营养失调与治疗杂志

抽象的

2015 年营养大会：维生素 K2 在龋齿中的潜在作用 - Ken Southward - 多伦多大学

肯·索斯沃德

传统上，龋齿被认为是一种仅限于口腔的牙齿脱矿过程。人们对口腔/全身联系的兴趣日益浓厚，需要新的范例来了解疾病过程。牙科研究的新机遇将会出现，特别是在神经科学和内分泌学领域。大脑下丘脑部分的作用不容小觑。在营养的影响下，它在龋齿的系统模型中起着重要作用。对口腔/全身联系的新理解表明，龋齿是一种不受控制的炎症反应，由大脑控制，并通过内分泌系统的下丘脑/腮腺轴进行调节。目前，正常的龋齿理论只考虑口腔环境，没有认识到大脑的任何重要作用。然而，健康的牙齿具有离心液流来滋养和清洁牙齿。这由下丘脑/腮腺轴调节，该轴向腮腺的内分泌部分发出信号。高糖摄入会导致下丘脑中的活性氧和氧化应激增加。当这种信号机制停止或逆转牙本质液流动时，牙齿就会容易受到口腔细菌的侵害，而口腔细菌现在可能会附着在牙齿表面。口腔细菌（如变形链球菌和乳酸杆菌）产生的酸会使牙釉质脱矿并刺激牙本质。酸的侵蚀会刺激炎症反应，最终导致牙本质因人体自身的基质金属蛋白酶而分解。维生素 K2 (K2) 已被证明在大脑中具有抗氧化潜力，可能被证明是一种有效的方法，可以保持内分泌控制的离心牙本质液流动。压力，包括氧化应激，会加剧人体的炎症反应。糖不仅可以增加口腔细菌酸的产生，还可以通过内分泌信号同时降低牙齿的防御能力。唾液分泌是唾液腺的外分泌功能。唾液的缓冲量对于中和口腔环境至关重要。这可最大限度地减少牙釉质的脱矿，并促进其再矿化。K2 与发酵奶酪中的 K2 类似，可通过对储存的钙和无机磷酸盐的影响来恢复唾液缓冲。

Data collected from numerous selected primitive cultures on the point of civilization established the difference in dental health thanks to diet. The basic diet group had scarce carious lesions when compared to the group which consumed a civilized diet high in sugar and refined carbohydrates. The primitives were ready to include the fat soluble vitamins, specifically K2, in their diet. More endocrine and neuroscience research is important to rose understand how nutrition influences the tooth’s defences through the hypothalamus/parotid axis. It will also link cavity to other inflammation related degenerative diseases like diabetes. The role of reactive oxygen species in the hypothalamus is a signalling factor in establishing tooth vulnerability or resistance. Vitamin K2 appears to have a significant antioxidant role in the brain as well as a key nutrient in the management of calcium in the body including bones and cardiovascular tissues. K2 works together with calcium and vitamin D . This systemic paradigm of dental caries places nutrition on the leading edge of prevention because it is focused on the cause of the disease rather than traditional preventive efforts focused on the symptoms. K2 also appears to have a potential salivary buffering role in the exocrine portion of the parotid gland as well as the other salivary glands. In this systemic paradigm, the potential preventive role of nutritionists and public health professionals is elevated to unprecedented levels. Working to widen existing dental recall programs beyond a sign focus will show welfares but will probably have to be driven by public education programs.

Some of the most revolutionary concepts in dentistry, such as dental implants and nickel-titanium metals in orthodontics and endodontics have their roots outside dental research. Data exists to support the systemic theory of dental caries and K2 as a critical component. Bringing dentinal fluid flow research up to date in the lab by substituting K2 and other antioxidants for carbamyl phosphate is the first step in proving this hypothesis. Re-evaluation of Price’s data is important as Activator X is now associated with K2. Determining a community evaluation group to test this hypothesis would be necessary. The objective would be seeking to halt the dental caries process in a study group since it would be virtually impossible to assemble a group of “never decayed” without many confounding factors. To minimize compliance issues, a controllable group such as the armed forces might be an appropriate place to start. Nutritional supplements, placebos and no supplements would differentiate the three test groups. Staff dentists could determine base line measurements and on-going changes. Another option might be school age children who could volunteer to take their supplements at school. Changes will happen faster in younger children with more rapid metabolisms than adults. It would be monitored by dental public health teams.

大自然提供了预防龋齿的证据。营养是这一过程中的主导因素。它影响内分泌方面，通过维持滋养的牙本质液体流动来增强牙齿的防御能力。唾液腺或唾液分泌和成分的外分泌方面也与营养有关。在预防龋齿方面，脂溶性维生素 K2 等最佳营养比传统的牙科建议（即少吃糖以尽量减少口腔细菌酸）发挥着更为重要的作用。牙科疾病将被视为另一种与炎症相关的退行性生活方式疾病，如心血管疾病、骨质疏松症和糖尿病。

谁将引领这一新的营养模式？随着牙医将研究范围扩大到大脑，是否会出现“神经牙科”领域？牙科行业在应用方面具有优势，因为可以将最佳营养添加到目前提供的有益的“从摇篮到坟墓”服务中。然而，其影响可能远远超出牙科疾病。它可能影响所有以炎症为基础的退行性疾病。将研究范围扩展到口腔之外可能会遇到一些阻力。或者，营养学家等其他学科可能会提供牙科营养计划，这些计划可能比目前的牙科预防计划更有效。最终，公共卫生团队可能会发挥关键作用。

注：该研究部分在 2015 年 10 月 26 日至 28 日在美国伊利诺伊州芝加哥举行的第四届国际营养会议和展览会上展示。