡—π™—°‡ß“‰«‚Õ≈‘π ªí®®ÿ∫—π ‡´≈≈åμ“¬ ø≈“‚«πÕ¬¥å®–∂Ÿ°ª≈¥ª≈àÕ¬Õ¬Ÿà„π¢Õß‡À≈« ‚ª√æÕ≈‘ ∂Ÿ°π”¡“„™â√—°…“∑’Ëº‘«Àπ—ß·≈–„™â‡ªìπ‡§√◊ËÕß ¢Õßæ◊™·≈–‡√´‘π ø≈“‚«πÕ¬¥å¡’ª√–¡“≥ 500 ™π‘¥ ·μà ”Õ“ß¡“°∑’Ë ÿ¥ ‡™àπ §√’¡∑“Àπâ“ §√’¡√—°…“ ‘« à«π „π‚ª√æÕ≈‘ æ∫‰¥âª√–¡“≥ 150 ™π‘¥ ø≈“‚«πÕ¬¥å °“√√—°…“∑“ßº‘«Àπ—ß ‡™àπ √—°…“∫“¥·º≈·≈–·º≈‰ø≈«° ¡’§ÿ≥ ¡∫—μ‘‡ªìπμ—«¢—∫Õπÿ¡Ÿ≈Õ‘ √–∑’Ë¥’·≈–≈¥°“√‡°‘¥Õπÿ¡Ÿ≈ °“√øóôπøŸ‡π◊ÈÕ‡¬◊ËÕ (tissue regeneration) ‡ªìπμâπ Õ‘ √–‚¥¬√«¡°—∫‚≈À–Àπ—° ·≈–¡’Õ‘∑∏‘æ≈μàÕ°“√´÷¡ºà“π πÕ°®“°π—Èπ¬—ß„™â‡ªìπÕ“À“√‡ √‘¡·≈–√—°…“‚√§Õ◊ËπÊ ‡™àπ ¢Õß‡¬◊ËÕ (permeability of membrane) ‡ªìπº≈∑”„Àâ √–∫∫À—«„®·≈–À≈Õ¥‡≈◊Õ¥ (‚√§‡≈◊Õ¥®“ß) √–∫∫∑“ß‡¥‘π ¡’ƒ∑∏‘Ï¶à“‡™◊ÈÕ·∫§∑’‡√’¬ πÕ°®“°π—Èπ¬—ß¡’ƒ∑∏‘Ïμâ“π°“√ À“¬„® ‚√§‡°’Ë¬«°—∫ÀŸ §Õ ®¡Ÿ°·≈–°≈àÕß‡ ’¬ß √–∫∫¿Ÿ¡‘ Õ—°‡ ∫ ‚¥¬¬—∫¬—Èßæ√Õ μ“·°≈π¥‘π (prostaglandin) §ÿâ¡°—π °“√√—°…“¡–‡√Áß °“√μ‘¥‡™◊ÈÕ·≈–·º≈¢Õß∑“ß‡¥‘π ∑”„Àâ≈¥‰¢â·°âª«¥‰¥25â Õ“À“√ ‚√§¢âÕμàÕÕ—°‡ ∫·≈–Õ◊ËπÊ „π∑“ß∑—πμ°√√¡ ®“°§ÿ≥ ¡∫—μ‘¥—ß°≈à“«¢Õß‚ª√æÕ≈‘ ®÷ß‡ªìπ‡√◊ËÕß ‚ª√æÕ≈‘ ∂Ÿ°„™â‡ªìπ à«πº ¡„π¬“ ’øíπ ‰À¡¢—¥øíπ πÈ”¬“ πà“ π„®∑’Ë®–‰¥â¡’°“√»÷°…“ª√– ‘∑∏‘¿“æ°“√μâ“π‡™◊ÈÕ ∫â«πª“° À¡“°Ω√—Ëß ‡æ◊ËÕ√—°…“‚√§‡Àß◊Õ°Õ—°‡ ∫ √‘¡Ωïª“° ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ ∑’Ë¡’®”Àπà“¬„πª√–‡∑»‰∑¬μàÕ‡™◊ÈÕ Õ—°‡ ∫ (cheilitis) ª“°Õ—°‡ ∫ (stomatitis) ·≈–¡’ „π§≈Õß√“°øíπ 2 ™π‘¥ §◊Õ ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ §ÿ≥ ¡∫—μ‘‡ªìπ¬“™“13,14 ¡’√“¬ß“π°“√»÷°…“«à“‚ª√æÕ≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫º≈ “¡“√∂§«∫§ÿ¡øíπºÿ‰¥â„π —μ«å∑¥≈Õß ≈¥°“√ – ¡¢Õß °∫°“√»— °…“∑÷ º’Ë “π¡“à ‡πÕß®“°ª√– ◊Ë ∑∏‘ ¿“æ¢Õß‚ª√æÕ≈‘ ‘ §√“∫®ÿ≈‘π∑√’¬å16,17 ·≈–‰¡à∑”Õ—πμ√“¬μàÕ‡π◊ÈÕ‡¬◊ËÕ„π·≈– ®“°·À≈ß∑à ¡“∑’Ë ·μ°μ’Ë “ß°à πÕ“®¡— ª√– ’ ∑∏‘ ¿“æ‰¡‘ ‡À¡à Õπ°◊ π— ‡π◊ÈÕ‡¬◊ËÕ√Õ∫ª≈“¬√“°øíπ ‚¥¬¡’√“¬ß“π°“√»÷°…“§«“¡ ·≈–‡æ◊ËÕ‡ªìπ·π«∑“ß°“√π”‚ª√æÕ≈‘ ¡“„™â√à«¡„π°“√ ¡’™’«‘μ¢Õß‡´≈≈å‡π◊ÈÕ‡¬◊ËÕ√Õ∫ª≈“¬√“°øíπ¢Õßøíπ∑’ËÀ≈ÿ¥ √—°…“§≈Õß√“°øíπ„Àâ¡’ª√– ‘∑∏‘¿“æ¥’¬‘Ëß¢÷Èπ ®“°‡∫â“øíπ‡¡◊ËÕ·™à„ππÈ”¬“™π‘¥μà“ßÊ æ∫«à“‚ª√æÕ≈‘ √âÕ¬≈– 10 ¡’§ÿ≥ ¡∫—μ‘¥’°«à“‡Õ™ ∫’ ‡Õ ‡Õ (HBSS, «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“ Hankûs balanced salt solution) ´÷Ëß‡Õ™ ∫’ ‡Õ ‡Õ °“√‡μ√’¬¡ “√≈–≈“¬‚ª√æÕ≈‘ ‡ªìππÈ”¬“ ”À√—∫·™àøíπ∑’ËÀ≈ÿ¥®“°‡∫â“øíπ ·π–π”‚¥¬ ‚ª√æÕ≈‘ ®“°∫√‘…—∑‚°≈∫Õ≈ μ“√åÕ‘π‡μÕ√å‡π™—Ëπ- ¡“§¡∑—πμ·æ∑¬å‡ÕÁπ‚¥¥Õπμå¢Õß À√—∞Õ‡¡√‘°“ ·π≈®”°—¥ (Global Star International Co.,Ltd) ª√–‡∑» (American Association of Endodontists)18,19 ·≈– Õ—ß°ƒ… ≈—°…≥–‡ªìπ¢Õß‡À≈« ’πÈ”μ“≈‡¢â¡ ‚¥¬¡’ ¡’√“¬ß“πª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬∑’Ëæ∫‰¥â ‚ª√æÕ≈‘ ≈–≈“¬„πμ—«∑”≈–≈“¬‚¡‚π‚æ√‰æ≈’π‰°≈§Õ≈ „π§≈Õß√“°øíπ∑’Ëμ‘¥‡™◊ÈÕ20,21,22 à«π„π‡∑§‚π‚≈¬’¥â“π (monopropylene glycol) „πª√‘¡“≥ 1:1 ‚¥¬πÈ”Àπ—° Õ“À“√ ¡’°“√„™â‚ª√æÕ≈‘ „π°“√∂πÕ¡Õ“À“√ ™à«¬¬◊¥ ‡μ√’¬¡ “√≈–≈“¬‚ª√æÕ≈‘ ®“°‚ª√æÕ≈‘ ¢â“ßμâπ‚¥¬‡μ‘¡ Õ“¬ÿ¢Õßª≈“·™à·¢ÁßÕÕ°‰ª‰¥âÕ’° 2-3 ‡∑à“ ‡æ‘Ë¡º≈º≈‘μ ¥’‡ÕÁ¡‡Õ ‚Õ (DMSO) √âÕ¬≈– 5 §‘¥‡ªìπ “√≈–≈“¬μ—Èßμâπ ¢Õß‰¢à‰°à ·≈–‡æ‘Ë¡πÈ”Àπ—°¢Õß‰°à‡≈’È¬ß13 ®“°º≈¢Õß ¢Õß‚ª√æÕ≈‘ 515 ¡‘≈≈‘°√—¡μàÕ¡‘≈≈‘≈‘μ√ ®“°π—Èπ∑”°“√ ‚ª√æÕ≈‘ ∑’Ëπ”¡“„™âª√–‚¬™πå„π°“√√—°…“‡π◊ËÕß®“° ‡®◊Õ®“ß¥â«¬πÈ”°≈Ë—πª√“»®“°‡™◊ÈÕ„Àâ‰¥â‚ª√æÕ≈‘ §«“¡ §ÿ≥ ¡∫—μ‘„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬ ‡™◊ÈÕ√“·≈–‰«√— 23,24 ‡¢â¡¢âπ 103, 20.6 ·≈– 4.12 ¡‘≈≈‘°√—¡μàÕ¡‘≈≈‘≈‘μ√

134 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

°“√‡μ√’¬¡·∫§∑’‡√’¬ ∑’Ë¡’ “√∑¥ Õ∫·≈–μ—«§«∫§ÿ¡·μà≈–™π‘¥«“ß≈ß∫πÕ“À“√ ‡™◊ÈÕ∑’Ë∑¥ Õ∫ §◊Õ ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ‡≈’È¬ß‡™◊ÈÕ ”À√—∫‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ®–Õ∫ “¬æ—π∏ÿå¡“μ√∞“π ATCC 19433 ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π „πμŸâ∫à¡‡™◊ÈÕ∑’ËÕÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ π“π 24 ™—Ë«‚¡ß ®‘π®‘«“≈‘ “¬æ—π∏ÿå¡“μ√∞“π W 50 à«π‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®–Õ∫„πμŸâ∫à¡‡™◊ÈÕ∑’Ë °“√‡æ“–‡≈’È¬ß‡™◊ÈÕ π”‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— Õÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ „π∫√√¬“°“»∑’Ë¡’‰Œ‚¥√‡®π øï§—≈≈‘ ¡“‡æ“–‡≈’È¬ß„πÕ“À“√‡≈’È¬ß‡™◊ÈÕ‡∫√πŒ“√å∑ √âÕ¬≈– 5 §“√å∫Õπ‰¥ÕÕ°‰´¥å ‰π‚μ√‡®π ∫“≈“π å Õ‘πøî«™—ËπÕ–°“√å (Brain heart infusion agar) Õ∫„πμŸâ √âÕ¬≈– 10 ·≈–‰π‚μ√‡®π∫√‘ ÿ∑∏‘Ï (√âÕ¬≈– 99.99) ∫à¡‡™◊ÈÕ∑’ËÕÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ π“π 24 ™—Ë«‚¡ß π“π 5-7 «—π ®“°π—Èππ”®“π‡æ“–‡™◊ÈÕ¡“μ√«®¥Ÿ°“√‡®√‘≠ à«π‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®–π”¡“‡æ“–‡≈’È¬ß„π ‡μ‘∫‚μ¢Õß‡™◊ÈÕ ·≈–«—¥¢π“¥¢Õß¢Õ∫‡¢μ°“√¬—∫¬—Èß‡™◊ÈÕ Õ“À“√‡≈’È¬ß‡™◊ÈÕ·Õπ·Õ‚√∫‡∫´—≈Õ–°“√å (Anaerobe basal (Inhibition zone) ‚¥¬°“√∑¥≈Õß∑”´È” 2 §√—Èß agar) (Oxoid, Hampshire, England) ‚¥¬‡μ‘¡‡≈◊Õ¥·°– °“√À“§«“¡‡¢â¡¢âπ¢Õß‚ª√æÕ≈‘ ∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë¡’ √âÕ¬≈– 5 Õ∫„πμŸâ∫à¡‡™◊ÈÕ∑’ËÕÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ º≈∑”≈“¬À√◊Õ§à“‡ÕÁ¡∫’´’ (MBC, minimal bactericidal „π∫√√¬“°“»∑’Ë¡’‰Œ‚¥√‡®π (hydrogen) √âÕ¬≈– 5 concentration) ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕ §“√å∫Õπ‰¥ÕÕ°‰´¥å‰π‚μ√‡®π ∫“≈“π å (carbon dioxide æÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ‚¥¬«‘∏’∫√Õ∏‰¥≈Ÿ™—Ëπ (Broth nitrogen balance) √âÕ¬≈– 10 ·≈–‰π‚μ√‡®π∫√‘ ÿ∑∏‘Ï dilution) (√âÕ¬≈– 99.99) π“π 5-7 «—π ‡μ√’¬¡ “√≈–≈“¬‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ „Àâ¡’§«“¡¢ÿàπ‡∑à“°—∫ «‘∏’°“√»÷°…“ ·¡§ø“√å·≈π¥å 0.5 „πÕ“À“√‡≈’È¬ß‡™◊ÈÕ ‡∫√πŒ“√å∑ °“√∑¥ Õ∫§«“¡ “¡“√∂„π°“√¬—∫¬—Èß‡™◊ÈÕ¥â«¬ Õ‘πøî«™—Ëπ∫√Õ∏ ·≈–‡™¥‡≈Õ√å·Õπ·Õ‚√∫∫√Õ∏ (Schaedler «‘∏’¥‘ §å¥‘øøî«™—π (Disc diffusion) anaerobe broth) μ“¡≈”¥—∫ ´÷Ëß®–¡’‡™◊ÈÕª√–¡“≥ ‡μ√’¬¡ “√≈–≈“¬®ÿ≈‘π∑√’¬å∑—Èß Õß™π‘¥„ππÈ”‡°≈◊Õ 0.5x108 μ—«μàÕ¡‘≈≈‘≈‘μ√ ®“°π—Èπ„ à “√≈–≈“¬‚ª√æÕ≈‘ ª√“»®“°‡™◊ÈÕ„Àâ¡’§«“¡¢ÿàπ‡∑à“°—∫·¡§ø“√å·≈π¥å 0.5 §«“¡‡¢â¡¢âπμà“ßÊ μ—Èß·μà 103 ®π∂÷ß 3.22 ¡‘≈≈‘°√—¡ (McFarland No. 0.5) ´÷Ëß§‘¥‡∑’¬∫‡ªìπª√‘¡“≥‡™◊ÈÕ μàÕ¡‘≈≈‘≈‘μ√ „π “√≈–≈“¬‡™◊ÈÕ·μà≈–™π‘¥„πÀ≈Õ¥∑¥≈Õß 0.5x108 μ—«μàÕ¡‘≈≈‘≈‘μ√ ·≈â«‡°≈’Ë¬∫πÕ“À“√‡≈’È¬ß‡™◊ÈÕ π”‰ªÕ∫„πμŸâ∫à¡‡™◊ÈÕ∑’ËÕÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ ∑’Ë „Àâ∑—Ë«‚¥¬„™â‰¡âæ—π ”≈’ª√“»®“°‡™◊ÈÕ Õ“À“√‡≈’È¬ß‡™◊ÈÕ¢Õß ∫√√¬“°“»‡À¡“– ¡π“π 24 ™—Ë«‚¡ß ”À√—∫‡™◊ÈÕ‡ÕÁπ‡∑Õ ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ®–„™â‡∫√πŒ“√å∑Õ‘πøî«™—Ëπ ‚√§Õ°§— øï§—≈≈‘ à«π‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ Õ–°“√å à«π‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®–„™â·Õπ- Õ∫„πμŸâ∫à¡‡™◊ÈÕ∑’ËÕÿ≥À¿Ÿ¡‘ 37 Õß»“‡´≈‡´’¬ „π∫√√¬“°“» ·Õ‚√∫‡∫´—≈Õ–°“√å ‚¥¬¡’§«“¡Àπ“¢ÕßÕ–°“√å‡∑à“°—∫ ∑’Ë¡’‰Œ‚¥√‡®π √âÕ¬≈– 5 §“√å∫Õπ‰¥ÕÕ°‰´¥å ‰π‚μ√‡®π 4 ¡‘≈≈‘‡¡μ√ ·≈–§«∫§ÿ¡§«“¡Àπ“‚¥¬„ àª√‘¡“μ√¢Õß ∫“≈“π å √âÕ¬≈– 10 ·≈–‰π‚μ√‡®π∫√‘ ÿ∑∏‘Ï (√âÕ¬≈– Õ–°“√å‡∑à“°—∫ 25 ¡‘≈≈‘≈‘μ√ 99.99) π“π 5-7 «—π ®“°π—Èππ”¡“μ√«®¥Ÿ°“√‡®√‘≠ π” “√≈–≈“¬‚ª√æÕ≈‘ §«“¡‡¢â¡¢âπ 515, 103, ‡μ‘∫‚μ¢Õß‡™◊ÈÕ„πÕ“À“√‡≈’È¬ß‡™◊ÈÕ‡À≈«¥—ß°≈à“« ‚¥¬ —ß‡°μ 20.6 ·≈– 4.12 ¡‘≈≈‘°√—¡μàÕ¡‘≈≈‘≈‘μ√ ª√‘¡“≥ ®“°§«“¡¢ÿàπ¢ÕßÕ“À“√‡≈’È¬ß‡™◊ÈÕ∑’Ë‡°‘¥®“°°“√‡®√‘≠‡μ‘∫‚μ 25 ‰¡‚§√≈‘μ√ À¬¥≈ß∫π°√–¥“…°√Õßª√“»®“°‡™◊ÈÕ ¢Õß‡™◊ÈÕ‡ª√’¬∫‡∑’¬∫°—∫°≈ÿà¡§«∫§ÿ¡ ‡æ◊ËÕÀ“§«“¡‡¢â¡¢âπ (sterile disc) ™π‘¥‡°√¥‡Õ‡Õ (AA discs) ¢π“¥ 6 ¡‘≈≈‘- ∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë “¡“√∂¬—∫¬—Èß‡™◊ÈÕ‰¥âÀ√◊Õ§à“‡ÕÁ¡‰Õ´’ (MIC, ‡¡μ√ ¢Õß∫√‘…—∑«Õ∑·¡π (Whatman) ª√–‡∑»Õ—ß°ƒ… minimal inhibitory concentration) ®“°π—Èππ”Õ“À“√‡≈’È¬ß °“√∑¥ Õ∫π’È®–„™â “√≈–≈“¬§≈Õ√å‡Œ°´‘¥’π√âÕ¬≈– ‡™◊ÈÕ‡À≈«À≈Õ¥∑’Ë‰¡àæ∫«à“¡’§«“¡¢ÿàπ ¡“‡æ“–‡≈’È¬ß∫π®“π 0.2 ‡ªìπμ—«§«∫§ÿ¡∫«°·≈– “√≈–≈“¬¥’‡ÕÁ¡‡Õ ‚Õ Õ“À“√‡æ“–‡™◊ÈÕ‡∫√πŒ“√å∑Õ‘πøî«™—Ëπ ·≈–·Õπ·Õ‚√∫- √âÕ¬≈– 5 „ππÈ”‡ªìπμ—«§«∫§ÿ¡≈∫ π”·ºàπ°√–¥“…°√Õß ‡∫´—≈Õ–°“√å ‡æ◊ËÕμ√«®¥Ÿ°“√‡®√‘≠‡μ‘∫‚μ¢Õß‡™◊ÈÕ‡ÕÁπ‡∑Õ

ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 135 ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ‚ª√æÕ≈‘ ¡’º≈¬—∫¬—Èß‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈– μ“¡≈”¥—∫ À“°‰¡àæ∫«à“¡’‚§‚≈π’ (colony) ¢Õß‡™◊ÈÕ ‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ‚¥¬¡’¢π“¥¢Õß¢Õ∫‡¢μ ª√“°Ø∫πÕ“À“√‡æ“–‡™◊ÈÕ ®–∂◊Õ«à“ “√≈–≈“¬‚ª√æÕ≈‘ °“√¬—∫¬—Èß‡™◊ÈÕ ¥—ßμ“√“ß∑’Ë 1 √Ÿª∑’Ë 1 ·≈–√Ÿª∑’Ë 2 §«“¡‡¢â¡¢âππ—Èπ “¡“√∂∑”≈“¬‡™◊ÈÕ‰¥â ∑”„Àâ “¡“√∂ °“√À“§à“‡ÕÁ¡‰Õ´’¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ À“§«“¡‡¢â¡¢âπ∑’ËπâÕ¬∑’Ë ÿ¥∑’Ë∑”≈“¬‡™◊ÈÕ‰¥â ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ °“√∑¥≈Õß∑—ÈßÀ¡¥®–∑”´È” “¡§√—Èß ‚¥¬·μà≈–§√—Èß ¥â«¬«‘∏’∫√Õ∏‰¥≈Ÿ™—Ëπ‰¡à “¡“√∂∑”‰¥â ‡π◊ËÕß®“°À≈—ß®“° ®–∑”°“√∑¥≈Õß„π≈—°…≥– triplicate „ à‚ª√æÕ≈‘ „π “√≈–≈“¬‡™◊ÈÕ·μà≈–™π‘¥ ®–‰¥â “√≈–≈“¬ ’πÈ”μ“≈ÕàÕπ·≈–®–‡°‘¥μ–°Õπ¢ÿàπ‡Àπ’¬« ’πÈ”μ“≈‡¢â¡ º≈°“√»÷°…“ ®π∂÷ß¥”∑ÿ°À≈Õ¥∑¥≈Õß ®÷ßμâÕßπ” “√≈–≈“¬¡“‡æ“– ®“°°“√∑¥ Õ∫¥â«¬«‘∏’¥‘ §å¥‘øøî«™—Ëπ æ∫«à“ ‡≈’È¬ßμàÕ„π®“πÕ“À“√‡æ“–‡™◊ÈÕ æ∫«à“ ‚ª√æÕ≈‘ “¡“√∂

Table 1 Inhibition zones (mm) of propolis against Enterococcus faecalis and Porphyromonas gingivalis 0.2% concentrations of propolis (mg/ml) Bacterial strains chlorhexidine 515 103 20.6 4.12 Enterococcus faecalis 15.5±0.5 8.75±0.25 7±0- - ATCC 19433 Porphyromonas gingivalis 22±1 13.5±1.5 9.5±0.5 8±0- W 50 - means no inhibition zone

Fig. 1 Inhibition zones of propolis against Enterococcus Fig. 2 Inhibition zones of propolis against Porphyro- faecalis monas gingivalis A) 5% DMSO, B) 0.2% chlorhexidine, A) 5% DMSO, B) 0.2% chlorhexidine, C) propolis 515 mg/ml, D) propolis 103 mg/ml, C) propolis 515 mg/ml, D) propolis 103 mg/ml, E) propolis 20.6 mg/ml, F) propolis 4.12 mg/ml E) propolis 20.6 mg/ml, F) propolis 4.12 mg/ml

136 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

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‰Œ¥√Õ°‰´¥ å ‡æ√“–¡√“¬ß“πª√– ’ ∑∏‘ ¿“æ„π°“√μ‘ “π∑“πâ Cohen S, editors. Cohenûs Pathways of the pulp. ‡™◊ÈÕ·∫§∑’‡√’¬„π°“√√—°…“§≈Õß√“°øíππÈ”π¡∑’Ëμ‘¥‡™◊ÈÕ 10 th ed. St Louis Missouri: Mosby Elsevier; ‚¥¬„™â‚ª√æÕ≈‘ º ¡°—∫·§≈‡´’¬¡‰Œ¥√Õ°‰´¥å æ∫«à“ 2011: 559-600. ‰¥âº≈¥’°«à“°“√„™â·§≈‡´’¬¡‰Œ¥√Õ°‰´¥å‡æ’¬ßÕ¬à“ß‡¥’¬«35 2. Peciuliene V, Maneliene R, Balcikonyte E, √«¡∂÷ß°“√»÷°…“§ÿ≥ ¡∫—μ‘Õ◊ËπÊ ¢Õß·§≈‡´’¬¡‰Œ¥√Õ°‰´¥å Drukteinis S, Rutkunas V. Microorganisms in root ‡¡◊ËÕº ¡°—∫‚ª√æÕ≈‘ «à“¡’°“√‡ª≈’Ë¬π·ª≈ßÀ√◊Õ‰¡à canal infections: a review. Stomatologija 2008; πÕ°®“°»÷°…“§ÿ≥ ¡∫—μ‘¥â“π°“√μâ“π‡™◊ÈÕ·≈â« §«√¡’°“√ 10: 4-9. »÷°…“∂÷ß§ÿ≥ ¡∫—μ‘¢Õß‚ª√æÕ≈‘ „π¥â“πÕ◊ËπÊ ‡™àπ °“√ 3. Peters LB, Wesselink PR, Buijs JF, Winkelhoff AJ. °”®—¥™—Èπ ‡¡’¬√å À√◊Õ≈–≈“¬‡π◊ÈÕ‡¬◊ËÕ„π °àÕπ∑’Ë®–π”‰ª„™â Viable bacteria in root dentinal tubules of teeth with „π∑“ß§≈‘π‘°μàÕ‰ª apical periodontitis. J Endod 2001; 27: 76-81. ∂÷ß·¡â«à“®–¡’√“¬ß“π‡°’Ë¬«°—∫°“√„™â‚ª√æÕ≈‘ 4. Matsuo T, Shirakami T, Ozaki K, Nakanishi T, „π°“√√—°…“‚√§¿Ÿ¡‘·æâ ·μà°Á¡’√“¬ß“π°“√·æâ‚ª√æÕ≈‘ Yumoto H, Ebisu S. An immunohistological study „π§π∑’Ë·æâº≈‘μ¿—≥±å¢Õßº÷Èß ´÷Ëß¡—°‡°‘¥®“°°“√„™â¿“¬πÕ° of the localization of bacteria invading root pulpal Õ“®‡ªìπ‡æ√“–¡’≈–ÕÕß‡° √ À√◊Õ¡’ à«πª√–°Õ∫∫“ßÕ¬à“ß walls of teeth with periapical lesions. J Endod ∑’Ë‡ªìπæ‘…13,14,15 ·≈–¢âÕ‡ ’¬Õ’°Õ¬à“ß¢Õß‚ª√æÕ≈‘ §◊Õ 2003; 29: 194-200. ‰¡à¡’º≈‘μ„πª√–‡∑»‰∑¬ μâÕßπ”‡¢â“®“°μà“ßª√–‡∑» ®÷ß 5. Gomes BP, Pinheiro ET, Gadê-Neto CR, Sousa EL, ∑”„ÀâÀ“‰¥â¬“°·≈–¡’√“§“·æß Ferraz CC, Zaia AA, et al. Microbiological examina- ®“°°“√∑’Ë‚ª√æÕ≈‘ ¡’§«“¡‡¢â“°—π∑“ß™’«¿“æ tion of infected dental root canals. Oral Microbiol °—∫‡π◊ÈÕ‡¬◊ËÕ„π·≈–‡π◊ÈÕ‡¬◊ËÕ√Õ∫ª≈“¬√“°øíπ ·≈–¡’ Immunol 2004; 19: 71-6. §ÿ≥ ¡∫—μ‘„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬ ‡™◊ÈÕ√“ μâ“π°“√Õ—°‡ ∫ 6. Pinheiro ET, Gomes BP, Ferraz CC, Sousa EL, ‚ª√æÕ≈‘ ®÷ßÕ“®‡ªìπ∑“ß‡≈◊Õ°Õ’°∑“ßÀπ÷Ëß„π°“√π”‰ª„™â Teixeira FB, Souza-Filho FJ. Microorganisms from „πß“π√—°…“§≈Õß√“°øíπ„πÕπ“§μ canals of root-filled teeth with periapical lesions. Int Endod J 2003; 36: 1-11. ∫∑ √ÿª 7. ≈–ÕÕß∑Õß «—™√“¿—¬ °“√∑”§«“¡ –Õ“¥·≈–°“√ ‚ª√æÕ≈‘ “¡“√∂¬—∫¬—Èß·≈–∑”≈“¬‡™◊ÈÕ‡ÕÁπ‡∑Õ ¢¬“¬§≈Õß√“°øíπ. „π §≈Õß√“°øíπ: «‘∏’°“√√—°…“ ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ·≈–°“√·°âªí≠À“ æ‘¡æå§√—Èß∑’Ë 2. °√ÿß‡∑æ¡À“π§√: ‚¥¬‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ‰«μàÕ‚ª√æÕ≈‘ πâÕ¬ Àâ“ßÀÿâπ à«π®”°—¥ ´—πμâ“°“√æ‘¡æå; 2547: 45-89. °«à“‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 8. Zehnder M. Root canal irrigants. J Endod 2006; 32: 389-98. °μμ‘ °√√¡ª√–°“»‘ 9. önça ö, Ho gor M, Hilmio lu S, Zekio lu O, Eronat ¢Õ¢Õ∫§ÿ≥ √».¥√.∑æ≠. √âÕ¬»‘√‘ ∑«’∫Ÿ√≥å ∑’Ë C, Burhano lu D. Comparison of antibacterial and „Àâ§”·π–π”„π°“√∑”«‘®—¬ ·≈–¢Õ¢Õ∫§ÿ≥‡®â“Àπâ“∑’Ë„π toxic effects of various root canal irrigants. Int ¿“§«‘™“®ÿ≈™’««‘∑¬“™àÕßª“° §≥–∑—πμ·æ∑¬»“ μ√å Endod J 2003; 36: 423-32. ¡À“«‘∑¬“≈—¬¡À‘¥≈ ∑’Ë„Àâ§«“¡™à«¬‡À≈◊Õ„π°“√∑”«‘®—¬ 10. Hülsmann M, Hahn W. Complications during root canal irrigation-literature review and case reports. ‡Õ° “√Õâ“ßÕ‘ß Int Endod J 2000; 33: 186-93. 1. Siqueira JF Jr, Rôças IN. Microbiology and treat- 11. Witton R, Henthorn K, Ethunandan M, Harmer S, ment of endodontic infections. In: Hargreaves KM, Brennan PA. Neurological complications following

138 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

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ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 139 ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

29. LeCorn DW, Vertucci FJ, Rojas MF, Progulske-Fox coccus faecalis: a laboratory study. Aust Endod A, Bélanger M. In vitro activity of amoxicillin, J 2009; 35: 52-8. clindamycin, doxycyclin, metronidazole, and 33. Kayaoglu G, Omürlü H, Akca G, Gürel M, Gençay O, moxifloxacin against oral actinomyces. J Endod Sorkun K, et al. Antibacterial activity of propolis 2007; 33: 557-60. versus conventional endodontic disinfectants 30. Ugur A, Arslan T. An in vitro study on antimicrobial against Enterococcus faecalis in infected dentinal activity of propolis from mugla province of Turkey. tubules. J Endod 2011; 37: 376-81. J Med Food 2004; 7: 90-4. 34. Koru O, Toksoy F, Acikel CH, Tunca YM, Baysallar 31. Uzel A, Sorkun K, Onça O, Cogulu D, Gençay O, M, Guclu AU,et al. In vitro antimicrobial activity of Salih B. Chemical compositions and antimicrobial propolis samples from different geographical activities of four different Anatolian propolis origins against certain oral pathogens. Anaerobe samples. Microbiol Res 2005; 160: 189- 2007; 13: 140-5. 95. 35. Rezende GP, Costa LR, Pimenta FC, Baroni DA. 32. Awawdeh L, AI-Beitawi M, Hammad M. Effective- In vitro antimicrobial activity of endodontic pastes ness of propolis and calcium hydroxide as a with propolis extracts and calcium hydroxide: A short-term intracanal medicament against Entero- preliminary study. Braz Dent J 2008; 19: 301-5.

140 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§– “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ MAHIDOL DENTAL JOURNAL « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 ∫∑«‘∑¬“°“√ °“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬«

∑«’æß»å Õ“√¬–æ‘»‘…∞ ∫∑§¥¬— Õà ∑.∫. ¿“§«‘™“°“¬«‘¿“§»“ μ√å «—μ∂ÿª√– ß§å: ¥—™π’øíπ‡¢’È¬«‡ªìπ«‘∏’∑“ßπ‘μ‘∑—πμ«‘∑¬“∑’Ë™à«¬„π°“√∑”π“¬‡æ» §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ¢Õß»æπ‘√π“¡ ‚¥¬‡ª√’¬∫‡∑’¬∫¥—™π’øíπ‡¢’È¬«∑’Ë§”π«≥®“°»æ °—∫¥—™π’øíπ‡¢’È¬« «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ ¡“μ√∞“π¢Õßª√–™“°√∑âÕß∂‘Ëππ—Èπ Õ¬à“ß‰√°Áμ“¡¬—ß‰¡àæ∫°“√ √â“ß¥—™π’ Ph.D. (Cell Biology & Anatomy) øíπ‡¢’È¬«¡“μ√∞“π¢Õß§π‰∑¬ °“√»÷°…“π’È®÷ß¡’«—μ∂ÿª√– ß§å‡æË◊Õ √â“ß¥—™π’ ¿“§«‘™“°“¬«‘¿“§»“ μ√å §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ øíπ‡¢’È¬«¡“μ√∞“π √«¡∑—Èßª√–‡¡‘π§«“¡·¡àπ¢Õß¥—™π’¥—ß°≈à“«„π°“√∑”π“¬ Õ—§√‘π ¿“πÿ ∂‘μ¬å ‡æ»§π‰∑¬°≈ÿà¡Àπ÷Ëß π—°»÷°…“∑—πμ·æ∑¬å «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“: Õ“ “ ¡—§√§π‰∑¬ ®”π«π 400 §π ‡ªìπ §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ™“¬ 200 §π ·≈–‡ªìπÀ≠‘ß 200 §π Õ“¬ÿ√–À«à“ß 18 ∂÷ß 22 ªï ∑’Ë¡’øíπÀπâ“ π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ π—°»÷°…“∑—πμ·æ∑¬å ∫π·≈–≈à“ß∑’Ë¢÷Èπ‡μÁ¡∑’Ë ª√“»®“°√Õ¬ºÿÀ√◊Õ°“√∫Ÿ√≥–„¥ Ê ‰¡à ÷° √«¡∑—Èß¡’ §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ °“√‡√’¬ßμ—«ª°μ‘ «—¥§«“¡°«â“ß¢Õßøíπ‡¢’È¬«∑—Èß 4 ´’Ë ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬« æß»å ∂‘μ ∫—≥±‘μ „π¢“°√√‰°√∫π·≈–≈à“ß¢ÕßÕ“ “ ¡—§√¥â«¬‡«Õ‡π’¬√å §“≈‘‡ªÕ√ å™π‘¥¥‘®‘μÕ≈ π—°»÷°…“∑—πμ·æ∑¬å ·≈–·∫àßÕ“ “ ¡—§√∑—ÈßÀ¡¥‡ªìπ 2 °≈ÿà¡‚¥¬°“√ ÿà¡ ¢âÕ¡Ÿ≈¢ÕßÕ“ “ ¡—§√ §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å °≈ÿà¡·√° (™“¬ 100 §π ·≈– À≠‘ß 100 §π) „™â„π°“√ √â“ß¥—™π’øíπ‡¢’È¬« π—°»÷°…“∑—πμ·æ∑¬å ¡“μ√∞“π¢Õß§π‰∑¬μ“¡«‘∏’°“√¢Õß Rao ·≈–§≥– ·≈â«π”‰ªª√–‡¡‘π§«“¡ §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ·¡àπ¢Õß¥—™π’øíπ‡¢’È¬«„πÕ“ “ ¡—§√°≈ÿà¡∑’Ë Õß (™“¬ 100 §π ·≈– À≠‘ß 100 §π) Õ∏‘∫“¬¥—™π’øíπ‡¢’È¬«¡“μ√∞“π·≈–§«“¡·¡àπ¢Õß¥—™π’øíπ‡¢’È¬«¥â«¬ ∂‘μ‘æ√√≥π“ √«¡∑—Èß«‘‡§√“–Àå§«“¡·μ°μà“ß√–À«à“ß‡æ»¢Õß§«“¡°«â“ßøíπ‡¢’È¬« ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«¥â«¬ ∂‘μ‘∑¥ Õ∫∑’∑’Ë√–¥—∫π—¬ ”§—≠ .05 º≈°“√»÷°…“: §«“¡°«â“ßøíπ‡¢’È¬«∑ÿ°´’Ë ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«„π¢“°√√‰°√ ∫π·≈–≈à“ß¢Õß‡æ»™“¬°«â“ß°«à“¢Õß‡æ»À≠‘ßÕ¬à“ß¡’π—¬ ”§—≠ ¥—™π’øíπ‡¢’È¬« ¡“μ√∞“π„π§π‰∑¬´÷Ëß§”π«≥®“°øíπ‡¢’È¬«∫π¢«“ øíπ‡¢’È¬«∫π´â“¬ øíπ‡¢’È¬« ≈à“ß¢«“ ·≈–øíπ‡¢’È¬«≈à“ß´â“¬ ‡ªìπ 0.216, 0.214, 0.257 ·≈– 0.250 μ“¡ ≈”¥—∫ ‚¥¬¡’§«“¡·¡àπ¢Õß¥—™π’øíπ‡¢’È¬«∑’Ë§”π«≥®“°øíπ‡¢’È¬«·μà≈–´’Ë‡ªìπ√âÕ¬≈– 53.5, 60.0, 61.5 ·≈– 67.0 μ“¡≈”¥—∫ μ‘¥μàÕ‡°’Ë¬«°—∫∫∑§«“¡: ∫∑ √ÿª: ∑«’æß»å Õ“√¬–æ‘»‘…∞ ¥—™π’øíπ‡¢’È¬«‚¥¬‡©æ“–‡¡◊ËÕ§”π«≥®“°øíπ‡¢’È¬«≈à“ß´â“¬‡ªìπ‡§√◊ËÕß¡◊Õ ¿“§«‘™“°“¬«‘¿“§»“ μ√å ∑’Ë™à«¬‡ √‘¡ª√– ‘∑∏‘¿“æ°“√∑”π“¬‡æ»»æ§π‰∑¬π‘√π“¡‰¥â §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ √À— §”: ¥—™π’øíπ‡¢’È¬«, °“√®”·π°‡æ», §π‰∑¬ 6 ∂. ‚¬∏’ ‡¢μ√“™‡∑«’ °∑¡ 10400 ‚∑√»—æ∑å: - ‚∑√ “√: - Õ’‡¡≈å: [email protected] ·À≈àß‡ß‘π∑ÿπ: ‰¥â√—∫∑ÿπ«‘®—¬®“° §≥–∑—π·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ «—π√—∫‡√◊ËÕß: 31 ¡°√“§¡ 2554 «—π¬Õ¡√—∫μ’æ‘¡æå: 1 ∏—π«“§¡ 2554

°“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« 141 ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ æß»å ∂‘μ ∫—≥±‘μ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 MAHIDOL DENTAL JOURNAL Original article Sexual dimorphism in Thais using canine index

Abstract Tawepong Arayapisit Objective: Canine index is used as a sex determination in forensic DDS Department of Anatomy, odontology by comparing the individual canine index with standard canine Faculty of Dentistry, Mahidol University index calculating from the local population. However, the standard canine Wanida Sripairojthikoon index in Thai population is not well established. This report was aimed to Ph.D. (Cell Biology & Anatomy) study on sex identity based on the standard canine index and evaluate its Department of Anatomy, Faculty of Dentistry, Mahidol University accuracy in a group of Thais Akkarin Panusatid Materials and methods: Thai subjects, 200 males and 200 females, Dental student, aged 18-22 years old who had fully erupted, caries-free, normal and Faculty of Dentistry, Mahidol University non-worn upper as well as lower anterior teeth with correct dental alignment Naiwinit Somsuktaweekoon Dental student, were selected. Male and female subjects were randomly allocated into Faculty of Dentistry, Mahidol University 2 groups each. Canine widths and intercanine widths in both jaws were Pongstit Bundit measured using digital vernier calipers. Data from the first group Dental student, (100 males and 100 females) were used to calculate standard canine Faculty of Dentistry, Mahidol University Nipit Supajarupan index according to Rao et al. Data of another group (100 males and Dental student, 100 females) was used to assess the accuracy of the previously estab- Faculty of Dentistry, Mahidol University lished standard canine index. Descriptive statistical data were obtained and the potential of sexual dimorphism of the canine and intercanine widths were analyzed by t-test (α=.05). Results: Canine widths and intercanine widths of males were significantly greater than those of female (p<.001). The standard canine indices calculated with upper right, upper left, lower right and lower left canines were 0.216, 0.214, 0.257 and 0.250, respectively. The respective index values showed accuracy for sex determination at 53.5%, 60.0%, 61.5% Correspondence author: and 67.0% Tawepong Arayapisit Conclusion: It was plausible that the canine index from left mandibular Department of Anatomy, canine, in particular, could be applied as an additional method for sex Faculty of Dentistry, Mahidol University. 6 Yothi Street, Rachathewi, identity in Thai population. Bangkok 10400, Thailand. Keyword: Canine index, sexual dimorphism, Thais Tel: - Fax: - E-mail: [email protected] Research grant: Supported by Faculty of Dentistry, Mahidol University Received: 31 January 2011 Accepted: 1 December 2011

142 °“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ æß»å ∂‘μ ∫—≥±‘μ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

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¥—™π’øíπ‡¢’È¬« (canine index) ‡æ◊ËÕ‡ √‘¡§«“¡∂Ÿ°μâÕß ª√–™‘¥ πÕ°®“°π’ÈÕ“ “ ¡—§√μâÕß‰¡àÕ¬Ÿà„π√–À«à“ß°“√ „π°“√∑”π“¬‡æ» √—°…“∑“ß∑—πμ°√√¡®—¥øíπ ·∫àßÕ“ “ ¡—§√∑—ÈßÀ¡¥‡ªìπ ¥—™π’øíπ‡¢’È¬«‡ªìπ —¥ à«π√–À«à“ß§«“¡°«â“ßøíπ 2 °≈ÿà¡ °≈ÿà¡·√°‡ªìπ‡æ»™“¬ 100 §π ·≈–‡æ»À≠‘ß ‡¢’È¬«·∑â„π·π«„°≈â°≈“ß‰°≈°≈“ß (mesiodistal width) 100 §π ”À√—∫°“√ √â“ß¥—™π’øíπ‡¢’È¬«¡“μ√∞“π ·≈– °—∫√–¬–√–À«à“ßøíπ‡¢’È¬«À√◊Õ√–¬–∑’Ë —Èπ∑’Ë ÿ¥„π·π«√–π“∫ °≈ÿà¡∑’Ë Õß ‡ªìπ‡æ»™“¬ 100 §π ·≈–‡æ»À≠‘ß 100 §π √–À«à“ß¬Õ¥ªÿÉ¡øíπ‡¢’È¬«´â“¬·≈–¢«“ ‚¥¬¥—™π’øíπ‡¢’È¬« ”À√—∫°“√«—¥§«“¡·¡àπ (accuracy) ¢Õß¥—™π’øíπ‡¢’È¬« ¢Õß·μà≈–∫ÿ§§≈∑’Ë§”π«≥‰¥â®–π”‰ª‡ª√’¬∫‡∑’¬∫°—∫¥—™π’ „π§π‰∑¬ øíπ‡¢’È¬«¡“μ√∞“π (standard canine index) À“°¡’§à“ πâÕ¬°«à“À√◊Õ‡∑à“°—∫¥—™π’øíπ‡¢’È¬«¡“μ√∞“π®–∑”π“¬‡ªìπ ¥—™π’øíπ‡¢’È¬«¡“μ√∞“π¢Õß§π‰∑¬ ‡æ»À≠‘ß ·μà∂â“¡’§à“¡“°°«à“®–∑”π“¬‡ªìπ‡æ»™“¬25 ¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈„πÕ“ “ ¡—§√°≈ÿà¡∑’ËÀπ÷Ëß ¥—™π’øíπ‡¢’È¬«∂Ÿ°‡ πÕ§√—Èß·√°„πªï §.». 1989 ¥â«¬°“√«—¥√–¬– 2 √–¬–‚¥¬μ√ß„π™àÕßª“° ‰¥â·°à §«“¡ ‚¥¬ Rao ·≈–§≥–25 ·≈–æ∫«à“¥—™π’øíπ‡¢’È¬«¡’§«“¡·¡àπ °«â“ßøíπ‡¢’È¬« ‚¥¬«—¥ à«π°«â“ß∑’Ë ÿ¥„π·π«„°≈â°≈“ß‰°≈ „π°“√∑”π“¬‡æ»√âÕ¬≈– 84.3 „π‡æ»™“¬·≈–√âÕ¬≈– °≈“ß¢Õßøíπ‡¢’È¬«∑—Èß 4 ´’Ë ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬« 87.5 „π‡æ»À≠‘ß °“√„™â¥—™π’øíπ‡¢’È¬«„π°“√·¬°‡æ»π—Èπ ‚¥¬«—¥√–¬–√–À«à“ß¬Õ¥ªÿÉ¡øíπ‡¢’È¬«´â“¬·≈–¢«“∑—Èß„π ∑”‰¥âßà“¬ –¥«°√«¥‡√Á« ·≈–¡’§«“¡∂Ÿ°μâÕß„π°“√∑”π“¬ ¢“°√√‰°√∫π·≈–≈à“ß ¥â«¬‡«Õ‡π’¬√å §“≈‘‡ªÕ√ å ™π‘¥ ‡ªìπ∑’Ëπà“æÕ„® ·μà°Á¡’¢âÕ®”°—¥∑’ËμâÕß¡’øíπ‡¢’È¬«∑—Èß Õß¢â“ß ¥‘®‘μÕ≈ (Digimatic calipers, Mitutoyo, Japan) ¡’°“√‡√’¬ßμ—«ª°μ‘ ‰¡à´âÕπ‡° ‡æ◊ËÕ„™â„π°“√«—¥√–¬–√–À«à“ß π”¢âÕ¡Ÿ≈∑’Ë«—¥‰¥â¡“§”π«≥¥—™π’øíπ‡¢’È¬« ·≈–¥—™π’ øíπ‡¢’È¬« πÕ°®“°π’È¬—ß¡’§«“¡·μ°μà“ß¢Õß¢π“¥¢Õßøíπ øíπ‡¢’È¬«¡“μ√∞“π¢Õßøíπ‡¢’È¬«∑—Èß 4 ´’Ë μ“¡«‘∏’°“√¢Õß „π·μà≈–‡™◊ÈÕ™“μ‘26 ¥—ßπ—Èπ°“√¡’¥—™π’øíπ‡¢’È¬«¡“μ√∞“π Rao ·≈–§≥–25 ”À√—∫·μà≈–°≈ÿà¡ª√–™“°√™à«¬„Àâ°“√∑”π“¬‡æ»¢Õß°≈ÿà¡ §«“¡°«“ßøâ π‡¢í ¬«„π·π«‰°≈°≈“ß‰°≈°≈“ß’È ¥—™π’øíπ‡¢’È¬« = ª√–™“°√π—Èπ Ê ¡’§«“¡∂Ÿ°μâÕß‡æ‘Ë¡¢÷ÈπÕ’°¥â«¬27,28 Õ¬à“ß‰√ √–¬–√–À«à“ßøíπ‡¢’È¬« °Áμ“¡¬—ß‰¡àæ∫√“¬ß“π¥—™π’øíπ‡¢’È¬«¡“μ√∞“π¢Õß§π‰∑¬ ¥—ßπ—Èπ°“√»÷°…“π’È®÷ß¡’«—μ∂ÿª√– ß§å‡æ◊ËÕ √â“ß¥—™π’øíπ‡¢’È¬« (Xm+SDm) + (Xf-SDf) ¥—™π’øíπ‡¢’È¬«¡“μ√∞“π = ¡“μ√∞“π √«¡∑—Èßª√–‡¡‘πª√– ‘∑∏‘¿“æ¢Õß¥—™π’øíπ‡¢’È¬« 2 „π°“√∑”π“¬‡æ»„π§π‰∑¬ ‡¡◊ËÕ Xm §◊Õ §à“‡©≈’Ë¬¢Õß¥—™π’øíπ‡¢’È¬«‡æ»™“¬ Xf §◊Õ §à“‡©≈’Ë¬¢Õß¥—™π’øíπ‡¢’È¬«‡æ»À≠‘ß «‘∏’¥”‡π‘π°“√«‘®—¬ SDm §◊Õ à«π‡∫’Ë¬ß‡∫π¡“μ√∞“π¢Õß¥—™π’øíπ‡¢’È¬« ª√–™“°√»°…“÷ ‡æ»™“¬ °“√»÷°…“π’È‰¥â√—∫°“√√—∫√Õß®“°§≥–°√√¡°“√ SDf §◊Õ à«π‡∫’Ë¬ß‡∫π¡“μ√∞“π¢Õß¥—™π’øíπ‡¢’È¬« ®√‘¬∏√√¡°“√«‘®—¬„π§π¢Õß¡À“«‘∑¬“≈—¬¡À‘¥≈ μ“¡ ‡æ»À≠ß‘ Àπ—ß ◊Õ√—∫√Õß‡≈¢∑’Ë MU-IRB 2008/137.1905 ‚¥¬ ¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈®“°Õ“ “ ¡—§√™“«‰∑¬Õ“¬ÿ 18 ∂÷ß §«“¡·¡àπ„π°“√∑”π“¬‡æ»¢Õß¥—™π’øíπ‡¢’È¬« 22 ªï ®”π«π 400 §π‡ªìπ‡æ»™“¬ 200 §π·≈–‡æ» „π§π‰∑¬ À≠‘ß 200 §π ∑’Ë¡’øíπÀπâ“∫π·≈–øíπÀπâ“≈à“ß√Ÿª√à“ß «—¥§«“¡°«â“ßøíπ‡¢’È¬«·≈–√–¬–√–À«à“ßøíπ‡¢’È¬« ª°μ‘§√∫ 12 ´’Ë ¡’°“√‡√’¬ßμ—«¢Õßøíπª°μ‘‰¡à¡’°“√´âÕπ‡° „πÕ“ “ ¡—§√°≈ÿà¡∑’Ë Õß ·≈–§”π«≥¥—™π’øíπ‡¢’È¬«¢Õß ¡’°“√ ∫øíπμ“¡°“√®”·π°·∫∫·Õß‡°‘≈ª√–‡¿∑∑’Ë 1 Õ“ “ ¡—§√·μà≈–∫ÿ§§≈μ“¡«‘∏’∑’Ë‰¥â°≈à“«¡“·≈â« ®“°π—Èπ (Angle classification I) øíπÀπâ“∫π·≈–≈à“ß∑ÿ°´’Ë π”¥—™π’∑’Ë§”π«≥‰¥â‰ª‡ª√’¬∫‡∑’¬∫°—∫¥—™π’øíπ‡¢’È¬« ‰¡à¡’°“√·μ°À—° ·≈–‰¡à‡§¬‰¥â√—∫°“√∫Ÿ√≥–∑“ß¥â“π ¡“μ√∞“π¢Õß§π‰∑¬∑’Ë √â“ß¢÷Èπ ‚¥¬À“°¥—™π’øíπ‡¢’È¬«

144 °“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ æß»å ∂‘μ ∫—≥±‘μ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

¢ÕßÕ“ “ ¡—§√πâÕ¬°«à“À√◊Õ‡∑à“°—∫¥—™π’øíπ‡¢’È¬«¡“μ√∞“π ´â“¬·μà≈–´’Ë„π‡æ»™“¬ ¡’§«“¡°«â“ß‡©≈’Ë¬‡ªìπ 8.05±0.51 ®–∑”π“¬‡ªìπ‡æ»À≠‘ß ·μà∂â“¥—™π’øíπ‡¢’È¬«¢ÕßÕ“ “ ¡—§√ ¡‘≈≈‘‡¡μ√, 8.01±0.52 ¡‘≈≈‘‡¡μ√, 7.30±0.42 ¡‘≈≈‘‡¡μ√ ¡“°°«à“¥—™π’øíπ‡¢’È¬«¡“μ√∞“π®–∑”π“¬‡ªìπ‡æ»™“¬ ·≈– 7.28±0.38 ¡‘≈≈‘‡¡μ√ μ“¡≈”¥—∫ ·≈–„π‡æ»À≠‘ß §”π«≥§«“¡·¡àπ¢Õß¥—™π’øíπ‡¢’È¬«®“°√âÕ¬≈–¢Õß®”π«π ¡§«“¡°«’ “ß‡©≈â ¬‡ª’Ë πì 7.62±0.57 ¡≈≈‘ ‡¡μ√,‘ 7.47±0.50 Õ“ “ ¡—§√∑’Ë∑”π“¬‡æ»‰¥â∂Ÿ°μâÕßμàÕ®”π«πÕ“ “ ¡—§√ ¡‘≈≈‘‡¡μ√, 6.89±0.47 ¡‘≈≈‘‡¡μ√ ·≈– 6.77±0.57 ∑—ÈßÀ¡¥„π°≈ÿà¡∑’Ë Õß ¡‘≈≈‘‡¡μ√ μ“¡≈”¥—∫ (μ“√“ß∑’Ë 1) „π¢≥–∑’Ë√–¬–√–À«à“ß πÕ°®“°π—Èπ ‡ª√’¬∫‡∑’¬∫§«“¡·μ°μà“ß√–À«à“ß‡æ» øíπ‡¢’È¬«‡©≈’Ë¬„π¢“°√√‰°√∫π·≈–¢“°√√‰°√≈à“ß„π ¢Õß§«“¡°«â“ßøíπ‡¢’È¬« ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«¢Õß ‡æ»™“¬ ‡ªìπ 36.84±2.28 ¡‘≈≈‘‡¡μ√ ·≈– 28.31±2.24 Õ“ “ ¡—§√∑—Èß Õß°≈ÿà¡¥â«¬ ∂‘μ‘∑¥ Õ∫§à“∑’ (t-test) ∑’Ë ¡‘≈≈‘‡¡μ√ μ“¡≈”¥—∫ ·≈–„π‡æ»À≠‘ß¡’√–¬–‡©≈’Ë¬‡ªìπ √–¥—∫π—¬ ”§—≠ .05 35.10±2.32 ¡‘≈≈‘‡¡μ√ ·≈– 27.42±1.78 ¡‘≈≈‘‡¡μ√ μ“¡≈”¥—∫ (μ“√“ß∑’Ë 2) º≈°“√»÷°…“ º≈°“√‡ª√’¬∫‡∑’¬∫§«“¡·μ°μà“ß√–À«à“ß‡æ» °“√»÷°…“„πÕ“ “ ¡—§√°≈ÿà¡·√° ‡ªìπ™“¬®”π«π ¥â«¬ ∂‘μ‘∑¥ Õ∫∑’ ∑’Ë√–¥—∫π—¬ ”§—≠ .05 æ∫«à“ §«“¡ 100 §π Õ“¬ÿ‡©≈’Ë¬ 19.89±1.69 ªï ·≈–‡ªìπÀ≠‘ß®”π«π °«â“ßøíπ‡¢’È¬«∑ÿ°´’Ë ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«∑—Èß¢“°√√‰°√ 100 §πÕ“¬ÿ‡©≈’Ë¬ 19.46±1.45 ªï ·≈–Õ“ “ ¡—§√°≈ÿà¡ ∫π·≈–¢“°√√‰°√≈à“ß„π‡æ»™“¬¡’§à“¡“°°«à“„π‡æ»À≠‘ß ∑’Ë Õß ‡ªìπ™“¬ 100 §π Õ“¬ÿ‡©≈’Ë¬19.45±1.30 ªï ·≈– Õ¬à“ß¡’π—¬ ”§—≠ (p<.001) À≠‘ß 100 §π Õ“¬ÿ‡©≈’Ë¬ 19.03±1.12 ªï æ∫«à“øíπ‡¢’È¬« ‡¡◊ËÕπ”√–¬–μà“ß Ê ∑’Ë«—¥„πÕ“ “ ¡—§√°≈ÿà¡·√° ∫π¢«“ øíπ‡¢’È¬«∫π´â“¬ øíπ‡¢’È¬«≈à“ß¢«“ ·≈–øíπ‡¢’È¬«≈à“ß §”π«≥À“¥—™π’øíπ‡¢’È¬«¡“μ√∞“π μ“¡ Ÿμ√¢â“ßμâπ º≈ Table 1 Mean and standard deviation (SD) of canine widths of males and females (mm) Upper right canine Upper left canine Lower right canine Lower left canine Group Sex Mean±SD P value Mean±SD P value Mean±SD P value Mean±SD P value 1 Male 8.07±0.51 <.001 8.01±0.51 <.001 7.32±0.42 <.001 7.27±0.40 <.001 Female 7.63±0.62 7.48±0.52 6.90±0.51 6.76±0.61 2 Male 8.03±0.52 <.001 8.01±0.52 <.001 7.29±0.41 <.001 7.28±0.37 <.001 Female 7.62±0.53 7.46±0.47 6.88±0.45 6.77±0.54 Total Male 8.05±0.51 <.001 8.01±0.52 <.001 7.30±0.42 <.001 7.28±0.38 <.001 Female 7.62±0.57 7.47±0.50 6.89±0.47 6.77±0.57

Table 2 Mean and standard deviation (SD) of intercanine widths of males and females (mm) Maxillary arch Mandibular arch Group Sex Mean±SD P value Mean±SD P value Male 36.90 2.19 <.001 28.27 2.15 <.001 1 ± ± Female 35.28±2.38 27.56±1.85 Male 36.77 2.37 <.001 28.36 2.34 <.001 2 ± ± Female 34.91±2.25 27.28±1.71 Male 36.84 2.28 <.001 28.31 2.24 <.001 Total ± ± Female 35.10±2.32 27.42±1.78

°“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« 145 ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ æß»å ∂‘μ ∫—≥±‘μ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Table 3 The standard canine index and its accuracy Accuracy (%) Tooth Standard canine index Male Female Total Upper right canine 0.216 55.00 52.00 53.50 Upper left canine 0.214 65.00 55.00 60.00 Lower right canine 0.257 59.00 64.00 61.50 Lower left canine 0.250 75.00 59.00 67.00

°“√§”π«≥æ∫«à“ ¥—™π’øíπ‡¢’È¬«¡“μ√∞“π∑’Ë √â“ß¢÷Èπ®“° ™à«¬¬◊π¬—π§«“¡ “¡“√∂¢Õßøíπ‡¢’È¬«„π°“√®”·π°‡æ» øíπ‡¢’È¬«∫π¢«“ øíπ‡¢’È¬«∫π´â“¬ øíπ‡¢’È¬«≈à“ß¢«“ ·≈– ∑—Èßπ’È§«“¡·μ°μà“ß√–À«à“ß‡æ»¢Õßøíπ‡™◊ËÕ«à“‡ªìπº≈®“° øíπ‡¢’È¬«≈à“ß´â“¬ ¡’§à“ 0.216, 0.214, 0.257 ·≈– §«“¡·μ°μà“ß∑“ßæ—π∏ÿ°√√¡ ‚¥¬°“√§«∫§ÿ¡¢Õß¬’π 0.250 μ“¡≈”¥—∫ (Table 3) ∑’Ë‡°’Ë¬«‡π◊ËÕß°—∫‡æ» (sex-linked gene)33 ¡’√“¬ß“π«à“ º≈°“√μ√«® Õ∫§«“¡·¡àπ„π°“√∑”π“¬‡æ»¢Õß ¬’πÕ‡¡‚≈®’π‘π (amelogenin gene) ∫π‚§√‚¡‚´¡‡Õ°´å ¥—™π’øíπ‡¢’È¬«¡“μ√∞“π¢Õßøíπ·μà≈–´’Ë„πÕ“ “ ¡—§√°≈ÿà¡ (X chromosome) ¡’º≈μàÕ¢π“¥¢Õßøíπ ∑”„Àâ§«“¡ ∑’Ë Õß æ∫«à“¥—™π’øíπ‡¢’È¬«¡“μ√∞“π¢Õßøíπ‡¢’È¬«≈à“ß´â“¬ Àπ“¢Õß‡§≈◊Õ∫øíπ (enamel thickness) ‡æ‘Ë¡¢÷Èπ ·μà ¡’§«“¡·¡àπ„π°“√∑”π“¬ Ÿß ÿ¥·μà¥—™π’øíπ‡¢’È¬«¡“μ√∞“π ‰¡à¡’º≈μàÕ°“√‡ª≈’Ë¬π·ª≈ß§«“¡Àπ“¢Õß‡π◊ÈÕøíπ (dentine ¢Õßøíπ‡¢’È¬«∫π¢«“¡’§«“¡·¡àπ„π°“√∑”π“¬πâÕ¬∑’Ë ÿ¥ thickness)34 ´÷Ëß Õ¥§≈âÕß°—∫°“√»÷°…“„πºŸâªÉ«¬°≈ÿà¡ ‚¥¬√âÕ¬≈–¢Õß§«“¡·¡àπ„π°“√∑”π“¬‡æ»¢Õß¥—™π’øíπ Õ“°“√‡∑Õ√å‡πÕ√å (Turner syndrome) ∑’Ë¡’‚§√‚¡‚´¡‡Õ°´å ‡¢’È¬«¡“μ√∞“π¢Õßøíπ‡¢’È¬«∫π¢«“ øíπ‡¢’È¬«∫π´â“¬ øíπ ‡æ’¬ßÕ—π‡¥’¬«‡ªìπ‚§√‚¡‚´¡‡æ» (45,XO) æ∫«à“ ‡¢¬«≈’È “ß¢«“à ·≈–øπ‡¢í ¬«≈’È “ß´à “¬¡â §’ “√à Õ¬≈–â 53.5, 60.0, ‡§≈◊Õ∫øíπ¢ÕßºŸâªÉ«¬∫“ß¡“°·μà‡π◊ÈÕøíπ¡’§«“¡Àπ“ª°μ35‘ 61.5 ·≈– 67.0 μ“¡≈”¥—∫ (μ“√“ß∑’Ë 3) πÕ°®“°π’È ¬—ßæ∫«à“‚§√‚¡‚´¡«“¬ (Y chromosome) ¡’º≈‡æ‘Ë¡∑—Èß§«“¡Àπ“¢Õß‡§≈◊Õ∫øíπ·≈–§«“¡Àπ“ «‘®“√≥å ¢Õß‡π◊ÈÕøíπ36 ¥—ßπ—Èπ‡π◊ÈÕøíπ¢Õß‡æ»™“¬®÷ß¡’¢π“¥„À≠à°«à“ ¢π“¥¢Õßøíπ‡¢’È¬« ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«‡ªìπ ‡æ»À≠‘ßÕ¬à“ß¡’π—¬ ”§—≠37-39 ®“°‡Àμÿº≈∑’Ë°≈à“«¡“ μ—«·ª√ ”§—≠„π°“√§”π«≥¥—™π’øíπ‡¢’È¬« ·μà√–¬–√–À«à“ß π—∫ πÿπ«à“øíπ∑ÿ°´’Ëπà“®–„™â®”·π°‡æ»‰¥â Õ¬à“ß‰√°Áμ“¡ øíπ‡¢’È¬«®–‡ª≈’Ë¬π·ª≈ßμ“¡Õ“¬ÿ‡π◊ËÕß®“°°“√‡®√‘≠¢Õß √“¬ß“π°“√»÷°…“μà“ß Ê °≈—∫æ∫«à“øíπ·μà≈–´’Ë¡’§«“¡ ¢“°√√‰°√ ®π°√–∑—Ëßøíπ‡¢’È¬«·∑â¢÷Èπ ¡∫Ÿ√≥å √–¬–π’È “¡“√∂„π°“√®”·π°‡æ»·μ°μà“ß°—π13,15,26,31,41,42 ®÷ß§ß∑’ËÀ√◊ÕÕ“®¡’°“√‡ª≈’Ë¬π·ª≈ß‡æ’¬ß‡≈Á°πâÕ¬29,30 ‡π◊ËÕß®“°‚§√‚¡‚´¡‡æ»¡’Õ‘∑∏‘æ≈μàÕ°“√ √â“ßøíπ·μà≈–´’Ë πÕ°®“°π’È¬—ß¡’°“√»÷°…“æ∫«à“§«“¡´âÕπ‡°¢ÕßøíπÀπâ“ ‰¡à‡∑à“°—π40 ”À√—∫øíπ‡¢’È¬«´÷ËßÀ≈“¬°“√»÷°…“™’È„Àâ‡ÀÁπ«à“ ®–∑”„Àâ§«“¡·¡àπ¢Õß¥—™π’øíπ‡¢’È¬«„π°“√∑”π“¬‡æ» ¡’§«“¡ “¡“√∂„π°“√®”·π°‡æ» Ÿß°«à“øíπ´’ËÕ◊Ëπ ≈¥≈ß27 ¥—ßπ—Èπ°“√»÷°…“π’È®÷ß‡≈◊Õ°Õ“ “ ¡—§√∑’Ë¡’°“√ π—Èπ13,15,41,42 æ∫«à“§«“¡Àπ“¢Õß‡π◊ÈÕøíπ¢Õßøíπ‡¢’È¬« ‡√’¬ßμ—«¢ÕßøíπÀπâ“‡ªìπª°μ‘ Õ“¬ÿ¡“°°«à“ 15 ªï ‡π◊ËÕß®“° „π‡æ»À≠‘ß∫“ß°«à“„π‡æ»™“¬Õ¬à“ß¡’π—¬ ”§—≠36,43 ·μà ‡ªìπ™à«ßÕ“¬ÿ∑’Ëøíπ‡¢’È¬«·∑â¢÷Èπ‡μÁ¡´’Ë„π™àÕßª“° ·≈–¡’√–¬– ¬—ß¡’§«“¡¢—¥·¬âß°—πÕ¬Ÿà‡°’Ë¬«°—∫§«“¡Àπ“¢Õß‡§≈◊Õ∫øíπ √–À«à“ßøíπ‡¢’È¬«§ß∑’Ë29,30 ¢Õßøíπ‡¢’È¬«π—Èπ ∫“ß°“√»÷°…“‰¡àæ∫§«“¡·μ°μà“ß¢Õß º≈°“√»÷°…“æ∫«à“§«“¡°«â“ßøíπ‡¢’È¬«∑ÿ°´’Ë¡’§«“¡ §«“¡Àπ“¢Õß‡§≈◊Õ∫øíπ„π√–À«à“ß‡æ»38 „π¢≥–∑’Ë∫“ß ·μ°μà“ß√–À«à“ß‡æ»Õ¬à“ß¡’π—¬ ”§—≠„π§π‰∑¬ ´÷Ëß °“√»÷°…“æ∫«à“‡§≈◊Õ∫øíπ„π‡æ»À≠‘ßÀπ“°«à“‡æ»™“¬ Õ¥§≈âÕß°—∫°“√»÷°…“Õ◊ËπÊ „πÀ≈“¬‡™◊ÈÕ™“μ‘ ∑—Èß„π∑«’ª ‡≈Á°πâÕ¬36,43,44 ‡Õ‡™’¬31,32 ·≈– À√—∞Õ‡¡√‘°“13,14 º≈°“√»÷°…“‡À≈à“π’È √–¬–√–À«à“ßøíπ‡¢’È¬«∑—Èß„π¢“°√√‰°√∫π·≈–¢“

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°√√‰°√≈à“ß‡ªìπÕ’°μ—«·ª√Àπ÷Ëß∑’Ë¡’√“¬ß“π«à“„π‡æ»™“¬ „Àâ‡ÀÁπ«à“¥—™π’∑’Ë§”π«≥®“°øíπ‡¢’È¬«´â“¬¡’§«“¡·¡àπ ¡’√–¬–°«â“ß°«à“„π‡æ»À≠‘ßÕ¬à“ß¡’π—¬ ”§—≠27,28,45-47 „π°“√∑”π“¬¡“°°«à“¥—™π’∑’Ë§”π«≥®“°øíπ‡¢’È¬«¢«“ ´÷Ëß π—∫ πÿπº≈°“√»÷°…“„π§√—Èßπ’È ∑—Èßπ’Èæ∫«à“§«“¡°«â“ß Õ¥§≈âÕß°—∫°“√»÷°…“„πÕ¥’μ∑’Ëæ∫«à“øíπ‡¢’È¬«≈à“ß´â“¬ ¢Õßøíπ‡¢’È¬«·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«¡’§«“¡ —¡æ—π∏å°—π ¡’§«“¡ “¡“√∂„π°“√®”·π°‡æ» (sexual dimorphism) Õ¬à“ß¡’π—¬ ”§—≠14 ‚¥¬‡©æ“–„πÕ“ “ ¡—§√∑’Ë¡’°“√‡√’¬ßμ—« Ÿß°«à“øíπ‡¢’È¬«≈à“ß¢«“13,15,41 ¢ÕßøíπÀπâ“ª°μ‘√–¬–√–À«à“ßøíπ‡¢’È¬«‰¥â√—∫Õ‘∑∏‘æ≈ °“√»÷°…“„πª√–‡∑»Õ‘π‡¥’¬√“¬ß“π«à“¥—™π’øíπ ∫“ß à«π®“°¢π“¥¢ÕßøíπÀπâ“25 ¥—ßπ—Èπ§«“¡·μ°μà“ß ‡¢’È¬«≈à“ß¡’§«“¡·¡àπ„π°“√∑”π“¬‡æ»√âÕ¬≈– 72.0 ∂÷ß √–À«à“ß‡æ»¢Õß¢π“¥øíπ®÷ß àßº≈„Àâ√–¬–√–À«à“ßøíπ‡¢’È¬« 85.914,28,48,49 ´÷Ëß Ÿß°«à“°“√»÷°…“„πª√–‡∑»Õ◊Ëπ ‡™àπ ¡’§«“¡·μ°μà“ß√–À«à“ß‡æ»¥â«¬ °“√»÷°…“„πª√–‡∑»‡πª“≈°≈—∫æ∫«à“¥—™π’øíπ‡¢’È¬«≈à“ß §«“¡·μ°μà“ß√–À«à“ß‡æ»∑’Ë™—¥‡®π¢Õßøíπ‡¢’È¬« ¡’§«“¡·¡àπ„π°“√∑”π“¬‡æ»‡æ’¬ß√âÕ¬≈– 51.2847 ·≈– ∑”„Àâ¡’°“√π”øíπ‡¢’È¬«¡“»÷°…“‡æ◊ËÕæ—≤π“«‘∏’∑”π“¬‡æ» °“√»÷°…“„πª√–‡∑»Ω√—Ëß‡» æ∫«à“¥—™π’øíπ‡¢’È¬«≈à“ß „π∑“ßπ‘μ‘«‘∑¬“»“ μ√å ‡™àπ Õ“»—¬°“√»÷°…“√“¬≈–‡Õ’¬¥ ¡’§«“¡·¡àπ„π°“√∑”π“¬‡æ» Ÿß ÿ¥√âÕ¬≈– 65.4827 ‡©æ“– à«π (Moiré topography)16 À√◊Õ °“√«‘‡§√“–Àå ´÷Ëß„°≈â‡§’¬ß°—∫°“√»÷°…“„πª√–‡∑»‰∑¬§√—Èßπ’È∑’Ëæ∫«à“ øŸ‡√’¬√å (Fourier analysis)17 ∂÷ß·¡â«à“«‘∏’°“√‡À≈à“π’È„Àâº≈ §«“¡·¡àπ„π°“√∑”π“¬‡æ»¢Õß¥—™π’øíπ‡¢’È¬« Ÿß ÿ¥ °“√∑”π“¬‡æ»∑’Ë·¡àπ¬” ·μà«‘∏’‡À≈à“π’È‡ªìπ«‘∏’∑’Ë¬ÿàß¬“° √âÕ¬≈– 67.0 ´—∫´âÕπ μâÕßÕ“»—¬§«“¡™”π“≠‡©æ“–„π°“√«‘‡§√“–Àå ∑—Èß∑’Ë§«“¡°«â“ßøíπ‡¢’È¬«·≈–√–¬–√–À«à“ßøíπ‡¢’È¬« ‰¡à‡À¡“– ¡°—∫°“√„™âß“π„πª√–™“°√°≈ÿà¡„À≠à ®÷ß¡’ ¡’§«“¡·μ°μà“ß√–À«à“ß‡æ»∑“ß ∂‘μ‘Õ¬à“ß™—¥‡®π ·μà °“√æ—≤π“«‘∏’∑’Ë‡À¡“– ¡°«à“ ‡¡◊ËÕπ”¡“§”π«≥‡ªìπ¥—™π’øíπ‡¢’È¬«°≈—∫¡’§«“¡ “¡“√∂ ¥—™π’øíπ‡¢’È¬«‡ªìπÕ’°«‘∏’°“√∑’Ë„™âß“π –¥«° √«¥‡√Á« „π°“√∑”π“¬‡æ»„π§π‰∑¬‰¥â‰¡à Ÿß¡“° ∑—Èßπ’ÈÕ“® ∑”‰¥âßà“¬‡π◊ËÕß®“°Õ“»—¬μ—«·ª√‡æ’¬ß 2 §à“ ‰¡àμâÕß°“√ ‡π◊ËÕß®“°¥—™π’øíπ‡¢’È¬«‡ªìπ§à“ —¡æ—∑∏å (relative value) §«“¡™”π“≠‡©æ“– √«¡∑—Èß„Àâº≈∑’Ëπà“‡™◊ËÕ∂◊Õ ®÷ß‡À¡“– ¡ ∑’Ë‡°‘¥®“° —¥ à«π√–À«à“ß§à“ —¡∫Ÿ√≥å (absolute value) °—∫°“√ª√–¬ÿ°μå„™â„π°≈ÿà¡ª√–™“°√¢π“¥„À≠à‰¥â7,46 ·μà 2 §à“ ‰¥â·°à §«“¡°«â“ßøíπ‡¢’È¬«·≈–√–¬–√–À«à“ßøíπ‡¢’È¬« ¢âÕ®”°—¥ª√–°“√ ”§—≠¢Õß¥—™π’øíπ‡¢’È¬«§◊Õ¥—™π’øíπ‡¢’È¬« ∑”„Àâ§«“¡·μ°μà“ß√–À«à“ß‡æ»¢Õß§à“ —¡∫Ÿ√≥å∂Ÿ°≈¥ ¡“μ√∞“π§«√‡ªìπ§à“‡©æ“–∑’Ë§”π«≥¢÷Èπ ”À√—∫ª√–™“°√ ∑Õπ≈ß47 μ—«Õ¬à“ß‡™àπ ∂â“ºŸâ™“¬¡’§«“¡°«â“ßøíπ‡¢’È¬« ·μà≈–∑âÕß∂‘Ëπ ‡æ◊ËÕ„Àâ°“√∑”π“¬¡’§«“¡·¡àπ¬”¡“°¢÷Èπ27 9 ¡‘≈≈‘‡¡μ√ ·≈–¡’√–¬–√–À«à“ßøíπ‡¢’È¬« 30 ¡‘≈≈‘‡¡μ√ ¥—ßπ—Èπ °“√»÷°…“π’È®÷ß‰¥â √â“ß¥—™π’øíπ‡¢’È¬«¡“μ√∞“π ·μàºŸâÀ≠‘ß¡’§«“¡°«â“ßøíπ‡¢’È¬« 7.5 ¡‘≈≈‘‡¡μ√ ·≈–¡’√–¬– „π§π‰∑¬ √«¡∑—Èßª√–‡¡‘π§«“¡·¡àπ¢Õß¥—™π’¥—ß°≈à“« √–À«à“ßøíπ‡¢’È¬« 25 ¡‘≈≈‘‡¡μ√ ∑—Èß§«“¡°«â“ßøíπ‡¢’È¬« ‡æ◊ËÕ‡æ‘Ë¡ª√– ‘∑∏‘¿“æ¢Õß¥—™π’øíπ‡¢’È¬«„π§π‰∑¬ ·≈–√–¬–√–À«à“ßøíπ‡¢’È¬«„πºŸâ™“¬¡’§à“¡“°°«à“„πºŸâÀ≠‘ß º≈°“√π”¥—™π’øíπ‡¢’È¬«¡“μ√∞“π∑’Ë§”π«≥‰¥â®“° Õ¬à“ß™—¥‡®π ·μà‡¡◊ËÕ§”π«≥¥—™π’øíπ‡¢’È¬«·≈â«°≈—∫æ∫«à“ Õ“ “ ¡—§√°≈ÿà¡·√° ¡“„™â„π°“√∑”π“¬‡æ»„πÕ“ “ ∑—ÈßºŸâ™“¬·≈–ºŸâÀ≠‘ßμà“ß¡’¥—™π’øíπ‡¢’È¬«‡∑à“°—π§◊Õ 0.3 ¡—§√°≈ÿà¡∑’Ë Õß æ∫«à“¥—™π’øíπ‡¢’È¬«∑’Ë§”π«≥®“°øíπ · ¥ß„Àâ‡ÀÁπ«à“¥—™π’øíπ‡¢’È¬«Õ“®¬—ß¡’¢âÕ®”°—¥„π°“√ ‡¢’È¬«≈à“ß¡’§«“¡·¡àπ„π°“√∑”π“¬‡æ»¡“°°«à“¥—™π’ ®”·π°§«“¡·μ°μà“ß√–À«à“ß‡æ» ∑’Ë§”π«≥®“°øíπ‡¢’È¬«∫π º≈°“√»÷°…“π’È Õ¥§≈âÕß°“√ º≈®“°°“√»÷°…“π’Èæ∫«à“¥—™π’øíπ‡¢’È¬«„π°“√ »÷°…“„πª√–™“°√ª√–‡∑»´“Õÿ¥‘Õ“√‡∫’¬ ∑’Ë√“¬ß“π«à“¥—™π’ ∑”π“¬‡æ»¡’§«“¡·¡àπ‰¡à Ÿß¡“°π—°„π§π‰∑¬ ®÷ß øíπ‡¢’È¬«∑’Ë§”π«≥®“°øíπ‡¢’È¬«∫π¡’Õ—μ√“§«“¡º‘¥æ≈“¥ ‰¡‡À¡“– ¡∑à ®–‡≈’Ë Õ°¥◊ ™π— ø’ π‡¢í ¬«‡ª’È π‡§√ì Õß¡◊Ë Õ≈”¥◊ ∫·√°— (rate of misclassification) √âÕ¬≈– 12.6 „π¢≥–∑’Ë¥—™π’ „π°“√∑”π“¬‡æ»»æπ‘√π“¡ ·μà§«√„™â√à«¡°—∫«‘∏’Õ◊Ëπ ∑’Ë§”π«≥®“°øíπ‡¢’È¬«≈à“ß¡’Õ—μ√“§«“¡º‘¥æ≈“¥‡æ’¬ß ‡∑à“∑’Ë “¡“√∂°√–∑”‰¥âμ“¡ ¿“æ»æ∑’Ëæ∫ ‡æ◊ËÕ™à«¬‡ √‘¡ √âÕ¬≈– 4.6546 πÕ°®“°π’Èº≈°“√»÷°…“„π§√—Èßπ’È¬—ß™’È §«“¡∂Ÿ°μâÕß¢Õßº≈°“√∑”π“¬ ‡™àπ °“√„™â°√–¥Ÿ°„∫Àπâ“

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¢“°√√‰°√≈à“ß À√◊Õ°√–¥Ÿ°‡™‘ß°√“π ´÷Ëß¡’√“¬ß“π§«“¡ pology. In Eckert WG editor. Introduction to ·¡àπ„π°“√∑”π“¬ Ÿß50,51 Õ¬à“ß‰√°Áμ“¡øíπ¬—ß§ß‡ªìπ forensic sciences 2nd edition. Florida:CRC Press; ‡§√◊ËÕß¡◊Õ∑“ßπ‘μ‘«‘∑¬“»“ μ√å∑’Ë¥’„π°“√æ‘ Ÿ®πå∫ÿ§§≈ 1997: 346-54. ®÷ß§«√∑”°“√»÷°…“ª√–¬ÿ°μå„™âøíπ„π√Ÿª·∫∫Õ◊ËπμàÕ‰ª ‡™àπ 7. Al-Rifaly MQ, Abdullah MA, Ashraf I, Khan N. °“√«‘‡§√“–Àå®”·π°ª√–‡¿∑ (discriminant analysis) Dimorphism of mandibular and maxillary canine ´÷ËßÕ“®™à«¬ √â“ß«‘∏’∑’Ë¡’ª√– ‘∑∏‘¿“æ¡“°¢÷Èπ„π°“√®”·π° teeth in establishing sex identity. Saudi Dent J ‡æ»‰¥âμàÕ‰ª 1997; 9: 17-20. 8. Sopher IM. Forensic dentistry. Iliinois:Charles C ∫∑ √ÿª Thomas; 1976: 35-46. ¥—™π’øíπ‡¢’È¬«¡’§«“¡·¡àπ„π°“√∑”π“¬‡æ»§π‰∑¬ 9. Sweet D, DiZinno JA. Personal identification ‰¥â Ÿß ÿ¥ª√–¡“≥√âÕ¬≈– 67.0 ‡¡◊ËÕ„™âøíπ‡¢’È¬«≈à“ß´â“¬ through dental evidence: tooth fragments to DNA. Õ¬à“ß‰√°Áμ“¡º≈°“√»÷°…“· ¥ß„Àâ‡ÀÁπ«à“§«“¡·¡àπ¢Õß J Calif Dent Assoc 1996; 24: 35-42. °“√∑”π“¬‡æ»¥â«¬¥—™π’øíπ‡¢’È¬«π’È‰¡à Ÿß¡“°π—° ®÷ß‰¡à 10. Petersen KB, Kogon SL. Dental identification in §«√„™â‡ªìπ«‘∏’À≈—°„π°“√∑”π“¬‡æ»∑“ßπ‘μ‘«‘∑¬“»“ μ√å the Woodbridge disaster. J Can Dent Assoc 1971; ·μà§«√„™â√à«¡°—∫«‘∏’Õ◊Ëπ ‡æ◊ËÕ‡ √‘¡ª√– ‘∑∏‘¿“æ„π°“√ 37: 275-9. ∑”π“¬‡æ» À√◊Õ„™â‡©æ“–„π°√≥’∑’Ë‰¡à “¡“√∂∑”π“¬‡æ» 11. Banister LH. Alimentary system. In Williams PL ¥â«¬«‘∏’Õ◊Ëπ‰¥â‡∑à“π—Èπ editor. Grayûs anatomy 38th edition. London: Churchill Livingstone; 1995: 1699-700. °μμ‘ °√√¡ª√–°“»‘ 12. Rothwell BR, Haglund W, Morton Jr TH. Dental ¢Õ¢Õ∫§ÿ≥§≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬ identification in serial homicides: the Green River ¡À‘¥≈ ”À√—∫∑ÿπ π—∫ πÿπ°“√«‘®—¬ ·≈–Õ“ “ ¡—§√ murders. J Am Dent Assoc1980; 119: 373-9. ∑ÿ°∑à“π∑’Ë„Àâ§«“¡Õπÿ‡§√“–Àå„π°“√‡°Á∫¢âÕ¡Ÿ≈ 13. Garn SM, Lewis AB, Swindler DR. Kerewsky RS. Genetic control of sexual dimorphism in tooth size. ‡Õ° “√Õâ“ßÕ‘ß J Dent Res 1967; 46: 963-72. 1. Pretty IA, Sweet D. A look at forensic dentistry- 14. Anderson DL, Thompson GW. Interrelationships Part 1: The role of teeth in the determination of and sex differences of dental and skeletal mea- human identity. Br Dent J 2001; 190: 359-66. surements. J Dent Res 1973; 52: 431-8. 2. Rothwell BR. Principles of dental identification. 15. Nair P, Rao BB, Annigeri RG. A study of tooth size, Dent Clin North Am 2001; 45: 253-70. symmetry and sexual dimorphism. J Forensic Med 3. Bushick RD. Forensic dentistry: An overview for Toxicol 1999; 16: 10-3. the general dentist. Gen dent 2006; 54: 48-52. 16. Suzuki T, Yokosawa S, Ueno M, Mizuno O, Endo H, 4. Hirsch CS, Morris RC, Moritz AR. Handbook of Ikeya T, Takahashi T, Takei T. A study on sex legal medicine 5th edition. St. Louis:C.V. Mosby; determination based on mandibular canines--by 1979: 13-5. Moiré topography. J Nihon Univ Sch Dent 1984; 5. Polson CJ, Gee DJ. The essentials of forensic 26: 246-55. medicine 3rd edition. New York: Pergamon; 1973: 17. Mizuno O. Sex determination from maxillary canine 44-95. by Fourier analysis. J Nihon Univ Sch Dent 1990; 6. Iscan MY, Loth SR. The scope of forensic anthro- 2: 139-42.

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deciduous and permanent dentitions. Eur J Orthod identity: comparison of two statistical methods. 1982; 4: 113-22. J Oral Rehabil 1996; 23: 627-31. 42. Lund H, Mörnstad H. Gender determination by 47. Acharya AB, Mainali S. Limitations of the mandibu- odontometrics in a Swedish population. J Forensic lar canine index in sex assessment. J Forensic Odontostomatol 1999; 17: 30-4. Leg Med 2009; 16: 67-9. 43. Schwartz GT, Dean MC. Sexual dimorphism in 48. Yadav S, Nagabhushana D, Rao BB, Mamatha modern human permanent teeth. Am J Phys GP. Mandibular canine index in establishing Anthropol 2005; 128: 312-7. sex identity. India J Dent Res 2002; 13: 148- 44. Saunders SR, Chan AHW, Kahlon B, Kluge HF, 6. FitzGerald CM. Sexual dimorphism of the dental 49. Kaushal S, Patnaik VVG, Sood V, Agnihotri G. Sex tissues in human permanent mandibular canines determination in north Indians using mandibular and third premolars. Am J Phys Anthropol 2007; canine index. J Indian Acad Forensic Med 2004; 133: 735-40. 26: 45-9. 45. Kaushal S, Patnaik VVG, Agnihotri G. Mandibular 50. Sweet D. Why a dentist for identification? Dent canine in sex determination. J Anat Soc India Clin North Am 2001; 45: 237-51. 2003; 52: 119-24. 51. Bruzek J, A method for visual determination of 46. Sherfudhin H, Abdullah MA. A cross-sectional sex, using the human hip bone, Am J Phys study of canine dimorphism in establishing sex Anthropol 2002; 117: 157-68.

150 °“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ æß»å ∂‘μ ∫—≥±‘μ π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ MAHIDOL DENTAL JOURNAL « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 Original article Physical properties of dental stones available in Thailand

Potchaman Sinavarat Abstract BSc, D.D.S, M.Sc Objective: To compare the physical properties of ten dental stones available Department of Prosthodontics Faculty of Dentistry, Mahidol University in Thailand. Kallaya Suputtamongkol Materials and methods: Ten dental stones used in this study were Comet 3, D.D.S, Ph.D. Planet Universal, Hard Stone (pink), Hard Stone (green), Pana Super Stone, Department of Prosthodontics Dentamerica, G10 Universal, Hydrock, Labstone and Quick Stone. The Faculty of Dentistry, Mahidol University Chatcharee Suchatlampong properties of dental stones were studied according to ISO 6873 Dental D.D.S, M.Phil (Dental Matcrials), gypsum products, i.e., initial setting time, setting expansion, compressive Diplamate, Thai Board in Prosthodontics strength and reproduction of detail. Statistical analyses of the mean setting Department of Prosthodontics time, setting expansion and compressive strength were performed using Faculty of Dentistry, Mahidol University one-way ANOVA and Tukeyûs multiple comparison tests. All properties were also determined according to ISO guidelines. Results: The mean setting time of seven dental stones were complied with the international standard. The products which showed the least expansion were Quick Stone, G10 Universal, Comet 3 and Labstone while setting expansion of Dentamerica, Planet Universal and Hard Stone (green and pink) exceeded the standard value recommended by the ISO 6873 Dental gypsum products. The mean values of compressive strength of all groups tested were at an acceptable limit. The compressive strength of Planet Universal, Quick Stone and Hydrock Model Stone were the highest and significantly different from the others (p<0.05). All products showed acceptable detail reproduction. Conclusion: Five of ten dental stones tested in this study possessed the acceptable properties except Dentamerica, Planet Universal, Quick stone and Hard Stone (green and pink) of which their setting time and setting Correspondence author: expansion did not comply with the standard criteria. Potchaman Sinavarat Key words: Department of Prosthodontics Dental stone, gypsum, calcium sulphate, hemihydrate Faculty of Dentistry, Mahidol University 6 Yothi Street, Ratchathewi, Bangkok 10400, Thailand. Tel: 02-203-6441 Fax: 02-203-6440 E-mail: - Research Grant: - Received: 23 March 2009 Accepted: December 2011

Physical properties of dental stones available in Thailand 151 Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 MAHIDOL DENTAL JOURNAL ∫∑«‘∑¬“°“√ ¡∫—μ‘‡™‘ß°“¬¿“æ¢Õßª≈“ ‡μÕ√åÀ‘π∑’Ë®”Àπà“¬„πª√–‡∑»‰∑¬

æ®¡“π »√’π«√—μπå ∫∑§¥¬— Õà ∑∫, M.Sc «—μ∂ÿª√– ß§å: ‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫ ¡∫—μ‘¢Õßª≈“ ‡μÕ√åÀ‘π 10 º≈‘μ¿—≥±å ∑’Ë ¿“§«™“∑‘ πμ°√√¡ª√–¥— …∞‘ å §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ ®”Àπà“¬„πª√–‡∑»‰∑¬ °—≈¬“ »ÿæÿ∑∏¡ß§≈ «— ¥ÿ·≈–«‘∏’°“√»÷°…“: «— ¥ÿ∑’Ë»÷°…“ ‰¥â·°à Comet 3, Planet Universal, Hard ∑∫, «∑¡, PhD Stone (pink), Hard Stone (green), Pana Super Stone, Dentamerica, G10 ¿“§«™“∑‘ πμ°√√¡ª√–¥— …∞‘ å Universal, Hydrock, Labstone ·≈– Quick Stone °“√»÷°…“¥”‡π‘π°“√μ“¡ §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ ™—™√’ ÿ™“μ‘≈È”æß»å «‘∏’∑¥ Õ∫¢Õß‡°≥±å¡“μ√∞“π ISO 6873 Dental gypsum products ¡∫—μ‘ ∑∫, M.Phil (Dental Matcrials), ∑’Ë»÷°…“ §◊Õ ‡«≈“∑’Ë„™â„π°“√°àÕμ—« °“√¢¬“¬μ—«¢≥–°àÕμ—« §«“¡∑π·√ßÕ—¥ ·≈– Õ∑ (∑—πμ°√√¡ª√–¥‘…∞å) °“√≈Õ°‡≈’¬π√“¬≈–‡Õ’¬¥ §à“‡©≈’Ë¬¢Õß°“√¢¬“¬μ—«¢≥–°àÕμ—« ·≈–§«“¡∑π ¿“§«™“∑‘ πμ°√√¡ª√–¥— …∞‘ å ·√ßÕ—¥ «‘‡§√“–Àå∑“ß ∂‘μ‘¥â«¬ one way ANOVA ·≈–∑¥ Õ∫‡™‘ß´âÕπ‚¥¬ §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ Tukeyûs multiple comparison √«¡∑—Èß°“√„™â‡°≥±å«‘‡§√“–μ“¡ ISO 6873 Dental gypsum products «‘‡§√“–Àåº≈‡«≈“∑’Ë„™â„π°“√°àÕμ—« ·≈–°“√≈Õ°‡≈’¬π √“¬≈–‡Õ’¬¥·≈–§«“¡∑π·√ßÕ—¥ º≈°“√»÷°…“: ‡«≈“∑’Ë„™â„π°“√°àÕμ—«¢ÕßªŸπÀ‘π 7 º≈‘μ¿—≥±å Õ¬Ÿà„π‡°≥±å ¡“μ√∞“π°”Àπ¥ °≈ÿà¡ Quick Stone, G10 Universal, Comet 3 ·≈– Labstone ¡’°“√¢¬“¬μ—«¢≥–°àÕμ—«μË” ÿ¥ ·μà Dentamerica Planet Universal·≈– Hard Stone(green ·≈– pink) ¢¬“¬μ—«¡“°°«à“‡°≥±å¡“μ√∞“π°”Àπ¥ §«“¡∑π ·√ßÕ—¥¢Õß∑ÿ°º≈‘μ¿—≥±åÕ¬Ÿà„π‡°≥±å¡“μ√∞“π°”Àπ¥ ∑—Èßπ’È Planet Universal, Quick Stone ·≈– Hydrock ¡’§«“¡∑π·√ßÕ—¥ Ÿß ÿ¥·≈–μà“ß®“°°≈àÿ¡Õ¬à“ß¡’ π—¬ ”§—≠∑“ß ∂‘μ‘ (p<.05) º≈°“√≈Õ°‡≈’¬π√“¬≈–‡Õ’¬¥¢Õß∑ÿ°º≈‘μ¿—≥±å Õ¬Ÿà „π‡°≥±å¡“μ√∞“π°”Àπ¥ √ÿª: ªŸπÀ‘π 5 ™π‘¥ ¡’ ¡∫—μ‘μ“¡‡°≥±å¡“μ√∞“π°”Àπ¥ ¬°‡«âπ Dentamerica Planet Universal, Quick Stone·≈– Hard Stone (green ·≈– pink) ∑’Ë¡’‡«≈“ ∑’Ë„™â„π°“√°àÕμ—«·≈–°“√¢¬“¬μ—«¢≥–°àÕμ—«‰¡à‡ªìπ‰ªμ“¡∑’Ë‡°≥±å¡“μ√∞“π °”Àπ¥ √À— §”: ªŸπÀ‘π, ¬‘ª´—¡, ·§≈‡´’¬¡´—≈‡øμ, ‡Œ¡‘‰Œ‡¥√μ μ‘¥μàÕ‡°’Ë¬«°—∫∫∑§«“¡: æ®¡“π »√’π«√—μπå ¿“§«™“∑‘ πμ°√√¡ª√–¥— …∞‘ å §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ 6 ∂.‚¬∏’ ‡¢μ√“™‡∑«’ °√ÿß‡∑æœ 10400 ‚∑√»—æ∑å: 02-203-6441 ·ø°´å: 02-203-6440 Õ’‡¡≈å: - ·À≈àß‡ß‘π∑ÿπ: ß∫ª√–¡“≥·ºàπ¥‘π ªï 2544 «—π√—∫‡√◊ËÕß: 23 ¡’π“§¡ 2552 «—π¬Õ¡√—∫μ’æ‘¡æå: 1 ¡’π“§¡ 2554

152 Physical properties of dental stones available in Thailand Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Introduction with the American Dental Association guideline for Gypsum is a natural white mineral with the dental gypsum products. The results indicated that chemical name calcium sulphate dihydrate. It has been those dental plasters were acceptable for dental use. used as a building material since the time of the However, the physical properties of dental stone Egyptians1. Dental plaster or plaster of Paris is produced in Thailand have not been previously studied. made from the mineral gypsum by heating in open The objectives of this study was to compare the kettles to 120 ÌC. This produces large, irregular, physical properties of ten dental stones, 5 of which porous particles which are referred to as beta hemihy- were locally produced in Thailand and the rest were drate particles2. Plaster as used in dentistry is imported. usually the best grade of commercial plaster modified with additives to adjust the setting time, Materials and Methods lower the setting expansion or both. Laboratory plaster Ten brands of dental stone used in this study is relatively weak and fragile when used for working are shown in Table1. Properties of dental stones casts. Thus, plaster is often used for mounting stone were evaluated according to ISO 6873 Dental gypsum models onto articulators and for preparing study products6, i.e., setting time, setting expansion, models. compressive strength and reproduction of detail. In 1933, a newer form of hemihydrate (alpha Characteristics of dental stone powder were observed hemihydrate) was produced by calcining gypsum using a scanning electron microscopy (Jeol 5410, under steam pressure in an autoclave at 120 ÌC Jeol, Japan). The mean compressive strength, setting -130 ÌC. This dental stone consists of small, regular, time, and setting expansion values of stone products dense, and well-formed elongated crystals with were statistically analysed using one-way ANOVA and some porosity. Its strength is about double that of Tukeyûs multiple comparison tests. The mean com- plaster3. When strength, hardness and accuracy pressive strength, setting time, and setting expansion are required, dental stones are normally used values of stone products were also evaluated according in preference to dental plaster. Dental stones are to the ISO 6873 requirements, including the detail commonly utilized to produce working casts used to reproduction quality of these stones. construct acrylic dentures and other dental appliances. In Thailand,high quality natural gypsum mineral is Setting time found in Pichit, Nakhorn Sawan, Surat Tanee and Setting time was determined using a Vicat Nakhorn Srithammarat provinces4. Gypsum has been need le apparatus. Each material was mixed according widely used for table ware, sanitary ware, ceramic to the manufacturerûs instruction. A metal mould, roof tile, gypsum fiberboard and specially for dental having an inside diameter of 70 mm and a height of use as dental plaster and dental stone. With the 40 mm, was completely filled with the mixed gypsum lingering economic crisis, reducing costs by using product and the material was leveled to the top of locally-produced products is appropriate. For this the mould6. The test began one or two minutes prior reason, Suchatlampong et al5 studied the physical to manufacturersû recommended setting time and the properties of three dental plasters that are locally needle was allowed to penetrate into the material at produced. The study was conducted in accordance 15±1 second intervals.

Physical properties of dental stones available in Thailand 153 Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Table 1 Details and properties as stated from manufacturers of 10 dental stones used in this study. Brand Manufacturer Lot. No./ Water/Powder Setting time Color 100 cc/gm time(min) Comet 3 High quality Lafarge Prestia Co. LTD., 5417, yellow 28 11-13 model stone Thailand* Dentamerica Model Stone Dentamerica Royal USA NA, yellow 30 9 G 10 Universal Dental Stone Plaster ADA, USA NA, Green 23-25 10 Hard Stone High Quality Siam Gypsum Plaster NA, Green 28 10 Public Co. Ltd., Thailand* Hard Stone High Quality Siam Gypsum Plaster NA, Pink 28 10 Public Co. Ltd., Thailand* Hydrock Model Stone SDS KERR Sybron Dental Lot# 1-23134 30 10 Specialties, USA Yellow Labstone Bayer, USA 9601002, 30 10-13 blue Pana Super Stone Pana Mix Plus, Thailand* 60000005, 30 10 Green Planet Universal Lafarge Prestia Co. LTD., 5428, Green 31 10 Dental stone Thailand* Quick Stone Whip Mix Corporation, NA, Blue 28-30 10-13 USA *Products of Thailand NA=NOT ACCESSIBLE The setting time was recorded as the total time from gauge capable of measuring to within 0.01 mm and the start of mixing to the time when the needle failed the setting expansion was calculated as a percentage to penetrate the specimen to a depth of at least 2 mm. of the original gauge length. Each group was tested The tests were carried out five times and the mean five times and the mean values of setting expansion setting time of each material was calculated. According of all materials were calculated. to the ISO requirements, the mean setting time of each material should be within 20% of the value Compressive strength claimed by the manufacturer. Each material was mixed and poured into a mould having a diameter of 20±0.2 mm and a length 6 Setting expansion of 40±0.4 mm . The material was vibrated gently for The mixed sample was added to completely 30 seconds during filling in the mould in order to fill the trough of setting expansion apparatus6 and minimize the formation of bubbles. Then a glass plate allowed to expand unrestrained for two hours at one was placed to cover the top of the over-filled mould end. The change in length was recorded by a dial and the material was allowed to solidify for 45 minutes

154 Physical properties of dental stones available in Thailand Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 after the start of mixing. The specimen was then According to ISO 6873, the stone specimen removed from the mould and the excess was removed. should be capable of reproducing the full length of The specimen was crushed to fracture using a universal the 50±8 μm line. Five specimens of each brand were testing machine (Instron Model 8516, USA) at a tested in this study. loading rate of 5±2 kN/min after the start of mixing for one hour. Ten specimens of each brand were tested. Characteristics of dental stone powder The characteristics of dental stone powder Reproduction of detail were observed using a scanning electron microscope Reproduction of detail was determined using a (Jeol 5410, Jeol, Japan). The stone powder was metal block having three parallel lines on the surface6. evenly distributed on the carbon-coated metal base. Each line was 25 mm long and 2.5 mm away from Then the specimen was sputter-coated with gold each other. The widths of these lines were 20±4, powder before examining with a scanning electron 50±8, and 75±8 μm. Each material was mixed and microscope. The size and shape of each dental stone poured onto a block under vibration for five seconds powder were examined and recorded. to minimize the formation of air bubbles. After 45 minutes from the start of mixing, the specimen was Results removed from the mould and examined using a light The mean setting time, setting expansion and microscope at 6X magnification. (MM-11C, Nikon, compressive strength of ten dental stones are shown Japan) in Table 2. Table 2 Mean values of setting time, setting expansion and compressive strength of ten dental stones. Brands Setting time Setting expansion Compressive (min) (%) strength (MPa) Comet 3 High quality 12.8 (±0.4) 0.12 (±0.03) a 29.5 (±3.3) b model stone Dentamerica Model Stone 5.2 (±0.1) a* 0.39 (±0.01) b* 23.2 (±2.5) b G 10 Universal 8.2 (±0.4) b 0.11 (±0.01) a 29.3 (±2.8) b Hard Stone High Quality 10.97 (±0.4) d 0.24 (±0.01) c* 27.7 (±2.8) b (Green) Hard Stone High Quality 5.1 (±0.3) a* 0.37 (±0.02) b* 28.2 (±5.7) b (Pink) Hydrock Model Stone 11.3 (±0.4) d 0.20 (±0.01) c 32.2 (±1.7) a Labstone 8.7 (±0.4) b 0.13 (±0.01) a 27.99 (±2.7) b Pana Super Stone 9.9 (±0.5) c 0.17 (±0.01) c 23.2 (±2.3) b Planet Universal Dental 9.5 (±0.3) c 0.25 (±0.01) c* 35.0 (±1.6) a stone Quick Stone 7.7 (±0.3) b* 0.10 (±0.01) a 35.0 (±2.8) a * Not comply with the ISO Criteria Same letter within each property means no significant difference.

Physical properties of dental stones available in Thailand 155 Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Setting time and Quickstone. There was a large variation of the mean setting time of 10 dental stones tested in this study, which Characteristics of dental stone powder ranged from 5.1 to 12.8 minutes. The setting times The sizes of powder of all stones were varied, of seven products were with in the acceptable limit composing of fine and large particles. Their shapes according to ISO criteria. The pink Hard Stone, Den- were irregular with some rod and prismatic crystals as tamerica and Quick stone exhibited faster setting shown in Figure 1. time than the values stated by the manufacturers. The setting time of Comet 3 was the longest (12.8± Discussion 0.4 min.). Ten dental stones were tested in this study. Five stones were imported and five stones were Setting expansion produced locally. Water to powder ratios of all stones The setting expansion values of six dental ranged from 3.2 to 4.3 cc/gm. Their setting times stones were within the values recommended by the were 5 to 12 minutes. A short setting time may ISO standard (0-0.2%) as shown in Table 2. be suitable for some specific laboratory or clinical Dentamerica, Hard Stone (pink and green), and procedures, but a longer setting time is easier for Planet Universal Dental Stone presented higher handling of a material. Because of the wide range of values of expansion (0.24-0.39%) which were setting times of these dental stones, technicians or higher than the recommended values. The mean setting dentists should be aware of these diverse values expansion of Quick Stone, G10 Universal, Comet 3 before selecting a material. For example, the products and Labstone were the lowest and significantly that set faster may be more appropriate for pouring different from the others (p<0.05). models than the one that set slower. On the other hand, if it is used for flasking, the selection may be Compressive strength differing. However, this is always depended on the The mean compressive strength of all products individual preferences. exceeded the minimum value (20 MPa) required for The compressive strength of all dental stones type 3 stone. Planet Universal, Quick Stone and exceeded the ISO requirement, so they were all Hydrock presented the highest strength. No significant acceptable for this property. One imported and three difference was found among the mean compressive locally produced stones had excessive setting expan- strengths in the remaining seven dental stones sion. In general, imported dental stones were superior (p>0.05). in terms of low setting expansion and high compressive strength, except one stone (Dentamerica). The high Reproduction of detail setting expansion of this stone could result from its All dental stones were capable of reproduc- faster setting time. After dissolution of the powder, ing the full length of 50 and 75 μm lines which dihydrate crystals grow outward. It is known that during were acceptable according to the ISO requirements. the crystallization process of a gypsum product, an The reproduction of 25 μm line were also observed outward stress develops as a result of the crystal for Hydrock, Dentamerica, G10 Universal, Labstone growth and entanglement of crystals7. A rapid

156 Physical properties of dental stones available in Thailand Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Fig. 1 Powder of ten dental stones used in the study.

Physical properties of dental stones available in Thailand 157 Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

setting time would provide less time to rearrange and reasonable setting expansion. G10 Universal these crystals and cause more stress. More outward and Labstone were also found acceptable for dental stress would result in a highly expanded structure use. and the set material would also be porous. This Five products were produced in Thailand by could also explain the low compressive strength of three companies. Comet 3 and Planet Universal Dental this stone. Stone were produced by Lafarge Prestia, Hard Stone, Three local dental stones had excessive setting both pink and green were produced by Siam Gypsum expansion. This could be a source of error for an unfit Plaster Ltd. The manufacturer in Thailand for Pana dental prosthesis. High setting expansion stone pro- Super Stone could not be identified. Concerning the duces a larger dental model, and a larger prosthesis. cost of materials, Hard stone (Green), a product of This error should be taken into consideration when Siam Gypsum Plaster Ltd, Thailand, was more selecting a gypsum product. economical to use with fair properties. All products showed acceptable detail reproduction in that they could provide a clear continuous Conclusion line of 50 μm without a disruption. Therefore, the The properties of five dental stones presented reproduction of detail of all groups satisfied and acceptable results. The mean setting expansion of passed the requirement for this property. Among Dentamerica, Planet Universal and Hard Stone (green ten dental stones tested, Hydrock showed the best and pink) were excessive and did not pass the ISO result for this property. standard requirement for setting expansion. The The characteristics of dental stone powder compressive strength and detail reproduction of all observed by scanning electron microscope showed materials were in an acceptable range in accordance fine and large irregular particles mixed with rod type with ISO 6873 Dental gypsum products. Hydrock crystals. Some of them were an admix of larger, rod- Model Stone had the highest quality among all groups, shaped type, such as Quick Stone, while powders of while G 10 Universal and Labstone exhibited accept- Planet Universal dental stone appeared to be smaller. able properties. However, it was difficult to distinguish the differences between the shape and size of the gypsum powders Acknowledgments that could affect the properties. The authors wish to thank Ms. Nongnuch Most of the dental stones tested in this study Tienchai and Mr. Apiwat Rittapai for their work on showed acceptable properties. However, four products, SEM photographs. Dentamerica, Planet Universaland Hard Stone (green and pink) failed to pass the ISO standard for setting References expansion. This property is important as it can 1. American Dental Association. Guide to dental result in the inaccuracy of a stone model. Therefore, materials and devices. 4th ed., Chicago; 1968: these four products should be used with caution in 76-9. dental applications. Hydrock could be considered one 2. McCabe JF. Andersonûs applied dental materials. of the high quality dental stones due to its excel- 6th ed, Oxford, London: Blackwell Scientific lent detail reproduction, high compressive strength Publications; 1985; 27-32.

158 Physical properties of dental stones available in Thailand Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

3. Smith BGN, Wright PS and Brown D. The clinical ∫“ß™π‘¥∑’Ëº≈‘μ„πª√–‡∑»‰∑¬.« ∑—πμ ¡À‘¥≈ 2536; handling of dental materials.Bristol: Wright; 13: 80-5. 1986: 189-94. 6. International Organization for Standardization 4. ¿“°“√‡À¡◊Õß·√à. ¬‘ª´—¡·√àÕÿμ “À°√√¡. ‡Õ° “√ 6873/1998. Dental gypsum products. «‘™“°“√ ©∫—∫∑’Ë 4 æ». 2534: Àπâ“ 1-20. 7. Anusavice KJ. Phillipsû Science of dental materials. 5. ™—™√’ ÿ™“μ‘≈È”æß»å, æ®¡“π »√’π«√—μπå, ®ÿ‰√ π“§–- 11th ed, Philadelphia: WB Saunders Company; ªí°…‘≥. §ÿ≥ ¡∫—μ‘ ∑“ß°“¬¿“æ ¢ÕßªŸπª≈“ ‡μÕ√å 2003: 255-81.

Physical properties of dental stones available in Thailand 159 Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

160 Physical properties of dental stones available in Thailand Potchaman Sinavarat Kallaya Suputtamongkol Chatcharee Suchatlampong “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ MAHIDOL DENTAL JOURNAL « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 ∫∑§«“¡ª√‘∑—»πå ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™

∫∑§¥¬— Õà ∑‘æπ“∂ «‘™≠“≥√—μπå CAGS (Pediatric Dentistry), °“√„™ø≈â ÕÕ‰√¥Ÿ ‡®≈·≈–ø≈å ÕÕ‰√¥Ÿ «“√å πå ™‡ª‘ π¡“μ√°“√∑ì ”§’Ë ≠„π°“√™— «¬à M.S.D (Dental Public Health) ªÑÕß°—πøíπºÿ„π√–¥—∫∫ÿ§§≈·≈–°≈ÿà¡ª√–™“°√∑’Ë¡’§«“¡‡ ’Ë¬ß„π°“√‡°‘¥øíπºÿ ¿“§«‘™“∑—πμ°√√¡™ÿ¡™π ‡π◊ËÕß®“°„πª√–‡∑»‰∑¬π—Èπæ∫«à“ª√–™“°√‡¥Á° à«π„À≠à¬—ß¡’§«“¡‡ ’Ë¬ß Ÿß §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ „π°“√‡°‘¥øíπºÿ ¥—ßπ—Èπ ®÷ß¡’§«“¡®”‡ªìπ∑’Ë∑—πμ∫ÿ§≈“°√§«√μ√–Àπ—°∂÷ß°“√„™â ø≈ŸÕÕ‰√¥å∑’Ë¡’§«“¡‡¢â¡¢âπ ŸßÕ¬à“ß‡À¡“– ¡ ‡æ◊ËÕ„Àâ‡°‘¥ª√–‚¬™πå Ÿß ÿ¥„π°“√ ªÑÕß°—πøíπºÿ·≈–≈¥°“√‡°‘¥º≈¢â“ß‡§’¬ß∑’ËÕ“®‡°‘¥¢÷Èπ ∫∑§«“¡π’È‰¥âª√–¡«≈ §«“¡√Ÿâ®“°À≈—°∞“π°“√»÷°…“∑’Ëºà“π¡“ ‚¥¬°≈à“«∂÷ß°≈‰°„π°“√ªÑÕß°—πøíπºÿ ¢Õßø≈ŸÕÕ‰√¥å‡©æ“–∑’Ë ª√– ‘∑∏‘¿“æ„π°“√ªÑÕß°—πøíπºÿ ¢âÕ∫àß™’È «‘∏’°“√„™â ¢âÕ¥’ ¢âÕ¥âÕ¬ ·≈–¢âÕ·π–π”°“√„™â„π‡¥Á°‰∑¬ ‡æ◊ËÕ‡ªìπ·π«∑“ß„π°“√„™â ø≈ŸÕÕ‰√¥å„π√Ÿª·∫∫‡®≈·≈–«“√åπ‘™Õ¬à“ß‡À¡“– ¡ √«¡∂÷ß¢âÕ‡ πÕ·π–°“√ »°…“„πÕπ“§μ÷ √À— §”: ø≈ŸÕÕ‰√¥å‡®≈, ø≈ŸÕÕ‰√¥å«“√åπ‘™, ªÑÕß°—πøíπºÿ, §«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥ øíπºÿ, ‡¥Á°‰∑¬

μ‘¥μàÕ‡°’Ë¬«°—∫∫∑§«“¡: ∑‘æπ“∂ «‘™≠“≥√—μπå ¿“§«‘™“∑—πμ°√√¡™ÿ¡™π §≥–∑πμ·æ∑¬»“ μ√— å ¡À“«∑¬“≈‘ ¬¡À— ¥≈‘ 6 ∂.‚¬∏’ ‡¢μ√“™‡∑«’ °√ÿß‡∑æœ 10400 ‚∑√»—æ∑å: 02-203-6420 ·ø°´å: 02-203-6423 Õ’‡¡≈å: [email protected] ·À≈àß‡ß‘π∑ÿπ: - «—π√—∫‡√◊ËÕß: 2 æƒ»®‘°“¬π 2554 «—π¬Õ¡√—∫μ’æ‘¡æå: 16 ∏—π«“§¡ 2554

ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ 161 ∑‘æπ“∂ «‘™≠“≥√—μπå “ «∑‘‘ ¬ “√ « ∑—πμ·æ∑¬»“ μ√å¡À‘¥≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 MAHIDOL DENTAL JOURNAL Review article Fluoride Gel and Fluoride Varnish

Abstract Tippanart Vichayanrat The use of fluoride gels and fluoride varnishes is an effective CAGS (Pediatric Dentistry), M.S.D (Dental Public Health) caries preventive measure for caries susceptible individuals and population. Department of Community Dentistry, Since the majorities of Thai children are still at high-risk caries, it is crucial Faculty of Dentistry, Mahidol University that dental practitioners should be aware of the appropriate use of high- dose fluoride to maximize its benefit and minimize the adverse effects that may occur. This article provides a comprehensive review of the topical fluoride mechanism, the effectiveness of caries prevention, indication, methods of use, advantages, and disadvantages of fluoride gels and fluoride varnishes. The uses of fluoride gels and varnishes for Thai children and future research are recommended. Key words: fluoride gel, fluoride varnish, caries prevention, high-risk caries, Thai children

Correspondence author: Tippanart Vichayanrat Department of Community Dentistry Faculty of Dentistry, Mahidol University 6 Yothi Street, Ratchathewi, Bangkok 10400, Thailand Tel: 02-203-6420 Fax: 02-203-6423 E-mail: [email protected] Research Grant: - Received: 2 November 2011 Accepted: 16 December 2011

162 ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ ∑‘æπ“∂ «‘™≠“≥√—μπå « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

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∑—Ë«‰ª„π§≈‘π‘° (office use) ‰¥â·°à 1.23 % Õ–´‘¥Ÿ‡≈∑ ·≈– 0.4% ·μππ— ø≈ŸÕÕ‰√¥å 21 øÕ ‡øμø≈ŸÕÕ‰√¥å (acidulated phosphate fluoride, ª√– ‘∑∏‘¿“æ¢Õßø≈ŸÕÕ‰√¥å‡®≈„π°“√ªÑÕß°—π APF) ´÷Ëß¡’ø≈ŸÕÕ‰√¥å 12,300 à«π„π≈â“π à«π (ppm) øíπºÿ ·≈– 2.2% ‚´‡¥’¬¡ø≈ŸÕÕ‰√¥å (sodium fluoride, NaF) °“√»÷°…“ª√– ‘∑∏‘¿“æ¢Õßø≈ŸÕÕ‰√¥å‡®≈‚¥¬ ´÷Ëß¡’ø≈ŸÕÕ‰√¥å 9,200 à«π„π≈â“π à«π ”À√—∫°“√„™â °“√«‘‡§√“–Àå‡™‘ßÕ¿‘¡“π (meta-analysis)22 æ∫§à“‡©≈’Ë¬

8-10% ·μππ— ø≈ŸÕÕ‰√¥å (stannous fluoride, SnF2) °“√ªÑÕß°—πøíπºÿ„πøíπ·∑â 22% (95% CI = 18-25%) π—Èπ‰¥â√—∫°“√»÷°…“∂÷ßª√– ‘∑∏‘¿“æ„π°“√ªÑÕß°—πøíπºÿ ´÷Ëß∑ÿ°°“√»÷°…“„™âÕ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å‡®≈ ·≈– „πÕ¥’μ17,18 ´÷Ëß„™â„π√Ÿª·∫∫ºßº ¡πÈ” ·μà‡π◊ËÕß®“°¡’√ ¢¡ ¡’§«“¡∂’Ë„π°“√∑“ 1-2 §√—ÈßμàÕªï ‚¥¬»÷°…“„π°≈ÿà¡Õ“¬ÿ ¢Õß‚≈À– μ‘¥ ’øíπ·≈–¢Õ∫«— ¥ÿ∫Ÿ√≥–øíπ √«¡∂÷ß‰¡à§ßμ—« μ—Èß·μà 6 ∂÷ß 15 ªï ‡π◊ËÕß®“°„πªí®®ÿ∫—π¬—ß‰¡à¡’À≈—°∞“π ®”‡ªìπμâÕßº ¡„À¡à∑ÿ°§√—Èß°àÕπ°“√„™â ´÷Ëß‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫ ∑’Ë‡æ’¬ßæÕ„π°“√ √ÿªª√– ‘∑∏‘¿“æ°“√ªÑÕß°—πøíπºÿ‡¡◊ËÕ °—∫Õ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å´÷Ëß¡’√ ™“μ‘∑’Ë¥’°«à“ ·≈– °“√∑“ø≈ŸÕÕ‰√¥å‡®≈‡æ’¬ßÀπ÷Ëß§√—ÈßμàÕªï ¥—ßπ—Èπ®÷ß¬—ß ¡’§«“¡§ßμ—« “¡“√∂‡°Á∫‰«â‰¥âπ“π°«à“ √«¡∂÷ß§à“ pH ∑’ËμË” π—∫ πÿπ°“√·π–π”„Àâ∑“Õ¬à“ßπâÕ¬ Õß§√—ÈßμàÕªï ‡æ◊ËÕ ´÷Ëß™à«¬°“√π”ø≈ŸÕÕ‰√¥å‡¢â“ Ÿàº‘«‡§≈◊Õ∫øíπ‰¥â¥’ ¥—ßπ—Èπ ª√– ‘∑∏‘¿“æ„π°“√ªÑÕß°—πøíπº23ÿ Õ–´¥‘ ‡≈∑øÕ ‡øμø≈Ÿ ÕÕ‰√¥Ÿ ®å ß‡ª÷ π√ì ª·∫∫∑Ÿ π’Ë ¬¡¡“°°«‘ “à 19 ®“°√“¬ß“π°“√∑∫∑«π«√√≥°√√¡Õ¬à“ß‡ªìπ√–∫∫ ∑—Èßπ’ÈÕ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å¡’¢âÕ¥âÕ¬§◊Õ Õ“®∑”„Àâ (systematic review) ‚¥¬ Marinho „πªï §.». 2008 º‘««— ¥ÿ∫Ÿ√≥–øíπ∑’Ë¡’„π™àÕßª“°‡™àπ ‡√´‘π (resin) ·≈– · ¥ßº≈¢Õßø≈ŸÕÕ‰√¥å‡®≈∑’Ë Õ¥§≈âÕß°—π24 ‚¥¬æ∫ æÕ´‡≈π (porcelain) ¡’º‘«¢√ÿ¢√–·≈– Ÿ≠‡ ’¬§«“¡ «¬ß“¡ ª√– ‘∑∏‘¿“æ¢Õßø≈ŸÕÕ‰√¥å‡®≈„π°“√ªÑÕß°—πøíπºÿ Õÿ¥ ¥—ßπ—Èπ®÷ß‰¡à·π–π”„Àâ„™â Õ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å ∂Õπ „π√–¥—∫¥â“π¢Õßøíπ·∑â (DMFS) 28% (95% CI = „π°≈¡ºÿà ªŸâ «¬∑É ¡’Ë «’ ¥— ‡À≈ÿ “πà „π™’È Õßª“°à 20 ·μ§«√„™à ‚´‡¥â ¬¡’ 19-37%) ®“°®”π«π 23 °“√»÷°…“∑’Ëπ”¡“«‘‡§√“–Àåπ—Èπ ø≈ŸÕÕ‰√¥å‡®≈‡æ◊ËÕªÑÕß°—π°“√°—¥°√àÕπ¢Õßº‘««— ¥ÿμ“√“ß ¡’°“√„™â™π‘¥¢Õßø≈ŸÕÕ‰√¥å‡®≈∑’ËÀ≈“°À≈“¬ ‰¥â·°à Õ–´‘- ∑’Ë 1 ‡ª√’¬∫‡∑’¬∫§ÿ≥≈—°…≥–¢Õß‚´‡¥’¬¡ø≈ŸÕÕ‰√¥å ¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å ‚´‡¥’¬¡ø≈ŸÕÕ‰√¥å ‡Õ¡’π ·μππ— ø≈ŸÕÕ‰√¥å ·≈–Õ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å ø≈ŸÕÕ‰√¥å ·≈– ‡μππ— ø≈ŸÕÕ‰√¥å ·μà à«π„À≠à‡ªìπÕ–´‘¥Ÿ πÕ°®“°π’È¬—ß¡’ø≈ŸÕÕ‰√¥å‡®≈ ”À√—∫ºŸâªÉ«¬„™â‡Õß ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å·≈–∑”°“√»÷°…“„π™à«ßÕ“¬ÿ 6 ∂÷ß ∑ÿ°«—π∑’Ë∫â“π †(home use) ´÷Ëß “¡“√∂ —Ëß®à“¬„ÀâºŸâ∑’Ë¡’ 15 ªï ¡’‡æ’¬ß Õß°“√«‘®—¬„π°“√«‘‡§√“–Àåπ’È∑’Ë· ¥ßº≈ §«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥øíπºÿ ‚¥¬·π–π”„ÀâºŸâªÉ«¬„™â·ª√ß ¢Õßø≈ŸÕÕ‰√¥å‡®≈„πøíππÈ”π¡ ‚¥¬»÷°…“„π™à«ßÕ“¬ÿ 2 ∂÷ß ’øíπªÑ“¬„Àâ∑—Ë«øíπ∑ÿ°´’Ë¿“¬À≈—ß°“√·ª√ßøíπ°àÕππÕπ 6 ªï ´÷Ëß¬—ß‰¡à¡’À≈—°∞“π‡æ’¬ßæÕ∑’Ë®– √ÿªº≈¢Õß§«“¡∂’Ë ·≈–„Àâ∫â«π∑‘Èß‚¥¬‰¡àμâÕß∫â«ππÈ” √Ÿª·∫∫∑’Ë„™â‰¥â·°à 1.1% „π°“√„™âø≈ŸÕÕ‰√¥å‡®≈ ·≈–º≈¢Õß°“√ªÑÕß°—πøíπºÿ„πøíπ ‚´‡¥’¬¡ø≈ŸÕÕ‰√¥å 0.5% Õ–´‘¥Ÿ‡≈∑øÕ ‡øμø≈ŸÕÕ‰√¥å πÈ”π¡‰¥â

Table 1 Characteristics of NaF, SnF2, and APF Characteristics NaF SnF APF 2 Percent F- (ppm) 2% (9,200) 8% (19,500) 1.23% (12,300) Taste Bland Metalic, disagreeable Acidic Stability Stable Unstable Stable in plastic container Tooth pigmentation No Yes No Gingival irritation No Occasional, transient No Note: adapted from Horowitz and Ismail16

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ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ 167 ∑‘æπ“∂ «‘™≠“≥√—μπå « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554 ·≈â«æ∫«à“¡’§à“πâÕ¬°«à“∑’Ë√“¬ß“π¿“¬À≈—ß°“√‰¥â√—∫ • À“°‡¥Á°‰¥â√—∫ø≈ŸÕÕ‰√¥å‡ √‘¡‡ªìπª√–®” §«√ß¥ ø≈ŸÕÕ‰√¥å‡®≈61 °“√∑“πø≈ŸÕÕ‰√¥å‡ √‘¡„π«—ππ—Èπ ¥—ßπ—Èπø≈ŸÕÕ‰√¥å«“√åπ‘™®÷ß‡ªìπ∑“ß‡≈◊Õ°∑’Ë¥’°«à“ ¢âÕ‡ πÕ·π–¢Õß°“√„™âø≈ŸÕÕ‰√¥å«“√åπ‘™„π °“√„™âø≈ŸÕÕ‰√¥å‡®≈‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß„π‡¥Á°‡≈Á° ·≈– ‡¥Á°‰∑¬ ºŸâ∑’Ë¡’§«“¡º‘¥ª°μ‘¥â“πæ—≤π“°“√34 πÕ°®“°π’È¬—ß “¡“√∂ ‡π◊ËÕß®“°ø≈ŸÕÕ‰√¥å«“√åπ‘™π—Èπ¡’°“√„™â∑’Ë°«â“ß¢«“ß ∑“„π‡¥Á°∑’ËÕ“‡®’¬π‰¥âßà“¬ ‡π◊ËÕß®“°‰¡à®”‡ªìπμâÕß„ à∂“¥ ·≈–‡ªìπ∑’Ë√Ÿâ®—°¡“°¢÷Èπ„πª√–‡∑»‰∑¬ ®÷ß§«√¡’§«“¡™—¥‡®π ‡®≈ø≈ŸÕÕ‰√¥å„π™àÕßª“° ®“°°“√√“¬ß“πæ∫«à“°“√„™â ‡°’Ë¬«°—∫¢âÕ∫àß™’È ”À√—∫‡¥Á°∑’Ë¡’§«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥ ø≈ŸÕÕ‰√¥å«“√åπ‘™¡’°“√¬Õ¡√—∫¡“°°«à“ø≈ŸÕÕ‰√¥å‡®≈∑—Èß øíπºÿ‡æ◊ËÕ„Àâ‡°‘¥§«“¡§ÿâ¡§à“ Ÿß ÿ¥ ‚¥¬§«√„Àâ§”π‘¬“¡¢Õß ®“°ºŸâªÉ«¬·≈–°≈ÿà¡ºŸâ„À—∫√‘°“√62 ‡π◊ËÕß®“°„™â‰¥âßà“¬√«¥‡√Á« ç§«“¡‡ ’Ë¬ß„π°“√‡°‘¥øíπºÿé „Àâ¡’§«“¡™—¥‡®π„π√–À«à“ß °«à“ ·≈– “¡“√∂§«∫§ÿ¡°“√°≈◊πø≈ŸÕÕ‰√¥å‰¥â¥’°«à“ °≈ÿà¡ºŸâ„Àâ∫√‘°“√∑“ß “∏“√≥ ÿ¢ ‡æ√“–°“√„™âø≈ŸÕÕ‰√¥å ¢âÕ¥âÕ¬ «“√åπ‘™π—Èπ¡’·π«‚πâ¡∑’Ë®–„™â„πß“π∫√‘°“√ “∏“√≥ ÿ¢ °“√∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™∫“ß™π‘¥∑”„Àâøíπ¡’ ’‡À≈◊Õß ‚¥¬°“√Ωñ°‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢∑’Ë‰¡à„™à∑—πμ∫ÿ§≈“°√ πÈ”μ“≈™—Ë«§√“«¿“¬À≈—ß°“√∑“ ‡π◊ËÕß®“° ’¢Õßø≈ŸÕÕ‰√¥å ¡“°¢÷Èπ ‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß°“√„™â„π°≈ÿà¡‡¥Á°‡≈Á° Õ¬à“ß‰√ «“√åπ‘™ ·μà “¡“√∂·ª√ßÕÕ°‰¥â„π«—π∂—¥‰ª ‚¥¬∑—Ë«‰ª °Á¥’‡°≥±å°“√ª√–‡¡‘π§«“¡‡ ’Ë¬ßμàÕ°“√‡°‘¥øíπºÿπ—Èπ¡’ ‰¡àæ∫Õ“°“√¢â“ß‡§’¬ßÕ¬à“ß√ÿπ·√ß®“°°“√„™âø≈ŸÕÕ‰√¥å À≈“°À≈“¬63-70 ·≈–‰¡à¡’À≈—°‡°≥±å∑’Ë∂◊Õ‡ªìπ¡“μ√∞“π «“√åπ‘™ πÕ°®“°√“¬ß“π°“√·æâ‚¥¬°“√ —¡º— (contact ‡æ’¬ßÀπ÷Ëß‡¥’¬« °“√‡≈◊Õ°„™â¢÷ÈπÕ¬Ÿà°—∫°“√æ‘®“√≥“·≈– allergy) πÕ°®“°π’ÈÕ“®¡’º≈¢â“ß‡§’¬ß§◊Õ¡’Õ“°“√ª«¥· ∫ μ°≈ß°—π√–À«à“ßºŸâªØ‘∫—μ‘ß“π‡æ◊ËÕ„Àâ‡°‘¥°“√„™âø≈ŸÕÕ‰√¥å √âÕπ (burning sensation) „π√–¬– —Èπ Ê ‡¡◊ËÕ —¡º— Õ¬à“ß‡À¡“– ¡·≈–¡’§«“¡§ÿâ¡§à“ Ÿß ÿ¥ μ“√“ß∑’Ë 2 ·≈– 3 ‡π◊ÈÕ‡¬◊ËÕ∫√‘‡«≥‡Àß◊Õ° · ¥ß·π«∑“ß°“√ª√–‡¡‘π§«“¡‡ ’Ë¬ßμàÕ°“√‡°‘¥øíπºÿ «‘∏’°“√„™â „π‡¥Á° ‚¥¬∑—πμ·æ∑¬å ¡“§¡·Ààßª√–‡∑»‰∑¬ ”À√—∫ °“√„™ø≈â ÕÕ‰√¥Ÿ «“√å πå ™·π–π”„À‘ ∑“Õ¬â “ßπà Õ¬∑â °ÿ Ê ‡¥Á°Õ“¬ÿμË”°«à“ 3 ªï ·≈–μ—Èß·μà 3 ªï¢÷Èπ‰ª71 6 ‡¥◊Õπ ‚¥¬¢—ÈπμÕπ„π°“√∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™π—Èπ “¡“√∂ °“√„™âø≈ŸÕÕ‰√¥å«“√åπ‘™§«√‡√‘Ë¡∑”„π‡¥Á°∑’Ë¬—ß‰¡à‡°‘¥ ∑”‰¥â‚¥¬ √Õ¬‚√§À√◊Õ¡’√Õ¬ºÿ‡æ’¬ß‡√‘Ë¡·√°∑’Ë‰¥â√—∫°“√ª√–‡¡‘π«à“ • „™âºâ“°äÕ´‡™Á¥øíπ„Àâ·Àâß À√◊Õ„™â≈¡‡ªÉ“ °“√°—Èπ ¡’§«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥øíπºÿ ·≈–∑“Õ¬à“ßπâÕ¬ Õß§√—Èß πÈ”≈“¬π—Èπ‰¡à®”‡ªìπ‡æ√“–ø≈ŸÕÕ‰√¥å«“√åπ‘™ “¡“√∂·¢Áßμ—« μàÕªï‡æ◊ËÕ„Àâ‡°‘¥ª√– ‘∑∏‘¿“æ Ÿß ÿ¥„π°“√ªÑÕß°—πøíπºÿ54,55 ·¡â«à“®–¡’§«“¡™◊Èπ πÕ°®“°π’ÈÀ“°„™â„π‚§√ß°“√√–¥—∫™ÿ¡™π§«√‡ªìπ‚§√ß°“√ • ‡μ√’¬¡ø≈ŸÕÕ‰√¥å«“√åπ‘™®”π«π 0.5-1 ¡‘≈≈‘≈‘μ√ ∑’Ëº ¡º “π‰ª°—∫ß“πª°μ‘ ‰¡à§«√‡ªìπ‚§√ß°“√·¬°‡¥’Ë¬« „π∂â«¬‡≈Á°Ê ´÷Ëß§«√ª√–¡“≥„Àâ‡æ’¬ßæÕ°—∫øíπ∑ÿ°´’Ë„πª“° ‡π◊ËÕß®“°Õ“®‰¡à‡°‘¥§«“¡§ÿâ¡§à“ ¥—ßπ—Èπ®÷ß§«√«“ß·π«∑“ß • ∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™∫“ß Ê ¥â«¬æŸà°—π À√◊Õ ”≈’ „Àâ¡’°“√º ¡º “π°“√∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™„πß“π§≈‘π‘° °âÕπ‡≈Á° Ê ‚¥¬æ¬“¬“¡‰¡à„Àâ®—∫‡ªìπ°âÕπÀ√◊ÕÀπ“∫πº‘« ‡¥Á°¥’ ‡π◊ËÕß®“°‡¥Á°„π™à«ß∑’Ë¡“√—∫«—§´’ππ—Èπ®–‡ªìπ™à«ßÕ“¬ÿ øíπ §«√À≈’°‡≈’Ë¬ß°“√∑“‚¥π∫√‘‡«≥‡Àß◊Õ° ‡æ◊ËÕ≈¥‚Õ°“ ∑’Ë°”Àπ¥™—¥‡®π·≈– “¡“√∂μ‘¥μ“¡‰¥â ´÷ËßμâÕß√«¡∂÷ß °“√·æÀ√â ÕÕ“°“√√–§“¬‡§◊ Õß◊ ‰¡§«√∑“‚¥¬μ√ß„π‚æ√ßøà πí °“√«“ß·ºπ°”≈—ß∫ÿ§≈“°√∑’Ë‡À¡“– ¡ °“√Õ∫√¡‡®â“Àπâ“∑’Ë ∑’Ëºÿ°«â“ß À√◊Õ∑–≈ÿ‚æ√ßª√– “∑øíπ ¢—ÈπμÕπ∑—ÈßÀ¡¥„™â ºŸâ‡°’Ë¬«¢âÕß∑—Èß§«“¡‡¢â“„®·π«§‘¥°“√ªÑÕß°—π‚√§øíπºÿ ‡«≈“ª√–¡“≥ 3-5 π“∑’ ¢÷ÈπÕ¬Ÿà°—∫®”π«πøíπ„π™àÕßª“° „π‡¥Á°‡≈Á° °“√ª√–‡¡‘π§«“¡‡ ’Ë¬ß μ≈Õ¥®π«“ß√–∫∫°“√ • ¿“¬À≈—ß°“√∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™ §«√‡≈’Ë¬ß μ‘¥μ“¡·≈–√“¬ß“π∑’Ë Õ¥·∑√°‡¢â“‰ª°—∫Àπà«¬ß“π Õ“À“√·¢Áßª√–¡“≥ 2-4 ™—Ë«‚¡ß ·≈–ß¥°“√·ª√ßøíπ ª∞¡¿¡Ÿ ‘ „π«—π∑’Ë∑“ø≈ŸÕÕ‰√¥å«“√åπ‘™ ‡æ◊ËÕ‡æ‘Ë¡°“√¬÷¥μ‘¥·≈–°“√ ®“°À≈—°∞“π„πªí®®ÿ∫—π ª√– ‘∑∏‘¿“æ‚¥¬√«¡¢Õß ª≈àÕ¬ø≈ŸÕÕ‰√¥å Ÿàº‘«‡§≈◊Õ∫øíπ ø≈ŸÕÕ‰√¥å«“√åπ‘™π—Èπ “¡“√∂ªÑÕß°—πøíπºÿ‰¥â‰¡à·μ°μà“ß°—∫

168 ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ ∑‘æπ“∂ «‘™≠“≥√—μπå « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Table 2 Caries risk assessment for children less than 3 years Indicators High risk Low risk Part I. General Health Assessment - Children with special health care needs, or Yes No have any systemic diseases Part II. Oral examination - Visible plaque on anterior teeth Yes No - Cavitated carious lesion Yes No - White spot lesion Yes No Note : from the Dental Association of Thailand71 The presence of a single risk indicator in any area of the çhigh-riské category is classified as high caries risk

Table 3 Caries risk assessment for children 3 years and older Indicators High Moderate Low Part I. General Health Assessment - Children with special health care needs, Yes No or have any systemic diseases Part II. Oral examination and radiographic findings - Cavitated carious lesion Yes No - Visible plaque Yes No - White spot lesion >1 area 1 area None - Enamel defects and/or deep pits and fissure Yes No in permanent molars - Interproximal lesion from radiography Yes No - Newly developed carious lesion <12 months 12-24 months >24 months Part III. Risk and protective factors - Regular dental chseck up once a day Yes No Note : from the Dental Association of Thailand71 - The presence of a single risk indicator is classified as high caries risk - The presence of at least 1 çmoderate riské indicator and no çhigh riské indicators is classified as moderate caries risk - The child who has none of çmoderate riské or çhigh riské indicators is classified as low caries risk

ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ 169 ∑‘æπ“∂ «‘™≠“≥√—μπå « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

°“√„™âø≈ŸÕÕ‰√¥å‡®≈ ·μàª√–‚¬™πå∑’Ëπà“®–π”¡“„™â‡ªìπÀ≈—° ·≈–§«“¡‡¢â¡¢âπ¢Õßø≈ŸÕÕ‰√¥å‡®≈·≈–«“√åπ‘™∑’Ëπ‘¬¡„™â §◊Õ°“√„™â„π‡¥Á°‡≈Á°μË”°«à“ 6 ªï∑’Ë¬—ß‰¡à “¡“√∂§«∫§ÿ¡ „πªí®®ÿ∫—π ·≈–μ“√“ß∑’Ë 5 · ¥ß¢âÕ·π–π”°“√„™âø≈ŸÕÕ‰√¥å °“√°≈◊π‰¥â¥’ ‡π◊ËÕß®“°¡’§«“¡ –¥«° §«“¡ª≈Õ¥¿—¬ ·≈– ‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™‚¥¬·∫àßμ“¡°≈ÿà¡Õ“¬ÿ·≈–√–¥—∫ ‰¥â√—∫°“√¬Õ¡√—∫¡“°°«à“ à«π°“√„™âø≈ŸÕÕ‰√¥å«“π‘™ §«“¡‡ ’Ë¬ß„π°“√‡°‘¥øíπºÿ „π‡¥Á°Õ“¬ÿ 6-12 ªïπ—Èπ§«√‡ªìπ∑“ß‡≈◊Õ°Àπ÷Ëß ·≈–μâÕß °“√»÷°…“«‘®—¬„πÕπ“§μ §«√‡æ‘Ë¡°“√»÷°…“√–¬– æ‘®“√≥“ªí®®—¬§«“¡®”‡ªìπÕ◊ËπÊ√à«¡¥â«¬‡™àπ §«“¡§ÿâ¡§à“ ¬“«·≈–¡’°≈ÿà¡»÷°…“∑’Ë„À≠à¢÷Èπ‡°’Ë¬«°—∫º≈¢Õßø≈ŸÕÕ‰√¥å √–¬–‡«≈“∑’Ë∑” ´÷Ëß§«√‰¥â√—∫°“√»÷°…“‡æ‘Ë¡‡μ‘¡μàÕ‰ª «“√åπ‘™„π‡¥Á°μË”°«à“ 3 ªï‚¥¬„™â°“√«‘®—¬‡™‘ß∑¥≈Õß·∫∫ ÿà¡ ‚¥¬¡’°≈ÿà¡§«∫§ÿ¡ »÷°…“√Ÿª·∫∫·≈–§«“¡§ÿâ¡§à“„π°“√„™â √ÿª·≈–¢âÕ‡ πÕ·π–‡æ◊ËÕ°“√»÷°…“„πÕπ“§μ ø≈ŸÕÕ‰√¥å«“√åπ‘™‚¥¬ºŸâ∑’Ë‰¡à„™à∑—πμ∫ÿ§≈“°√∑’Ë‰¥â√—∫°“√ °“√„™âø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ ‡ªìπ Ωñ°Ωπ„π‚§√ß°“√√–¥—∫™ÿ¡™π »÷°…“ª√– ‘∑∏‘¿“æ¢Õß ¡“μ√°“√ªÑÕß°—πøíπºÿ∑’Ë ”§—≠∑—Èß„π√–¥—∫∫ÿ§§≈·≈– ø≈ŸÕÕ‰√¥å«“√åπ‘™™π‘¥μà“ß Ê ∑’ËπÕ°‡Àπ◊Õ®“° 5% ‚´‡¥’¬¡ „π√–¥—∫™ÿ¡™π ‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß„πª√–‡∑»‰∑¬∑’Ë ø≈ŸÕÕ‰√¥å ª√– ‘∑∏‘¿“æ¢Õßø≈ŸÕÕ‰√¥å‡®≈™π‘¥‚´‡¥’¬¡ ª√–™“°√‡¥Á° à«π„À≠à¬—ß¡’§«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥øíπºÿ ø≈ŸÕÕ‰√¥å º≈¢Õß°“√„™â„π§«“¡∂’Ë∑’Ë·μ°μà“ß°—π ‚¥¬ ¥—ßπ—Èπ∑—πμ∫ÿ§≈“°√§«√μ√–Àπ—°∂÷ß°“√„™âø≈ŸÕÕ‰√¥å∑’Ë¡’ ‡©æ“–Õ¬à“ß¬‘Ëß„π°≈ÿà¡ºŸâªÉ«¬æ‘‡»… (special needs) º≈ §«“¡‡¢â¡¢âπ ŸßÕ¬à“ß‡À¡“– ¡‡æ◊ËÕ„Àâ‡°‘¥ª√–‚¬™πå Ÿß ÿ¥ °“√„™âø≈ŸÕÕ‰√¥å«“√åπ‘™ ”À√—∫ªÑÕß°—πøíπºÿ∫√‘‡«≥√“°øíπ „π°“√ªÕß°Ñ πø— πºí ·≈–≈¥°“√‡°ÿ ¥º≈¢‘ “ß‡§â ¬ß∑’ Õ“®‡°’Ë ¥¢‘ π÷È (root caries) ·≈–°“√‡°‘¥øíπºÿ´È” (recurrent caries) ®“°À≈—°∞“π°“√»÷°…“∑’Ëºà“π¡“· ¥ßª√– ‘∑∏‘¿“æ¢Õß «‘‡§√“–Àå‡æ◊ËÕÀ“√Ÿª·∫∫ ®”π«π§√—Èß §«“¡∂’Ë∑’Ë¡’§«“¡§ÿâ¡ ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ „π°“√≈¥°“√‡°‘¥øíπºÿ §à“¢Õß°“√„™âø≈ŸÕÕ‰√¥å«“√åπ‘™ √«¡∂÷ßªí®®—¬∑’Ë¡’º≈μàÕ ∑—Èß„πøíπ·∑â·≈–øíππÈ”π¡„π°≈ÿà¡ª√–™“°√∑’Ë¡’§«“¡‡ ’Ë¬ß §«“¡§ÿâ¡§à“¢Õß°“√„™âø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ „π°“√‡°‘¥øíπºÿ Ÿß ‚¥¬„™âÕ¬à“ßπâÕ¬∑ÿ° Ê 6 ‡¥◊Õπ „π™à«ß „π‚§√ß°“√∑—πμ°√√¡ªÑÕß°—π„π‚√ß‡√’¬π∑’Ëπ—°‡√’¬π¡’ ‡«≈“μ‘¥μàÕ°—πÕ¬à“ßπâÕ¬ 2 ªï √à«¡°—∫°“√„Àâ∑—πμ ÿ¢ §«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥øíπºÿ πÕ°®“°π’È§«√ àß‡ √‘¡°“√ »÷°…“ °“√„™âø≈ŸÕÕ‰√¥å«“√åπ‘™‡æ◊ËÕªÑÕß°—πøíπºÿ„π‡¥Á°‡≈Á° »÷°…“‡æ◊ËÕæ—≤π“º≈‘μ¿—≥±å À√◊Õ√–∫∫°“√„™âø≈ŸÕÕ‰√¥å μË”°«à“ 3 ªï §«√‡√‘Ë¡∑“°àÕπ∑’Ë®–¡’√Õ¬‚√§øíπºÿ„π°≈ÿà¡‡¥Á° ∑’Ë¡’°“√ª≈àÕ¬ø≈ŸÕÕ‰√¥åÕ¬à“ß™â“ Ê ‡æ◊ËÕ‡æ‘Ë¡ª√– ‘∑∏‘¿“æ ∑’Ë¡’§«“¡‡ ’Ë¬ß„π°“√‡°‘¥øíπºÿ Ÿß μ“√“ß∑’Ë 4 √ÿª™π‘¥ „π°“√ªÑÕß°—πøíπºÿ

Table 4 Types and concentration of fluoride gel and varnish Types Fluoride Concentration mgF/ml % F ion ppm Fluoride Gel - Office use 1.23% APF 12.3 1.23 12,300 2% NaF 9.2 0.92 9,200 - Home use 0.5% APF 5 0.5 5,000 1.1% NaF 5 0.5 5,000

0.4% SnF2 1 0.1 1,000 Fluoride Varnish 5% NaF 22.6 2.26 22,600 1% Difluorosilane 1 0.1 1,000

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Table 5 Recommendation for professionally applied topical fluoride Caries Risk Age Categories* <3 years ≥3 years Low May not have additional benefit from May not have additional benefit from professional topical fluoride professional topical fluoride Moderate Fluoride varnish application at 6-month Fluoride varnish OR gel application intervals at 6-month intervals** High Fluoride varnish application at 3-6-month Fluoride varnish OR gel application at intervals 3-6-month intervals** Note : *All age and risk groups are recommended to use an appropriate amount of fluoride toothpaste and brushing twice a day. **Fluoride varnish application should be considered if patients cannot tolerate 4-minute fluoride tray.

‡Õ° “√Õâ“ßÕ‘ß 7. Koch G, Petersson LG. Fluoride content of enamel 1. Petersson G, Bratthal D. The caries decline: a surface treated with a varnish containing sodium review of reviews. Eur J of Oral Sci 1996; 104: fluoride. Odontol Revy 1972; 23: 437-46. 436-43. 8. Stamm JW. Fluoride uptake from topical sodium 2. Ripa LW. A Critique of Topical Fluoride Methods fluoride varnish measured by an in vivo enamel (Dentifrices, Mouthrinses, Operator-, and Self- biopsy. Dent J 1974; 40: 501-5. applied Gels) in an Era of Decreased Caries and 9. Seppa L, Luoma H, Hausen H. Fluoride content Increased Fluorosis Prevalence. J Public Health in enamel after repeated applications of fluoride Dent 1991; 51: 23-41. varnishes in a community with fluoridated water. 3. Han D, Kim J, Park D. The decline in dental caries Caries Res 1982; 16: 7-11. among children of different ages in Korea, 2000- 10. Fejerskov O, Thylstrup A, Larsen MJ. Rational use 2006. Int Dent J 2010; 60: 329-35. of fluorides in caries prevention. A concept based 4. Bratthall D, Hansel-Petersson G, Sundberg H. on possible cariostatic mechanisms. Acta Odontol Reasons for the caries decline: what do the Scand 1981; 39: 241-9. experts believe? Eur J Oral Sci 1996; 104: 416- 11. Rolla G. On the role of calcium fluoride in the 22. cariostatic mechanism of fluoride. Acta Odontol 5. Dye B, Arevalo O, Vargas C. Trends in paediatric Scand 1988; 46: 341-5. dental caries by poverty status in the United 12. Ogaard B, Gaffar A, Bahl MK, Rolla G, Helgeland States, 1988-1994 and 1999-2004. Int J K. Fluoride retention in clean and plaque-covered Paediatr Dent 2010; 20: 132-43. demineralized enamel in vivo after application of 6. The 6th National Oral Health Survey 2006-2007 monofluorophosphate. Scand J Dent Res 1985; [database on the Internet]. Department of Health, 93: 486-93. Ministry of Public Health, Thailand. 2007 [cited 13. Beltran-Aguilar E, Goldstein J, Lockwood S. 9 Dec 2010]. Available from: http://dental.anamai. Fluoride varnishes: a review of their clinical use, moph.go.th/journal.php. cariostatic mechanism, efficacy and safety. J Am

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Kemthong Mitrakul Abstract D.D.S., Cert. in Pediatric Dentistry, Black tooth stain is one of common problems in pediatric dentistry. D.Sc.D Department of Pediatric Dentistry, Even though it does not result in pain but it associates with esthetic which Faculty of Dentistry, Mahidol University most parents are concern about. In this article, etiology, prevalence, possible causes, associated oral microflora, diagnosis and ongoing researches on black stain were reviewed. Many studies demonstrated a positive association between black stain and decreased dental caries prevalence as well as the relationship between degree of black stain and caries severity. As a dental professional, we should capable of providing an updated knowledge in this aspect as well as delivering a high quality of dental treatment. Keywords: black tooth stain in children, bacteria, dental plaque, dental caries

Correspondence author: Kemthong Mitrakul Department of Pediatric Dentistry Faculty of Dentistry, Mahidol University 6 Yothi Street, Ratchathewi, Bangkok 10400, Thailand. Tel: 02-203-6450-3 extension 114 Fax: 02-203-6450 Mobile phone: 085-256-2922 E-mail: [email protected] Research grant: - Received: 7 October 2011 Accepted: 26 December 2011

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∫∑π” ‡¢â“‰ª ‡™àπ ∏“μÿ∑Õß·¥ß ∑”„Àâ‡°‘¥§√“∫ ’‡¢’¬«∏“μÿ‡ß‘π √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ° ∑”„Àâ‡°‘¥§√“∫ ’¥” ‡ªìπμâπ „π‡¥Á° (√Ÿª∑’Ë 1 ∂÷ß 3) æ∫‰¥â∫àÕ¬§√—Èß∑“ß§≈‘π‘° ·¡â«à“ °“√∑”§«“¡ –Õ“¥‚¥¬°“√·ª√ßøíπ “¡“√∂ ®–‰¡à°àÕ„Àâ‡°‘¥§«“¡‡®Á∫ª«¥·μà°Á àßº≈μàÕ§«“¡ «¬ß“¡ ¢®—¥√Õ¬§√“∫¿“¬πÕ°øíππ’ÈÕÕ°‰¥â‡ªìπ à«π¡“° „πªí®®ÿ∫—π æ∫ºŸâªÉ«¬‡¥Á°À√◊ÕºŸâª°§√Õß ¡“¥â«¬Õ“°“√ 2. √Õ¬§√“∫¿“¬πÕ°øíπ·∫∫μ‘¥·πàπ (tenacious ”§—≠ (chief complaint) «à“¡’√Õ¬§√“∫ ’¥”∫πøíπ tooth stain) §√“∫‡À≈à“π’È¡—°‡°‘¥®“°°“√ Ÿ∫∫ÿÀ√’Ë‡ªìπ√–¬– „πÕ—μ√“∑’Ë Ÿß¢÷Èπ°«à“∑’Ëºà“π¡“ ‚¥¬ºŸâª°§√Õß à«π„À≠à¡—° ‡«≈“π“πÊ ∫√‘‡«≥∑’Ëæ∫‰¥âπ—Èπ πÕ°®“°®–æ∫„π∫√‘‡«≥ °—ß«≈«à“√Õ¬§√“∫π’È„™à√ŸºÿÀ√◊Õ‰¡à ®“°°“√»÷°…“„πª√–‡∑» ¥â“π·°â¡¢Õßøíπ°√“¡∫π·≈–≈à“ß ¥â“π≈‘Èπ¢ÕßøíπÀπâ“≈à“ß À√“™Õ“≥“®°√‚¥¬„À— °≈â ¡Õ“ “ ¡ÿà §√°√Õ°·∫∫ Õ∫∂“¡— ·≈â«®–æ∫∫√‘‡«≥„πÀ≈ÿ¡√àÕßøíπ°√“¡À≈—ß ‚¥¬¡“°¡—°¡’ ‡√’¬ß≈”¥—∫ªí≠À“„π™àÕßª“°∑’Ë àßº≈μàÕ§«“¡ «¬ß“¡®“° ’πÈ”μ“≈‡¢â¡‡°◊Õ∫¥” √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ ¡“°‰ªπâÕ¬¥â«¬μπ‡Õß ‰¥âº≈«à“√Õ¬§√“∫ ’¥”√–À«à“ßøíπ ¢Õ∫‡Àß◊Õ°®—¥Õ¬Ÿà„π√Õ¬§√“∫ª√–‡¿∑π’È °“√∑”§«“¡ ‡ªìπªí≠À“Õ—π¥—∫∑’Ë 3 √Õß®“°‚√§øíπºÿ·≈–°“√‡ÀÁπ¢Õ∫ –Õ“¥¥â«¬°“√·ª√ßøíπ ·¡â®–„™â·ª√ß‰øøÑ“ °Á‰¡à “¡“√∂ §√Õ∫øíπ‡«≈“¬‘È¡ μ“¡≈”¥—∫1 ¢®—¥§√“∫π’ÈÕÕ°‰¥â 2, 4, 5 μâÕß‰¥â√—∫°“√¢—¥øíπ®“°∑—πμ- °“√‡ª≈’Ë¬π ’¢Õßøíπ (tooth staining/discolora- ·æ∑¬å´÷ËßμâÕß„™âÀ—«¬“ß (rubber cup) ·≈–ºß¢—¥ (pumice) tion) À√◊Õ√Õ¬§√“∫∫πøíππ—Èπ·μ°μà“ß°—π„π·ßà¥—ßμàÕ‰ªπ’È ÕÕ°·√ß°¥‡≈Á°πâÕ¬¢≥–¢—¥À√◊Õ∂â“§√“∫μ‘¥·πàπ¡“°Ê ‰¥â·°à ¡ÿØ∞“π«‘∑¬“ (etiology) ≈—°…≥–∑“ß§≈‘π‘° (clini- μâÕß„™â‡§√◊ËÕß¢Ÿ¥À‘ππÈ”≈“¬Õ—≈μ√“‚´π‘° å (ultrasonic cal appearance) μ”·Àπàß∑’Ëæ∫„π™àÕßª“° (location) scaler) √à«¡¥â«¬‡æ◊ËÕ¢®—¥ÕÕ° à«πª√–°Õ∫„π√Õ¬§√“∫ (composition) §«“¡√ÿπ·√ß 3. √Õ¬§√“∫¿“¬„πøíπ (intrinsic tooth stain) ‡ªìπ (severity) ·≈–§«“¡ “¡“√∂„π°“√¬÷¥‡°“–∫πøíπ¢Õß √Õ¬§√“∫∑’Ë‡°‘¥¿“¬„π™—Èπ‡§≈◊Õ∫øíπ·≈–‡π◊ÈÕøíπ æ∫‰¥â §√“∫‡À≈à“π—Èπ (degree of adherence) ∑—Èß„πºŸâ„À≠à·≈–‡¥Á° ‡°‘¥‰¥â®“°À≈“¬ “‡Àμÿ „π«—¬ºŸâ„À≠à ª√–‡¿∑¢Õß°“√‡ª≈’Ë¬π ’¢Õßøíπ (type of tooth Õ“®¡“®“° “‡ÀμÿμàÕ‰ªπ’È ‰¥â·°à °“√‡ª≈’Ë¬π·ª≈ß¢Õß«—¬ staining/discoloration) ¥—ß· ¥ß‰«â„πμ“√“ß∑’Ë 1 “¡“√∂ (aging) °“√√—∫ª√–∑“πÕ“À“√À√◊Õ¬“∑’Ë¡’ à«πº ¡¢Õß ·∫àß‰¥â ¥—ßπ’È 2 ∏“μÿ‚≈À–‡ªìπ√–¬–‡«≈“π“πÊ °“√ Ÿ∫∫ÿÀ√’Ë·≈–¡’º‘«‡§≈◊Õ∫ 1. √Õ¬§√“∫¿“¬πÕ°øíπ·∫∫‰¡àμ‘¥·πàπ (extrinsic øíπ·μ° (crack enamel) „π‡¥Á°‡°‘¥‰¥â®“° 2 “‡Àμÿ„À≠à tooth stain) ‡ªìπ§√“∫∑’Ë‡°“–Õ¬Ÿà∫πº‘«‡§≈◊Õ∫øíπ ‡°‘¥¢÷Èπ ‰¥â·°à ®“°§«“¡º‘¥ª°μ‘·μà°”‡π‘¥ (congenital causes) ®“° “‡Àμÿ¿“¬πÕ° ‡™àπ °“√ Ÿ∫∫ÿÀ√’Ë ‡æ√“–„π¬“ Ÿ∫ ‰¥â·°à ¡’§«“¡º‘¥ª°μ‘¢Õß‡´≈≈å∑’Ë§«∫§ÿ¡°“√ √â“ßº‘« ¡’ “√®”æ«°∑“√å∑’Ë∑”„Àâ‡°‘¥°“√μ‘¥ ’∫πøíπ °“√∫√‘‚¿§ ‡§≈◊Õ∫øíπÀ√◊Õ‡π◊ÈÕøíπ¢≥– √â“ßÕ—π‡π◊ËÕß¡“®“°√à“ß°“¬ Õ“À“√∫“ß™π‘¥ ‰¥â·°à πÈ”™“ °“·ø À√◊ÕÕ“À“√∑’Ë¡’ ÕàÕπ·Õ ´÷Ëß‡°‘¥‰¥â®“°À≈“¬ “‡Àμÿ ‡™àπ °“√μ‘¥‡™◊ÈÕ ‡ªìπ ‡§√◊ËÕß‡∑»¡“°Ê ‡æ√“–„πÕ“À“√À√◊Õ‡§√◊ËÕß¥◊Ë¡‡À≈à“π’È ¿“«–¥’´à“π·∫∫√ÿπ·√ß„π«—¬∑“√° (severe jaundice in ¡’ “√·∑ππ‘π (tannin) ∑’Ë∑”„Àâ‡°‘¥°“√μ‘¥ ’∫πøíπ ·≈– infancy) ·≈–°“√‰¥â√—∫¬“ªØ‘™’«π–∫“ß™π‘¥ ‡™àπ ‡μμ√â“- ÿ¥∑â“¬§◊Õ§√“∫À‘πªŸπ ‚¥¬ “¡“√∂æ∫√Õ¬§√“∫·∫∫π’È ‰´§≈‘π “‡Àμÿ∑’Ë 2 §◊Õ§«“¡º‘¥ª°μ‘À≈—ß°”‡π‘¥ (acquired ‰¥âÀ≈“¬ ’ μ—«Õ¬à“ß‡™àπ causes) ‰¥â·°à °“√‰¥â√—∫ “√ø≈ŸÕÕ‰√¥å (fluoride) ¡“° 1.1. √Õ¬§√“∫ ’πÈ”μ“≈ ¡—°æ∫„πºŸâ∑’Ë·ª√ßøíπ ‡°‘π‰ª5-9 ·≈–°“√‡ª≈’Ë¬π ’¢Õßøíπ‡π◊ËÕß¡“®“°√Õ¬‚√§ ‰¡à –Õ“¥À√◊Õ·ª√ß‚¥¬‰¡à„™â¬“ ’øíπ “¡“√∂æ∫√Õ¬ øíπºÿ (√Ÿª∑’Ë 4) √Õ¬§√“∫¿“¬„πøíππ’È‰¡à “¡“√∂¢—¥ÕÕ° §√“∫ ’πÈ”μ“≈Õ¬à“ßÀπ“∫√‘‡«≥¥â“π·°â¡¢Õßøíπ°√“¡ ‰¥â °“√√—°…“‰¥â·°à °“√øÕ° ’øíπ (tooth bleaching) °“√ ∫π·≈–≈à“ß ¥â“π≈‘Èπ¢ÕßøíπÀπâ“≈à“ß ∫Ÿ√≥–øíπ¥â«¬§√Õ∫øíπ ∫“ß§√—Èß√Õ¬§√“∫¿“¬πÕ°øíπ 1.2. √Õ¬§√“∫ ’‚≈À– ‡°‘¥®“°°“√√—∫ª√–∑“π ∑’Ëμ‘¥·πàπÕ¬Ÿà∫πøíπ‡ªìπ√–¬–‡«≈“π“πÊ°Á°≈“¬‡ªìπ√Õ¬ ¬“∑’Ë¡’ à«πº ¡¢Õß‚≈À–3 À√◊ÕÀ“¬„®‡Õ“ΩÿÉπ∏“μÿ¢Õß‚≈À– §√“∫¿“¬„πøíπ‰¥â

√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° 177 ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

i.e. veneer or full

scratch testing cleaning

fiber optic, UV light professional tooth exposure bleaching, restorative

), crown

i.e. tea, coffee, wine with rubber cup and

generalize smoking, plaque or visual inspection, vigorous brushing, calculus, certain scratch testing professional cleaning kind of food i.e. tannins in tea, coffee and other beverages buccal surfaces of poor OH care, professional cleaning posterior teeth, improper tooth lingual surfaces of brushing, prevalence: lower anterior teeth M>F generalize metallic compounds visual inspection, professional

generalize, pit and long term smoking, visual inspection, professional cleaning fissure of posterior plaque or calculus, scratch testing pumice or combine teeth certain kind of food with an ultrasonic

amelogenesis imperfecta, dentinogenesis imperfecta

Congenital and acquired causes i.e. stannous fluoride,

In children:

Aging, some medications contain metallic compounds, smoking, crack

green stain

orange stain

heavy grey to green, soft and ùfurryû film, found bacteria and fungi

1.2.2. mercury and lead dust; blue-

1.2.3. copper and nickel; green to blue

1.2.4. chromic acid fumes; deep

1.2.5. Iodine solution; brown stain

beyond cervical 1/3, following contour of the gingival or incompletely coalescent dark dots rarely extend beyond cervical 1/3 In adult: enamel; chlorhexidine, hematopoietic disorders (sickle cell anemia, thalassemia), or developmental disorders ( dietary mouth rinse, and dental caries

Type Characteristic Area Causes Clinical examination Treatment

Summary of type and nature of tooth staining/discoloration

Brown and/or green stain

1.1

1.2. Metal stain 1.2.1. silver; black stain

1. Extrinsic tooth stain thin, bacteria-free, pellicle-like film

2. Tenacious tooth stain thin, black pigmented line not extend

3. Intrinsic tooth stain

Table 1

178 √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

Fig. 1 Clinical aspect of black tooth stains in primary Fig. 2 Mixed dentition of 8-yr.-old Thai boy presented dentition. Stain shown a continuous pigmented with black tooth stains line limited to half of cervical third of the tooth surfaces6

Fig. 3 Clinical presentation of black tooth stains in per- Fig. 4 Intrinsic tooth stain which is represented in a manent dentition6 non-continuous pigmented line extending beyond half of the cervical third of the tooth surfaces6

Fig. 5 Clinical aspect of black tooth stains score 26 Fig. 6 Clinical aspect of black tooth stains score 36 with is a continuous pigmented lines limited to with a pigmented stains extending beyond half half of the cervical third of the tooth surfaces of the cervical third of the tooth surfaces

√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° 179 ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

67 73

59 81

5NA NA

0.1 NA NA

0.48 1

2.09

1 DMF-T: 2.42

4 DMF-T: 9

1 DMF-T: 6

2 DMF-T: 2.5

0.5 5.5 : 3 1 6.5 : 4

NA NA 31 49

6: 3 7: 4

1 DMF-T: 2

-10

grd

correlated with CF** complete 6- 3 p: 8

13-14 between two groups

gr. 6-8

BSs areas** 2.5

prevalence caries BS

India 1,097 14 staining degree Confirmed** 13-16 NA NA incomplete 11- 18 d: 31 USA 355 19 more frequent in M Not confirmed* 4-20 DMF-T: 8 Germany 12,890 11 more frequent in M Confirmed* 1 UK 1,205 NA NA Confirmed* 5 NA NA 20 29 Switzerland 2,127 20 prevalence peak at age Not significant 7-15 NA NA NA NA UK 86 2 no difference in OH Confirmed* 11-12 DMF-T: 3

Switzerland 614 3 NA NA 5.5-6.5 dmf-t dmf-t NA NA

Germany 801 4 more frequent in age NA 6-11 NA NA NA NA

Brazil 263 14.8 DMF-T lower in BS** Not confirmed ** 6-12 DMF-T: 1.5 Spain 1,100 7.54 sex was not assoc. with Not confirmed* 4-11 NA NA 30 30 Philippines 1,748 16 BS higher in remote Confirmed** 12

Summary of search publication in black stain in children

Authors Country Subject BS* Additional finding Association with Age (yr.) dmf-t/DMF-T No Caries prevalence No

lzow, 1963

Shourie, 1947

Leung, 1950 Commerell, 1955

Mellanby et al, 1957 G

Sutcliffe, 1967 Renz, 1976

Koch et al, 1996

Gasparetto et al., 2003 Paredes et al, 2005

Heinrich et al, 2009

Table 2

NA=not applicable, assoc.=associate, BS=black stain, OH=oral hygiene, CF=caries-free, grd.=grade, **=statistic significant

180 √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ « ∑—πμ ¡À‘¥≈ ªï∑’Ë 31 ‡≈à¡∑’Ë 3, 2554

√Õ¬§√“∫∫πøíπ∑—Èß 3 ª√–‡¿∑π’È„™â·√ß„π°“√¬÷¥ (white spot lesion) ∑’Ë¡’°“√ Ÿ≠‡ ’¬·√à∏“μÿ (decalcifica- ‡°“–∫πøíπ∑’Ë·μ°μà“ß°—π‰ªμ“¡ª√–‡¿∑ μ—«Õ¬à“ß‡™àπ tions7) ·√ß«“≈‡¥Õ«“« (van der Waals forces) ·√ß‰Œ‡¥√™—Ëπ (hydration forces) ·√ß‰Œ‚¥√‡®π (hydrogen bonds) ·≈– °“√«‘π‘®©—¬ (diagnosis) ·≈–°“√®—¥ª√–‡¿∑ °“√¬÷¥¥â«¬¢—È«‡¥’¬«°—π ‡™àπ ¢—È«ªØ‘°‘√‘¬“∑’Ë‰¡à™Õ∫πÈ” (classification) ¢Õß√Õ¬§√“∫ ’¥”∫πøíπ (hydrophobic interactions) Õ¬à“ß‰√°Áμ“¡ °≈‰°‡À≈à“π’È ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ° ¬—ß§ß¡’°“√»÷°…“«‘®—¬Õ¬ Ÿà 10 ·√°‡√‘Ë¡π—Èπ Shourie14 ·π–π”°“√®—¥ª√–‡¿∑ ·≈–§«“¡√ÿπ·√ß¢Õß√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ ≈—°…≥–∑“ß§≈‘π‘°¢Õß√Õ¬§√“∫ ’¥”∫πøíπ ¢Õ∫‡Àß◊Õ°‚¥¬°“√·∑π¥â«¬μ—«‡≈¢Õ¬à“ß‡ªìπ√–∫∫ ‡æ◊ËÕ„Àâ ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ° ßà“¬μàÕ°“√ ◊ËÕ “√√–À«à“ß∑—πμ·æ∑¬å ¥—ßμ“√“ß∑’Ë 4 μàÕ¡“ √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°π’È Leung15 ‰¥â·π–π”‡æ‘Ë¡‡μ‘¡ ‚¥¬‡æ‘Ë¡§–·ππ¢÷Èπ¡“Õ’° 1 ¡’§«“¡‡Àπ’¬«·≈– “¡“√∂¬÷¥‡°“–°—∫øíπ‰¥â¥’°«à“√Õ¬ §–·ππ‡√’¬°«à“ four-point scale μàÕ¡“ Gasparetto §√“∫¿“¬πÕ°øíπ·∫∫‰¡àμ‘¥·πàπ æ∫‰¥â∫àÕ¬§√—Èß„π‡¥Á° ·≈–§≥–6 ‰¥â‡æ‘Ë¡À≈—°‡°≥∑å‚¥¬∂◊Õæ◊Èπ∑’Ë∑’Ë√Õ¬§√“∫ ’¥” ™à«ßÕ“¬ÿøíππÈ”π¡·≈–™à«ßÕ“¬ÿøíπ™ÿ¥º ¡5-8, 10-13 ∑’Ë §√Õ∫§≈ÿ¡μ—«øíπ‡æ‘Ë¡‡μ‘¡„π‡«≈“μàÕ¡“ πà“ π„®§◊Õ ‡¡◊ËÕøíπ·∑â¢÷Èπ¡“§√∫·≈â«„π™àÕßª“° √Õ¬ §√“∫π’È®–®“ß≈ßÀ√◊Õæ∫‰¥âπâÕ¬≈ß¡“° ∫“ß°“√»÷°…“ «‘∏’°“√μ√«® °≈à“««à“∑’Ë “¡“√∂æ∫√Õ¬§√“∫·∫∫π’È„πÕ—μ√“∑’Ë Ÿß„π‡¥Á° ”À√—∫«‘∏’°“√μ√«®‡æ◊ËÕ™à«¬·¬°·¬–«à“‡ªìπ√Õ¬ π—Èπ ‡π◊ËÕß¡“®“°≈—°…≥–¢Õßº‘«‡§≈◊Õ∫øíπ„π‡¥Á°¡’√Ÿæ√ÿπ §√“∫ª√–‡¿∑„¥π—Èπ “¡“√∂·∫àß‰¥â ¥—ßπ’È 2, 7 ‡À¡“–·°à°“√¬÷¥‡°“–¢Õß√Õ¬§√“∫π’È¡“°°«à“‡¡◊ËÕ‡∑’¬∫°—∫ 1. °“√μ√«®¥â«¬°“√¥Ÿ (visual inspection) ‚¥¬ °≈ÿà¡ºŸâ„À≠à 10 √Õ¬§√“∫π’È¡’≈—°…≥–‡©æ“–μ—« ¥—ßπ’È √Õ¬ „™â°√–®°·≈–Õ¬Ÿà„π∫√‘‡«≥∑’Ë¡’· ß «à“ß‡æ’¬ßæÕ‡æ◊ËÕ„Àâ ¥”¡—°®–μàÕ‡π◊ËÕß°—π‡ªìπ·∂∫À√◊Õ ‡ªìπ®ÿ¥‡≈Á°Ê ‡™◊ËÕ¡ “¡“√∂·¬°·¬–‚∑π ’ (shades) ∑’Ëμ‘¥øíπ‰¥â μàÕ°—π‚¥¬¡’‡ âπºà“π»πŸ¬å°≈“ßπâÕ¬°«à“ 0.5 ¡‘≈≈‘‡¡μ√ 2. °“√μ√«®¥â«¬°“√„™â· ß àÕßºà“π (transillumi- ¡—°®–‡ ¡Õ°—π·≈–‡™◊ËÕ¡°—π∫πæ◊Èπº‘« (surfaces) ¢Õßøíπ nation) ∑”‰¥â‚¥¬°“√„™â‡§√◊ËÕß¡◊Õ ‡™àπ fiber optic probe Õ¬à“ßπâÕ¬ 2 ´’Ë¢÷Èπ‰ª “¡“√∂æ∫‰¥â¡“°∫√‘‡«≥„°≈â¢Õ∫ ‚¥¬∑”°“√ àÕßºà“π®“°¥â“π¢â“ß·°â¡‰ª¬—ß¥â“π≈‘Èπ «‘∏’π’È ‡Àß◊Õ° (gingival margin) ‚¥¬®–‡°“–Õ¬Ÿà∑’Ëº‘«øíπ‡Àπ◊Õ „™â‡ªìπ«‘∏’‡ √‘¡®“°°“√μ√«®¥â«¬°“√¥Ÿ·≈–°“√„™â‡§√◊ËÕß¡◊Õ ¢Õ∫‡Àß◊Õ°ª√–¡“≥ 1 ∂÷ß 2 ¡‘≈≈‘‡¡μ√ ¡’≈—°…≥–¢π“π μ√«®øíπ (explorer) ‡æ◊ËÕ·¬°ª√–‡¿∑¢Õß°“√μ‘¥ ’∫πøíπ ‰ª°—∫¢Õ∫‡Àß◊Õ° ‚¥¬ à«π„À≠à·≈â«®–‰¡à‡°‘π à«π∑’ËªÉÕß „πøíπ∑Ë ß ’ —¬«à“‡ªìπ√Õ¬ºÿÀ√◊Õ‰¡à ∑’Ë ÿ¥¢Õßμ—«øíπÀ√◊Õ∑’Ë‡√’¬°«à“ à«π∑’Ë 3 ¢Õßμ—«øíπ∑“ß§≈‘π‘° 3. °“√μ√«®¥â«¬°“√„™â· ßÕ—≈μ√“‰«‚Õ‡≈Áμ (ultra- (cervical third) ‚¥¬‰¡‡≈¬‰ª∂à ß∫√÷ ‡«≥¥‘ “πª√–™â ¥‘ (proxi- violet light exposure) «‘∏’π’È‰¡à§àÕ¬‡ªìπ∑’Ëπ‘¬¡π—° ·μà mal surface) ¢Õßøíπ (√Ÿª∑’Ë 1 ·≈– 5) ¡—°®–‰¡à¡’§«“¡ “¡“√∂„™â‡ √‘¡‡æ◊ËÕ™à«¬·¬°·¬–ª√–‡¿∑¢Õß°“√μ‘¥ ’ Àπ“ (thinkness) ¡’§«“¡·¢Áß„°≈â‡§’¬ß°—∫À‘ππÈ”≈“¬·≈– ∫πøíπ‚¥¬‡©æ“–√Õ¬§√“∫¿“¬„πøíπ‡æ√“–· ß®– àÕß ¡—°®–‡°‘¥¢÷Èπ„À¡à (reform) Õ¬à“ß√«¥‡√Á«¿“¬„π√–¬– 2 ∂÷ß ºà“π„πÕ—μ√“∑’Ë‰¡à‡∑à“°—π 3 ‡¥◊ÕπÀ≈—ß®“°¢—¥ÕÕ°‰ª·≈â« ∫√‘‡«≥∑’Ëæ∫‰¥â¡“°∑’Ë ÿ¥ 4. °“√μ√«®¥â«¬«‘∏’¢Ÿ¥∑’Ëº‘«‡§≈◊Õ∫øíπ (scratch ‰¥â·°à ¥â“π≈‘Èπ¢ÕßøíπÀπâ“≈à“ß (lingual of lower anterior testing) ‚¥¬°“√¢Ÿ¥‡∫“Ê∑’Ëº‘«‡§≈◊Õ∫øíπ∑’Ëª°§≈ÿ¡¥â«¬√Õ¬ teeth) ´ß‡ª÷Ë π∫√ì ‡«≥∑‘ „°≈’Ë °â ∫√— ‡ªŸ ¥¢Õß∑î Õμà Õ¡πà È”≈“¬„μ≈â π‘È §√“∫¥â«¬‡§√◊ËÕß¡◊Õμ√«®øíπÀ√◊Õ‡§√◊ËÕß¡◊Õ¢Ÿ¥À‘ππÈ”≈“¬ (opening sublingual duct) ·≈–‡¡◊ËÕ¢—¥ÕÕ°·≈â« º‘« (sickle) ”À√—∫§√“∫¿“¬πÕ°øíπ·∫∫‰¡àμ‘¥·πàπÀ√◊Õ ‡§≈◊Õ∫øíπ∑’ËÕ¬àŸ„μâ√Õ¬§√“∫π’È®–ª°μ‘ ‰¡à¡’°“√ Ÿ≠‡ ’¬ ‡ªìπ·§à·ºàπ§√“∫®ÿ≈‘π∑√’¬åπ—Èπ®– “¡“√∂¢Ÿ¥ÕÕ°‰¥â¥â«¬ ·√à∏“μÿ´÷Ëßμà“ß®“°º‘«‡§≈◊Õ∫øíπ„π√–¬–√Õ¬‚√§ ’¢“« ‡§√◊ËÕß¡◊Õμ√«®øíπ‡æ’¬ßÕ¬à“ß‡¥’¬« ·μà√Õ¬§√“∫¿“¬πÕ°

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øíπ·∫∫μ‘¥·πàππ—ÈπμâÕß„™â‡§√◊ËÕß¡◊Õ¢Ÿ¥À‘ππÈ”≈“¬√à«¡°—∫ ®ÿ≈‘π∑√’¬åμ‘¥ ’‡ªìπ°≈ÿà¡‡¥Á°∑’Ë¡’øíππÈ”π¡·≈–°≈ÿà¡‡¥Á°∑’Ë¡’ °“√ÕÕ°·√ß¢Ÿ¥¡“°¢÷Èπ∂÷ß®–¢Ÿ¥ÕÕ°‰¥â øíπ·∑â §‘¥‡ªìπ √âÕ¬≈– 31 ·≈– 8 μ“¡≈”¥—∫ ·≈–¬—ß √“¬ß“π‡æ‘Ë¡‡μ‘¡∂÷ßÕ—μ√“°“√‡°‘¥øíπºÿ ‚¥¬„π°≈ÿà¡∑’Ëæ∫ §«“¡™ÿ° (prevalence) ¢Õß√Õ¬§√“∫ ’¥”∫π ·ºàπ§√“∫®ÿ≈‘π∑√’¬åμ‘¥ ’¡’Õ—μ√“°“√‡°‘¥øíπºÿ√âÕ¬≈– 14 øíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° ·≈– 5 „π°≈ÿà¡‡¥Á°∑’Ë¡’øíππÈ”π¡·≈–°≈ÿà¡‡¥Á°∑’Ë¡’øíπ·∑â „π√–¬–10 ªï∑’Ëºà“π¡“ „πª√–‡∑» À√—∞Õ‡¡√‘°“ μ“¡≈”¥—∫ ºŸâ«‘®—¬ √ÿª«à“·ºàπ§√“∫®ÿ≈‘π∑√’¬åμ‘¥ ’¡’§«“¡ ¡’√“¬ß“π§«“¡™ÿ°¢Õß√Õ¬§√“∫ ’¥”∑’Ë Ÿß¢÷ÈπÕ¬à“ß¡’π—¬ —¡æ—π∏å°—∫Õ—μ√“°“√‡°‘¥øíπºÿ∑’ËπâÕ¬≈ß „π√“¬ß“ππ’È¬—ß ”§—≠11 ‚¥¬ „π√“¬ß“π à«π„À≠à √ÿª«à“∑’Ë°“√‡æ‘Ë¡¢÷Èπ ‡ πÕ°“√‡°≥∑å°“√®—¥ª√–‡¿∑§«“¡√ÿπ·√ß¢Õß·ºàπ§√“∫ ¢ÕßÕ—μ√“§«“¡™ÿ°π—Èπ‡π◊ËÕß¡“®“°¡’ºŸâÕæ¬æ (immi- ®ÿ≈‘π∑√’¬åμ‘¥ ’ (degree of pigmentation) ‡ªìπ√–∫∫μ—«‡≈¢ grants) ®”π«π¡“°¢÷Èπ ‡æ√“–«à“Õ—μ√“§«“¡™ÿ°®– Ÿß„π Õ’°¥â«¬ (μ“√“ß∑’Ë 3 ·≈– 4) ‚¥¬„π°“√»÷°…“μàÕ¡“ °≈ÿà¡μ—«Õ¬à“ß∑’Ë‡ªìπºŸâÕæ¬æ ‚¥¬‡©æ“–ºŸâÕæ¬æ®“° °Á„Àâº≈‡™àπ‡¥’¬«°—π15 ·μàμàÕ¡“ Gülzow16 ‰¥â√“¬ß“π«à“ ª√–‡∑»∑’Ë‡ªìπÀ¡Ÿà‡°“–∑’ËÕ¬Ÿà„°≈â‡§’¬ßª√–‡∑» À√—∞Õ‡¡√‘°“ ‰¡àæ∫§«“¡ —¡æ—π∏å√–À«à“ß§«“¡™ÿ°¢Õß√Õ¬§√“∫ ’¥” (islands bases) ‰¥â·°à ª√–‡∑»‡Œμ‘ (Haiti) ª√–‡∑» °—∫Õ—μ√“°“√‡°‘¥‚√§øíπºÿ∑’ËπâÕ¬≈ß Õ¬à“ß‰√°Áμ“¡®“° „π·∂∫∑–‡≈§“√‘∫‡∫’¬π (Caribbean) ‡ªìπμâπ °“√»÷°…“ °“√»÷°…“π’È√“¬ß“π‡æ‘Ë¡‡μ‘¡«à“ „π‡¥Á°Õ“¬ÿ√–À«à“ß 13 √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°‡√‘Ë¡‡ªìπ ∂÷ß 14 ¡’§«“¡™ÿ°¢Õß√Õ¬§√“∫ ’¥” Ÿß ÿ¥·≈â«≈¥≈ßÀ≈—ß ∑’Ë π„®„π¬ÿ§»μ«√√…∑’Ë 50 ∂÷ß 70 ‚¥¬‡√‘Ë¡μâπ¡“®“° ®“°π—Èπ ´÷ËßºŸâ«‘®—¬‰¥â √ÿª«à“Õ“®®–‡ªìπ‡æ√“–¡’°“√¥Ÿ·≈ √“¬ß“π§«“¡™ÿ°„πª√–™“°√Õ‘π‡¥’¬‚¥¬ Shourie14 ÿ¢¿“æ™àÕßª“°∑’Ë¥’¢÷Èπ ‚¥¬¡’√“¬ß“π‡æ‘Ë¡‡μ‘¡μàÕ¡“∑’Ë„Àâº≈ »÷°…“„π°≈ÿà¡‡¥Á°™“¬®”π«π 1,097 §π Õ“¬ÿ√–À«à“ß 13 ‡™àπ‡¥’¬«°—π°—∫ Gülzow ‡ªìπ∑’Ëπà“ —ß‡°μ«à“ Õ“®‡ªìπ‡æ√“– ∂÷ß 16 ªï ‚¥¬„π‡«≈“π—ÈπºŸâ∑”°“√«‘®—¬‡√’¬°√Õ¬§√“∫ ’¥” °≈ÿà¡Õ“¬ÿ∑’Ë»÷°…“π—ÈπÕ¬Ÿà„π™à«ß‡¢â“ Ÿà«—¬√ÿàπ´÷ËßÕ¬Ÿà„π™ÿ¥øíπ π’È«à“·ºàπ§√“∫®ÿ≈‘π∑√’¬åμ‘¥ ’ (pigmented plaque) æ∫ º ¡μÕπª≈“¬ ®÷ßÕ“®®–∑”„Àâº≈∑’Ë‰¥â·μ°μà“ß°—∫°≈ÿà¡ §«“¡™ÿ°‡∑à“°—∫√âÕ¬≈– 14 ‚¥¬°≈ÿà¡∑’Ë‰¡àæ∫·ºàπ§√“∫ ™à«ßÕ“¬ÿÕ◊Ëπ∑’Ë¡’‡æ’¬ß™ÿ¥øíππÈ”π¡ ‚¥¬μàÕ¡“ Koch ·≈–

Table 3 Summary of search retrieval on the detection of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in children Authors Technique Sample Age (yr.) Total subject Results Watson et al, 199124 BANA, ELISA Subgingival NA 135 Pg was detected in one plaque subject Morinushi et al, 200025 immunoblotting, Plaque, saliva 2 - 18 40 Pg was detected >60% ELISA Saba et al, 200613 PCR Plaque NA 100 Pg, Pm: not assoc. Aa : assoc. Okuda et al, 200026 PCR Plaque 2-12 104 Aa, Pg were not detected in CF subjects Lamell et al, 200028 PCR NA 0-18 222 Aa was not assoc. with age Pg level was more stable when age increased •NA=not applicable, Aa=Actinobacillus actinomycetemcomitans, Pg=Porphyromonas gingivalis, assoc.= associate, CF=caries-free, Pm=......

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Table 4 Summary of the criteria for the diagnosis of black stain References Number Description Shourie14 1 No line 2 Incomplete coalescence of pigmented spots 3 Continuous line of pigmented spots Gasparetto et al6 1 Corresponds to the presence of pigmented dots or thin lines with incomplete coalescence6 parallel to the gingival margin 2 Continuous pigmented lines, limited to 1/2 of cervical third of the tooth surface 3 Continuous pigmented stains extending beyond 1/2 of cervical third of the tooth surface Leung15 1 Thin line of 1 mm. or less in width across the surface 2 Equalling staining of 1/3 of the tooth surface 3 Equalling staining of 2/3 of the tooth surface 4 The entire of gingivo-occlusal surface

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children5, 8) ·∑π°“√¥◊Ë¡π¡´÷ËßÕ“®¡“®“° “‡Àμÿ„¥Ê °Á iron salts) ·§≈‡´’¬¡ (calcium) ·≈–øÕ ‡øμ (phos- μ“¡∑’Ë∑”„Àâ‡¥Á°‰¡à “¡“√∂¥◊Ë¡π¡‰¥â ´÷Ëß®–‰¡à¢Õ°≈à“«„π phate) ‚¥¬„πªï §. ». 1976 Reid ·≈–§≥–19 »÷°…“ ∑’Ëπ’È ”À√—∫‡¥Á°«—¬ª√–∂¡Õ“®¡’ “‡Àμÿ¡“®“°°“√∫√‘‚¿§ Õß§åª√–°Õ∫¢Õß√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫ «‘μ“¡‘π‡ √‘¡∑’Ë¡’ à«πª√–°Õ∫¢Õß∏“μÿ‡À≈Á° Ÿß °“√√—∫ ‡Àß◊Õ°æ∫«à“ª√–°Õ∫¥â«¬‡°≈◊Õ‡øÕ√‘§ (ferric salt) ®”æ«° ª√–∑“π≈Ÿ°‡°¥ º≈‰¡âæ«°∫Ÿ≈‡∫Õ√’ËÀ√◊Õ„πμ√–°Ÿ≈‡∫Õ√√’Ë ‡øÕ√‘§´—≈‰ø¥å (ferric sulfide) ∑’Ë √â“ß¢÷Èπ®“°ªØ‘°‘√‘¬“ º≈‰¡âÀ√◊ÕÕ“À“√∑’Ë¡’·ªÑß‡ªìπ à«πª√–°Õ∫∑’Ë Ÿß (heavy √–À«à“ß‰Œ‚¥√‡®π´—≈‰ø¥å (hydrogen sulfide) ∑’Ëº≈‘μ stratch foods) ‡™àπ ·Õª‡ªÁ îô≈ ¡—πΩ√—Ëß·≈–º—°„∫ ’‡¢’¬«‡¢â¡ ‚¥¬‡™Õ·∫§∑◊È ‡√’ ¬’ ‚¥¬¡ “√μ’ ßμ—È π‰¥â ·°â ∏“μà ‡À≈ÿ °„ππÁ È”≈“¬ ∑’Ë¡’∏“μÿ‡À≈Á° Ÿß ‡™àπ §–πâ“ μ”≈÷ß À√◊Õ‡°≈◊Õ„πÕ“À“√‡Õß À√◊Õ„π¢Õß‡À≈«„π¢Õ∫‡Àß◊Õ° (gingival crevice) ´÷Ëß °ÁÕ“®‡ªìπ “‡Àμÿ‰¥â √«¡∂÷ß°“√¥◊Ë¡πÈ”∑’Ë§—Èπ®“°º≈‰¡âÀ√◊Õ Õ“®‡ªìπ§”μÕ∫¢Õß¢âÕ ß —¬∑’Ë«à“ ∑”‰¡∂÷ßæ∫√Õ¬§√“∫ º—°¥—ß∑’Ë‰¥â°≈à“«¡“·≈â« ´÷Ëß°“√‡°‘¥√Õ¬§√“∫π’ÈÕ“®®– ’¥”¡“°∑’Ë∫√‘‡«≥¥â“π≈‘Èπ¢ÕßøíπÀπâ“≈à“ß ‚¥¬‡¡◊ËÕ¡’°“√ —¡æ—π∏å°—∫¬“ß¢Õßº≈‰¡â‡À≈à“π’È ´÷Ëß¬“ßÕ“® àß‡ √‘¡„Àâ‡°‘¥ √â“ß√Õ¬§√“∫¢÷Èπ·≈â«π—Èπ®– àß‡ √‘¡„Àâ·§≈‡´’¬¡·≈– °“√ √“ß√Õ¬§√“∫‰¥â â ‡æ√“–«“¬“ß∫“ßª√–‡¿∑‡ªà π‚ª√μì π’ øÕ ‡øμ – ¡¡“°¢÷Èπμ√ß∫√‘‡«≥π—ÈπÊ ∑”„Àâ°“√≈–≈“¬ ∑’ËÕ“®®– —¡æ—π∏å°—∫°“√μ‘¥ ’∫πøíπ‰¥â Õ¬à“ß‰√°Áμ“¡ ¬—ß ¢Õßº‘«‡§≈◊Õ∫øíπ (enamel dissolution) ≈¥≈ß §«“¡ ‰¡à¡’√“¬ß“π°“√»÷°…“∑’Ë·πà™—¥ ”À√—∫º≈‰¡â„πª√–‡∑» “¡“√∂„π°“√∑”„Àâ‡ªìπ°≈“ß (buffering capacity) ‰∑¬∑’Ë¡’¬“ß§àÕπ¢â“ß¡“° ‰¥â·°à ¡–≈–°Õ —∫ª–√¥ °Á ‡æ‘Ë¡¢÷Èπ ´÷ËßÕ“®®–‡ªìπ§”μÕ∫¢Õß¢âÕ ß —¬∑’Ë«à“∑”‰¡„π πà“ π„®∑’Ë®–»÷°…“‡æ‘Ë¡‡μ‘¡„π‡¥Á°∑’Ë¡’°“√∫√‘‚¿§º≈‰¡â °≈ÿà¡Õ“ “ ¡—§√∑’Ë¡’√Õ¬§√“∫ ’¥”¡’§à“‡©≈’Ë¬Õ—μ√“°“√‡°‘¥ ®”æ«°π’È‡ªìπª√–®”«à“æ∫√Õ¬§√“∫ ’¥”À√◊Õ‰¡à Õ¬à“ß‰√ øíπºÿπâÕ¬°«à“ μàÕ¡“¡’°“√»÷°…“∂÷ßÕß§åª√–°Õ∫∑“ß‡§¡’ 2. °“√„™âøŸ≈ÕÕ‰√¥å‚¥¬‡©æ“–æ«° ·μππ— (chemical composition)18, 19 ¢ÕßπÈ”≈“¬„π‡¥Á°Õ“¬ÿ øŸ≈ÕÕ‰√¥å (stannous fluoride) À√◊ÕπÈ”¬“∫â«πª“°∫“ß √–À«à“ß 4 ∂÷ß 16 ªï∑’Ë¡’·≈–‰¡à¡’√Õ¬§√“∫ ’¥” æ∫«à“„π ™π‘¥ ‡™àπ πÈ”¬“§≈Õ‚√‡Œ° ‘¥’π (chlorhexidine rinse πÈ”≈“¬¢Õß‡¥Á°∑’Ë¡’√Õ¬§√“∫ ’¥”¡’ª√‘¡“≥·§≈‡´’¬¡ 0.12%) ‡ªìπ√–¬–‡«≈“ 2 ∂÷ß 3 —ª¥“Àå 9 ‡´μ‘≈‰æ√‘¥’- øÕ ‡øμ ∑Õß·¥ß (copper) ‚´‡¥’¬¡ (sodium) ·≈– ‡π’¬¡ §≈Õ‰√¥å (cetylpyridinium chloride) ∑’Ë‡ªìπ ‚ª√μ’π Ÿß°«à“ ·μà¡’ª√‘¡“≥°≈Ÿ‚§ πâÕ¬°«à“‡¥Á°∑’Ë‰¡à¡’√Õ¬ «πº ¡„ππà È”¬“∫«πª“°∫“ß¬â À’Ë Õ∑â «“ß®”Àπ’Ë “¬„πª√–‡∑»à §√“∫ ’¥” ·≈–„π‡¥Á°∑’ËπÈ”≈“¬¡’Õß§åª√–°Õ∫∑“ß‡§¡’ À√—∞Õ‡¡√‘°“ ‡™àπ Cepacol ·≈– Scope Õ¬à“ß‰√°Áμ“¡ ‡À≈à“π—Èπ¡’Õ—μ√“°“√‡°‘¥øíπºÿπâÕ¬≈ß¥—ßπ—Èπ®÷ß¡’ ¡¡μ‘∞“π ¬—ß‰¡à¡’√“¬ß“π°“√„™âπÈ”¬“∫â«πª“° Õß¬’ËÀâÕπ’È„πª√–‡∑» ∑’Ë«à“√Õ¬§√“∫ ’¥”π’ÈÕ“®®–¡’§«“¡ —¡æ—π∏å°—∫‡™◊ÈÕ·∫§- ‰∑¬ ∑’‡√’¬ „π™àÕßª“°∑’Ë‰¡à —¡æ—π∏åÀ√◊Õ¡’§«“¡ —¡æ—π∏å°—∫ 3. ‡™◊ÈÕ·∫§∑’‡√’¬5, 7, 13, 18 ‡π◊ËÕß®“°√Õ¬§√“∫ ¿“«–™àÕßª“°∑’Ë¡’ ÿ¢¿“æ¥’ ‰¡à¡’øíπºÿ ’¥”æ∫∫πº‘«øíπ¥—ßπ—Èπ®÷ßμâÕß —¡æ—π∏åÕ¬à“ß„°≈â™‘¥°—∫ ·ºàπ§√“∫®ÿ≈‘π∑√’¬å (dental plaque) ¥—ß∑’Ë∑√“∫°—π¥’ ∫∑∫“∑¢Õß‡™◊ÈÕ·∫§∑’‡√’¬„π™àÕßª“°μàÕ°“√ «à“·ºàπ§√“∫®ÿ≈‘π∑√’¬å‡ªìπ‰∫‚Õøî≈¡å™π‘¥Àπ÷Ëß∑’Ëæ∫„π ‡°‘¥√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫ ™àÕßª“° (oral biofilm) ‰∫‚Õøî≈¡å‡ªìπ°“√Õ¬Ÿà√à«¡°—π¢Õß ‡Àß◊Õ° ‡™◊ÈÕ®ÿ≈™’æ (microorganism) „π ¿“«–·«¥≈âÕ¡∑’Ë ®“°°“√√«∫√«¡ß“π«‘®—¬·≈–√“¬ß“π≈à“ ÿ¥ (sys- ‡À¡“– ¡ ”À√—∫°“√‡®√‘≠‡μ‘∫‚μ·∫∫æ÷Ëßæ“Õ“»—¬°—π ¡’ tematic literature review)20 æ∫«à“ ‡™◊ÈÕ°≈ÿà¡¡‘«·∑π å §«“¡‡ªìπ‡Õ°≈—°…≥å (unique) ¢Õß√–∫∫®ÿ≈π‘‡«» ‚¥¬ ‡μ√Áª‚μ§Õ§‰§¬—ß§ß¡’∫∑∫“∑„π°“√°àÕ„Àâ‡°‘¥‚√§øíπºÿ „π·ºàπ§√“∫®ÿ≈‘π∑√’¬åπ—Èπ πÕ°®“°®–ª√–°Õ∫‰ª¥â«¬‡™◊ÈÕ Õ¬à“ß‰√°Áμ“¡ „π°≈ÿà¡μ—«Õ¬à“ß∑’Ë¡’øíπºÿπ—Èπ‰¡à®”‡ªìπ∑’Ë®– ·∫§∑’‡√’¬·≈â« ¬—ßª√–°Õ∫¥â«¬ “√®”æ«°‚æ≈’·´§- μÕß¡â ‡™’ Õ°≈◊È ¡πÿà „π√–¥’È ∫ — ß‡ ¡Õ‰ªŸ ‚¥¬‡©æ“–„π‰∫‚Õø≈¡î å §“‰√¥å (polysaccharide) ∑’Ë‡™◊ÈÕ·∫§∑’‡√’¬ √â“ß¢÷Èπ‡æ◊ËÕ„™â ∑’Ë‰¥â¡“®“°∫√‘‡«≥√Õ¬‚√§øíπºÿ√–¬–‡√‘Ë¡μâπ∑’Ë¬—ß‰¡à‡ªìπ√Ÿ „π°“√¬÷¥‡°“– ‡™àπ ‡°≈◊Õ‡À≈Á°∑’Ë‰¡à≈–≈“¬ (insoluble (non-cavitated stages of lesion formation) ´÷Ëß®“°

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∑ƒ…Æ’°“√‡°‘¥·ºàπ§√“∫®ÿ≈‘π∑√’¬å„πªí®®ÿ∫—π ‰¥â·°à ∑ƒ…Æ’ ·Õ§μ‘‚π‰¡´‘‡μÁ¡‚§¡’·∑π å (Actinobacillus actino- √–∫∫π‘‡«» (ecological plaque hypothesis) ∑’Ë°≈à“««à“ mycetemcomitans) æÕ√å‰ø‚√‚¡·π ®‘π®‘«“≈‘ (Pro- √Õ¬‚√§øíπºÿ®–‡°‘¥¢÷Èπ°ÁμàÕ‡¡◊ËÕ ¿“«–¢Õß√–∫∫π—Èπ‡ ’¬ phyromonas gingivalis) æ√’‚«‡∑≈≈“ ‡¡≈“‚π®‘π‘§“ ¡¥ÿ≈ πÕ°®“°π’È∑’Ë ”§—≠§◊Õ √Õ¬‚√§øíπºÿπ—ÈπÕ“®®–‰¡à‰¥â (Prevotella melanogenica) ·≈–æ√’‚«‡∑≈≈“ Õ‘π‡μÕ√å- ‡°‘¥®“°‡™◊ÈÕ°≈ÿà¡¡‘«·∑π å ‡μ√Áª‚μ§Õ§‰§ ‡æ’¬ß°≈ÿà¡‡¥’¬« ¡‘‡¥’¬ (Prevotella intermedia)13, 20 ‚¥¬ à«π„À≠à‡ªìπ ·μà‡™◊ÈÕ∑’Ë‰¡à„™à°≈ÿà¡¡‘«·∑π å∑’Ë “¡“√∂º≈‘μ·≈–∑π°√¥‰¥â¥’ ‡™◊ÈÕ·∫§∑’‡√’¬°√—¡≈∫ (gram-negative) ·μà°àÕπ∂Ÿ° (non-mutans acidogenic and aciduric bacteria) ‡√’¬°√«¡Ê«à“·∫§∑’‡√’¬°≈ÿà¡‚§√‚¡®‘π‘§ (chromogenic) ∑’Ë ‡™àπ‡™◊ÈÕ·Õ§μ‘‚π‰¡´‘ 13, 20 ∑’Ë¡’§«“¡ —¡æ—π∏å„°≈â™‘¥ ¡—°æ∫„πºŸâªÉ«¬∑’Ë‡ªìπ‚√§‡Àß◊Õ°·≈–‚√§ª√‘∑—πμå 22 ‚¥¬ °—∫°“√‡°‘¥øíπºÿ„π√–¬–‡√‘Ë¡·√° (initiation of caries) Õß§ª√–°Õ∫¢Õß·ºå π§√“∫®à ≈ÿπ∑√‘ ¬’ „μå ‡Àßâ Õ°◊ (subgingival ‚¥¬‡©æ“–√Õ¬‚√§ ’¢“« √Õ¬‚√§ºÿ∫√‘‡«≥√“°øíπ (root plaque) ∑’Ë¬÷¥‡°“–∫√‘‡«≥º‘«øíπ·≈–‡π◊ÈÕ‡¬◊ËÕ„π°√–‡ªÜ“ surface caries) °ÁÕ“®®–¡’∫∑∫“∑∑’Ë ”§—≠ „π°√–∫«π ª√‘∑—πμå (periodontal pocket) „πºŸâªÉ«¬‡À≈à“π’È®–¡’ °“√‡°‘¥‚√§øíπºÿ°Á‡ªìπ‰ª‰¥â Ÿß ‡æ√“–«à“¡—π¡’§ÿ≥ ¡∫—μ‘ °“√‡ª≈’Ë¬π·ª≈ß ‚¥¬¡’‡™◊ÈÕ·∫§∑’‡√’¬°√—¡≈∫∑’Ë‰¡àæ÷Ëßæ“ ¥—ß∑’Ë‰¥â°≈à“«¡“·≈â« ∑”„Àâπ—°«‘®—¬∫“ß°≈ÿà¡ —ππ‘…∞“π«à“ ÕÕ°´‘‡®π ‡™àπ ‡™◊ÈÕæÕ√å‰ø‚√‚¡·π ·≈–æ√’‚«‡∑≈≈“‡æ‘Ë¡¢÷Èπ ‡™◊ÈÕ·Õ§μ‘‚π‰¡´‘ Õ“®‡ªìπ‡™◊ÈÕ ”§—≠„π°“√‡°‘¥‚√§øíπºÿ ‡¡◊ËÕ‡∑’¬∫°—∫§π∑’Ë‰¡à¡’‚√§‡Àß◊Õ°·≈–‚√§ª√‘∑—πμå ”À√—∫ (key player) Õ¬à“ß‰√°Áμ“¡ „π∫“ß°“√»÷°…“√“¬ß“π«à“ °“√»÷°…“„π‡¥Á°π—Èπ Wojcicki ·≈–§≥–23 √“¬ß“π«à“ “¡“√∂æ∫‡™Õπ◊È ∫πº’È «ø‘ π∑í ¬’Ë ß‰¡— ºà ÿ(sound crown surface) ‰¡àæ∫§«“¡·μ°μà“ß¢Õß§«“¡™ÿ°¢Õß‡™◊ÈÕæÕ√å‰ø‚√‚¡·π ¢Õß§π ÀπŸ·Œ¡ ‡μÕ√å (hamster) ·≈–ÀπŸ∑’Ëª≈Õ¥‡™◊ÈÕ ·≈–æ√‚«‡∑≈≈“„π‡¥’ °«Á ¬°— Õπ‡¢à “ â «Ÿà ¬√— πÿà (prepuberscent) (gnotobiotic rat) ‚¥¬μ√«®‡™◊ÈÕ¥â«¬«‘∏’∑“ß™’«‚¡‡≈°ÿ≈ √–¬–«—¬√ÿàπ (circumpuberscent) ·≈–√–¬–À≈—ß«—¬√ÿàπ (molecular technique) ·μàπ—°«‘®—¬Õ’°°≈ÿà¡‡ πÕ¢âÕ (postpubertal) ‚¥¬ √ÿª«à“ §«“¡™ÿ°¢Õß‡™◊ÈÕ·∫§∑’‡√’¬ ¡¡ÿμ‘∞“π∑’Ë«à“ æ∫‡™◊ÈÕ·Õ§μ‘‚π‰¡´‘ „π√–¥—∫ Ÿß°≈—∫æ∫ Õßμ—«π’È ‰¡à Õ¥§≈âÕß°—∫°“√‡æ‘Ë¡¢÷Èπ¢ÕßŒÕ√å‚¡π‡¡◊ËÕ«—¬ ‡™◊ÈÕ°≈ÿà¡ ‡μ√Áª‚μ§Õ§‰§„π√–¥—∫μË”·≈–¡’§«“¡ —¡æ—π∏å ‡ª≈’Ë¬π·ª≈ß ¥—ßπ—Èπ®÷ß‰¡àπà“∑’Ë®–¡’§«“¡‡°’Ë¬«¢âÕß°—∫‚√§ °—∫°“√‡°‘¥‚√§øíπºÿ∑’ËμË”≈ß ´÷Ëß„Àâº≈‰ª„π∑“ß‡¥’¬«°—π°—∫ ‡Àß◊Õ°Õ—°‡ ∫À√◊Õ‚√§ª√‘∑—πμå‡™àπ‡¥’¬«°—∫∑’Ëæ∫„πºŸâ„À≠à √“¬ß“π∑’Ë«à“ √Õ¬§√“∫ ’¥”¡’§«“¡ —¡æ—π∏å°—∫Õ—μ√“°“√ ‡Àμÿº≈∑’Ë ”§—≠Õ’°Õ¬à“ßÀπ÷Ëß§◊Õ„π‡¥Á°π—Èπ ¿“«–°“√‡°‘¥ ‡°‘¥‚√§øíπºÿ∑’ËμË” ®“°¢âÕ ¡¡ÿμ‘∞“π∑—Èß 2 π—Èπ ¡¡ÿμ‘∞“π ‚√§‡ÀßÕ°Õ◊ °‡ ∫¢— π°÷È ∫°“√‡ª≈— ¬π·ª≈ß¢Õß√–¥’Ë ∫ŒÕ√— ‚¡πå Õ—π∑’Ë 2 πà“®–¡’§«“¡‡ªìπ‰ª‰¥â Ÿß°«à“ Õ¬à“ß‰√°Áμ“¡ ¡“°°«à“®“°ª√‘¡“≥·ºàπ§√“∫®ÿ≈‘π∑√’¬å ´÷Ëß‰¡à‰¥â¡’§«“¡ ¢âÕ ß —¬Õ’°¢âÕÀπ÷Ëß∑’Ë«à“ ∑”‰¡®÷ß “¡“√∂æ∫√Õ¬§√“∫ ’¥” —¡æ—π∏å∑’Ë‡ªìπ·π«μ√ß‡À¡◊Õπ„πºŸâ„À≠à (‡™àπ ¬‘Ëß¡’®”π«π ‰¥â·§à„π∫“ß§π‡∑à“π—Èπ ∑—ÈßÊ∑’Ë‡™◊ÈÕ‡À≈à“π’È°Á “¡“√∂æ∫‰¥â ·ºàπ§√“∫®ÿ≈‘π∑√’¬å¡“°°Á∑”„Àâ‡°‘¥Õ“°“√Õ—°‡ ∫¡“° „π°≈ÿà¡μ—«Õ¬à“ß°≈ÿà¡„À≠à ´÷ËßÕ“®‡π◊ËÕß¡“®“°∑’Ë«à“„π·μà ¬‘Ëß¢÷Èπ) Õ¬à“ß‰√°Áμ“¡ ª√‘¡“≥·ºàπ§√“∫®ÿ≈‘π∑√’¬å‡ªìπÀπ÷Ëß ≈–§πÕ“®¡’Õß§åª√–°Õ∫¢Õß‡™◊ÈÕ®ÿ≈™’æ„π·ºàπ§√“∫ „πªí®®—¬‡ √‘¡∑’Ë∑”„ÀâÕ“°“√Õ—°‡ ∫¢Õß‡Àß◊Õ°·¬à≈ß μàÕ¡“ ®ÿ≈‘π∑√’¬å·≈–°√–∫«π°“√‡º“º≈“≠μà“ßÊ ∑’Ëμà“ß°—π ∂÷ß Watson ·≈–§≥–24 √“¬ß“π«à“æ∫‡™◊ÈÕæÕ√å‰ø‚√‚¡·π ·¡â«à“®–„Àâº≈≈—æ∑å∑“ß§≈‘π‘°∑’Ë‡À¡◊ÕπÀ√◊Õμà“ß°—π (¡’øíπºÿ ®‘π®‘«“≈‘ ·≈–∑√’‚ªπ’Ë¡“ ‡¥πμ‘‚§≈à“ (Treponema den- À√◊Õª√“»®“°øíπºÿ) ‡ªìπ∑’Ë·πàπÕπ«à“‡™◊ÈÕ∑’Ë‡¥àπ∑’Ë —¡æ—π∏å ticola) „π·ºàπ§√“∫®ÿ≈‘π∑√’¬å¡“°∂÷ß√âÕ¬≈– 86 „π‡¥Á° °—∫°“√‡°‘¥‚√§øíπºÿπ—Èππà“®–‡À¡◊Õπ°—π ·μàÕß§åª√–°Õ∫ ∑’Ë¡’ ÿ¢¿“æ·¢Áß·√ß ‰¡à¡’‚√§ª√–®”μ—«·≈–‰¡à‰¥â∫√‘‚¿§∏“μÿ À√◊Õ‡™◊ÈÕ∑’Ë‰¡à‡¥àπ·≈–Õß§åª√–°Õ∫¢Õß·√à∏“μÿμà“ßÊ„π ‡À≈Á°À√◊Õ«‘μ“¡‘π‡ √‘¡„¥Ê ·μàμàÕ¡“ Morinushi ·≈– πÈ”≈“¬·≈–¢Õß‡À≈«®“°‡Àß◊Õ°πà“®–·μ°μà“ß°—π21 §≥–25 √“¬ß“π«à“æ∫‡™◊ÈÕæÕ√å‰ø‚√‚¡·π ®‘π®‘«“≈‘ ‚¥¬ √ÿª ‡™◊ÈÕ·∫§∑’‡√’¬∑’Ë‡°’Ë¬«¢âÕß°—∫√Õ¬§√“∫ ’¥” ¡“°°«à“√âÕ¬≈– 60 „π‡¥Á°Õ“¬ÿ‡©≈’Ë¬ 12 ªï ·≈– √âÕ¬≈– 75 ‰¥â·°à ‡™◊ÈÕ„π°≈ÿà¡·Õ§μ‘‚π‰¡´‘ (Actinomyces) ·Õ§- ¢Õß‡¥Á°∑’Ëæ∫‡™◊ÈÕ·Õ§μ‘‚π∫“´‘≈≈— ·Õ§μ‘‚π‰¡´‘‡μÁ¡‚§ °√‘‡°μ‘·∫§‡μÕ√å (Aggregatibactor) À√◊Õ·Õ§μ‘‚π∫“´‘≈≈— ¡’·∑π å¡’Õ“°“√‡Àß◊Õ°Õ—°‡ ∫·μà‰¡à‰¥â√“¬ß“π«à“‡Àß◊Õ°

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Õ“®π”‰ª Ÿà°“√√—°…“·∫∫∑¥·∑π (replacement of oral nous fluoride and essential oil mouth rinses to pathogens) „π≈°…≥–∑— ‡À¡’Ë Õπ°◊ ∫‚ª√‰∫‚Õμ— ° ‘ ·∫§∑å ‡√’ ¬’ induce tooth and tongue staining. Clin Oral Investig „π°“√√—°…“‚√§øíπºÿ (probiotic approach in caries 2011; 26. [Epub ahead of print] prophylaxis)32 10. Koch MJ, Bove M, Schroff J, Perlea P, Garcia- Godoy F, Staehle H. Black stain and dental caries in schoolchildren in Potenza, Italy. J Dent Child ‡Õ° “√Õâ“ßÕ‘ß 2001; 68: 353-5. 1. Cunliffe J, Pretty I. Patientsû ranking of interdental 11. Bonecker M, Cleaton-Jones P. Trends in dental çblack trianglesé against other common aesthetic caries in Latin American and Caribbean 5-6 problems. Eur J Prosthodont Restor Dent 2009; and 11-13-year-old children: a systematic 17: 177-81. review. Community Dent Oral Epidemiol 2003; 2. Nathoo SA. The chemistry and mechanisms of 31: 152-6. extrinsic and intrinsic discoloration. J Am Dent 12. Heinrich-Weltzien R, Van Palentein B, Helderman Assoc 1997; 128: 6-10S. W. Prevalence of çBlack-stainsé and dental caries 3. Bowden LP, Royer MC, Hallman JR, Lewin-Smith in Phillipino school children. Community Dent Oral M, Lupton GP. Rapid onset of argyria induced by Epidemiol 2009; 37: 182-7. a silver-containing dietary supplement. J Cutan 13. Saba C, Solidani M, Berlutti F, Vestri A, Ottolenghi Pathol 2011; 38: 832-5. L, Polimeni A. Black Stains in the mixed dentition: 4. Moran J, Addy M, Courtney M, Smith S, Newcombe a PCR microbiological study of the etiopathogenic R. A clinical study to assess the ability of a bacteria. J Clin Pediatr Dent 2006; 30: 219-24. powered toothbrush to remove chlorhexidine/tea 14. Shourie KL. Mesenteric line or pigmented plaque: dental stain. J Clin Periodontol 2004; 31: 95-8. a sign of comparative freedom from caries. J Am 5. Bandon D, Chabane-Lemboub A, Le Gall M. Dent Assoc 1947; 35: 805-7. Exogenous black dental colorings at the child: 15. Leung SW. Naturally occurring stains on the teeth Black-stains. Archives de pe?diatrie 2011; 14: of children. J Am Dent Assoc 1950; 41: 191-7. 7-11. 16. Gülzow HJ. Schwarze und grüne Zahnbeläge. 6. Gasparetto A, Conrado CA, Maciel SM, Miyamoto Untersuchungen über ihre Häufigkeit und über ihre EY, Chicarelli M, Zanata RL. Prevalence of black Beziehungen zur Kariesfrequenz. Dtsch Zahnärztl Z tooth stains and dental caries in Brazilian school- 1963; 18: 1370-76. children. Braz Dent J 2003; 14: 157-61. 17. Koch MJ, Bove M, Niekusch U. Prävalenz schwarzer 7. Ronay V, Attin T. Black stain - a review. Oral Zahnbeläge bei Schulkindern. Dtsch Zahnärztl Z Health Prev Dent. 2011; 1: 37-45. 1996; 51: 664-5. 8. Paredes-Gallardo V, Paredes Cencillo C. Black- 18. Slots J. The microflora of black stain on human Stain: a common problem in pediatrics. An primary teeth. Scand J Dent Res 1974; 82: 484- Pediatr (Barc) 2005; 62: 258-60. 90. 9. West NX, Addy M, Newcombe R, Macdonald E, 19. Reid JS, Beeley JA, Macdonald DG. Investigations Chapman A, Davies M, et al. A randomised into black extrinsic tooth stain. J Dent Res 1976; crossover trial to compare the potential of stan- 56: 895-9.

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·π«‚πâ¡¢Õß§«“¡°«â“ßøíπ¢ÕßºŸâÕ“»—¬„π°√ÿß‡∑æ¡À“π§√ 1 »—°¬¿“æ¢Õß§«“¡°«â“ßøíπ‡¢’È¬«„π°“√®”·π°‡æ»§π‰∑¬°≈ÿà¡Àπ÷Ëß 15 °“√√—∫√Ÿâ≈—°…≥–„∫Àπâ“¥â“π¢â“ß ·≈–Õ‘∑∏‘æ≈¢Õß∫ÿ§§≈√Õ∫¢â“ßμàÕ§«“¡μâÕß°“√√—∫°“√√—°…“∑“ß∑—πμ°√√¡ ®—¥øíπ¢ÕßºŸâªÉ«¬∑’Ë§≈‘π‘°®—¥øíπ §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ 25 º≈°“√¬÷¥Õ¬Ÿà∑“ß§≈‘π‘°¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑’Ë„™â√à«¡°—∫ “√¬÷¥μ‘¥‡ª√’¬∫‡∑’¬∫°—∫«— ¥ÿ‡§≈◊Õ∫ À≈ÿ¡√àÕßøíπ™π‘¥°≈“ ‰Õ‚Õ‡¡Õ√å„πøíπ°√“¡∂“«√´’Ë∑’Ë Õß∑’Ë¢÷Èπ‡æ’¬ß∫“ß à«π 37 ª√– ‘∑∏‘¿“æ·≈–§«“¡ª≈Õ¥¿—¬¢Õß·ª√ß ’øíπ™π‘¥¢Õß·ª√ßª≈“¬‡√’¬«·À≈¡º ¡ª≈“¬μ—¥ 47 °“√√—°…“ºŸâªÉ«¬¢âÕμàÕ¢“°√√‰°√À—°¥â«¬«∏‘ ’¥—¥·ª≈ß‚§≈ √’¥—°™—Ëπ: √“¬ß“πºŸâªÉ«¬ 1 √“¬ 57 º≈¢Õß “√‰æ√‡¡Õ√å ”À√—∫‚≈À–¡’μ√–°Ÿ≈μàÕ°”≈—ß·√ß¬÷¥·∫∫¥÷ß√–¥—∫®ÿ≈¿“§√–À«à“ß‡√´‘π´’‡¡πμå ·≈–‡´Õ√å‚§‡π’¬ 65 º≈¢ÕßπÈ”¬“≈â“ßøíπ‡∑’¬¡∑’Ë¡’ à«πª√–°Õ∫¢Õß “√ °—¥®“°·°√πŸ≈„π‡¡≈Á¥≈”‰¬μàÕ‡ ∂’¬√¿“æ¢Õß ’, §«“¡¢√ÿ¢√–º‘« ·≈–§«“¡·¢Áßº‘«¢ÕßæÕ≈‘‡¡Õ√åª√–¥‘…∞å∞“πøíπ‡∑’¬¡ 73 °“√„™â¿“æ√—ß ’‚§π∫’¡§Õ¡æ‘«‡μÁ¥‚∑‚¡°√“øïª√–‡¡‘π‡æ◊ËÕ™à«¬„π°“√μ—¥ ‘π„®°àÕπ°“√√—°…“Õ‘π‡∑π™—ππÕ≈ ‡ÕÁπ‚¥¥Õπμå 81 °“√‡Àπ’Ë¬«π”‡´≈≈å·μ°μ“¬‡Õß„π‡´≈≈å¡–‡√Áß™àÕßª“°™π‘¥ §«“¡— ¥â«¬ “√ °—¥°√–™“¬ 89 ªí®®—¬∑’Ë¡’Õ‘∑∏‘æ≈μàÕæƒμ‘°√√¡°“√∫√‘‚¿§º≈‘μ¿—≥±å¥Ÿ·≈ ÿ¢¿“æ™àÕßª“°¢ÕßºŸâªÉ«¬§≈‘π‘°∑—πμ°√√¡∫√‘°“√ (§≈‘π‘°æ‘‡»…) §≥–∑—πμ·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ 101 Õ‘∑∏‘æ≈¢Õß§«“¡«‘μ°°—ß«≈¢ÕßºŸâª°§√ÕßμàÕ√–¥—∫§«“¡°≈—« / §«“¡«‘μ°°—ß«≈„π°“√∑”øíπ„π‡¥Á°‰∑¬°≈ÿà¡Àπ÷Ëß 111 §à“‡´ø“‚≈‡¡μ√‘°„πºŸâªÉ«¬øíπÀπâ“ ∫‡ªî¥∑’Ë®—¥øíπ√à«¡°—∫°“√„™â·≈–‰¡à„™âÀ¡ÿ¥¬÷¥∑“ß∑—πμ°√√¡®—¥øíπ 121 ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ 131 °“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« 141 ¡∫—μ‘∑“ß°“¬¿“æ¢Õßª≈“ ‡μÕ√åÀ‘π∑’Ë®”Àπà“¬„πª√–‡∑»‰∑¬ 151 ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ 161 √Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° 175 B 192

Subject Index: Volume 31, 2011

Trend of tooth width of Bangkok residents 1 Potential sex identification of canine width in a group of Thais 15 Self perception and social influence on facial profile of the patients seeking for orthodontic treatment at Orthodontic Clinic, Faculty of Dentistry, Mahidol University 25 The clinical comparison of sealant retention between resin-based fissure sealant with adhesive and glass ionomer sealant on partially erupted second permanent molars 37 Effectiveness and safety of slim mixed cut ends bristle toothbrushes 47 The treatment of condylar fractured by applying closed reduction: A case report 57 Effect of noble metal primers on the microtensile bond strength of resin cements to zirconia 65 Effect of denture cleanser containing longan-extract granules on color stability, surface roughness and hardness of a polymeric denture base material 73 Using cone-beam computerized tomography before initiation intentional endodontic treatment 81 Apoptotic induction of Boesenbergia pandurata extract on oral squamous carcinoma cells 89 Factors influencing oral health care products consuming behavior of patients in dental clinic (Special clinic) at Faculty of Dentistry Mahidol University 101 The influences of parental anxiety on level of dental fear/anxiety in a group of Thai children 111 Cephalometric assessment in anterior open bite patients treated woth and without mini-implant anchorages 121 Antimicrebial Efficacy of Propolis against Enterococcus faeclis and Porphyromonas gingivalis 131 Sexual dimorphism in Thais using canine index 141 Physical properties of dental stones available in Thailand 151 Fluoride gel and Fluoride varnish 161 Black stains in children: An update 175 B 193

¥√√™π’ºŸâ·μàß: ªï∑’Ë 31, æ.». 2554

°π°«√√≥ æ—≤π‰æ√ ≥±å 47 ≈’√«√√≥ ∫Ÿ√≥®√√¬“°ÿ≈ 111 °¡≈“ «ÿ≤‘ “√«—≤π“ 65 «‘¿“¥“ ‡≈‘»ƒ∑∏‘Ï 1 °Õß°“≠®πå æ√ Ÿß àß 47 «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ 15, 89, 141 °—≈¬“ »ÿæÿ∑∏¡ß§≈ 151 «√“π—π∑å ∫—«®’∫ 73 ¢®√‡°’¬√μ‘ ‡®π∫¥‘π∑√å 89 «‘°ÿ≈ «‘≈“ ‡ ∂å 47 ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ 111, 175 «‘™≠ °“≠®π–« ‘μ 73 ®‘πμπ“ “√–∫√√®ß 131 »»‘¿“ ∏’√¥‘≈° 25 ®ÿ±“√—μπå ‡™’Ë¬««“π‘™ 25 ¡™—¬ ¡‚πæ—≤π°ÿ≈ 1 ®ÿÃ“≈—°…≥å °…μ√ ÿ«√√≥ 47 ¡™“¬ Õÿ√æ’æ≈ 65 ™π—≠∏√ ∑Õß ≈ÿ°«ß»å 89 ÿæ—≤™—¬ ∫ÿ≠ª√–∂—¡¿å 25,121 ™≈“∏‘ª ™¡æŸπÿ™ ≥ Õ¬ÿ∏¬“ 111 ÿ√™—¬ ‡≈‘» ÿ√»—°¥“ 57 ™—™√’ ÿ™“μ‘≈È”æß»å 151 ÿ√—μπå ¡ß§≈™—¬Õ√—≠≠“ 47 ™‘μ«≈’ ≈’μ√–°Ÿ≈«√√≥“ 81 ÿ«√√≥’ ≈—¿π–æ√≈“¿ 121 ≥—∞°“πμå ‰μ√μ“ππ∑å 111 À¬“¥æ‘√ÿ≥ ®‘√«—≤π°ÿ≈ 89 ≥—∞«√√∏πå æ’√∑—μ‡«™°ÿ≈ 101 Õ—§√‘π ¿“πÿ ∂‘μ¬å 141 ¥πÿ™‘…≥å æπ¡¬ß§å 81 Õ“√’√—μπå º≈‘μππ∑å‡°’¬√μ‘ 47 ∑«’æß»å Õ“√¬–æ‘»‘…∞ 15, 89, 141 Õ‘∑∏‘°√ ·´à≈âÕ 1 ∑‘æπ“∂ «‘™≠“≥√—μπå 161 ∏π‘¬“ À¡«¥‡™’¬ß§– 131 ππ∑‘π’ μ—Èß‡®√‘≠¥’ 47 π≈‘π’ Õÿ¥¡™—¬ °ÿ≈ 73 π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ 141 π‘μ¬“ ‡æÁß√—°…å 25 π‘æ‘∞ ÿ¿“®“√ÿæ—π∏å 141 ∫ÿ…¬√—μπå —πμ‘«ß»å 47 ªï¬å‡¡∏ ∫ÿ≠¡’¢“« 1 æß»å ∂‘μ ∫—≥±‘μ 141 æß»∏√ æŸà∑Õß§” 121 æ®¡“π »√’π«√—μπå 151 æ√æ®πå ‡øóòÕß∏“√∑‘æ¬å 1 æ’√»ÿ…¡å √Õ¥Õπ—πμå 101 ‡æÁ≠ª√–¿“ ™‘«™√—μπå 121 ¡“≈’ Õ√ÿ≥“°Ÿ√ 111 ¬ÿ«¥’ Õ—»«π—π∑å 111 √«‘π—π∑å ¡—Ëß§ß 89 √–«’«√√≥ Õ“√¬– —πμ‘¿“æ 81 B 194

Author Index: Volume 31, 2011

Akkarin Panusatid 141 Sasipa Thiradilok 25 Areerat Phalitnonkiat 47 Somchai Manopatanakul 1 Busayarat Santiwong 37 Somchai Urapepon 65 Chalatip Chompunud Na Ayudthaya 111 Supatchai Boonprathum 25, 121 Chanunthorn Thongsagulwong 89 Surachai Kertsurasakda 57 Chatcharee Suchatlampong 151 Surat Mongkilnchai-aranya 47 Chitvaree Leetrakulwanna 81 Suwannee Luppanapornlarp 121 Danuchit Banomyong 81 Tawepong Arayapisit 15, 89, 141 Ittigon Law 1 Thaniya Muadcheingka 131 Jintana Sarabunchong 131 Tippanart Vichayanrat 161 Julalux Kasetsuwan 47 Wanida Sripaifohthikoon 15, 89, 141 Jutharat Chiewvanich 25 Waranun Buajeeb 73 Kajohnkiart Janebodin 89 Widchaya Kanchanavasita 73 Kallaya Suputtamongkol 151 Wikul Visalseth 47 Kamala Wootthisarnwatthana 65 Wipada Lertrid 1 Kanokwan Pattanapraison 47 Yardpiroon Jirawattanakul 89 Kemthong Mitrakul 111, 175 Yuwadee Asvanund 111 Kongkarn Pornsoongsong 37 Leerawan Buranajanyakul 111 Malee Arunakul 111 Naiwinit Somsuktaweekoon 141 Nalinee Udomchaisakul 73 Nattakan Traitanon 111 Nipit Supajarupan 141 Nittaya Pengrux 25 Nontinee Tangchareondee 47 Nuttawat Peeratatavetkul 101 Pemet Boonmegaew 1 Penprapa Chiewcharat 121 Pirasut Rodanant 101 Pongstit Bundit 141 Pongstorn Putongkam 121 Pornpoj Fuangtharnthip 1 Potchaman Sinavarat 151 Raweewan Arayasantiparb 81 Rawinun Munkong 89 B 1

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¿“æ∂à“¬ „™â‰¥â∑—Èß¿“æ ’À√◊Õ¢“«¥” „π°√≥’‡ªìπ¿“æ∂à“¬„ÀâÕ—¥¥â«¬°√–¥“…¡—π¢π“¥ 8.9X14 ´¡. (‚ª °“√å¥) ·≈–¿“æ∂à“¬μâÕß™—¥‡®π §«√∫Õ°™◊ËÕ‡√◊ËÕß ™◊ËÕºŸâ‡¢’¬π À¡“¬‡≈¢μ“¡≈”¥—∫¢Õß¿“æ·≈–∑”‡§√◊ËÕßÀ¡“¬· ¥ß¢Õ∫∫π¢Õß¿“æ·≈–„ à´Õß·¬°μà“ßÀ“° °√≥’‡ªìπ¿“æ·∫∫¥‘®‘∑μÕ≈ (digital) §«√¡’·øÑ¡¢âÕ¡Ÿ≈·¬°μà“ßÀ“°‰¡à§«√ Õ¥·∑√°„π‡π◊ÈÕ‡√◊ËÕß ‚¥¬„™â√Ÿª·∫∫„¥°Á‰¥â ‡™àπ (gps, fpg) μâÕß “¡“√∂‡ªî¥‰¥â¥â«¬‚ª√·°√¡®—¥°“√¿“æ (adobe photoshop) ·≈–§«√∫—π∑÷°¿“æ≈ß„π·ºàπ∫—π∑÷° (diskette) À√◊Õ ´’¥’√Õ¡ (CD ROM) ¥â«¬§«“¡≈–‡Õ’¬¥¢Õß¿“æ‰¡àπâÕ¬°«à“ 300 ¥’æ’‰Õ (dpi) °√≥’¿“æ≈“¬‡ âπ °√“ø À√◊Õ·ºπ¿¡‘Ÿ „Àâ‡¢’¬πÀ√◊Õæ‘¡æå≈ß∫π°√–¥“…¡—π §«√„™âÀ¡÷° ’¥” ·≈–μâÕß¡’§”∫√√¬“¬·°πμ—Èß (ordinate) ·≈–·°ππÕπ (abscissa) 5. ¿“æ√—ß ’ „Àâ∂à“¬√Ÿª®“°øî≈å¡‡Õ°´‡√¬åμâπ©∫—∫‡ ’¬°àÕπ ·≈â«π”‰ªÕ—¥‡ªìπ¿“æ¢“«-¥” ‰¡à§«√Õ—¥¿“æ®“°øî≈å¡‡Õ°´‡√¬å ‡æ√“–®–‰¥â¿“æ∑’Ë º‘¥®“°§«“¡‡ªìπ®√‘ß ·≈–‰¡à§«√π”¿“æ√—ß ’‰ª°√“¥¿“æ (scan) ‡æ◊ËÕ·ª≈ß‡ªìπ¿“æª√–°Õ∫√Ÿª·∫∫¥‘®‘μÕ≈ 6. μ“√“ß (Table) 1. μâÕß∑”μ“√“ß·¬°μà“ßÀ“°®“°‡π◊ÈÕ‡√◊ËÕß ‚¥¬æ‘¡æåÀπâ“≈– 1 μ“√“ß ‡«âπ∑’Ë«à“ß„π‡π◊ÈÕ‡√◊ËÕßæ√âÕ¡∑—Èß‡¢’¬π·®âß‰«â„π°√Õ∫ §”Õ∏‘∫“¬¿“æ„™â ¿“…“Õ—ß°ƒ… 2. μâÕß¡’™◊ËÕ (Title) ∑’Ë —Èπ ◊ËÕ‡π◊ÈÕÀ“¢Õßμ“√“ß ¡’‡≈¢°”°—∫μ“¡≈”¥—∫∑’ËÕâ“ß∂÷ß„π∫∑§«“¡ „Àâæ‘¡æå‡Àπ◊Õμ“√“ß §”∫√√¬“¬μ“√“ß„Àâæ‘¡æå μàÕ®“°™◊ËÕμ“√“ß·≈–§«√¡’‡©æ“–∑’Ë ”§—≠·≈–®”‡ªìπ B 8

3. ‡™‘ßÕ√√∂ (Footnote) „μâμ“√“ß ∫√√¬“¬§”¬àÕ —≠≈—°…≥å À√◊Õ‡§√◊ËÕßÀ¡“¬∑’Ëª√“°Ø„πμ“√“ß μ≈Õ¥®π§à“∑¥ Õ∫∑“ß ∂‘μ‘ (∂â“¡’) Õ¬à“ß §√∫∂â«π ‡™‘ßÕ√√∂‰¡à§«√„™â‡≈¢°”°—∫‡æ√“–Õ“® —∫ π°—∫‡≈¢°”°—∫¢Õß‡Õ° “√Õâ“ßÕ‘ß „Àâ„™â‡ªìπ —≠≈—°…≥å μ—«Õ¬à“ß ‡™àπ *, +, #, ** ‡ªìπμâπ 4. ‰¡àμâÕß¡’‡ âπ¥‘Ëß·≈–‡ âπ¢«“ß„πμ“√“ß ‰¡àμâÕß¡’°√Õ∫μ“√“ß °“√„™â¿“æª√–°Õ∫∑’Ë¡“®“°·À≈àßÕ◊Ëπ μâÕß¡’Àπ—ß ◊Õ§”¬‘π¬Õ¡®“°‡®â“¢Õß¿“æÀ√◊ÕºŸâ∂◊Õ≈‘¢ ‘∑∏‘Ï¿“æ ·≈–‡¢’¬π°”°—∫‰«â √Ÿª·∫∫¢Õß°“√‡μ√’¬¡∫∑«‘∑¬“°“√ à«π∑’ËÀπ÷Ëß ∫∑§«“¡«‘∑¬“°“√§«√ª√–°Õ∫¥â«¬À—«¢âÕμà“ß Ê ¥—ßμàÕ‰ªπ’È 1. ™Õ‡√◊Ë Õß◊Ë (Title) §«“¡¬“« ‰¡à‡°‘π 100 μ—«Õ—°…√ §«√¡’≈—°…≥–‡ªìπ¢âÕ§«“¡°√–™—∫ ◊ËÕ§«“¡À¡“¬¢Õß‡√◊ËÕßÕ¬à“ß™—¥‡®π 2. ™◊ËÕºŸâπ‘æπ∏å (Author) ™◊ËÕ·≈–π“¡ °ÿ≈‡∑à“π—Èπ ∂â“¡’ºŸâ‡¢’¬πÀ≈“¬§π„Àâ‡√’¬ß≈”¥—∫§«“¡ ”§—≠μàÕ‡√◊ËÕß√“¬≈–‡Õ’¬¥‡°’Ë¬«°—∫ºŸâ‡¢’¬π ‡™àπ «ÿ≤‘°“√»÷°…“ μ”·Àπàß∑“ß«‘™“°“√ ∂“∫—π∑’Ë∑”ß“π À√◊Õ∑’ËÕ¬Ÿà∑’Ëμ‘¥μàÕ‰¥â –¥«° 3. ºŸâπ‘æπ∏å´÷Ëß√—∫º‘¥™Õ∫μ‘¥μàÕ‡°’Ë¬«°—∫∫∑§«“¡ (Correspondence author) ¡’™◊ËÕºŸâπ‘æπ∏å‡æ’¬ß§π‡¥’¬« π“¡ °ÿ≈ μ”·Àπàß∑“ß «‘™“°“√ ∂“π∑’Ë∑”ß“π À¡“¬‡≈¢‚∑√»—æ∑å∑’Ë∑”ß“π À¡“¬‡≈¢‚∑√»—æ∑å¡◊Õ∂◊Õ ‚∑√ “√ √«¡∑—ÈßÕ’‡¡≈å (E-mail) ∑’Ë “¡“√∂μ‘¥μàÕ‰¥â –¥«°·≈–√«¥‡√Á« 4. ·À≈àß‡ß‘π∑ÿπ (Research grant) „Àâ∫Õ°√“¬≈–‡Õ’¬¥ ·À≈àß∑ÿπ π—∫ πÿπ°“√»÷°…“ ‡√’¬ßμ“¡≈”¥—∫¥—ßπ’È ™◊ËÕ∑ÿπ ™◊ËÕ ∂“∫—π∑’Ë„Àâ∑ÿπ ªï∑’Ë‰¥â√—∫∑ÿπ À¡“¬‡≈¢¢Õß∑ÿπ«‘®—¬ (∂â“¡’) à«π∑’Ë Õß ¡’√“¬≈–‡Õ’¬¥¥—ßπ’È 1. ∫∑§¥¬— Õà (Abstract) ¡’§«“¡¬“«‰¡à‡°‘π 250 §” ª√–°Õ∫¥â«¬À—«¢âÕ¥—ßπ’È - «μ∂— ª√– ß§ÿ å (Objective) ®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√»÷°…“√«¡∑—ÈßÕâ“ß∂÷ß ¡¡μ‘∞“π¢Õß°“√»÷°…“ - «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“ (Materials and methods) «— ¥ÿÕÿª°√≥åÀ√◊ÕºŸâªÉ«¬∑’Ëπ”¡“»÷°…“ ®”π«π ™π‘¥ ª√–‡¿∑ «‘∏’°“√»÷°…“ À√◊Õ«‘∏’°“√∑¥≈Õß ·≈– ∂‘μ‘∑’Ëπ”¡“„™â - º≈°“√»°…“÷ (Results) º≈∑’Ë‰¥â®“°°“√»÷°…“∑¥≈Õß ·≈–°“√«‘‡§√“–Àå∑“ß ∂‘μ‘ - ∫∑ √ªÿ (Conclusion) º≈°“√»÷°…“∑’Ë ”§—≠∑’Ë‰¥â®“°°“√∑¥≈Õß - √À— §” (Key words) 3-6 §” „Àâ‡√’¬ß§” ”§—≠μ“¡Õ—°…√·≈–∂â“‡ªìπ¿“…“Õ—ß°ƒ…§—Ëπ¥â«¬‡§√◊ËÕßÀ¡“¬®ÿ≈¿“§ (,) - °“√‡μ√’¬¡∫∑§«“¡ª√‘∑—»πå „π°“√‡¢’¬π∫∑§—¥¬àÕ§«√¡’À—«¢âÕ¥—ßπ’È - «μ∂— ª√– ß§ÿ å (Objective) ®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√»÷°…“√«¡∑—ÈßÕâ“ß∂÷ß ¡¡μ‘∞“π¢Õß°“√»÷°…“ - √À— §” (Key words) 3-6 §”„Àâ‡√’¬ß§” ”§—≠μ“¡Õ—°…√·≈–§—Ëπ¥â«¬‡§√◊ËÕßÀ¡“¬®ÿ≈¿“§ (,) à«π∑’Ë “¡ ‡π◊ÈÕ‡√◊ËÕßæ‘¡æå‡ªìπ¿“…“‰∑¬À√◊ÕÕ—ß°ƒ…°Á‰¥â À—«¢âÕ¢Õß‡π◊ÈÕ‡√◊ËÕß æ‘¡æå„Àâ™‘¥À—«·∂«´â“¬¡◊Õ ÿ¥ ·μà≈–À—«¢âÕ„Àâ¢÷Èπ°√–¥“…·ºàπ„À¡à ´÷Ëß∫∑«‘∑¬“°“√ ·≈–∫∑§«“¡ª√‘∑—»πå®–„™âÀ—«¢âÕ‡À¡◊Õπ°—π∑ÿ°ª√–°“√ ‚¥¬ ‡√’¬ß≈”¥—∫À—«¢âÕ¢Õß‡π◊ÈÕ‡√◊ËÕß¥—ßπ’È 1. ∫∑π” (Introduction) ‡ªìπ à«π°≈à“«π”‚¥¬Õ“»—¬°“√μ√«®‡Õ° “√ ¢âÕ¡Ÿ≈®“°√“¬ß“π«‘®—¬ §«“¡√Ÿâ ·≈–À≈—°∞“πμà“ß Ê ®“°Àπ—ß ◊ÕÀ√◊Õ «‘∑¬“ “√∑’Ë‡°’Ë¬«¢âÕß°—∫‡√◊ËÕß∑’Ë»÷°…“ ·≈–°≈à“«∂÷ß‡Àμÿº≈À√◊Õ§«“¡ ”§—≠¢Õßªí≠À“„π°“√»÷°…“ ¡¡μ‘∞“π¢Õß°“√»÷°…“ μ≈Õ¥®π«—μ∂ÿª√– ß§å¢Õß °“√»÷°…“„Àâ™—¥‡®π ¢Õ∫‡¢μ ·≈–«‘∏’°“√¥”‡π‘π°“√«‘®—¬ §«√¡’°“√°≈à“«Õâ“ß∂÷ß∫∑§«“¡À√◊Õ‡Õ° “√∑’Ë‡°’Ë¬«¢âÕß°—∫‡√◊ËÕß∑’Ë°”≈—ß∑”°“√«‘®—¬ ‡æ◊ËÕ· ¥ß§«“¡ —¡æ—π∏å¢Õßß“π∑’Ë‡ πÕ„π∫∑§«“¡π’È°—∫§«“¡√Ÿâ‡¥‘¡‡∑à“∑’Ë∑√“∫°—πÕ¬Ÿà ‡ªìπ à«π¢Õß∫∑§«“¡∑’Ë∫Õ°‡Àμÿº≈ π”‰ª Ÿà°“√»÷°…“ ·μà‰¡àμâÕßμ√«®‡Õ° “√ (Litera- ture Review) ∑’Ë‰¡à‡°’Ë¬«°—∫®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√»÷°…“ §«√‡ªìπ à«π∑’ËÕ∏‘∫“¬„ÀâºŸâÕà“π√Ÿâ«à“®–μÕ∫§”∂“¡Õ–‰√ „Àâ√«¡«—μ∂ÿª√– ß§å¢Õß°“√»÷°…“‡ªìπ√âÕ¬ ·°â«„π à«π∑â“¬¢Õß∫∑π” ·μà‰¡àμâÕß‡¢’¬πº≈°“√»÷°…“·≈– √ÿª 2. «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“ (Materials and methods) °≈à“«∂÷ß√“¬≈–‡Õ’¬¥¢Õß«— ¥ÿÕÿª°√≥å ™◊ËÕ‡§¡’¿—≥±å ·À≈àß∑’Ë¡“ ≈—°…≥– ‡©æ“–À√◊Õ√“¬≈–‡Õ’¬¥¢ÕßÕÿª°√≥å‡§√◊ËÕß¡◊Õ‡§√◊ËÕß„™âμà“ß Ê ¢—ÈπμÕπ¢Õß°“√∑¥≈Õß ¡“μ√°“√∑’Ë„™â»÷°…“ «‘∏’°“√‡°Á∫¢âÕ¡Ÿ≈ «‘∏’°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ ·≈– ∂‘μ‘∑’Ëπ”¡“„™â«‘‡§√“–Àå¢âÕ¡Ÿ≈ 3. º≈°“√»÷°…“ (Results) · ¥ßº≈∑’Ë‰¥â®“°°“√»÷°…“∑¥≈Õß·≈–«‘‡§√“–Àåº≈ §«√®”·π°ÕÕ°‡ªìπÀ¡«¥À¡Ÿà·≈– —¡æ—π∏å°—∫«—μ∂ÿª√– ß§å ¢Õß°“√»÷°…“ §«√„™â¿“æª√–°Õ∫ μ“√“ß °√“ø À√◊Õ·ºπ¿Ÿ¡‘·ª≈§«“¡À¡“¬¢Õßº≈∑’Ë§âπæ∫À√◊Õ«‘‡§√“–Àå Õ¬à“ß„¥Õ¬à“ßÀπ÷Ëß √ÿª‡ª√’¬∫‡∑’¬∫°—∫ ¡¡ÿμ‘∞“π∑’Ë«“ß‰«â μ“¡«‘∏’∑“ß ∂‘μ‘∑’Ë«‘‡§√“–Àå 4. ∫∑«®“√≥‘ å (Discussion) «‘®“√≥å‰¥âμ—Èß·μà«—μ∂ÿª√– ß§å ¡¡ÿμ‘∞“π¢Õß°“√«‘®—¬ º≈∑’Ë‰¥â®“°°“√»÷°…“‡À¡◊ÕπÀ√◊Õ·μ°μà“ß‰ª®“°º≈ß“π∑’Ë ¡’ºŸâ√“¬ß“π‰«â°àÕπÀ√◊Õ‰¡à Õ¬à“ß‰√ ‡æ√“–‡Àμÿ„¥®÷ß‡ªìπ‡™àππ—Èπ ‡æ◊ËÕ„Àâ¡’§«“¡‡¢â“„®À√◊Õ‡°‘¥§«“¡√Ÿâ„À¡à∑’Ë‡°’Ë¬«¢âÕß°—∫ß“π«‘®—¬π—Èπ √«¡∑—Èß¢âÕ¥’ ¢âÕ‡ ’¬¢Õß «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√ ‡ πÕ·π–§«“¡§‘¥‡ÀÁπ„À¡à Ê ªí≠À“μà“ß Ê ∑’Ë‰¥â®“°°“√»÷°…“∑¥≈Õß§√—Èßπ’È 5. ∫∑ √ªÿ (Conclusion) º≈‚¥¬¬àÕ¢Õß°“√»÷°…“ º≈∑’Ë‰¥âμ√ß°—∫«—μ∂ÿª√– ß§å°“√«‘®—¬À√◊Õ‰¡à 6. °‘μμ‘°√√¡ª√–°“» (Acknowledgements) °≈à“«¢Õ∫§ÿ≥μàÕÕß§å°√ Àπà«¬ß“π À√◊Õ∫ÿ§§≈∑’Ë„Àâ§«“¡™à«¬‡À≈◊Õ√à«¡¡◊Õ„π°“√«‘®—¬ 7. ‡Õ° “√Õ“ßÕâ ß‘ (References) „ àμ—«‡≈¢Õ“√∫‘°À≈—ß¢âÕ§«“¡À√◊ÕÀ≈—ß™◊ËÕ∫ÿ§§≈‡®â“¢Õß¢âÕ§«“¡∑’ËÕâ“ß∂÷ß „ÀâÕâ“ßÕ‘ß¥â«¬μ—«‡≈¢∑’Ë‡ªπμì «¬°— (superscript) À≈—ß¢âÕ§«“¡ ´÷Ëß‡√’¬ßÀ¡“¬‡≈¢ 1, 3, 6 À√◊ÕÀ¡“¬‡≈¢ 1-3 ™‘¥´â“¬‡ ¡Õ·≈–‰¡àμâÕß„ à«ß‡≈Á∫ ‡√’¬ßμ“¡≈”¥—∫°àÕπÀ≈—ß∑’Ë°≈à“«∂÷ß„π∫∑§«“¡ ∂â“μâÕß°“√Õâ“ßÕ‘ß´È”„Àâ„™âÀ¡“¬‡≈¢‡¥‘¡ °“√‡¢’¬π‡Õ° “√Õâ“ßÕ‘ß „™â°“√Õâ“ßÕ‘ßμ“¡√–∫∫·«π§‡«Õ√åŸ (Vancouver system) ™◊ËÕ«“√ “√„Àâ„™â™◊ËÕ¬àÕμ“¡√ª·∫∫°“√‡¢’¬πÕâ“ßÕ‘ß„πŸ Pubmed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) „π°√≥’∑’Ë™◊ËÕ¬àÕ«“√ “√‰¡àª√“°Ø„π PubMed „Àâ„™â™◊ËÕ¬àÕ«“√ “√μ“¡ Index Medicus ‚¥¬¡’μ—«Õ¬à“ß¥—ßπ’È 7.1 °“√Õâ“ßÕ‘ß«“√ “√ ∂â“ºŸâπ‘æπ∏å‰¡à‡°‘π 6 §π „Àâ„ à™◊ËÕ∑ÿ°§π∂â“¡“°°«à“ 6 §π„Àâ„ à 6 §π·√°μ“¡¥â«¬ çet al.é ∂â“‡ªìπ¿“…“Õ—ß°ƒ… À√◊Õ ç·≈–§≥–é ∂â“‡ªìπ ¿“…“‰∑¬ 7.1.1 «“√ “√¿“…“Õ—ß°ƒ… ™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ∫∑§«“¡. ™◊ËÕ«“√ “√ ªï∑’Ëæ‘¡æå; ªï∑’Ë: Àπâ“∑’ËÕâ“ßÕ‘ß. μ—«Õ¬à“ß (¢÷Èπμâπ¥â«¬π“¡ °ÿ≈ μ“¡¥â«¬ Õ—°…√μ—«·√°¢Õß™◊ËÕμâπ·≈–™◊ËÕ°≈“ß à«πªï∑’Ëæ‘¡æå‡ªìπªï§√‘ μå»—°√“™) μ—«Õ¬à“ß Harnirattisai C, Inokoshi S, Shimada Y, Hosada H. Interfacial morphology of an adhesive composite resin and etched caries-affected dentin. Oper Dent 1992; 17: 222-8. B 9

7.1.2 «“√ “√¿“…“‰∑¬ ™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ∫∑§«“¡. ™◊ËÕ«“√ “√ ªï∑’Ëæ‘¡æå; ªï∑’Ë: Àπâ“∑’ËÕâ“ßÕ‘ß. μ—«Õ¬à“ß (™◊ËÕºŸâπ‘æπ∏å„Àâ„™â™◊ËÕ‡μÁ¡∑—Èß™◊ËÕμ—« ·≈–π“¡ °ÿ≈ ·≈–ªï∑’Ëæ‘¡æå‡ªìπªïæÿ∑∏»—°√“™) μ«Õ¬— “ßà ∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√, ÿ∑—» √—°ª√– ‘∑∏‘Ï°≈,Ÿ ≥—∞æß»å ‘√‘π∑«—≤πå, «’√–»—°¥‘Ï ‰æ√—™‡«∑¬å, ª√–¿“°√ ®”πßª√– “∑æ√. ª√– ‘∑∏‘¿“æ ¢Õß¬“™“Õ“√åμ‘‡§π·≈–¬“™“≈‘‚¥‡§π„π°“√ºà“μ—¥øíπ°√“¡§ÿ¥≈à“ß´’Ë∑’Ë “¡. « ∑—πμ ¡À‘¥≈ 2548; 25: 59-66. 7.1.3 ºŸâπ‘æπ∏å∑’Ë‡ªìπÕß§å°√ ™◊ËÕÕß§å°√. ™◊ËÕ∫∑§«“¡. ™◊ËÕ«“√ “√ ªï∑’Ëæ‘¡æå; ªï∑’Ë: Àπâ“∑’ËÕâ“ßÕ‘ß. μ—«Õ¬à“ß §≥–ºŸâ‡™’Ë¬«™“≠®“° ¡“§¡Õÿ√‡«™·Ààßª√–‡∑»‰∑¬. ‡°≥±å°“√«‘π‘®©—¬·≈–·π«∑“ß°“√ª√–‡¡‘π°“√ Ÿ≠‡ ’¬ ¡√√∂¿“æ¢Õß ‚√§√–∫∫°“√À“¬„®‡π◊ËÕß®“°°“√ª√–°Õ∫Õ“™’æ. ·æ∑¬ ¿“ “√ 2538; 24: 190-204. Council on Dental Materials and Devices. New American Dental Association Specification No. 27 for direct filling resins. J Am Dent Assoc 1977; 94: 1191-4. 7.2 °“√Õâ“ßÕ‘ßÀπ—ß ◊Õ 7.2.1 ºŸâπ‘æπ∏å∑’Ë‡ªìπºŸâ‡¢’¬π ™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕÀπ—ß ◊Õ §√—Èß∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå; ªï∑’Ë μ«Õ¬— “ßà ¡π— ‚√®πå«π“°“√, ÿ∑—» √—°ª√– ‘∑∏‘Ï°≈.Ÿ øíπ§ÿ¥ æ‘¡æå§√—Èß∑’Ë 1. °√ÿß‡∑æ¡À“π§√: ‚√ßæ‘¡æå ÿ∑∏‘- “√°“√æ‘¡æå; 2530: 14-15. Ringsven MK, Bond D. Gerotology and leadership skills for nurses. 2nd ed. Albany (NY): Delmar Publishers; 1996: 215-30. 7.2.2 ºŸâπ‘æπ∏å∑’Ë‡ªìπÕß§å°√ ™◊ËÕÕß§å°√. ™◊ËÕÀπ—ß ◊Õ. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå; ªï∑’Ëæ‘¡æå. μ—«Õ¬à“ß Õß§å°√ºŸâ∫√‘À“√§≥–∑—πμ·æ∑¬»“ μ√å·Ààßª√–‡∑»‰∑¬. øíπ¥’¡’„™âμ≈Õ¥™’«‘μ. °√ÿß‡∑æ¡À“π§√: ‚√ßæ‘¡æå∫√‘…—∑™—μ‡μÕ√å ·Õπ¥åÕ‘ß§å; 2538. Virginia Law Foundation. The medical and legal implication of AIDS. Chalottevill: The Foundation; 1987. 7.2.3 ºŸâπ‘æπ∏å∑’Ë‡ªìπºŸâ‡¢’¬π·≈–∫√√≥“∏‘°“√„πμ”√“ ™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ∫∑∑’ËÕâ“ßÕ‘ß. „π: ™◊ËÕ∫√√≥“∏‘°“√, (∂â“‡ªìπ¿“…“Õ—ß°ƒ…„™â in) ∫√√≥“∏‘°“√. ™◊ËÕÀπ—ß ◊Õ. §√—Èß∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå; ªï∑’Ëæ‘¡æå.Àπâ“∑’ËÕâ“ßÕ‘ß. μ—«Õ¬à“ß ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈. ¿“«–·∑√°´âÕπ‡©æ“–∑’Ë®“°°“√©’¥¬“™“‡©æ“–∑’Ë. „π: ÿ∑—» √—°ª√– ‘∑∏‘Ï-°Ÿ≈, ∫√√≥“∏‘°“√. μ”√“¬“™“ ‡©æ“–∑’Ë@∑—πμ°√√¡. æ‘¡æå§√—Èß∑’ËÀπ÷Ëß. °√ÿß‡∑æ¡À“π§√: ‚√ßæ‘¡æå‡∑Á°´å·Õπ¥å‡®Õ√åπ—≈æ—∫≈‘‡§™—Ëπ®”°—¥; 2548: 333-50. Yamada KM. Fibronectin and other cell interactive glycoproteins. In: Hay ED, editor. Cell biology of extracellular matrix. 2nd ed. New York: Plenum Press; 1991: 111-46. 7.2.4 ºŸâπ‘æπ∏åÀ≈“¬§π‚¥¬·¬°‡¢’¬π‡©æ“–∫∑·≈–¡’∫√√≥“∏‘°“√¢ÕßÀπ—ß ◊Õ ™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ∫∑∑’ËÕâ“ßÕ‘ß. „π: ™◊ËÕ∫√√≥“∏‘°“√, (∂â“‡ªìπ¿“…“Õ—ß°ƒ…„™â In) ∫√√≥“∏‘°“√. ™◊ËÕÀπ—ß ◊Õ. §√—Èß∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå; ªï∑’Ëæ‘¡æå. Àπâ“∑’ËÕâ“ß∂÷ß. μ—«Õ¬à“ß ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈, ∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√. °“¬«‘¿“§„π°“√©’¥¬“™“‡©æ“–∑’Ë. „π: ÿ∑—» √—°-ª√– ‘∑∏‘Ï°Ÿ≈, ∫√√≥“∏‘°“√. μ”√“¬“™“‡©æ“–∑’Ë@∑—πμ°√√¡. æ‘¡æå§√—Èß∑’ËÀπ÷Ëß. °√ÿß‡∑æ¡À“π§√: ‚√ßæ‘¡æå‡∑Á°´å-·Õπ¥å‡®Õ√åπ—≈æ—∫≈‘‡§™—Ëπ®”°—¥; 2548: 99-146. Philipps SJ, Whisnant JP. Hypertension and stroke. In:Largh JH, Brenner BM, editors. Hypertension:patophysiology, diagnosis, and management. 2nd ed. New York:Raven Press; 1995: 465-78. °“√æ‘®“√≥“°≈—Ëπ°√Õß ∫∑§«“¡®–‰¥â√—∫°“√æ‘®“√≥“°≈—Ëπ°√Õß‚¥¬ºŸâ∑√ß§ÿ≥«ÿ≤‘„π “¢“«‘™“π—Èπ Ê Õ¬à“ßπâÕ¬ 2 ∑à“π ‚¥¬„™â‡«≈“ª√–¡“≥ 4 ∂÷ß 8 —ª¥“Àå ®“°π—Èπ ®–·®âßº≈°“√æ‘®“√≥“„ÀâºŸâ‡¢’¬π∑√“∫ μâπ©∫—∫∑’Ë‰¥â√—∫°“√æ‘®“√≥“‡æ◊ËÕ®–μ’æ‘¡æå„π«‘∑¬“ “√ ∫√√≥“∏‘°“√®–®—¥ àß∫∑§«“¡„ÀâºŸâ√—∫º‘¥™Õ∫·°â‰¢ß“π„π°√≥’∑’ËºŸâ∑√ß§ÿ≥«ÿ≤‘‡ πÕ ·π–„Àâ·°â‰¢„Àâ·°â‰¢À√◊Õ™’È·®ß‡æ‘Ë¡‡μ‘¡®π‡ªìπ∑’Ë‡√’¬∫√âÕ¬°àÕπ®÷ß®–μ’æ‘¡æå ·≈–μâÕß àß‡Õ° “√∑—ÈßÀ¡¥°≈—∫§◊π¡“μ“¡‡«≈“∑’Ë°”Àπ¥¡‘©–π—Èπ®–∂◊Õ«à“∑à“π ‰¡àμâÕß°“√≈ßμ’æ‘¡æå °√≥’∑’Ë∫∑§«“¡‰¥â√—∫°“√æ‘®“√≥“„Àâμ’æ‘¡æå ∫√√≥“∏‘°“√®–·®âß„ÀâºŸâπ‘æπ∏å àß∫∑§«“¡μâπ©∫—∫∑’Ë·°â‰¢§√—Èß ÿ¥∑â“¬ æ√âÕ¡·ºàπ´’¥’√Õ¡ (CD ROM) ∑’Ë∫√√®ÿ‡π◊ÈÕÀ“·≈–¢âÕ¡Ÿ≈∑’Ë¡’Õ¬Ÿà„π∫∑§«“¡∑—ÈßÀ¡¥∑’Ë‰¥â·°â‰¢·≈â« ∑—Èßπ’ÈºŸâπ‘æπ∏åμâÕß¡’ ”‡π“‡°Á∫‰«â¥â«¬‡æ◊ËÕ°“√Õâ“ßÕ‘ß·≈–¬◊π¬—π„π¿“¬À≈—ß °√≥’∑’ËÕ¬Ÿà„π¢—ÈπμÕπ°“√®—¥æ‘¡æå ∑“ß∫√√≥“∏‘°“√®– àßμâπ©∫—∫ (artwork) „ÀâºŸâ√—∫º‘¥™Õ∫μ√«®æ‘ Ÿ®πåÕ—°…√·≈–§«“¡∂Ÿ°μâÕß∑“ß«‘™“°“√ (À“°ºŸâ√—∫º‘¥™Õ∫‰¡à àß§◊πμ“¡‡«≈“∑’Ë°”Àπ¥ ®–∂◊Õ«à“∑à“π‰¡àμâÕß°“√≈ßμ’æ‘¡æå) ”À√—∫∫∑§«“¡∑’Ë‰¡à‰¥â√—∫°“√μ’æ‘¡æå®–¡’°“√·®âßº≈æ√âÕ¡§◊πμâπ©∫—∫∫∑§«“¡π—Èπ·°àºŸâπ‘æπ∏å ∑“ß°Õß∫√√≥“∏‘°“√¢Õ ß«π ‘∑∏‘Ï∑’Ë®– ‰¡àæ‘®“√≥“∫∑§«“¡´÷Ëß¡’°“√‡μ√’¬¡∫∑§«“¡‰¡à∂Ÿ°μâÕß ·≈–‰¡à·°â‰¢μ“¡ºŸâ∑√ß§ÿ≥«ÿ≤‘ B 10

Mahidol Dental Journal Information for Authors

Objectives of the Journal

1. To disseminate knowledge gained from academic research in dentistry and other related medical sciences; 2. To promote valued research for academic advancement; 3. To create an academic network and to build relationships among dentists and others in related fields in order to keep up with constantly developing knowledge; 4. To enhance the reputation of the Faculty of Dentistry and Mahidol University Dentistry Alumni Association.

Mahidol Dental Journal is financially supported by the Faculty of Dentistry, Mahidol University.

Submission of Manuscripts

Manuscripts for publication should be addressed to

The Editor, Mahidol Dental Journal Academic Promotion and Development Unit, Bld. 4, Fl. 9 Faculty of Dentistry, Mahidol University 6 Yothi Road, Ratchathewi District Bangkok 10400

Tel. 0-2660-7769 Fax. 0-2660-7767 Email: [email protected]

Manuscript Types

Mahidol Dental Journal publishes several types of articles. These include the following:

1. Original articles are articles including new research reports, survey reports in epidemiology, relevant case reports, and reports concerning new dental materials and technical procedures. These articles should be useful to the profession of dentists and must be previously unpublished. 2. Review Articles are articles that derive knowledge from new textbooks and journals or from the author’s own work and experience. They should be composed in an analytical, critical, and comparative style for the advancement of knowledge. 3. Miscellany encompasses the following: 3.1 Special reports are short academic reports pertinent to dentists. These may be analyses; discussions; summaries of other useful academic papers; articles reviewing aspects of the body of knowledge; summarized translations from international journals; commentaries; reviews; papers introducing medical appliances or interesting books and textbooks; or reports of both national and international conferences. 3.2 Current concepts are concepts or knowledge in any certain areas that are useful. They can be translated or composed from other journals recognized for their high standard. 3.3 Ask the expert are responses to readers’ academic or clinical problems by experts in a particular field. Interesting questions and answers from conferences may also be published for the benefit of those who have not attended the conferences. 3.4 Letters to the editor are questions or academic comments valuable to readers and the profession. 3.5 Research summaries or book reviews that are noteworthy.

Preparation of Manuscripts (effective from Volume 27 Number 1 2007)

1. Manuscripts must not be folded. One original and four copies of the manuscript as well as three copies of illustrations and tables must be submitted along with a submission form for consideration for publication via a registered mail to protect against loss. Each copy of the manuscript should be clipped, not stapled. The manuscript should be 10-20 pages including illustrations and tables of no more than 10 pages. The manuscript must be double-spaced on one-sided portrait A4 paper with an equal margin of 2.5 centimeters at all sides and paginated with the number on the top right corner. The manuscript file must be operated on Microsoft Word with the Cordia New 16 font. 2. The Thai spelling must conform to the Dictionary of the Royal Academy (1999 edition). English technical terms must be translated into Thai with the original words provided in parentheses only the first time they appear. Words that have been coined by the Royal Academy must be used. Words that have not been coined must be transliterated in accordance with the criteria for transliteration set by the Royal Academy with the original words parenthesized for their first time use. (See www.royin.go.th for more information.) Only Arabic notation can be used in the manuscript. 3. Units of length, weight, volume, etc. should be given in metric measures. A measurement of temperatures must be in Celsius. Pressure must be in mercury millimeter. A hematologic measurement and a measurement of clinical chemistry should also be in metric unit. Other measurements should follow the universal standard. Only standard abbreviations and symbols must be employed. No abbreviations should appear in the title or abstract. When an abbreviation is used, its full form should be provided after its first use in the text, with an exception of units of measurement. For manuscripts written in English, a tooth may be identified either by its name such as upper left canine or with FDI two-digit notations followed by its name in parenthesis the first time it is mentioned, for instance, Tooth #31 (lower left central incisor).

Manuscript Format and Structure

Part One must contain the following headings written in Thai and sequentially ordered.

1. Title: The title should be written in as much Thai as possible, be concise, and convey the main objective of the study. It must contain no abbreviations and should not exceed 100 letters in length. 2. Name of the author: Only first name and last name should be given. If there are many authors, their names should be organized according to their contributions to the research with the most important one listed first. 3. Degree of education: A maximum of two highest degrees should be provided after the author’s name in their official abbreviated forms. If the author has graduated from a university outside Thailand, the degree must be given in the language of the country from which he or she has obtained the degree. B 11

4. Address: All authors should provide the detailed address of their organization. If they are not affiliated with any institution, their clinic address must be given. 5. Corresponding author: One author must be designated as the corresponding author. The last name, position, professional affiliation, office phone, cell phone, fax, and e-mail address must be provided for the corresponding author for fast and convenient contact. 6. Research grant: If the study is financially supported, specify grant citing in a sequence name of the grant, organization awarding the grant, year the grant is awarded, and grant number (if any). 7. Received: Write the date appearing in the editor’s acknowledgement upon the receipt of the manuscript. 8. Accepted: Write the date appearing in the editor’s letter confirming the manuscript will be published. 9. Abstract: The abstract is a summary of the whole paper. However, no conclusion should be drawn from the discussion. Neither must there be any references, illustrations and tables. A tooth must be identified by its name rather than symbols. No English terminologies can be used. Instead they may be either translated or transliterated into Thai. No originals are needed. The following are to be included in the abstract: Objectives along with the hypotheses of the study must be given. Materials and Methods provide information on materials or patients employed in the study, number, type, method of the study or experiment, and statistics utilized in the study. Results present findings of the study including experimental study and statistical study (in case there is an analysis). Conclusion. 10. Key words: 3-6 key words from the abstract are to be provided in alphabetical order and separated from one another with commas (,).

Part Two presents the information from Part One written in English.

1. Title: The first letter of each word in the English title must be capitalized while the rest, except for proper names, are written in lower case letters. 2. Name of the author: Use the author’s first name followed by last name only. 3. Degree of education: Use universal abbreviated forms of degrees. 4. Address: Provide an address of every author. Add the country “Thailand” after area code. 5. Corresponding author: Give name and address of the corresponding author for later contact regarding the manuscript. 6. Research grant: Cite source of funding. 7. Received: Write the date appearing in the editor’s acknowledgement upon the receipt of the manuscript. 8. Accepted: Write the date appearing in the editor’s letter confirming the manuscript will be published. 9. Abstract: The abstract should not exceed 250 words and include objectives, materials and methods, results and conclusion. 10. Key words: There should be 3-6 key words whose meanings match the Thai key words and arranged in alphabetical order.

Part Three can be written in Thai or in English.

Headings of Part Three must not be indented. Use a new page for each heading. The headings are ordered sequentially as follows:

1. Introduction This first section introduces the whole paper by reviewing literature presenting knowledge and evidence from research as well as books or journals related to the study. In addition, the introduction provides rationale or significance, hypotheses, objectives, scope and methods of the study with references to other articles to relate the present study to the known prior knowledge. In other words, it should address reasons leading to the study and inform readers what questions the study is trying to answer. Thus, the introduction should review only pertinent literature and leave out those outside the scope and objectives of the study. Neither should it report results and conclusion of the study.

2. Materials and Methods Under this second heading, two subheadings are to be included.

2.1 Materials The material section imparts on details of the materials employed in the study citing chemical names, sources, characteristics or specifications of materials, and experimental samples of animals and patients. Experimentation involving human and animal subjects requires the presentation of relevant details, for instance, whether the samples are patients or normal persons, animal and plant types, number of samples as well as other specific characteristics such as gender, age, weight, and so on. Research involving experimental procedure on humans and animals must be conducted in full accordance with ethical principles. In this case, the author must be able to identify that the research has been conducted as such and supply evidence that it has been approved by the organization’s ethical board.

2.2 Methods The method section explains experimental methodology, observations or techniques for securing data, experimental procedures, measures of study, data collection, data analyses, and statistics utilized in the analysis of data. The explanation should be adequately detailed so as to allow for repeated experimentation.

3. Results This part presents findings obtained from experiments and analyses categorized into sections based on objectives of the study. Straightforward findings without too many numbers can be descriptively presented. Complicated findings with numerous numbers and variables should be presented using illustrations, tables, graphs, or charts with the interpretation of the findings in comparison with the suggested hypotheses. (Be careful not to reiterate the results given in the illustrations or tables in the text.)

4. Discussion Discussion can be drawn from objectives, hypotheses, and findings of the study. It can be discussed whether the present study reveals findings similar to or different from those previously presented, how they are alike or differ, and reasons for such similarities and differences in order for readers to understand and obtain novel knowledge created by the study. The author may discuss advantages and disadvantages of materials and methods employed in the study. New ideas or problems from the study can also be put forward. The author should discuss unexpected findings candidly and offers recommendations on how those findings can be of any use.

5. Conclusion The conclusion part encompasses the following: a summary of the findings of the study, a statement to show whether the findings correspond with the hypotheses, a conclusion drawn from the discussion, and suggestions for further use of the results as well as further study. B 12

6. Acknowledgements This one-paragraph section is where the author acknowledges organizations and persons who have made substantive contributions to the study. (It should be remarked, however, that citing in the acknowledgements too many organizations and persons can undermine the article as readers may assume that most of the study has been carried out with assistance from others.)

7. References References include the list of documents the author has cited in the text. References are indicated by superscript Arabic numbers right after the cited names or statements and should be numbered consecutively (for example, 1,3,6 or 1-3. They should be neither indented nor parenthesized. The same numbers must be used for repeated references. Using abstracts as references and unpublished data must be avoided. All references in the list should be numbered consecutively as they appear in the text, following the Vancouver system. Abbreviated names of journals must follow the reference style in the PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi). If a journal name does not appear in the PubMed, then the Index Medicus should be applied.

7.1 Journal references

Names of all authors must be included if there are no more than six authors. If there are more than six authors, only the first six names are included followed by ‘et al.’ in English and ‘·≈–§≥–’ in Thai.

7.1.1 English Journals References of English journals should contain the following: name of author. title of article. title of journal followed by year of publication;volume:page numbers. (As for the author’s name, last name precedes first initials of first and middle names. Christian calendar is used for publication year.) Below is an example:

Harnirattisai C, Inokoshi S, Shimada Y, Hosada H. Interfacial morphology of an adhesive composite resin and etched caries-affected dentin. Oper Dent 1992;17:222-8.

7.1.2 Thai Journals References of Thai journals must have the following: name of author. title of article. title of journal followed by year of publication;volume:Page numbers. (Both first and last names are written in full forms. Buddhist calendar is used for publication year.) An example is given below: ∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√, ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈, ≥—∞æß»å ‘√‘π∑«—≤πå, «’√–»—°¥‘Ï ‰æ√—™‡«∑¬å, ª√–¿“°√ ®”πßª√– “∑æ√. ª√– ‘∑∏‘¿“æ¢Õß¬“™“Õ“√åμ‘‡§π·≈–¬“ ™“≈‘‚¥‡§π„π°“√ºà“μ—¥øíπ°√“¡§ÿ¥≈à“ß´’Ë∑’Ë “¡. « ∑—πμ ¡À‘¥≈ 2548;25:59-66.

7.1.3 Organizational authors Journal references with organizational authors should have the following: name of organization. title of article. title of journal followed by year of publication;volume:page numbers., e.g., §≥–ºŸâ‡™’Ë¬«™“≠®“° ¡“§¡Õÿ√‡«™·Ààßª√–‡∑»‰∑¬. ‡°≥±å°“√«‘π‘®©—¬·≈–·π«∑“ß°“√ª√–‡¡‘π°“√ Ÿ≠‡ ’¬ ¡√√∂¿“æ¢Õß‚√§√–∫∫°“√À“¬„®‡π◊ËÕß®“°°“√ ª√–°Õ∫Õ“™’æ. ·æ∑¬ ¿“ “√ 2538;24:190-204. Council on Dental Materials and Devices. New American Dental Association Specification No. 27 for direct filling resins. J Am Dent Assoc 1977;94:1191-4.

7.2 Book references

7.2.1 Book references with individual authors Book references with individual authors must be written as follows: name of author. title of book followed by edition. city of publication:publisher; year of publication:page numbers., e.g., ¡π— ‚√®πå«√“°“√, ÿ∑—» √—°ª√– ‘∑∏å°Ÿ≈. øíπ§ÿ¥ æ‘¡æå§√—Èß∑’ËÀπ÷Ëß. °√ÿß‡∑æ¡À“π§√:‚√ßæ‘¡æå ÿ∑∏‘ “√°“√æ‘¡æå;2530:14-15. Ringsven MK, Bond D. Gerotology and leadership skills for nurses 2nd ed. Albany (NY):Delmar Publishers;1996:215-30.

7.2.2 Book references with organizational authors Book references with organizational authors should be written as follows: name of organization. title of book. city of publication:publisher; year of publication., e.g., Õß§å°√ºŸâ∫√‘À“√§≥–∑—πμ·æ∑¬»“ μ√å·Ààßª√–‡∑»‰∑¬. øíπ¥’¡’„™âμ≈Õ¥™’«‘μ. °√ÿß‡∑æ¡À“π§√:‚√ßæ‘¡æå∫√‘…—∑™—μ‡μÕ√å·Õπ¥åÕ‘ß§å;2538. Virginia Law Foundation. The medical and legal implication of AIDS. Chalottevill:The Foundation;1987.

7.2.3 Book or textbook references with authors and editors References of books with authors and editors must contain the following: name of author. title of cited chapter. In:name of editors, (use the word „π in Thai) editor. title of book. edition. city of publication: publisher;year of publication.page numbers.,e.g., ÿ∑—» √—°ª√– ‘∑∏å°Ÿ≈. ¿“«–·∑√°´âÕπ‡©æ“–∑’Ë®“°°“√©’¥¬“™“‡©æ“–∑’Ë. „π: ÿ∑—» √—°ª√– ‘∑∏å°Ÿ≈, ∫√√≥“∏‘°“√. μ”√“¬“™“‡©æ“–∑’Ë@∑—πμ°√√¡. æ‘¡æå§√—Èß∑’Ë Àπ÷Ëß. °√ÿß‡∑æ¡À“π§√:‚√ßæ‘¡æå‡∑Á°´å·Õπ¥å‡®Õ√åπ—≈æ—∫≈‘‡§™—Ëπ®”°—¥;2548:333-50. Yamada KM. Fibronectin and other cell interactive glycoproteins. In: Hay ED, editor. Cell biology of extracellular matrix. 2nd ed. New York:Plenum Press;1991:111-46.

7.2.4 Book references with editors and several authors writing separate chapters The following are needed for references of books with editors and several authors writing separate chapters: name of author. title of cited chapter. In:name of editors, (use the word „π in Thai) editor. title of book. edition. city of publication: publisher;year of publication.page numbers.,e.g., ÿ∑—» √—°ª√– ‘∑∏å°Ÿ≈, ∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√. °“¬«‘¿“§„π°“√©’¥¬“‡©æ“–∑’Ë. „π: ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈, ∫√√≥“∏‘°“√. μ”√“¬“™“‡©æ“–∑’Ë@∑—πμ°√√¡. æ‘¡æå §√—Èß∑’ËÀπ÷Ëß. °√ÿß‡∑æ¡À“π§√:‚√ßæ‘¡æå‡∑Á°´å·Õπ¥å‡®Õ√åπ—≈æ—∫≈‘‡§™—Ëπ®”°—¥;2548:99-146. B 13

Philipps SJ, Whisnant JP. Hypertension and stroke. In:Largh JH, Brenner BM, editors. Hypertension:pathophysiology, diagnosis, and management. 2nd ed. New York:Raven Press;1995:465-78.

7.3 Dissertation references Dissertation references should be written as follows: name of author. title of dissertation (type of degree). department,faculty. city:university;year of degree conferring.,e.g., ™μÿ¡“‘ «“ß.à º≈¢Õß¬“ ø’ πø≈í ÕÕ‰√¥Ÿ ∑å º ¡‰´≈’Ë ∑Õ≈μ‘ Õª√à ¡“≥‡™‘ Õ¡◊È «·∑π ‘ å ‡μ√æ‚μ§Õ°‰´·≈–·≈§‚μ·∫´Á ‰≈‘ (ª√–°“»π∫’ μ√∫— ≥±— μ).‘ ∑πμ°√√¡ ”À√— ∫— ‡¥Á°, ¡À“«‘∑¬“≈—¬¡À‘¥≈. °√ÿß‡∑æ¡À“π§√:¡À“«‘∑¬“≈—¬¡À‘¥≈;2547-2548. Rassameemasmaung S. Effects of porphyromonas gingivalis on human gingival fibroblasts (Doctor of Philosophy). Oral biology, Mahidol University. Bangkok:Mahidol University;2002.

7.4 Conference paper references

7.4.1 Conference documents References of conference documents are written as follows: name of author. title of document. title of conference. year month date;venue;year of publication.,e.g.,

Royce JC. Finches of Du page County. Page read at 2nd Annual conference on bird-watching. 1986 May 24-26;Midland University, Illinois:Flat Prairie;1986.

7.4.2 Reports published in series The following must be included for references of reports published in series: name of author. title. country of publication. publisher;year of publication.,e.g., °Õß∑—πμ “∏“√≥ ÿ¢, °√¡Õπ“¡—¬, °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√ ”√«® ¿“«–∑—πμ ÿ¢¿“æ·Ààß™“μ‘§√—Èß∑’Ë 5 æ.». 2543-2544. ª√–‡∑»‰∑¬. °√ÿß‡∑æ¡À“π§√. ‚√ßæ‘¡æå∫√‘…—∑ “¡‡®√‘≠æ“≥‘™¬å (°√ÿß‡∑æ) ®”°—¥;2545. Fluoride and human health. WHO Monograph;1970. Series no. 59.

7.4.3 Proceedings References of proceedings should contain the following: name of author. itle. In:ame of editors, (use the word „π in Thai) editors. title of proceedings;year month date of conference; venue. city of publication:publisher;year of publication:page numbers.,e.g.,

Hotz PR. Dental plaque control and caries. In:Lang PN, Attstrom R, Loe H, editors. Proceedings of European Workshop on Mechanical Plaque Control;1998 May 9-12;Berne, Switzerland. Chicago:Quintessence publication; 1998:35-49.

7.5 Newspaper article references Newspaper article references contain the following: name of author. title of article. title of newspaper followed by date month year of publication;section:page numbers (column number).,e.g., ‡æ≈‘ß¡√°μ. À¡Õ. Àπ—ß ◊Õæ‘¡æå‰∑¬√—∞ «—π∑’Ë 30 ‘ßÀ“§¡ 2539;23. (§Õ≈—¡πå 5) Rensberger B, Specter B. CFCs may be destroyed by natural process. The Washington Post 1989 Aug 7;Sect. A:2(col.5).

7.6 Electronic references Electronic references are of two groups:

7.6.1 Online references from homepages and websites Online references must be written as follows: name of author. title of article. title of journal (media type) followed by year of publication (date month year of retrieval); volume (number): (illustration). source.,e.g.,

Morse SS. Factors in the emergence of infections disease. Emerg Infect Dis (serial online) 1995 Jan-Mar (cited 1996 Jun 5);1(1):(24 screens). Available from:URL:http://www/cdc.gov/ncidod/EID/eid.htm.

7.6.2 Other electronic references including CD-ROM, diskettes, other computer databases

An example of other electronic references is given below:

CDI,clinical dematology illustrated (monograph on CD-ROM). Reeves JRT, Maibach H. CMEA Multimedia Group, producers. 2nd ed. Version 2.0 San Diego:CMEA;1995.

7.7 Audio-visual aid references Audio-visual aid references should be written as follow: title of article (videocassette). city of manufacturing: manufacturer;year of manufacturing.,e.g.,

HIV+/AIDS: the facts and the future (videocassette). St. Louis (MO):Mosby-year Book;1995.

Illustrations

1. All illustrations must be concisely titled in English and numbered in order of appearance in the text using Arabic notation. They can be drawings, photographs, diagrams or graphs. 2. Titles and legends must be typed underneath the illustrations which are submitted on separate pages. Color names, dying techniques, and magnification rates may be provided after legends or designated as bars within the illustrations. Symbols, arrows, or letters within the illustrations must be clearly identified. 3. A box must be left in the text to indicate the area where each illustration will be put and marked within the illustration “Illustration 1”, e.g., B 14

Illustration 1

4. Both color and black & white photographs can be used. As for color photographs, high-quality glossy prints of 8.9×14 cm. (postcard) are required. The title, number and author’s name should be indicated on the back of each photograph lightly in pencil so as not to leave any unwanted mark on the front. Also indicate the top edge of each photograph. All illustrations should not be adhered to anything and must be placed in a separate envelop. Digital photographs should not be embedded in the text. Instead they should be separately filed. High resolution photographs of no less than 300 dpi must be saved on a diskette or a CD-ROM. They can be in any format that can be opened using Adobe Photoshop (tiff, gps, fpg, etc.). To avoid blur and fuzz, polaroids should not be used. 5. Radiographs should not be printed directly from the x-rays as the prints may be different from their originals. Black & white prints should be obtained from copies of the original x-rays. Scans of radiographs should not be used either. 6. Line drawings, graphs or charts must be drawn or printed with explanatory ordinate and abscissa in black & white on glossy paper. 7. Prints from slides are required. 8. If all or parts of previously published illustrations are used, permissions must be obtained from the copyright holder concerned and the permissions must be indicated.

Tables 1. Each table should be typed on a separate page. A box must be left in the text to indicate the area where each table will be put and marked within table “Table 1”. 2. Tables should be numbered consecutively and should have a concise explanatory title in English written over each table. Tables should be kept to the minimum essential for proper presentation of the results. 3. Each table must be typed with the footnote explaining abbreviations, symbols, or statistical values (if any) appearing on the table. Table footnotes should not be numbered using Arabic numerals as they may be mixed up with the references. To avoid such confusions, symbols such as *, +, #, ** may be used instead. 4. Tables should contain no vertical lines, horizontal lines, and borderlines.

Review Process It is imperative that authors prepare manuscripts in accordance with the format guidelines of the Journal. The manuscripts must be checked and proofread for accuracy before being submitted to the editor. Manuscripts will be reviewed by at least two experts in the field. Review process generally takes two to eight weeks. The Journal then informs the corresponding author of the result of the review process. Manuscripts with potential for publication will be sent to the authors for revision. When all revisions and changes are made according to the referees’ comments, revised manuscripts must be submitted to the editor within a set period. Otherwise, the Journal will assume the author no longer wants to publish his or her manuscript. The Editor will notify the author when the manuscript is accepted for publication. The final version of revised manuscript must be saved on diskette or CD-ROM and submitted along with the diskette or CD-ROM. The author must keep a copy of the manuscript for later reference or confirmation. During the printing process, the Editor will send the artwork of the manuscript to the corresponding author once for proofreading and checking for academic accuracy. (If the author does not return the proofread manuscript within a set period, the Journal will assume the author no longer wants to publish his or her manuscript.) The Editor will not send the manuscript to the author for proofreading again but more proofreading will be carried out by the editorial board to enable faster printing process. Authors will be informed of review results and manuscripts unaccepted for publication will be returned to the authors. The Journal reserves the right not to consider manuscripts that have not been prepared in accordance with the Journal’s guidelines.

Copyright To conform to the copyright law, all authors are required to assign and transfer the copyright on their articles and original manuscripts to Mahidol Dental Journal. Authors must also attest that the manuscript is previously unpublished and that the manuscript is submitted to the Journal only and is not currently under consideration elsewhere and the research reported will not be submitted for publication elsewhere no matter in what languages the manuscript is prepared. Manuscripts under multiple publication policy are exempt from the said practice. Articles published in Mahidol Dental Journal are the copyright of the Journal. No part of the articles may be copied, modified, reproduced or utilized in any form for any purposes without permission from the Journal. The contents and opinions presented in the articles published in Mahidol Dental Journal belong specifically to the author, not necessarily shared by the Journal’s editorial board.

Permission and Waivers Permission of the copyright holders must be obtained in writing for the direct use of illustrations or tables previously published and under copyright (except for reference use). Written permission must be submitted to the Editor before the manuscript can be published. Quotations must be written in quotation marks and references must be identified for each quotation. Permission of author is required for quotations exceeding 5 lines. Waivers must be obtained in writing for photographs showing potentially identifiable persons and waivers must be presented to the Editors.

Reprints Authors will be given 20 copies of reprints and 1 copy of the Journal. If additional reprints and journal or reprints with color illustrations are desired, they must be ordered when the final revised version of the article is submitted to the Editor. An extra amount will be charged for additional reprints, journals, and color illustrations based on the price fixed by the publishing house.

Readers’ Comments Readers’ comments on articles or other matters are welcome. These should be sent to the Editor via mail, fax or e-mail at the address given above.

Advertising and Subscription Contact the Editor at the above address for advertising, order and subscription.

Subscription Rates Mahidol Dental Journal is published as one volume of three issues annually (January-April, May-August, and September-December). Subscription rates for one issue are: 150 Baht for domestic order and 400 Baht for international order (including shipping and handling).

Subscription and Membership Payment Please mail an order form with money order payable to “Ms. Sirilux Promvisut” to the Editor at the address provided above.

«∑¬“ “√∑‘ πμ·æ∑¬»“ μ√— ¡Àå ¥≈‘ Mahidol Dental Journal ªï∑’Ë ÛÒ ©∫—∫∑’Ë Û °.¬.-∏.§. ÚııÙ Volume 31 Number 3 Sep.-Dec. 2011

“√∫≠— Contents

∫∑«∑¬“°“√‘ Original article §à“‡´ø“‚≈‡¡μ√‘°„πºŸâªÉ«¬øíπÀπâ“ ∫‡ªî¥∑’Ë®—¥øíπ 121 Cephalometric assessment in anterior open bite patients √à«¡°—∫°“√„™â·≈–‰¡à„™âÀ¡ÿ¥¬÷¥∑“ß∑—πμ°√√¡®—¥øíπ treated with and without mini-implant anchorages ‡æÁ≠ª√–¿“ ™‘«™√—μπå ÿ«√√≥’ ≈—¿π–æ√≈“¿ Penprapa Chiewcharat Suwannee Luppanapornlarp ÿæ—≤™—¬ ∫ÿ≠ª√–∂—¡∂å æß»∏√ æŸà∑Õß§” Supatchai Boonpratham Pongstorn Putongkam

ª√– ‘∑∏‘¿“æ„π°“√μâ“π‡™◊ÈÕ·∫§∑’‡√’¬¢Õß 131 Antimicrobial Efficacy of Propolis against Enterococcus faecalis ‚ª√æÕ≈‘ μàÕ‡™◊ÈÕ‡ÕÁπ‡∑Õ‚√§Õ°§— øï§—≈≈‘ and Porphyromonas gingivalis ·≈–‡™◊ÈÕæÕ√åøî‚√‚¡·π ®‘π®‘«“≈‘ Jintana Sarabunchong Thaniya Muadcheingka ®‘πμπ“ “√–∫√√®ß ∏π‘¬“ À¡«¥‡™’¬ß§–

°“√®”·π°‡æ»§π‰∑¬¥â«¬¥—™π’øíπ‡¢’È¬« 141 Sexual dimorphism in Thais using canine index ∑«’æß»å Õ“√¬–æ‘»‘…∞ «π‘¥“ »√’‰æ‚√®πå∏‘°Ÿ≈ Tawepong Arayapisit Wanida Sripairojthikoon Õ—§√‘π ¿“πÿ ∂‘μ¬å π—¬«‘π‘μ ¡ ÿ¢∑«’°Ÿ≈ Akkarin Panusatid Naiwinit Somsuktaweekoon æß»å ∂‘μ ∫—≥±‘μπ‘æ‘∞ ÿ¿“®“√ÿæ—π∏å Pongstit Bundit Nipit Supajarupan

¡∫—μ‘‡™‘ß°“¬¿“æ¢Õßª≈“ ‡μÕ√åÀ‘π∑’Ë®”Àπà“¬ 151 Physical properties of dental stones available in Thailand „πª√–‡∑»‰∑¬ Potchaman Sinavarat Kallaya Suputtamongkol æ®¡“π »√’π«√—μπå °—≈¬“ »ÿæÿ∑∏¡ß§≈ Chatcharee Suchatlampong ™—™√’ ÿ™“μ‘≈È”æß»å

∫∑§«“¡ª√∑‘ »π— å 161 Review article ø≈ŸÕÕ‰√¥å‡®≈·≈–ø≈ŸÕÕ‰√¥å«“√åπ‘™ Fluoride Gel and Fluoride Varnish ∑‘æπ“∂ «‘™≠“≥√—μπå Tippanart Vichayanrat

√Õ¬§√“∫ ’¥”∫πøíπ∫√‘‡«≥‡Àπ◊Õ¢Õ∫‡Àß◊Õ°„π‡¥Á° 175 Black Stains in Children: An update ‡¢Á¡∑Õß ¡‘μ√°Ÿ≈ Kemthong Mitrakul