The European Academy of Paediatric Dentistry (EAPD) recommends regular fluoride use in children. It supports the use of fluoride toothpaste as part of a basic preventive program to check the development of dental caries in children. A 2008 EAPD conference in Athens established guidelines for fluoride use in children based on the Scottish Intercollegiate Guidelines Network methodology for developing evidence-based recommendations. The guidelines provide advice on fluoride toothpaste dosage and frequency tailored to different age groups.

1. O‰ËÁ›Â˜ ¯Ú‹Û˘ ÙÔ˘ ÊıÔÚ›Ô˘ ÛÙ· ·È‰È¿
∞fi ÙËÓ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜
(European Academy of Paediatric Dentistry)
£∂O¢øƒ√™ ∫√À´ªΔ∑∏™
ª¤ÏÔ˜ ¢™ ∂ÏÏËÓÈ΋˜ ¶·È‰Ô‰ÔÓÙÈ΋˜ ∂Ù·ÈÚ›·˜
¡π∫√™ §À°π¢∞∫∏™
¶Úfi‰ÚÔ˜ ∂ÏÏËÓÈ΋˜ ¶·È‰Ô‰ÔÓÙÈ΋˜ ∂Ù·ÈÚ›·˜
ª∂Δ∞ºƒ∞™∏ - E¶πª∂§∂π∞
H E˘Úˆ·˚΋ Aη‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ (EAPD) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë Î·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË ÊıÔÚ›Ô˘ ·ÔÙÂÏ› ·Ó·fiÛ·-
ÛÙÔ ÛÙÔÈ¯Â›Ô Î¿ı ÚÔÏËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÙÂÚˉfiÓ·˜ ÛÙ· ·È‰È¿. H ÚÔÙÂÈÓfiÌÂÓË ‰fiÛË ÊıÔÚ›Ô˘ ı· Ú¤ÂÈ
Ó· ·ÔÛÎÔ› ÛÙËÓ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓ·˜, ¯ˆÚ›˜ fï˜ Ó· ˘ÂÚ‚·›ÓÂÈ Ù· fiÚÈ· ·ÛÊ·Ï›·˜ Î·È Ó· ›-
Ó·È ·Ó¿ÏÔÁË Ì ÙÔÓ Ù‡Ô ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ (ÚÔÏËÙÈÎfi ÚfiÁÚ·ÌÌ· Û ·ÙÔÌÈÎfi Â›Â‰Ô ‹ Û Â›Â‰Ô ÎÔÈÓfiÙËÙ·˜). ŒÓ· Ù¤ÙÔÈÔ ÚÔ-
ÏËÙÈÎfi ÚfiÁÚ·ÌÌ· ı· Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁÂ›Ù·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Î·È Ó· ÚÔÛ·ÚÌfi˙ÂÙ·È ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ οı ·È‰ÈÔ‡.
°È· ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ E˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ, Ë EAPD Û˘ÛÙ‹ÓÂÈ ÙË ¯Ú‹ÛË Ù˘ ηٿÏÏËÏ˘ ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ Ô˘ ÛÂ Û˘Ó-
‰˘·ÛÌfi Ì ηϋ ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹, ·ÔÙÂÏÔ‡Ó Ù· ·ÚÈ· ÛÙÔȯ›· ÙÔ˘ ‚·ÛÈÎÔ‡ ÚÔÏËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÙÂÚË-
‰fiÓ·˜ ÛÙ· ·È‰È¿.
1. I™TOPIKA ™TOIXEIA °IA TH ¢HMIOYP°IA
TøN EYPø¶A´KøN O¢H°IøN XPH™H™ TOY º£OPIOY
H E˘Úˆ·˚΋ Aη‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ (EAPD)
ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ EÏÏËÓÈÎfi TÌ‹Ì· Ù˘, ÔÚÁ¿ÓˆÛ ¤Ó· ™˘-
ÌfiÛÈÔ ÛÙËÓ Aı‹Ó· ÙÔÓ IÔ‡ÓÈÔ ÙÔ˘ 1997 Ì ÛÎÔfi Ó· Û˘Ìʈ-
ÓËıÔ‡Ó ·fi ÎÔÈÓÔ‡ ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ÊıÔÚ›Ô˘ ÛÙ·
·È‰È¿ Ù˘ E˘ÚÒ˘. TÔ ÚÒÙÔ Û¯¤‰ÈÔ ·˘ÙÒÓ ÙˆÓ Ô‰ËÁÈÒÓ ‰Ë-
ÌÔÛȇÙËΠÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ÂÊËÌÂÚ›‰· Ù˘ Aη‰ËÌ›·˜ Î·È Ù·
̤ÏË Ù˘ ·fi fiÏË ÙËÓ E˘ÚÒË ÎÏ‹ıËÎ·Ó Ó· οÓÔ˘Ó Û¯fiÏÈ· ηÈ
ÚÔÙ¿ÛÂȘ Â’ ·˘ÙÒÓ. TÔ ‰ÈÔÚıˆÌ¤ÓÔ Û¯¤‰ÈÔ Û˘˙ËÙ‹ıËΠ̠ο-
ı ÏÂÙÔ̤ÚÂÈ· Î·È ˘¤ÛÙË ÚÔÛÂÎÙÈ΋ ÂÂÍÂÚÁ·Û›· ÛÙÔ Û˘Ó¤-
‰ÚÈÔ Ù˘ EAPD, ÛÙË ™·Ú‰ËÓ›· ÙÔ 1998. OÈ Ô‰ËÁ›Â˜ ÂÁÎÚ›ıËηÓ
·fi Ù· ̤ÏË ÙÔ˘ Û˘Ó‰ڛԢ Î·È Ë ÔÌ¿‰· ÂÚÁ·Û›·˜ ·ÔÙÂÏÔ‡-
ÌÂÓË ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÙÔ˘ ·Ú¯ÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ·Ó¤Ï·‚ ӷ
Û˘ÓÙ¿ÍÂÈ Î·È Ó· ‰ËÌÔÛȇÛÂÈ ÙÔ ÙÂÏÈÎfi ΛÌÂÓÔ ÙˆÓ Ô‰ËÁÈÒÓ [Oulis
et al., 2000].
H EAPD ÁÈ· Ó· ÂÈηÈÚÔÔÈ‹ÛÂÈ ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯Ú‹ÛË ÊıÔ-
Ú›Ô˘, ÔÚÁ¿ÓˆÛ ÂÎ Ó¤Ô˘ ¤Ó· ™˘ÌfiÛÈÔ ÛÙËÓ Aı‹Ó· ÙÔ NԤ̂ÚÈÔ
ÙÔ˘ 2008 (EÈÎfiÓ· 1). A˘Ùfi ÙÔ ·Ó·ıˆÚË̤ÓÔ ÚˆÙfiÎÔÏÏÔ (EÈ-
ÎfiÓ· 2) ¯ÚËÛÈÌÔÔ›ËÛ ÂÈϤÔÓ ÙË ‚·ÛÈṲ̂ÓË Û ÙÂÎÌËÚȈ̤-
Ó· ‰Â‰Ô̤ӷ ÌÂıÔ‰ÔÏÔÁ›· ·ÍÈÔÏfiÁËÛ˘ ÌÂÏÂÙÒÓ SIGN (Scottish
Intercollegiate Guidelines Network) ÁÈ· Ó· ·ÍÈÔÏÔÁËı› ÙÔ Â›-
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
AÓ·‰ËÌÔÛ›Â˘ÛË ÛÙ· ÂÏÏËÓÈο ÙÔ˘ ¿ÚıÚÔ˘ Guidelines on the use of fluoride in children:
an EAPD policy document. European Archives of Paediatric Dentistry 2009; 10 (3):129-135.
EÈÎfiÓ· 1. AÊ›-
Û· ÙÔ˘ ™˘ÌÔ-
Û›Ô˘ Ô˘ ¤ÁÈÓÂ
ÛÙËÓ Aı‹Ó·
ÙÔ NԤ̂ÚÈÔ
ÙÔ˘ 2008
24

2. 25
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
Â‰Ô ÙÂÎÌËÚ›ˆÛ˘ Î·È Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ë ·ÍÈÔÈÛÙ›· ‚·Ú‡ÙË-
Ù· οı ԉËÁ›·˜ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ÊıÔÚ›Ô˘ [SIGN 83, 2005;
SIGN 50, 2008]. ™‡Ìʈӷ Ì ÙË ÌÂıÔ‰ÔÏÔÁ›· SIGN, ÔÈ ÌÂϤÙ˜
ÌÔÚÔ‡Ó Ó· ‚·ıÌÔÏÔÁËıÔ‡Ó ·Ó¿ÏÔÁ· Ì ÙË ÙÂÎÌËÚ›ˆÛË ÙÔ˘˜
Ì ÙȘ ‚·ıÌÔÏÔÁ›Â˜ 1++,1+, 1, 2++, 2+,2, 3, 4, Ì ÙËÓ ÚÒÙË Ó·
¤¯ÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÍÈÔÈÛÙ›· ¢ÚËÌ¿ÙˆÓ Î·È ÙË ÙÂÏÂ˘Ù·›· ÙËÓ
ÌÈÎÚfiÙÂÚË. AÓÙ›ÛÙÔȯ·, ÔÈ ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜ Ô˘ ÚÔ·ÙÔ˘Ó ·fi
ÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ‚·ıÌÔÏÔÁÔ‡ÓÙ·È Ì A, B, C, D, Ì ÙÔ A Ó·
¤¯ÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË ÎÏÈÓÈ΋ ·Í›· Î·È ÙÔ D ÙË ÌÈÎÚfiÙÂÚË.
2. EI™A°ø°H
™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ÛÙÔȯ›·, Ë ·ÓÙÈÙÂÚˉÔÓÔÁfiÓÔ˜ ‰Ú¿-
ÛË ÙÔ˘ ÊıÔÚ›Ô˘ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÙÔÈ΋ ·Ú¿ ÛÙË Û˘ÛÙË-
Ì·ÙÈ΋ ÙÔ˘ ¯Ú‹ÛË [Featherstone, 1999]. A˘Ù‹ Ë ‰Ú¿ÛË Ê·›ÓÂÙ·È
fiÙÈ ÂÓÈÛ¯‡ÂÙ·È ·fi ÙËÓ Î·Ï‹ ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹, ȉȷ›ÙÂÚ· fiÙ·Ó ÙÔ
‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ Û˘Ó‰˘¿˙ÂÙ·È Ì ÊıÔÚÈÔ‡¯Ô Ô‰ÔÓÙfi-
ÎÚÂÌ· [Rolla et al., 1991]. H ·ÓËÛ˘¯›· Ô˘ ¤¯ÂÈ ÂÎÊÚ·ÛÙ› Û¯Â-
ÙÈο Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÊıÔÚ›·Û˘ (‰È¿ÛÙÈÎÙ˘ ·‰·Ì·ÓÙ›Ó˘), Û¯Â-
Ù›˙ÂÙ·È Î˘Ú›ˆ˜ Ì ÙË ¯Ú‹ÛË Û˘ÌÏËÚˆÌ¿ÙˆÓ ÊıÔÚ›Ô˘, ÂȉÈο η-
Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 6 ¯ÚfiÓˆÓ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡ [Ismail
and Bandekar, 1999], ·Ó Î·È Î¿ÔÈÔÈ Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›-
˙Ô˘Ó fiÙÈ Î·È Ë ÚfiˆÚË ¤ÎıÂÛË Û ÊıÔÚÈÔ‡¯Ô Ô‰ÔÓÙfi·ÛÙ· ÌÔ-
Ú› Ó· Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÊıÔÚ›·Û˘ [Levy et al., 1995;
Mascarenhas and Burt, 1998]. MÂϤÙ˜ Ô˘ ÂÚ‡ÓËÛ·Ó ÙÔÓ Î›Ó-
‰˘ÓÔ ÁÈ· ÊıÔÚ›·ÛË ÙˆÓ ‰ÔÓÙÈÒÓ, ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ·
fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ fiÙ·Ó Ë ¤ÎıÂÛË Û˘Ì‚·›ÓÂÈ Ùfi-
ÛÔ ÛÙËÓ ·Ú¯È΋ ÂÎÎÚÈÙÈ΋ Ê¿ÛË fiÛÔ Î·È ÛÙË Ê¿ÛË ˆÚ›Ì·ÓÛ˘
Ù˘ ·‰·Ì·ÓÙ›Ó˘ [DenBesten,1999; Evans and Stamm,1991]. EÔ-
̤ӈ˜ ÙÚÂȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ÌÔÚÔ‡Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó, ·Ó¿-
ÏÔÁ· Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ‰È¿ÛÙÈÎÙ˘ ·‰·Ì·ÓÙ›Ó˘:
0-4 ÂÙÒÓ
BÚ¤ÊË Î·È ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ÂÙÒÓ ıˆÚÔ‡ÓÙ·È fiÙÈ ‚Ú›-
ÛÎÔÓÙ·È Û ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· ÊıÔÚ›·ÛË ÙˆÓ ÌÔÓ›ÌˆÓ ÙÔ̤ˆÓ
Î·È ÚÒÙˆÓ ÌÔÓ›ÌˆÓ ÁÔÌÊ›ˆÓ, ÁÈ·Ù› Ë ÂÓ·Û‚ÂÛÙ›ˆÛË Î·È ˆÚ›Ì·ÓÛË
Ù˘ ·‰·Ì·ÓÙ›Ó˘ ÙˆÓ ‰ÔÓÙÈÒÓ ·˘ÙÒÓ Á›ÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·
Ù˘ ¯ÚÔÓÈ΋˜ ·˘Ù‹˜ ÂÚÈfi‰Ô˘. EȉÈÎfiÙÂÚ·, Ë ÂÚ›Ô‰Ô˜ ÙˆÓ ÚÒ-
ÙˆÓ 15-30 ÌËÓÒÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÔÓÔÌ¿˙ÂÙ·È «·Ú¿ı˘ÚÔ ‰Â-
ÎÙÈÎfiÙËÙ·˜» (susceptibility window) Î·È ÂÎÙÈÌ¿Ù·È ˆ˜ ÂÚ›Ô‰Ô˜
˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË ÊıÔÚ›·Û˘ [Evans and Stamm,
1991]. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ÂÚÈfi‰Ô˘, Ë ¯Ú‹ÛË ÊıÔÚ›-
Ô˘ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜ Ù˘ ‚ÚÂÊÈ΋˜ Î·È ÓËȷ΋˜
ËÏÈΛ·˜ Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÚÔÛÂÎÙÈ΋. E›Û˘, ȉȷ›ÙÂÚË ÚÔ-
ÛÔ¯‹ Ú¤ÂÈ Ó· ‰›‰ÂÙ·È ÙËÓ ›‰È· ÂÚ›Ô‰Ô Î·È ÛÙËÓ ÙÔÈ΋ ¯Ú‹ÛË
ÊıÔÚ›Ô˘, ÏfiÁˆ Ù˘ ÂÚÈÔÚÈṲ̂Ó˘ ‰˘Ó·ÙfiÙËÙ·˜ Ô˘ ¤¯Ô˘Ó Ù·
·È‰È¿ Ó· ÂϤÁ¯Ô˘Ó Ï‹Úˆ˜ ÙËÓ Î·Ù¿ÔÛ‹ ÙÔ˘˜.
4-6 ÂÙÒÓ
K·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ÂÚÈfi‰Ô˘ ¿ÏÏ· Ô›ÛıÈ· ÌfiÓÈÌ·
‰fiÓÙÈ· (ÚÔÁfiÌÊÈÔÈ Î·È ‰Â‡ÙÂÚÔÈ ÁÔÌÊ›ÔÈ) ÂÓ·Û‚ÂÛÙÈÒÓÔÓÙ·È Î·È
ˆÚÈÌ¿˙Ô˘Ó ÔfiÙ ‚Ú›ÛÎÔÓÙ·È Û ΛӉ˘ÓÔ ÁÈ· ÊıÔÚ›·ÛË. ¶·ÚfiÏ·
·˘Ù¿, Ë ÂÌÊ¿ÓÈÛË ÊıÔÚ›·Û˘ ÛÙ· ‰fiÓÙÈ· ·˘Ù¿ ‰ÂÓ ·ÔÙÂÏ› ȉȷ›-
ÙÂÚÔ ·ÈÛıËÙÈÎfi Úfi‚ÏËÌ· Î·È Û›ÁÔ˘Ú· ·ÓÙÈÛÙ·ıÌ›˙ÂÙ·È ·fi ÙÔ ÏÂ-
ÔÓ¤ÎÙËÌ· Ù˘ ÚfiÏ˄˘ Ù˘ ÙÂÚˉfiÓ·˜ ·fi ÙË ¯Ú‹ÛË ÊıÔÚ›Ô˘.
6 ÂÙÒÓ Î·È ÌÂÙ¿
K·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ÂÚÈfi‰Ô˘, Ô Î›Ó‰˘ÓÔ˜ ‰È¿ÛÙÈÎÙ˘
·‰·Ì·ÓÙ›Ó˘ Â›Ó·È ÂÏ¿¯ÈÛÙÔ˜, Ì ÂÍ·›ÚÂÛË ÌfiÓÔ ÙÔ˘˜ ÙÚ›ÙÔ˘˜
ÁÔÌÊ›Ô˘˜.
3. O¢H°IE™ XPH™H™ º£OPIOY
OÈ ·ÎfiÏÔ˘ı˜ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯Ú‹ÛË ÊıÔÚ›Ô˘ ÚÔÙ›ÓÔÓÙ·È
ˆ˜ ·Ó·fiÛ·ÛÙÔ Ì¤ÚÔ˜ ÂÓfi˜ ÚÔÏËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ·
Ù· ·È‰È¿. A˘Ù¤˜ ÔÈ Ô‰ËÁ›Â˜ ı· Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È Î·È Ó·
ÚÔÛ·ÚÌfi˙ÔÓÙ·È ·fi ÙÔ ıÂÚ¿ÔÓÙ· Ô‰ÔÓÙ›·ÙÚÔ, Û‡Ìʈӷ ÌÂ
ÙȘ ·Ó¿ÁΘ ÙÔ˘ οı ·È‰ÈÔ‡.
I. ºıÔÚ›ˆÛË ÙÔ˘ ÓÂÚÔ‡
H ÊıÔÚ›ˆÛË ÙÔ˘ ÓÂÚÔ‡ Â›Ó·È Ô ÂÏÂÁ¯fiÌÂÓÔ˜ ÂÌÏÔ˘ÙÈÛÌfi˜
Û˘ÁΤÓÙÚˆÛ˘ Ê˘ÛÈÎÔ‡ ÊıÔÚ›Ô˘ ÛÙÔ fiÛÈÌÔ ÓÂÚfi, Ì ÛÙfi¯Ô ÙËÓ
Â›Ù¢ÍË Ù˘ ˘Á›·˜ ÙˆÓ ‰ÔÓÙÈÒÓ. H ÊıÔÚ›ˆÛË ÙÔ˘ ÓÂÚÔ‡ ›ӷÈ
·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË Ì›ˆÛË Ù˘ ÙÂÚˉfiÓ·˜ [McDonagh et al.,
2000; Griffin et al., 2007, National Health and Medical Research
Council, 2007] Î·È ¤¯ÂÈ ·Ó·ÊÂÚı› Û·Ó ¤Ó· ·fi Ù· 10 ÌÂÁ·Ï‡-
ÙÂÚ· ÂÈÙ‡ÁÌ·Ù· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÛÙÔÓ 20Ô ·ÈÒÓ· (EÈÎfiÓ· 3)
[Centers for Disease Control and Prevention, 1999a, b]. E›Ó·È
ÌÈ· “ÎÔÈÓˆÓÈο ‰›Î·ÈË” ‰È·‰Èηۛ·, ‰ÈfiÙÈ Â˘ÂÚÁÂÙÂ›Ù·È ÙÔ Û‡ÓÔ-
ÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ ¯ˆÚ›˜ η̛· ÎÔÈÓˆÓÈ΋ ‰È¿ÎÚÈÛË. M ÂÍ·›ÚÂ-
ÛË ÙË ÊıÔÚ›·ÛË ÙˆÓ ‰ÔÓÙÈÒÓ, ÙÔ ÊıÔÚȈ̤ÓÔ ÓÂÚfi ‰ÂÓ ¤¯ÂÈ Û˘-
Û¯ÂÙÈÛÙ› Ì ¿ÏÏË ‰˘ÛÌÂÓ‹ Â›ÙˆÛË [McDonagh et al., 2000;
National Health and Medical Research Council, 2007]. H È-
ı·ÓfiÙËÙ· fï˜ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÊıÔÚ›·Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿
ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È¿Ï·Û‹ ÙÔ˘˜, ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ Î·Ù¿Ô-
ÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÔÛfiÙËÙ·˜ ÊıÔÚ›Ô˘ ·fi fiϘ ÙȘ Èı·Ó¤˜
ËÁ¤˜ ÚfiÛÏ˄˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ Ô‰ÔÓÙfiÎÚÂÌ·˜.
T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË ÂÌÊȷψ̤ÓÔ˘ ÓÂÚÔ‡ ›ӷÈ
Ôχ ÈÔ ‰È·‰Â‰Ô̤ÓË. T· ÂÌÊȷψ̤ӷ ÓÂÚ¿ Ô˘ ÂÚȤ¯Ô˘Ó ˘„Ë-
Ï¿ Â›‰· ÊıÔÚ›Ô˘ ÛÙË Û‡ÛÙ·Û‹ ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· ÌÔÚÔ‡Ó Ó·
‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜, ·ÏÏ¿ ¯ÚÂÈ¿˙ÂÙ·È ÂÈ-
ϤÔÓ ¤Ú¢ӷ ÁÈ· ÙÔÓ ·ÎÚÈ‚‹ ÚfiÏÔ Ô˘ ÌÔÚ› Ó· ·›ÍÔ˘Ó ÛÙÔ
ÙÔ̤· ·˘Ùfi ηıÒ˜ Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ÊıÔÚ›·Û˘.
H EAPD Â·Ó·‚‚·ÈÒÓÂÈ ÙËÓ ˘ÔÛÙ‹ÚÈÍ‹ Ù˘ ÛÙË ¯Ú‹ÛË ÙÔ˘
ÊıÔÚȈ̤ÓÔ˘ ÓÂÚÔ‡ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜, Û·Ó Ì¤-
ÙÚÔ ·Ú¤Ì‚·Û˘ ÛÙÔ Â›Â‰Ô Ù˘ ÎÔÈÓfiÙËÙ·˜.
EÈÎfiÓ· 2.
TÔ Ù‡¯Ô˜ ÙÔ˘ European
Archives of Paediatric
Dentistry Ì ÙȘ ·Ó·ıˆ-
ÚË̤Ó˜ Ô‰ËÁ›Â˜ ¯Ú‹Û˘
ÙÔ˘ ÊıÔÚ›Ô˘.

3. II. T·ÌϤÙ˜ Î·È ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘, ÊıÔÚ›ˆÛË ÙÔ˘ Á¿-
Ï·ÎÙÔ˜ Î·È ÙÔ˘ ·Ï·ÙÈÔ‡.
OÈ Ù·ÌϤÙ˜ Î·È ÔÈ ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘ (ÁÓˆÛÙ¤˜ Î·È Û·Ó
Û˘ÌÏËÚÒÌ·Ù· ÊıÔÚ›Ô˘), Ë ÊıÔÚ›ˆÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ Î·È Ë ÊıÔ-
Ú›ˆÛË ÙÔ˘ ·Ï·ÙÈÔ‡ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂ-
ÚˉfiÓ·˜ Â‰Ò Î·È ‰ÂηÂٛ˜. ™ÙÔ ·ÚÂÏıfiÓ Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÙfi-
¯Â˘Â Ó· ˘ÔηٷÛÙ‹ÛÂÈ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÊıÔÚ›Ô˘ ·fi Ê˘ÛÈο
ÊıÔÚȈ̤ÓÔ ÓÂÚfi, Û ÂÚÈÔ¯¤˜ Ô˘ ‰ÂÓ ÂÚÈ›¯·Ó ÊıfiÚÈÔ ÛÙÔ
fiÛÈÌÔ ÓÂÚfi. T· ÙÂÏÂ˘Ù·›· fï˜ ¯ÚfiÓÈ·, Ë ·ÓÙ›ÏË„Ë Ô˘ ÂÈ-
ÎÚ·Ù› Â›Ó·È fiÙÈ Ë ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË Â›Ó·È Î˘Ú›ˆ˜ ÙÔÈ΋
Î·È ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÙÂÚˉfiÓ·˜ ÛÙȘ Ï›˜ ÂÈ-
Ê¿ÓÂȘ ÙˆÓ ‰ÔÓÙÈÒÓ [Hellwig and Lennon, 2004], ÂÓÒ Ô fiÚÔ˜
“Û˘ÌÏËÚÒÌ·Ù·” Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ·ÔʇÁÂÙ·È. ¶·ÚfiÙÈ
Û‹ÌÂÚ· Ë ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ Â›Ó·È ·ÁÎÔÛÌ›ˆ˜
‰È·‰Â‰Ô̤ÓË, ÔÈ ˘fiÏÔÈÔÈ ÙÚfiÔÈ ¯ÔÚ‹ÁËÛ˘ ÊıÔÚ›Ô˘ ÌÔÚ›
Ó· ¤¯Ô˘Ó ÂÈÚfiÛıÂÙË ‰Ú¿ÛË ÛÙ· ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ·
ÙËÓ ÂÌÊ¿ÓÈÛË ÙÂÚˉfiÓ·˜. EÂȉ‹ ¤¯ÂÈ ‰Âȯı› fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ-
΋ ¯Ú‹ÛË ÊıÔÚ›Ô˘ ·›˙ÂÈ Ôχ ÌÈÎÚfiÙÂÚÔ ÚfiÏÔ ÛÙËÓ ·Ó·¯·›ÙÈ-
ÛË Ù˘ ÙÂÚˉfiÓ·˜, ÌÔÚ› Ó· ˘ÔÛÙËÚȯÙ› fiÙÈ ÙÔ ÊıfiÚÈÔ Ú¤ÂÈ
Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈο ·ÓÙ› ÁÈ· ÙË Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ÙÔ˘.
H ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fï˜, ηıÒ˜ Î·È Ë ·ÛÊ¿ÏÂÈ· Ù˘ ¯ÔÚ‹-
ÁËÛ˘ ÙÔ˘ ÊıÔÚȈ̤ÓÔ˘ ÓÂÚÔ‡, ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋
¯ÔÚ‹ÁËÛË ÙÔ˘ ÊıÔÚ›Ô˘ ÂÍ·ÎÔÏÔ˘ı› Ó· Â›Ó·È Ì›· ·Ô‰ÂÎÙ‹ ̤-
ıÔ‰Ô˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘, ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·˘Ù‹ Ê·›ÓÂÙ·È Ó·
Â›Ó·È Ë ÈÔ Â‡ÎÔÏË Î·È Ú·ÎÙÈ΋ ÚÔÛ¤ÁÁÈÛË [Yeung, 2008].
EÈϤÔÓ, Û ÌÈ· Cochrane Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË Ô˘ ÂÍÂ-
Ù¿ÛÙËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÈÚfiÛıÂÙ˘ ÙÔÈ΋˜ ¯Ú‹-
Û˘ ÊıÔÚ›Ô˘ Û ۯ¤ÛË Ì ·˘Ù‹Ó Ô˘ ÚÔηÏ› Ë ÊıÔÚÈÔ‡¯Ô˜
Ô‰ÔÓÙfiÎÚÂÌ· ·fi ÌfiÓË Ù˘, ‚Ú¤ıËΠÔχ ÌÈÎÚ‹ ÂÈϤÔÓ Ì›-
ˆÛË Ù˘ ÙÂÚˉfiÓ·˜ [Marinho et al., 2004].
MÂÚÈο ¿ÙÔÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-
Û˘ ÙÂÚˉfiÓ·˜ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ “·ÛıÂÓ›˜ Ì ΛӉ˘ÓÔ
ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓ·˜”. °ÂÓÈο Ù· ‰fiÓÙÈ· Ô˘ ¤¯Ô˘Ó ·Ó·Ù›ÏÂÈ
ÚfiÛÊ·Ù· ÛÙÔ ÛÙfiÌ· Â›Ó·È ÈÔ Â˘·ı‹ ÛÙËÓ ÙÂÚˉfiÓ· [Arrow,
2007] Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ¯ÚÔ-
ÓÈΤ˜ ÂÚ›Ô‰ÔÈ Ù˘ ·Ó·ÙÔÏ‹˜ ÙÔ˘˜ ÛÙȘ “ÂÚÈfi‰Ô˘˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ·
ÂÌÊ¿ÓÈÛË ÙÂÚˉfiÓ·˜”. E›Û˘, ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜
ËÏÈΛ·˜ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ÙÂÚˉfiÓ· ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 3
ÂÙÒÓ, ÂȉÈο fiÙ·Ó ·˘Ù¿ ‚Ú›ÛÎÔÓÙ·È Û ÎÔÈÓˆÓÈο ÌË ÚÔÓÔÌÈÔ‡-
¯Â˜ ÔÌ¿‰Â˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË Ó· ÂÊ·ÚÌfi-
˙ÂÙ·È ¤Ó· ÚÔÏËÙÈÎfi ÚfiÁÚ·ÌÌ· ·fi Ôχ ÌÈÎÚ‹ ËÏÈΛ· [Wendt
et al., 2001; Scottish Intercollegiate Guidelines Network, 2005;
Skeie et al., 2005]. Afi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, fiÛÔ ÈÔ ÓˆÚ›˜ ‰›ÓÔ˘ÌÂ
Û˘ÌÏËÚÒÌ·Ù· ÊıÔÚ›Ô˘ ÙfiÛÔ ÌÂÁ·ÏÒÓÂÈ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘
ÊıÔÚ›·Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ [Wang et al., 1997], ÂÓÒ ‰È¿ÊÔÚ˜
ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÌÈÎÚ‹ ‹ ̤ÛÔ˘ ‚·ıÌÔ‡ ÊıÔÚ›·ÛË Â›Ó·È Ë
·ÚÈ· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÙˆÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ ÊıÔÚ›Ô˘ [Ismail
and Hasson, 2008]. ŒÓ· ¿ÏÏÔ Úfi‚ÏËÌ· Ì ÙȘ ÂÓ·ÏÏ·ÎÙÈΤ˜
ËÁ¤˜ ÊıÔÚ›Ô˘ ÂÎÙfi˜ Ù˘ Ô‰ÔÓÙfiÎÚÂÌ·˜, Â›Ó·È Ë ÌË Û˘ÌÌfiÚʈÛË
Ì ÙȘ Ô‰ËÁ›Â˜ ¯Ú‹Û˘ ·fi ÙȘ ÔÌ¿‰Â˜ ÛÙfi¯Ô˘˜, ‰ËÏ·‰‹ ÙÔ˘˜
·ÛıÂÓ›˜ Ì “ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓ·˜” [Horowitz, 2000].
H ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ Â›Ó·È Ë ‚·ÛÈ΋ ÚÔÙÂÈ-
ÓfiÌÂÓË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜ Î·È Â›Ó·È Î·Ïfi
Ó· Û˘ÛÙ‹ÓÂÙ·È ÛÙÔÓ ÏËı˘ÛÌfi ·fi fiÏÔ˘˜ ÙÔ˘˜ ˘¢ı‡ÓÔ˘˜ ÊÔ-
Ú›˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ ‰Â Á›ÓÂÙ·È
Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ [Alm, 2008] ‹ Ô Î›Ó‰˘ÓÔ˜ ÙÂÚˉfiÓ·˜ ›-
Ó·È ·˘ÍË̤ÓÔ˜ ÁÈ· ¿ÏÏÔ˘˜ ÏfiÁÔ˘˜ fiˆ˜ ·Ó·Ê¤ÚıËΠÚÈÓ, Ùfi-
ÙÂ Â›Ó·È ¯Ú‹ÛÈ̘ ÔÈ ‰È¿ÊÔÚ˜ ÂÈÚfiÛıÂÙ˜ ËÁ¤˜ ÊıÔÚ›Ô˘. ¶·-
ÚfiÏ· ·˘Ù¿, Û‡Ìʈӷ Ì ÙȘ ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÁÈ· ÙÔ ÊıÔ-
ÚȈ̤ÓÔ Á¿Ï· Î·È ·Ï¿ÙÈ, ÙȘ Ù·ÌϤÙ˜ Î·È ÙȘ ÛÙ·ÁfiÓ˜ ÊıÔÚ›-
Ô˘, Ë ÙÂÎÌËÚ›ˆÛË ÁÈ· Ó· Á›ÓÔ˘Ó Û·Ê›˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ¯Ú‹ÛË
ÙÔ˘˜ Â›Ó·È ·ÓÂ·Ú΋˜ [Swedish Council on Technology Assessment
in Health Care, 2002; Yeung et al., 2005; National Health
and Medical Research Council, 2007;], ÂÓÒ Î·È Ë ÌÂıÔ‰ÔÏÔ-
Á›· ·ÚÎÂÙÒÓ ÚÔ¸·Ú¯fiÓÙˆÓ
ÌÂÏÂÙÒÓ Â›Ó·È ÚÔ‚ÏËÌ·ÙÈ΋
[Ismail and Hasson, 2008]. T·
ÚÔËÁÔ‡ÌÂÓ· ‰Â ÛËÌ·›ÓÔ˘Ó
˘Ô¯ÚˆÙÈο fiÙÈ ÏfiÁˆ ¤ÏÏÂȄ˘
ÙÂÎÌËÚÈˆÌ¤ÓˆÓ ÌÂÏÂÙÒÓ fiϘ
·˘Ù¤˜ ÔÈ Ì¤ıÔ‰ÔÈ ‰ÂÓ Â›Ó·È ·Ô-
ÙÂÏÂÛÌ·ÙÈΤ˜. °ÂÓÈο fï˜ ˘¿Ú-
¯ÂÈ ·Ó¿ÁÎË ÁÈ· Ôχ ηϿ Û¯Â-
‰È·Ṳ̂Ó˜ ÌÂϤÙ˜ Ô˘ Ó· ‰›-
ÓÔ˘Ó ··ÓÙ‹ÛÂȘ Û ·˘Ù¿ Ù· ı¤-
Ì·Ù·, ÌÂϤÙ˜ Ô˘ ›ӷÈ
‰‡ÛÎÔÏÔ Ó· Ú·ÁÌ·ÙÔÔÈËıÔ‡Ó
fï˜ Û‹ÌÂÚ·, ηıÒ˜ ÁÈ· Ïfi-
ÁÔ˘˜ ËıÈ΋˜ Î·È ‰ÂÔÓÙÔÏÔÁ›·˜
‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó
ÔÌ¿‰· ·ÚÓËÙÈÎÒÓ Ì·ÚÙ‡ÚˆÓ.
ºıÔÚ›ˆÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜
¢‡Ô ‚·ÛÈṲ̂Ó˜ ÛÙËÓ ÙÂÎÌËÚ›ˆÛË ·Ó·ÛÎÔ‹ÛÂȘ [Yeung et
al., 2005; National Health and Medical Research Council, 2007]
¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÊıÔÚȈ̤ÓÔ Á¿Ï· Â›Ó·È ¤Ó· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ̤-
ÛÔ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜. ¶·ÚfiÏ· ·˘Ù¿, Û ÌÈ· Úfi-
ÛÊ·ÙË ·Ó·ÛÎfiËÛË [Espelid, 2008] ˘¿Ú¯ÂÈ ÌfiÓÔ ÌÈ· ÌÂϤÙË
[Maslak et al., 2004] ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹ ‰Â›ÁÌ·ÙÔ˜ Î·È ÔÌ¿‰·˜
ÂϤÁ¯Ô˘ Ô˘ ‚·ıÌÔÏÔÁÂ›Ù·È 1+ Û‡Ìʈӷ Ì ÙÔ Û‡ÛÙËÌ· ·ÍÈÔ-
ÏfiÁËÛ˘ SIGN50 [Scottish Intercollegiate Guidelines Network,
2008]. A˘Ù‹ Ë ÙÚ›¯ÚÔÓË ÌÂϤÙË Â›¯Â ÌÈÎÚfi ÌfiÓÔ ·ÚÈıÌfi ·Ô¯Ò-
ÚËÛ˘ Û˘ÌÌÂÙ¯fiÓÙˆÓ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó Û·Ê‹ Úfi-
ÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜ ·fi ÙÔ ÊıÔÚȈ̤ÓÔ Á¿Ï·. EÍ¿¯ÚÔÓ· ·È-
‰È¿ Ô˘ ¤ÈÓ·Ó ÊıÔÚȈ̤ÓÔ Á¿Ï· ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ Â›-
¯·Ó 76,4% ¯·ÌËÏfiÙÂÚÔ DMFT ȉȷ›ÙÂÚ· ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÌfiÓÈ-
ÌÔ˘˜ ÁÔÌÊ›Ô˘˜ Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (p<0.05).
°È· Ù· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ· ·Ú·ÙËÚ‹ıËΠÂ›Û˘ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË
Ù˘ ÙÂÚˉfiÓ·˜ (31.3 %, p<0.05).
TÔ ÊıÔÚȈ̤ÓÔ Á¿Ï· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ÂÚÈÔÚÈṲ̂Ó˜ ÔÌ¿-
‰Â˜ ·È‰ÈÒÓ, ΢ڛˆ˜ Û ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜, ·ÏÏ¿ ‰ÂÓ ˘¿Ú-
¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ηϋ˜ ÌÂıÔ‰ÔÏÔÁ›·˜ Ô˘ Ó· ÂÍÂÙ¿˙Ô˘Ó
ÙËÓ Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜ ÛÙȘ ËÏÈ˘ ·˘-
Ù¤˜ [Yeung et al., 2005]. H Û˘ÁΤÓÙÚˆÛË ÊıÔÚ›Ô˘ ÛÙÔ Á¿Ï·
Û˘Ó‹ıˆ˜ Î˘Ì·›ÓÂÙ·È 2,5-5,0 mg F/lt.
ºıÔÚ›ˆÛË ÙÔ˘ ¿Ï·ÙÔ˜
TÔ ÊıÔÚȈ̤ÓÔ ·Ï¿ÙÈ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙË °ÂÚÌ·Ó›·,
°·ÏÏ›· Î·È EÏ‚ÂÙ›· Î·È ·ÔÙÂÏ› ÙÔ 30-80% ÙÔ˘ ·Ï·ÙÈÔ‡ Ô˘ ¯ÚË-
26
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
EÈÎfiÓ· 3. ™Î‡·ÛÌ· ÊıÔÚ›Ô˘
·fi ÙȘ ·Ú¯¤˜ ÙÔ˘ 20Ô˘ ·ÈÒÓ·.

4. 27
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
ÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÔÈÎȷ΋ ¯Ú‹ÛË [Marthaler and Petersen, 2005].
¶¿Óˆ ·fi 30 ¯ÒÚ˜ ·ÁÎÔÛÌ›ˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÊıÔÚȈ̤ÓÔ
·Ï¿ÙÈ Î·È ·˘Ùfi˜ Ô ÙÚfiÔ˜ ¯ÔÚ‹ÁËÛ˘ ÊıÔÚ›Ô˘ Û˘ÓÈÛÙ¿Ù·È È‰È-
·ÈÙ¤Úˆ˜ ·fi ÙÔÓ ¶·ÁÎfiÛÌÈÔ OÚÁ·ÓÈÛÌfi YÁ›·˜. TÔ ·Ï¿ÙÈ Â›Ó·È
Û˘Ó‹ıˆ˜ ÊıÔÚȈ̤ÓÔ ÛÂ Û˘ÁΤÓÙÚˆÛË 250 mg ÊıÔÚ›Ô˘ ·Ó¿
ÎÈÏfi [Gillespie et al., 2005]. ™‡Ìʈӷ Ì ÙȘ ÈÔ ÚfiÛÊ·Ù˜ ·Ó·-
ÛÎÔ‹ÛÂȘ fï˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ÌÂϤÙË ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹
Ì·ÚÙ‡ÚˆÓ (RCT) Ô˘ Ó· Ì·˜ ‰È·ÊˆÙ›˙ÂÈ Ï‹Úˆ˜ Û ·˘Ùfi ÙÔ ı¤-
Ì· [Swedish Council on Technology Assessment in Health Care,
2002; National Health and Medical Research Council, 2007;
Espelid, 2008;]. MÂÚÈΤ˜ ‰È·ÛÙڈ̷ÙÈΤ˜ ÌÂϤÙ˜, ηıÒ˜ ηÈ
ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹ ·ÛıÂÓÒÓ Î·È Ì·ÚÙ‡ÚˆÓ
‰Â›¯ÓÔ˘Ó fï˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÊıÔÚȈ̤ÓÔ˘ ·Ï·-
ÙÈÔ‡ ÛÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜ ·Ó Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ùfi ›-
Ó·È ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi Û ·È‰È¿ ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ô˘ ÙÔ
‰È·ÈÙÔÏfiÁÈfi ÙÔ˘˜ ÂÚȤ¯ÂÈ Ï›ÁÔ ·Ï¿ÙÈ, fiˆ˜ ¿ÏψÛÙÂ Û˘ÓÈÛٿٷÈ
ÁÈ· ·˘Ù‹Ó ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰·.
T·ÌϤÙ˜/·ÛÙ›ÏȘ ÊıÔÚ›Ô˘ Î·È ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘
MÈ· ηϿ ۯ‰ȷṲ̂ÓË ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË ÌÂ Ù˘¯·›· ÂÈ-
ÏÔÁ‹ ·ÛıÂÓÒÓ Ì·ÚÙ‡ÚˆÓ ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ù·ÌÏÂÙÒÓ
ÊıÔÚ›Ô˘ Ì Â›‚Ï„Ë, ÌÔÚ› Ó· Â›Ó·È ¤Ó· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÚÔ-
ÏËÙÈÎfi ̤ÙÚÔ Û ·È‰È¿ “˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË ÙÂÚË-
‰fiÓ·˜” [Stephen and Campbell, 1978]. A˘Ù‹ Ë ÌÂϤÙË ‚·ıÌÔ-
ÏÔÁ‹ıËΠ̠1+ Ì ÙÔ Û‡ÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘ SIGN50 Î·È Ë ÌÂ-
Á¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ·È‰ÈÒÓ ·Ú¤ÌÂÈÓ ÛÙË ÌÂ-
ϤÙË Ì¤¯ÚÈ Ù¤ÏÔ˘˜ [Espelid, 2008]. EӉȷʤÚÔÓ fï˜ Â›Ó·È ÙÔ
‡ÚËÌ· Ì›·˜ ¿ÏÏ˘ Â›Û˘ ηϿ ۯ‰ȷṲ̂Ó˘ ÌÂϤÙ˘ ‚·ı-
ÌÔÏÔÁË̤Ó˘ Ì 1+ Ô˘ ‰ÂÓ ÌfiÚÂÛ ӷ ·ԉ›ÍÂÈ ÙËÓ ÂÈÚfi-
ÛıÂÙË ‰Ú¿ÛË ÙˆÓ Ù·ÌÏÂÙÒÓ ÊıÔÚ›Ô˘ Û˘ÁÎÚÈÓfiÌÂÓˆÓ Ì ÙË ‰Ú¿-
ÛË ÙˆÓ ÊıÔÚÈÔ‡¯ˆÓ ÛÙÔÌ·ÙÔÏ˘Ì¿ÙˆÓ [Poulsen et al., 1981].
T¤ÏÔ˜, ÌÂÚÈΤ˜ ¿ÏϘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹ Ì·Ú-
Ù‡ÚˆÓ Ô˘ ¤¯Ô˘Ó fï˜ ‚·ıÌÔÏÔÁËı› Û·Ó ¯·ÌËÏ‹˜ ÔÈfiÙËÙ·˜
ÌÂϤÙ˜ ÏfiÁˆ ¤ÏÏÂȄ˘ ÙÂÎÌËÚ›ˆÛ˘, ·Ó·Ê¤ÚÔ˘Ó ·ÓÙÈÊ·ÙÈο ¢-
Ú‹Ì·Ù· [Swedish Council on Technology Assessment in Health
Care, 2002; Espelid, 2008].
¶›Ó·Î·˜ 1. ¶ÚfiÁÚ·ÌÌ· ÚÔÙÂÈÓfiÌÂÓ˘ ‰fiÛ˘ Ù·ÌÏÂÙÒÓ ÊıÔ-
Ú›Ô˘ (fiÙ·Ó ÙÔ fiÛÈÌÔ ÓÂÚfi ÂÚȤ¯ÂÈ < 0,3 mg F/L)
HÏÈΛ· ¶ÚÔÙÂÈÓfiÌÂÓË ‰fiÛË
0-24 ÌËÓÒÓ K·Ì›·
2-6 ÂÙÒÓ 0,25 mg F/ËÌÂÚËÛ›ˆ˜
7-18 ÂÙÒÓ 0,50 mg F/ËÌÂÚËÛ›ˆ˜
EÈϤÔÓ ÛÙÔȯ›· Ô˘ Ú¤ÂÈ Ó· ÚÔÛ¯ıÔ‡Ó Î·Ù¿
ÙË ¯ÔÚ‹ÁËÛË Û˘ÌÏËڈ̷ÙÈÎÔ‡ ÊıÔÚ›Ô˘:
ñ AÓ Ù· Â›‰· ÊıÔÚ›Ô˘ ÛÙÔ fiÛÈÌÔ ÓÂÚfi Î˘Ì·›ÓÔÓÙ·È ÌÂ-
ٷ͇ 0,3-0,6 mg F/lt, ‰Â ¯ÚÂÈ¿˙ÂÙ·È ÂÈϤÔÓ ¯ÔÚ‹ÁËÛË
ÊıÔÚ›Ô˘ ¤Ú·Ó ·˘Ù‹˜ Ù˘ ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜, ÁÈ·
ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 2-3 ÂÙÒÓ. °È· ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ-
ÎȷΤ˜ ÔÌ¿‰Â˜, Ë ËÌÂÚ‹ÛÈ· ‰fiÛË ı· Ú¤ÂÈ Ó· ÌÂȈı› ÛÙÔ
0,25 mg F ËÌÂÚËÛ›ˆ˜.
ñ ºıfiÚÈÔ Û ÛÙ·ÁfiÓ˜ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‚Èٷ̛Ә ÌÔ-
Ú› Ó· ¯ÔÚËÁËı› ÁÈ· ÙÔÈ΋ ¯Ú‹ÛË Ì ÛÙfi¯Ô ÙËÓ ÚÔÏË-
ÙÈ΋ ‰Ú¿ÛË ¤Ó·ÓÙÈ Ù˘ ÙÂÚˉfiÓ·˜ [Espelid, 2008]. E›-
Û˘, ÎÏÈÓÈ΋ ÌÂϤÙË ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹ Ì·ÚÙ‡ÚˆÓ Î·È ÌÂ
·ÚÓËÙÈ΋ ÔÌ¿‰· ÂϤÁ¯Ô˘ Ô˘ Û˘Ó¤ÎÚÈÓ ٷÌϤÙ˜ ηÈ
ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜, ¤‰ÂÈ-
Í fiÙÈ ÌÂÙ¿ ·fi 2 ¯ÚfiÓÈ· ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ÚÔÏËÙÈ΋
‰Ú¿ÛË Î·È Ì ÙÔ˘˜ ‰˘Ô ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ ¯ÔÚ‹ÁË-
Û˘ [Lin and Tsai, 2000]. ™‡Ìʈӷ Ì ·˘Ù‹Ó ÙË ÌÂϤÙË,
ÙÔ Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ· ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜
ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘ ¯ÔÚËÁÔ‡ÌÂÓ˜ 2 ÊÔ-
Ú¤˜ ÙËÓ Ë̤ڷ, Û˘ÁÎÚÈÙÈο Ì ÙËÓ Î·ıËÌÂÚÈÓ‹ ηٷӿψ-
ÛË Ì›·˜ ÌfiÓÔ ÊıÔÚÈÔ‡¯Ô˘ Ù·ÌϤٷ˜ (0,25 mg NaF).
°ÂÓÈΤ˜ O‰ËÁ›Â˜ ÁÈ· Ù· Û˘ÌÏËÚÒÌ·Ù· ÊıÔÚ›Ô˘
TÔ ÊıÔÚȈ̤ÓÔ Á¿Ï· Î·È ÙÔ ÊıÔÚȈ̤ÓÔ ·Ï¿ÙÈ ÌÔÚÔ‡Ó Ó·
·ÔÙÂϤÛÔ˘Ó Ì¤Û· ‰ËÌfiÛÈ·˜ ˘Á›·˜ Û “ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ-
‰‡ÓÔ˘” Ô˘ ‰Â Û˘ÌÌÔÚÊÒÓÔÓÙ·È ·fiÏ˘Ù· Ì ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ
‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ, ȉȷ›ÙÂÚ· Û ÂÚÈÔ¯¤˜ ¯ˆÚ›˜ ÊıÔÚȈ-
̤ÓÔ ÓÂÚfi. OÈ Ù·ÌϤÙ˜ Î·È ÔÈ ÛÙ·ÁfiÓ˜ ÊıÔÚ›Ô˘ ÌÔÚÔ‡Ó Ó·
‰ÔıÔ‡Ó Û ·ÙÔÌÈÎfi Â›‰Ô, Û “·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÂ-
ÚˉfiÓ·” (B·ıÌfi˜ Û‡ÛÙ·Û˘: C ηٿ SIGN50).
III. ºıÔÚÈÔ‡¯· ˙ÂϤ, ÛÙÔÌ·ÙÔχ̷ٷ Î·È ‚ÂÚÓ›ÎÈ·
TÔÈ΋ ¯Ú‹ÛË ÊıÔÚ›Ô˘ Ì ÌÔÚÊ‹ ÊıÔÚÈÔ‡¯ˆÓ ˙ÂϤ, ÛÙÔÌ·-
ÙÔÏ˘Ì¿ÙˆÓ Î·È ‚ÂÚÓÈÎÈÒÓ ÌÔÚ› Ó· Á›ÓÂÈ Û ·È‰È¿ Ì “·˘ÍË-
̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓ·˜”, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ
·È‰ÈÒÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜. OÈ ÌÂϤÙ˜, ÙÔ
Â›Â‰Ô ·ÍÈÔÏfiÁËÛ‹˜ ÙÔ˘˜ Î·È Ù· ÛËÌ›· Ô˘ Ú¤ÂÈ Ó· ÚÔ-
Û¯ıÔ‡Ó Î·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÔÚÊÒÓ ·˘ÙÒÓ ·Ó·-
ʤÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (‚Ϥ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¿ÚıÚÔ˘).
IV. ºıÔÚÈÔ‡¯Â˜ Ô‰ÔÓÙfiÎÚÂ̘
KÏÈÓÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·
H ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ Ê·›ÓÂÙ·È fiÙÈ
Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÏfiÁÔ˘˜ ÁÈ· ÙË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘
ÙÂÚˉfiÓ·˜ Ô˘ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ·ÁÎÔÛÌ›ˆ˜ Ù· ÙÂÏÂ˘Ù·›· 30 ¯Úfi-
ÓÈ·. TÔ ‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ Ì ÊıÔÚÈÔ‡¯Ô Ô‰ÔÓÙfiÎÚÂÌ· ›-
Ó·È ÌÈ· ‚ÔÏÈ΋, ÌË ‰··ÓËÚ‹, ÔÏÈÙÈÛÌÈο ·Ô‰ÂÎÙ‹ Î·È Â˘Ú¤ˆ˜
‰È·‰Â‰Ô̤ÓË Ì¤ıÔ‰Ô˜ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ÙËÓ Î·ıÈÛÙ¿ Û¯Â-
‰fiÓ È‰·ÓÈ΋ [Burt, 1998]. H ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜
ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜ ÛÂ
·ÚÎÂÙ¤˜ Û˘ÛÙËÌ·ÙÈΤ˜ ·Ó·ÛÎÔ‹ÛÂȘ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·
[Marinho et al., 2003a; Twetman et al., 2003; Ammari et al., 2003,
Marinho, 2008] Î·È Ë ·ÓÙÈÙÂÚˉÔÓÈ΋ ‰Ú¿ÛË Ù˘, ÂÎÊÚ·Ṳ̂ÓË ÛÂ
ÔÛÔÛÙfi ÚfiÏ˄˘ ÙÂÚˉfiÓ·˜, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3.

5. 28
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
¶›Ó·Î·˜ 3. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÓÙÈÙÂÚˉÔÓÈ-
΋ ‰Ú¿ÛË Ù˘ ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ fiˆ˜ ·Ó·Ê¤ÚÔ-
ÓÙ·È ÛÂ Û˘ÛÙËÌ·ÙÈΤ˜ ·Ó·ÛÎÔ‹ÛÂȘ. ¶ÔÛÔÛÙfi ÚfiÏ˄˘ ÙÂ-
ÚˉfiÓ·˜ (PF%) Ì ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ (95%CI) [prevented
fraction (PF%) with confidence intervals].
¶·Ú¤Ì‚·ÛË OÌ¿‰· ÂϤÁ¯Ô˘ ¶ÔÛÔÛÙfi ÚfiÏ˄˘
(95% CI)
ºıÔÚÈÔ‡¯Ô˜
Ô‰ÔÓÙfiÎÚÂÌ· Placebo 24% (21-28)
BÔ‡ÚÙÛÈÛÌ· BÔ‡ÚÙÛÈÛÌ·
Ì Â›‚ÏÂ„Ë ¯ˆÚ›˜ Â›‚ÏÂ„Ë 11% (4-18)
BÔ‡ÚÙÛÈÛÌ· 2 M›· ÊÔÚ¿ ÙËÓ
ÊÔÚ¤˜ ÙËÓ Ë̤ڷ Ë̤ڷ 14% (6-22)
¶ÂÚÈÂÎÙÈÎfiÙËÙ· ¶ÂÚÈÂÎÙÈÎfiÙËÙ·
1450-1500 ppm F 1000-1100 ppm F 8% (1-16)
ºıÔÚÈÔ‡¯Ô˜ ºıÔÚÈÔ‡¯Ô˜
Ô‰ÔÓÙfiÎÚÂÌ· + Ô‰ÔÓÙfiÎÚÂÌ·
¿ÏϘ ËÁ¤˜ ÊıÔÚ›Ô˘* 10% (2-17)
* ÊıÔÚȈ̤ÓÔ ÓÂÚfi, ‚ÂÚÓ›ÎÈ· ÊıÔÚ›Ô˘, ˙ÂϤ ÊıÔÚ›Ô˘, ‹ ÊıÔ-
ÚÈÔ‡¯· ÛÙÔÌ·ÙÔχ̷ٷ
¶Èı·Ófi˜ ΛӉ˘ÓÔ˜
ŒÓ· Úfi‚ÏËÌ· Ô˘ ÚÔ·ÙÂÈ ·fi ÙË ¯Ú‹ÛË Ô‰ÔÓÙfi-
ÎÚÂÌ·˜ ÛÙ· ÌÈÎÚ¿ ·È‰È¿, Â›Ó·È Ë Èı·Ó‹ ηٿÔÛË ÛË-
Ì·ÓÙÈÎÒÓ ÔÛÔÙ‹ÙˆÓ Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ‡·ÚÍË ÎÈÓ‰‡-
ÓÔ˘ ÁÈ· ÊıÔÚ›·ÛË ÙˆÓ ‰ÔÓÙÈÒÓ [Mascarenhas and Burt,
1998]. H ÊıÔÚÈÔ‡¯Ô˜ Ô‰ÔÓÙfiÎÚÂÌ· Â›Ó·È Û‹ÌÂÚ· ˘‡-
ı˘ÓË ÁÈ· ÙËÓ ÚfiÛÏË„Ë ¿Óˆ ÙÔ˘ 80% ÙÔ˘ ÊıÔÚ›Ô˘ Ô˘
Ï·Ì‚¿ÓÔ˘Ì ηıËÌÂÚÈÓ¿ [de Almeida et al., 2007] Î·È ÙÔ
ÁÂÁÔÓfi˜ ·˘Ùfi Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÛËÌ·ÓÙÈÎfi Î·È ÁÈ· Ù· ÚÒ-
Ù· 3 ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜. ™˘ÓÂÒ˜, fiÛÔÓ ·ÊÔÚ¿ Ù· Ôχ ÌÈ-
ÎÚ¿ ·È‰È¿ Ú¤ÂÈ Ó· ‰ÔıÔ‡Ó Û˘Ì‚Ô˘Ï¤˜ ÛÙÔ˘˜ ÁÔÓ›˜ ÁÈ·
¯Ú‹ÛË ÔÛfiÙËÙ·˜ Ô‰ÔÓÙfiÎÚÂÌ·˜ ÛÙËÓ Ô‰ÔÓÙfi‚Ô˘ÚÙÛ·
ÛÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÌÈ˙ÂÏÈÔ‡, ηıÒ˜ Â›Û˘ Ó· ÙÔ˘˜ ÚÔ-
ÙÚ¤Ô˘Ì ӷ ‚ÔËıÔ‡Ó ‹ Ó· ÂȂϤÔ˘Ó ÙÔ ‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ
‰ÔÓÙÈÒÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ·
ÙˆÓ 7 ÂÙÒÓ. EÈϤÔÓ, ηÏfi ı· ‹Ù·Ó Ó· ÙÔ˘˜ Û˘ÛÙ‹ÛÔ˘ÌÂ
ÌÈ· ·È‰È΋ Ô‰ÔÓÙfiÎÚÂÌ· Ì ¯·ÌËÏfiÙÂÚË Û˘ÁΤÓÙÚˆÛË
ÊıÔÚ›Ô˘, ·Ó Î·È ‰ÂÓ ˘¿Ú¯ÂÈ Â·Ú΋˜ ÂÚ¢ÓËÙÈ΋ ÙÂÎÌË-
Ú›ˆÛË ÁÈ· ÙËÓ ÚÔÏËÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÊıÔÚ›Ô˘ ÛÂ Û˘ÁΤ-
ÓÙÚˆÛË ÌÈÎÚfiÙÂÚË ÙˆÓ 500 ppmF [Twetman et al., 2003;
Steiner et al., 2004].
OÈ ÚÔÙ¿ÛÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜
Ô˘ ÚÔ·ÙÔ˘Ó ÌÂÙ¿ ·fi ÌÂϤÙ˜ ÛÙËÚÈÁ̤Ó˜ ÛÙËÓ ÙÂÎ-
ÌËÚ›ˆÛË, ÔÈ ÂÌÂÈÚÈΤ˜ ÚÔÙ¿ÛÂȘ [Davies et al., 2003;
Twetman, 2009] Î·È ÔÈ ÚÔÙ¿ÛÂȘ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙȘ
Û˘ÛÙËÌ·ÙÈΤ˜ ·Ó·ÛÎÔ‹ÛÂȘ [Marinho et al., 2003a; Twetman
et al., 2003; Ammari et al., 2003], ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›-
ӷη 4:
¶›Ó·Î·˜ 4. ¶ÚÔÙ¿ÛÂȘ ¯Ú‹Û˘ ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ ÌÂ
‚·ıÌfi ·ÍÈÔÏfiÁËÛ˘ Û‡Ìʈӷ Ì SIGN 50 [2008]
¶ÚÔÙ¿ÛÂȘ Î·È Ô‰ËÁ›Â˜ B·ıÌfi˜
·ÍÈÔÏfiÁËÛ˘*
TÔ Î·ıËÌÂÚÈÓfi ‚Ô‡ÚÙÛÈÛÌ· Ì ÊıÔÚÈÔ‡¯Ô 1++
Ô‰ÔÓÙfiÎÚÂÌ· ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÙÂÚˉfiÓ·
A˘Í¿ÓÔÓÙ·˜ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘
‚Ô˘ÚÙÛ›ÛÌ·ÙÔ˜ Ì ÊıÔÚÈÔ‡¯Ô Ô‰ÔÓÙfiÎÚÂÌ· 1+
·˘Í¿ÓÂÙ·È Ë ÚfiÏË„Ë Ù˘ ÙÂÚˉfiÓ·˜
H ‚Ô‹ıÂÈ· /Â›‚ÏÂ„Ë ÂÓ‹ÏÈη ÛÙÔ ‚Ô‡ÚÙÛÈÛÌ· 2+
ÙˆÓ ‰ÔÓÙÈÒÓ ÙÔ˘ ·È‰ÈÔ‡ ·˘Í¿ÓÂÈ ÙËÓ ÚfiÏË„Ë
Ù˘ ÙÂÚˉfiÓ·˜
O‰ÔÓÙfiÎÚÂ̘ Ì ÌÂÁ·Ï‡ÙÂÚË Û˘ÁΤÓÙÚˆÛË 1++
ÊıÔÚ›Ô˘ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ ÚfiÏË„Ë
Ù˘ ÙÂÚˉfiÓ·˜ ·fi ÂΛӘ Ì ÌÈÎÚfiÙÂÚË
Û˘ÁΤÓÙÚˆÛË ÊıÔÚ›Ô˘
ŒÓ·ÚÍË ‚Ô˘ÚÙÛ›ÛÌ·ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ ÚÈÓ ·fi ÙËÓ 3
ËÏÈΛ· ÙÔ˘ 1 ¤ÙÔ˘˜ ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ·
ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓ·˜
H ηٿÔÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ ·fi Ù· 2
ÌÈÎÚ¿ ·È‰È¿ Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ
ÊıÔÚ›·Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ
* B·ıÌÔÏÔÁ›· ·fi 1++ (˘„ËÏ‹ ·ÍÈÔÏfiÁËÛË ÌÂÏÂÙÒÓ) ̤¯ÚÈ
4 (¯·ÌËÏ‹ ·ÍÈÔÏfiÁËÛË ÌÂÏÂÙÒÓ)
™˘Ó‹ıÂȘ ‚Ô˘ÚÙÛ›ÛÌ·ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ
H ‰È¿ÚÎÂÈ· ‚Ô˘ÚÙÛ›ÛÌ·ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ Ú¤ÂÈ Ó· ÍÂÂÚÓ¿-
ÂÈ ÙÔ ¤Ó· ÏÂÙfi οı ÊÔÚ¿ Î·È Ù· ·È‰È¿ Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡-
ÓÔÓÙ·È Ó· ÊÙ‡ÓÔ˘Ó ÙËÓ Ô‰ÔÓÙfiÎÚÂÌ· Î·È Ó· ÌËÓ ÍÂϤÓÔ˘Ó ÙÔ
ÛÙfiÌ· ÙÔ˘˜ Ì ÓÂÚfi. ¢ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÛÙ¿ÛÂȘ ‚·ÛÈṲ̂Ó˜ ÛÙËÓ
ÙÂÎÌËÚ›ˆÛË Ô˘ Ó· ÚÔÙ›ÓÔ˘Ó ÙËÓ È‰·ÓÈ΋ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ‚Ô˘Ú-
ÙÛ›ÛÌ·ÙÔ˜, ·ÏÏ¿ ÌÈ· Û˘ÓËıÈṲ̂ÓË Û‡ÛÙ·ÛË ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ
‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ Ó· Á›ÓÂÙ·È ·ÎÚÈ‚Ò˜ ÚÈÓ ÙÔ ‚Ú·‰ÈÓfi
ÙÔ˘˜ ‡ÓÔ Î·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ· ·ÎfiÌ· ÊÔÚ¿ ̤۷ ÛÙËÓ Ë̤ڷ.
MÂÙ¿ ÙÔ ‚Ô‡ÚÙÛÈÛÌ· ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ. T·
·È‰È¿ ÌÔÚÔ‡Ó Ó· ‚Ô˘ÚÙÛ›˙Ô˘Ó Ù· ‰fiÓÙÈ· ÙÔ˘˜ ›Ù Ì ·Ï‹
›Ù Ì ËÏÂÎÙÚÈ΋ Ô‰ÔÓÙfi‚Ô˘ÚÙÛ·, Ô˘ Ó· ¤¯ÂÈ ÌÈÎÚ‹ Î·È Ì·Ï·-
΋ ÎÂÊ·Ï‹.
KÏÈÓÈΤ˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ¯Ú‹ÛË
ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜
OÈ Ô‰ËÁ›Â˜ Ù˘ European Academy of Paediatric Dentistry
ÁÈ· ÙË ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰ÔÓÙfiÎÚÂÌ·˜ ÛÙ· ·È‰È¿ ÂÚÈÏ·Ì‚¿-
ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. H ηıËÌÂÚÈÓ‹ ¯Ú‹ÛË ÊıÔÚÈÔ‡¯Ô˘ Ô‰Ô-
ÓÙfiÎÚÂÌ·˜, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ԉËÁ›Â˜ Î·È ÛˆÛÙ¤˜ Û˘Ó‹ıÂȘ ÛÙÔ-
Ì·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜, Û˘ÓÈÛÙ¿Ù·È Û·Ó ÙÔ ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ ÂÓfi˜
ÚÔÏËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ηٿ Ù˘ ÙÂÚˉfiÓ·˜, Ô˘ ı· ÂÚÈ-
Ï·Ì‚¿ÓÂÈÂ›ÛË˜Û˘Ì‚Ô˘Ï¤˜‰È·ÙÚÔÊÈÎÒÓÛ˘ÓËıÂÈÒÓ,ÙÔÈ΋ÂÊ·Ú-
ÌÔÁ‹ ÊıÔÚ›Ô˘ Î·È ÚÔÏËÙÈΤ˜ ηχ„ÂȘ ÔÒÓ-Û¯ÈÛÌÒÓ. ¶ÚÔ-
ÁÚ¿ÌÌ·Ù·ÛÙÔÛ¯ÔÏ›ԋÛÙÔÛ›ÙÈÔ˘ÛÙÔ¯Â‡Ô˘ÓÛ“ÔÌ¿‰Â˜˘„Ë-
ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË ÙÂÚˉfiÓ·˜” fiˆ˜ Â›Û˘ Î·È Û ÂıÓÈ-
Τ˜ ÌÂÈÔÓfiÙËÙ˜ ÌÔÚ› Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈο [Twetman, 2009].

6. 29
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
™Â ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 6 ÂÙÒÓ, fiÙ·Ó Î·Ù·ÚÙ›˙Ô˘Ì ¤Ó· ÔÏÔ-
ÎÏËڈ̤ÓÔ ÚÔÏËÙÈÎfi ÚfiÁÚ·ÌÌ· ·ÔÛÎÔԇ̠ÛÙË ÌÂÁ·Ï‡-
ÙÂÚË ‰˘Ó·Ù‹ ÚÔÛÙ·Û›· ·fi ÙËÓ ÙÂÚˉfiÓ· Ì ÙÔ ÌÈÎÚfiÙÂÚÔ
‰˘Ó·Ùfi ΛӉ˘ÓÔ ÊıÔÚ›·Û˘. ™Â ·˘Ù‹Ó ÙËÓ ÂÚ›ÙˆÛË, fiÙ·Ó ¯ÚË-
ÛÈÌÔÔÈÂ›Ù·È ÊıÔÚÈÔ‡¯Ô˜ Ô‰ÔÓÙfiÎÚÂÌ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿Ï-
Ï· Û΢¿ÛÌ·Ù· ÊıÔÚ›Ô˘, Ë Û˘ÓÔÏÈ΋ ÔÛfiÙËÙ· ÊıÔÚ›Ô˘ ı· Ú¤-
ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿ ˘’ fi„ÈÓ. OÈ ÂÈÏÔÁ¤˜ ÙÔ˘ Ô‰ÔÓÙÈ¿-
ÙÚÔ˘ ı· Ú¤ÂÈ Â›Û˘ Ó· ‚Ú›ÛÎÔÓÙ·È Û ·ÚÌÔÓ›· Ì ÙȘ ÚÔÙÈ-
Ì‹ÛÂȘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. H ÁÂÓÈÎfiÙÂÚË ¤ÎıÂÛË ÙˆÓ ·È‰ÈÒÓ ÛÂ
ÊıfiÚÈÔ, fiˆ˜ Â›Û˘ ÙÔ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÎÔÈ-
ÓfiÙËÙ·˜ fiÔ˘ ˙Ô˘Ó, ÌÔÚ› Ó· ÂËÚ¿˙ÂÈ ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜
Û˘ÛÙ¿ÛÂȘ Ì·˜.
¶›Ó·Î·˜ 5. O‰ËÁ›Â˜ ¯Ú‹Û˘ ÊıÔÚÈÔ‡¯Ô˘
Ô‰ÔÓÙfiÎÚÂÌ·˜ ÛÙ· ·È‰È¿
HÏÈΛ· ™˘ÁΤÓÙÚˆÛË ∏ÌÂÚ‹ÛÈ· ¶ÔÛfiÙËÙ·
ÊıÔÚ›Ô˘ ¯Ú‹ÛË Ô‰ÔÓÙfiÎÚÂÌ·˜
ËÌÂÚËÛ›ˆ˜
6 ÌËÓÒÓ-
<2 ÂÙÒÓ 500 ppm ¢˘Ô ÊÔÚ¤˜ M¤ÁÂıÔ˜
ÌÈ˙ÂÏÈÔ‡
2-<6
ÂÙÒÓ 1000 (+) ppm ¢˘Ô ÊÔÚ¤˜ M¤ÁÂıÔ˜
ÌÈ˙ÂÏÈÔ‡
6 ÂÙÒÓ
Î·È ¿Óˆ 1450 ppm ¢˘Ô ÊÔÚ¤˜ 1-2 cm
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EYXAPI™TIE™
H E˘Úˆ·˚΋ Aη‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ı·
‹ıÂÏ ӷ ¢¯·ÚÈÛÙ‹ÛÂÈ ÙÔ˘˜: K·ıËÁËÙ‹ Jack Toumba (™˘-
ÓÙÔÓÈÛÙ‹ ÙÔ˘ ™˘ÌÔÛ›Ô˘ Î·È Û˘ÁÁڷʤ· Ù˘ ÙÂÏÈ΋˜ ¤ÎıÂ-
Û˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ), ¢Ú N›ÎÔ §˘Áȉ¿ÎË (¶Úfi‰ÚÔ Ù˘
EAPD) Î·È AÓ·ÏËÚˆÙ‹ K·ıËÁËÙ‹ KˆÓÛÙ·ÓÙ›ÓÔ O˘Ï‹ (™˘-
ÓÙÔÓÈÛÙ‹ ÙÔ˘ ™˘ÌÔÛ›Ô˘) ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÙÔ˘ «2nd
European
Symposium and Guidelines Workshop on Contemporary
Usage of Fluoride in Dentistry» fiÔ˘ η٤ÛÙË ‰˘Ó·Ùfi Ó·
ÂÈηÈÚÔÔÈËıÔ‡Ó ÔÈ Ô‰ËÁ›Â˜ Ù˘ EAPD ÁÈ· ÙÔ ÊıfiÚÈÔ. E›-
Û˘, ı· ‹ıÂÏ ӷ ¢¯·ÚÈÛÙ‹ÛÂÈ ÙÔ˘˜ 54 ÂȉÈÎÔ‡˜ ÂÈÛÙ‹-
ÌÔÓ˜ ·fi 25 Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Ô˘ ‹Ú·Ó ̤ÚÔ˜ ÛÙÔ
™˘ÌfiÛÈÔ, Î·È ÂȉÈÎfiÙÂÚ· ÙÔ˘˜ ÔÌÈÏËÙ¤˜ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ
ÔÌ¿‰ˆÓ, ÔÈ ÔÔ›ÔÈ Ì ÙËÓ ÔχÙÈÌË ÁÓÒÛË ÙÔ˘˜ Û˘Ó¤‚·Ï·Ó
ÂÈÛÙËÌÔÓÈο ÛÙË Û˘ÁÎÚfiÙËÛË ·˘ÙÒÓ ÙˆÓ Ô‰ËÁÈÒÓ.
T¤ÏÔ˜, ¢¯·ÚÈÛٛ˜ ı· Ú¤ÂÈ Ó· ‰ÔıÔ‡Ó ÛÙÔ˘˜ Û˘ÓÙÔ-
ÓÈÛÙ¤˜ ηıÒ˜ Î·È ÛÙ· ̤ÏË ÙˆÓ 4 ÔÌ¿‰ˆÓ ÂÚÁ·Û›·˜ ÙÔ˘ ™˘-
ÌÔÛ›Ô˘ Î·È ÂȉÈÎfiÙÂÚ· ÛÙÔ˘˜ ·ÎÔÏÔ‡ıÔ˘˜:
I. ºıÔÚ›ˆÛË ÙÔ˘ NÂÚÔ‡: ™˘ÓÙÔÓÈÛÙ¤˜: Carmel
Parnell (Ireland) & Martin Curzon (UK). M¤ÏË: Cheryl Butz
(Germany), Katarzyna Emerich (Poland), Miguel Hernandez
(Spain), Betul Kargul (Turkey), Haroula Koletsi-Kounari
(Greece), Adam Maxim (Romania), Ilija Skrinjaric (Croatia),
Vassiliki Topitsoglou (Greece), Annie-Maria Vierrou (Greece),
Alexia Vlotoma (Cyprus).
II. T·ÌϤÙ˜ Î·È ™Ù·ÁfiÓ˜/°¿Ï·/AÏ¿ÙÈ: ™˘ÓÙÔ-
ÓÈÛÙ¤˜: Ivar Espelid (Norway) & Constantine Oulis (Greece).
M¤ÏË: Kostas Arapostathis (Greece), Dimitris Emanouil
(Greece), Padraig Fleming (Ireland), Sotirios Kalfas (Greece),
Rok Kosem (Slovenia), Teresa Leisebach (Switzerland), Cor
van Loveren (Netherlands), Argy Polychronopoulou (Greece),
Colin Robinson (UK), Nikolai Sharkov (Bulgaria), Ulrich
Schiffner (Germany), Karin Ziskind (Israel).
III. ZÂϤ/™ÙÔÌ·ÙÔχ̷ٷ/BÂÚÓ›ÎÈ·: ™˘ÓÙÔÓÈ-
ÛÙ¤˜: Sven Poulsen (Denmark) & Lisa Papagiannoulis
(Greece). M¤ÏË: Ivana Bagic (Croatia), Verena Buerkle
(Austria), Monty Duggal (UK), Sotiria Gizani (Greece), Nikos
Kotsanos (Greece), Valeria Marinho (UK), Elsa Paiva
(Portugal), William Papaioannou (Greece), Laura
Strohmenger (Italy), George Vadiakas (Greece), Vesna
Zivojinovic (Serbia).
IV. O‰ÔÓÙfiÎÚÂ̘: ™˘ÓÙÔÓÈÛÙ¤˜: Svante Twetman
(Denmark) & Richard Welbury (UK). M¤ÏË: Dominique
Declerck (Belgium), Roger Ellwood (UK), Guy Goffin
(Switzerland) Sara Karjalainen (Finland), Katerina Kavvadia
(Greece), Gunilla Klingberg (Sweden), Goran Koch (Sweden),
Kostas Louloudiadis (Greece), Nick Lygidakis (Greece),
Helen Mamai-Homata (Greece), Jean-Louis Sixou (France),
Christian Splieth (Germany), Jack Toumba (UK), Ferranti
Wong (UK).

8. £ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
31
K·ÙËÁÔڛ˜ AÓ·ÛÎÔ‹ÛÂȘ AÔÙÂϤÛÌ·Ù· AÍÈÔÏfiÁËÛË ¶ÚÔÙ¿ÛÂȘ B·ıÌÔÏÔÁ›· KÏÈÓÈΤ˜ Ô‰ËÁ›Â˜
Û΢·ÛÌ¿ÙˆÓ Û¯ÂÙÈÎÒÓ ·ÍÈÔÏÔÁËı¤ÓÙˆÓ ÌÂÏÂÙÒÓ ¯Ú‹Û˘ ÙˆÓ ÚÔÙ¿ÛÂˆÓ ¯Ú‹Û˘ Û‡Ìʈӷ
ÌÂÏÂÙÒÓ ÌÂÏÂÙÒÓ Û‡Ìʈӷ Ì ÊıÔÚÈÔ‡¯ˆÓ Û‡Ìʈӷ Ì Ì ÙȘ ÌÂϤÙ˜
[SIGN 50, 2008]* Û΢·ÛÌ¿ÙˆÓ [SIGN 50,
2008]**
ZÂϤ ÊıÔÚ›Ô˘ ñ Cochrane ñ NÂÔÁÈÏ¿ ‰fiÓÙÈ·. 1++ ÁÈ· NÂÔÁÈÏ¿ ‰fiÓÙÈ· D ÁÈ· Ù· ñ™˘¯ÓfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜
(Â·ÁÁÂÏÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË H ·ÔÙÂÏÂÛ- ÓÂÔÁÈÏ¿ N· ÌË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÓÂÔÁÈÏ¿ 2-4 ÊÔÚ¤˜ ÂÙËÛ›ˆ˜.
¯Ú‹ÛË Marinho et al., Ì·ÙÈÎfiÙËÙ¿ ÙˆÓ Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ‰fiÓÙÈ· ¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ˙ÂϤ
5,000-12,500 2002a ˙ÂϤ ÛÙ· ÓÂÔÁÈÏ¿ ÙˆÓ 6 ÂÙÒÓ, ÏfiÁˆ ı· Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È
ppm F) ñ AÓ·ÛÎfiËÛË ‰fiÓÙÈ· Â›Ó·È ·Û·Ê‹˜ ÎÈÓ‰‡ÓÔ˘ ηٿÔÛ˘ Ë Ô‰ÔÓÙÈ΋ ÌÈÎÚԂȷ΋
Poulsen, 2009 ÙÔ˘ ˙ÂϤ Ͽη.
ñ √ Ô‰ÔÓÙ›·ÙÚÔ˜ ÁÈ· Ó· ·ÔʇÁÂÈ
ñ MfiÓÈÌ· ‰fiÓÙÈ·. 1++ ÁÈ· MfiÓÈÌ· ‰fiÓÙÈ·. A ÁÈ· Ù· ÙÔÓ Î›Ó‰˘ÓÔ ÙÔÍÈÎfiÙËÙ·˜
AÔÙÂÏÂÛÌ·ÙÈο ÌfiÓÈÌ· N· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌfiÓÈÌ· ı· Ú¤ÂÈ [Whitford,1992]Ó·
ÛÙËÓ ÚfiÏË„Ë Ù˘ ÁÈ· ÚfiÏË„Ë Ù˘ ‰fiÓÙÈ· ÂÈϤÁÂÈ ÙÔ ÂӉ‰ÂÈÁ̤ÓÔ
ÙÂÚˉfiÓ·˜ ÙˆÓ ÙÂÚˉfiÓ·˜ ÙˆÓ Ì¤ÁÂıÔ˜ ‰ÈÛηڛˆÓ
ÌÔÓ›ÌˆÓ ÌÔÓ›ÌˆÓ ‰ÔÓÙÈÒÓ Î·È Ó· ¯ÚËÛÈÌÔÔÈ›ٷÈ
·Ó·ÚÚfiÊËÛË Î·Ù¿ ηÈ
ÌÂÙ¿ ÙË ÊıÔÚ›ˆÛË
ñ TÔ ·È‰› Ú¤ÂÈ Ó· οıÂÙ·È
ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ηڤÎÏ·
¤¯ÔÓÙ·˜ οıÂÙË ÙË ı¤ÛË
Ù˘ Ï¿Ù˘ Î·È Ó· ÌË
ηٷ›ÓÂÈ ÙÔ ˙ÂϤ.
ñ N· ÚÔÙ›ÓÂÈ ÛÙÔ ·È‰›
Ó· ÊÙ‡ÛÂÈ ÙÔ ˙ÂϤ.
ñ N· ÛÎÔ˘›˙ÂÈ Ù· ‰fiÓÙÈ·
ÌÂ Á¿˙·.
ñ N· ˙ËÙ¿ÂÈ ·fi ÙÔ ·È‰›
Ó· ·ÔʇÁÂÈ ÙËÓ
ÚfiÛÏË„Ë ÙÚÔÊÒÓ Î·È
ÚÔÊËÌ¿ÙˆÓ ÁÈ· 20-30
ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÊıÔÚ›ˆÛË
™ÙÔÌ·ÙÔχ̷ٷ ñ AÓ·ÛÎfiËÛË ñ NÂÔÁÈÏ¿ ‰fiÓÙÈ· - ÁÈ· Ù· ¡ÂÔÁÈÏ¿ ‰fiÓÙÈ· D ÁÈ· Ù· ñ ∂›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο
ÁÈ· ¯Ú‹ÛË ÛÙÔ Poulsen, 2009 ¢ÂÓ ˘¿Ú¯ÂÈ ÓÂÔÁÈÏ¿ ∞ÔÊ˘Á‹ ¯Ú‹Û˘ ÓÂÔÁÈÏ¿ fiÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
Û›ÙÈ ‹ ñ Cochrane ‰È·ı¤ÛÈÌË Û ·È‰È¿ ‰fiÓÙÈ· ˘fi ÙËÓ Â›‚ÏÂ„Ë ÂÓ‹ÏÈη
ÛÙÔ Û¯ÔÏ›Ô. ·Ó·ÛÎfiËÛË ·ÍÈfiÏÔÁË ÌÈÎÚfiÙÂÚ· ÙˆÓ 6 ñ ™ÙÔÌ·ÙfiÏ˘ÛË
K·ıËÌÂÚÈÓ¿: Marinho et al., ‚È‚ÏÈÔÁÚ·Ê›· ÂÙÒÓ, ÏfiÁˆ 10 ml ÛÙÔÌ·ÙÔχ̷ÙÔ˜
0.05% NaF 2003b ·˘ÍË̤ÓÔ˘ ÁÈ· 1 ÏÂÙfi
(225 ppm F). ÎÈÓ‰‡ÓÔ˘ ñ ∑ËÙ¿Ì ·fi ÙÔ ·È‰›
E‚‰ÔÌ·‰È·›ˆ˜: ηٿÔÛ˘ ÙÔ˘ Ó· ·ÔʇÁÂÈ ÙËÓ ÚfiÏË„Ë
0.2% NaF ÛÙÔÌ·ÙÔχÛÌ·ÙÔ˜ ÙÚÔÊÒÓ Î·È ÚÔÊËÌ¿ÙˆÓ
(900 ppm F). ÁÈ· 20-30 ÏÂÙ¿ ÌÂÙ¿ ÙË
ÛÙÔÌ·ÙfiÏ˘ÛË
ñ ªfiÓÈÌ· ‰fiÓÙÈ· 1++ ÁÈ· Ù· ªfiÓÈÌ· ‰fiÓÙÈ· ∞ ÁÈ· Ù· ÌfiÓÈÌ·
∞ÔÙÂÏÂÛÌ·ÙÈο ÌfiÓÈÌ· ¡· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰fiÓÙÈ·
ÛÙËÓ ÚfiÏË„Ë ‰fiÓÙÈ· ÁÈ· ÚfiÏË„Ë Ù˘
Ù˘ ÙÂÚˉfiÓ·˜ ÙÂÚˉfiÓ·˜ ÙˆÓ
ÌÔÓ›ÌˆÓ ‰ÔÓÙÈÒÓ
¶›Ó·Î·˜ 2. MÂϤÙ˜, Â›Â‰Ô ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÌÂÏÂÙÒÓ Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙË ÎÏÈÓÈ΋ ¯Ú‹ÛË ÙÔ˘˜ Û¯ÂÙÈο
Ì ٷ ÊıÔÚÈÔ‡¯· ˙ÂϤ, Ù· ÛÙÔÌ·ÙÔχ̷ٷ Î·È Ù· ‚ÂÚÓ›ÎÈ·.

9. 32
£ ∂ ª ∞ Δ ∞ ∂ ¶ π ™ Δ ∏ ª O ¡ π ∫ O À E ¡ ¢ π ∞ º ∂ ƒ O ¡ Δ O ™
μÂÚÓ›ÎÈ· ñ ∞Ó·ÛÎfiËÛË ∞ÔÙÂÏÂÛÌ·ÙÈο 1++ ¡· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ∞ ÁÈ· Ù· ñ ÃÚ‹ÛË 2-4 ÊÔÚ¤˜ ÂÙËÛ›ˆ˜
(Â·ÁÁÂÏÌ·ÙÈ΋ Poulsen, 2009 ÛÙËÓ ÚfiÏË„Ë Ù˘ ÁÈ· ÙËÓ ÚfiÏË„Ë ÓÂÔÁÈÏ¿ ñ ¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹
¯Ú‹ÛË 1000 ñ Cochrane ÙÂÚˉfiÓ·˜ ÙfiÛÔ Ù˘ ÙÂÚˉfiÓ·˜ Î·È Ù· ÙÔ˘ ‚ÂÚÓÈÎÈÔ‡ ı· Ú¤ÂÈ
-56300 ppm ·Ó·ÛÎfiËÛË ÛÙ· ÓÂÔÁÈÏ¿ fiÛÔ ÙfiÛÔ ÛÙ· ÓÂÔÁÈÏ¿ ÌfiÓÈÌ· Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È
F) Marinho et al., Î·È ÛÙ· ÌfiÓÈÌ· fiÛÔ Î·È ÛÙ· ‰fiÓÙÈ· Ë Ô‰ÔÓÙÈ΋ ÌÈÎÚԂȷ΋ Ͽη.
2002b ‰fiÓÙÈ· ÌfiÓÈÌ· ‰fiÓÙÈ· ñ √ Ô‰ÔÓÙ›·ÙÚÔ˜, ÁÈ· Ó·
·ÔʇÁÂÈ ÙÔÓ Î›Ó‰˘ÓÔ
ÙÔÍÈÎfiÙËÙ·˜, ı· Ú¤ÂÈ Ó·
·›ÚÓÂÈ ÙȘ ›‰È˜ ÚÔÊ˘Ï¿ÍÂȘ
Ì ÂΛӘ ÁÈ· ÙË ¯Ú‹ÛË ˙ÂϤ
ñ ªÔÚ› Ó· ÙÔÔıÂÙËı›
ÏÂÙÔ‡ ¿¯Ô˘˜ Ôχ ÌÈÎÚ‹
ÔÛfiÙËÙ· ‚ÂÚÓÈÎÈÔ‡ ÛÙȘ
ÂÈÊ¿ÓÂȘ ÙˆÓ ‰ÔÓÙÈÒÓ
Ô˘ ÎÈÓ‰˘ÓÂ‡Ô˘Ó ·fi ÙÂÚˉfiÓ·.
ñ ¢›ÓÔ˘Ì ԉËÁ›Â˜ ÛÙÔ
·È‰› Ó· ·ÔʇÁÂÈ ÙËÓ
ÚfiÛÏË„Ë ÙÚÔÊÒÓ Î·È
ÚÔÊËÌ¿ÙˆÓ ÁÈ· 20-30 ÏÂÙ¿
ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË
ÙÔ˘ ‚ÂÚÓÈÎÈÔ‡
* B·ıÌÔÏÔÁ›· ·fi 1++ (˘„ËÏ‹ ·ÍÈÔÏfiÁËÛË ÌÂÏÂÙÒÓ) ̤¯ÚÈ 4 (¯·ÌËÏ‹ ·ÍÈÔÏfiÁËÛË ÌÂÏÂÙÒÓ)
** B·ıÌÔÏÔÁ›· ·fi A (˘„ËÏ‹˜ ·Í›·˜ Ô‰ËÁ›·) ̤¯ÚÈ D (¯·ÌËÏ‹˜ ·Í›·˜ Ô‰ËÁ›·)