牙齒漂白是一個廣泛被應用去改善牙齒的方法。牙齒敏感是活性牙齒漂白主要的副作用。研究顯示氟化物可以降低牙齒敏感的發生率。因為牙齒本質上是管狀含液體的結構。氟化物會封閉牙本質小管，限制外界刺激對牙本質小管內液體的流動，以達到去敏感效果。另外， 根據文獻回顧, 氟化物也許會改進牙齒機械性質。因此最近，牙齒漂白時使用含中性氟化物的漂白藥劑是被推薦的，以達去敏感效果。本實驗探討漂白劑含不同濃度氟化物對牙齒的影響。評估的項目包括了牙釉質(1)表面型態、(2)機械性質、(3) 牙齒色度、(4)牙齒鍵結強度的比較。
本體外實驗主要是研究比較牙齒使用含不同濃度氟化物的10% carbamide peroxide漂白凝膠後，依不同等待時間，測試牙釉質的微硬度、色度與複合樹脂的鍵結強度 (uTBS)，並利用SEM來觀察型態的變化。取73顆牛的門牙，分成兩部分。第一部分取25顆牛的門牙(每顆切成切緣與齒頸兩部分)，然後分別用環氧樹脂包埋，並把唇側面琺瑯質硏磨為1μm的平面，依不塗任何藥劑(控制組)或不同漂白藥劑 (10% carbamide peroxide (漂白8小時/天，連續14天)、10% carbamide peroxide漂白後塗NaF1分鐘、10% carbamide peroxide含0.11%氟、10% carbamide peroxide含0.37 %氟)分成五組，並依照不同時間(起始、漂白一週、漂白二週、回復一週、回復二週) 做微硬度測試並記錄色度變化與SEM觀察型態。第二部分取48顆牛的門牙唇側面琺瑯質，利用砂紙硏磨後，依不塗任何藥劑(控制組)或不同漂白藥劑(10% carbamide peroxide、10% carbamide peroxide含0.11%氟、10% carbamide peroxide含0.37%氟)共分成四組，並依照不同時間(起始、回復一週、回復二週)與複合樹脂(Z 250)鍵結，之後以萬用試驗機來測試複合樹脂和牙釉質的鍵結強度( microtensile bond strength)，並利用SEM來觀察斷面情形。
不同漂白藥劑漂白二週後，琺瑯質的微硬度明顯下降。牙齒漂白後經過二星期，牙釉質表面硬度回復到基準線。SEM的觀察顯示，牙齒在含氟的漂白藥劑處理過後，表面蝕刻情形較輕微，特別是含氟量高的漂白劑。牙齒漂白二星期後，微拉伸鍵結強度(µTS) 明顯下降。牙齒漂白後浸泡在人工唾液經過二星期，微拉伸鍵結強度(µTS) 回復到基準線。含氟漂白劑可防止漂白後，微拉伸鍵結強度(µTS)下降。結果顯示，添加氟化物可防止漂白後表面微硬度下降和酸蝕刻作用，且不減少漂白的效果。

Tooth whitening is a widely used procedure to improve the dental appearance. During the whitening treatment, tooth sensitivity is a common side effect. Studies showed that fluoride can occludes the dentinal tubules and reduce the incidence of tooth sensitivity. In addition, literatures suggest that the fluoride may improve the mechanical properties of tooth. Recently, a bleaching agent containing neutral fluoride is recommended to be used to resolve the problem of tooth sensitivity. This study was aimed to assess the effects of fluoride in the bleaching agents on enamel in multi-approaches. Changes in color characterization, superficial morphology, microhardness, and microtensile bonding strength (µTS) of enamel bleached with different fluoride concentration were evaluated.
In the first part of the study, twenty five bovine incisors were cut into the incisal and cervical halves. The specimens were divided into 5 groups: control groups without treatment, bleached with 10% carbamide peroxide (CP), CP then fluoridated with 0.9 % NaF, CP containing fluoride of 0.11% and 0.37 %. Teeth receiving bleaching were treated eight hours per day for 14 days, then soaked in saliva for the following two weeks. The morphology changes of enamel were evaluated on Day14. The color changes of enamel were evaluated on Day0, 7, 14. The microhardness changes of enamel were evaluated on Day0, 7, 14, 21, and 28.
The remaining forty eight teeth were used to evaluate the microtensile bonding strength of composite restorations on bleached enamel. Flat enamel of bovine incisors were bleached with similar treatments. Subsequently, composite resin fillings were built on the enamels at 0, 1, 2 weeks after bleaching treatment. The µTS of composite resin to enamel were tested with the beam cut from the specimens. The fracture modes were evaluated with SEM.
After two week, groups receiving bleaching treatments showed a significant decrease in the enamel microhardness compared to their baseline data. The hardness of enamel had recovered to the baseline data 2 weeks after bleaching. The color of the bleaching enamel specimens were showed to increase in whiteness and decrease in yellow. SEM observation showed a milder etched change of enamel with bleaching containing fluoride, especially the high fluoride contained agents. The µTS data were significant decrease after bleaching 2 weeks. The µTS had recovered to the control group data after immersion in artificial saliva 2 weeks. The addition of fluoride may prevent the reduce microtensile bond strength. The result reveals that the addition of fluoride may prevent the complications of bleaching like reduce surface hardness and acid etching effect but does not reduce the whitening effect.

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