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99
ªï∑’Ë Ú˘ ©∫—∫∑’Ë Ò ¡.§. - ‡¡.¬. æ.». ÚııÚ Vol. 29 No. 1 Jan - Apr. 2009 ë The research and clinical dental arch from of angleûs classification III in Thais ë Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients ë Effect of denture cleanser on color stability and flexural strength of three denture base materials ë Effect of denture cleanser on surface hardness and roughness of 3 denture base materials ë The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells ë °“√√—Ë«´÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Õß™π‘¥ ë §«“¡√Ÿâ ÷°‡§√’¬¥¢Õßπ—°»÷°…“∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ë ¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡

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Page 1: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

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ahidol Dental Journal Volum

e 29 Num

ber 1 January-April 2009

«‘‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈

Mahidol Dental Journal

ªï∑’Ë Ú˘ ©∫—∫∑’Ë Ò ¡.§.-‡¡.¬. ÚııÚ Volume 29 Number 1 Jan-Apr. 2009

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Contents

Original articleThe research and clinical dental arch from of angleûs

classification III in Thais

Nuttaya Chantarasamee Pornrachanee Sawaengkit

Jiraporn Chaiwat

Long term efficacy of occlusal splint therapy

in self-reported bruxists and temporomandibular

disorders patients

Kanjana Chavalertsakul Panupen Sitthisomwong

Somsak Mitrirattanakul

Effect of denture cleanser on color stability

and flexural strength of three denture base

materials

Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness

and roughness of 3 denture base materials

Tieng Chhnoeum Widchaya Kanchanavasita

The cytotoxic effect of Andrographis paniculata extract

and Andrographis paniculata gel on human periodontal

ligament cells

Sakulwun Noppamassiri Mullika Sirirat

Rudee Surarit Julalux Kasetsuwan

Pleumchitt Rojanapanthu

Microleakage of two fluoride-releasing pit

and fissure sealants

Praphasri Rirattanapong Katkao Vongsavan

Rudee Surarit

Perceived stress in dental students of

Mahidol University

Weera Sukhumthummarat Pornpoj Fuangtharnthip

Somsak Mitrirattanakul Nitipun Jeeraphat

Review articleAntiplatelet drugs in dentistry

Benjamas Apipan Artidtaya Charoensukasem

1

15

23

55

37

45

29

ªï∑’Ë Ú˘ ©∫—∫∑’Ë Ò ¡.§. - ‡¡.¬. æ.». ÚııÚ Vol. 29 No. 1 Jan - Apr. 2009

67

ë The research and clinical dental arch from of angleûs classification III in Thais

ë Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular

disorders patients

ë Effect of denture cleanser on color stability and flexural strength of three denture base

materials

ë Effect of denture cleanser on surface hardness and roughness of 3 denture base materials

ë The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on

human periodontal ligament cells

ë °“√√—Ë«´÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Õß™π‘¥

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ë ¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡

cover 29(1) 23/7/09, 10:051

Page 2: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

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ahidol Dental Journal Volum

e 29 Num

ber 1 January-April 2009

«‘‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈

Mahidol Dental Journal

ªï∑’Ë Ú˘ ©∫—∫∑’Ë Ò ¡.§.-‡¡.¬. ÚııÚ Volume 29 Number 1 Jan-Apr. 2009

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∫∑«‘∑¬“°“√·π«§«“¡‚§âß°“√‡√’¬ßµ—«¢Õßøíπ∑“ß«‘®—¬·≈–∑“ߧ≈‘π‘°

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Contents

Original articleThe research and clinical dental arch from of angleûs

classification III in Thais

Nuttaya Chantarasamee Pornrachanee Sawaengkit

Jiraporn Chaiwat

Long term efficacy of occlusal splint therapy

in self-reported bruxists and temporomandibular

disorders patients

Kanjana Chavalertsakul Panupen Sitthisomwong

Somsak Mitrirattanakul

Effect of denture cleanser on color stability

and flexural strength of three denture base

materials

Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness

and roughness of 3 denture base materials

Tieng Chhnoeum Widchaya Kanchanavasita

The cytotoxic effect of Andrographis paniculata extract

and Andrographis paniculata gel on human periodontal

ligament cells

Sakulwun Noppamassiri Mullika Sirirat

Rudee Surarit Julalux Kasetsuwan

Pleumchitt Rojanapanthu

Microleakage of two fluoride-releasing pit

and fissure sealants

Praphasri Rirattanapong Katkao Vongsavan

Rudee Surarit

Perceived stress in dental students of

Mahidol University

Weera Sukhumthummarat Pornpoj Fuangtharnthip

Somsak Mitrirattanakul Nitipun Jeeraphat

Review articleAntiplatelet drugs in dentistry

Benjamas Apipan Artidtaya Charoensukasem

1

15

23

55

37

45

29

ªï∑’Ë Ú˘ ©∫—∫∑’Ë Ò ¡.§. - ‡¡.¬. æ.». ÚııÚ Vol. 29 No. 1 Jan - Apr. 2009

67

ë The research and clinical dental arch from of angleûs classification III in Thais

ë Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular

disorders patients

ë Effect of denture cleanser on color stability and flexural strength of three denture base

materials

ë Effect of denture cleanser on surface hardness and roughness of 3 denture base materials

ë The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on

human periodontal ligament cells

ë °“√√—Ë«´÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Õß™π‘¥

ë §«“¡√Ÿâ ÷°‡§√’¬¥¢Õßπ—°»÷°…“∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈

ë ¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡

cover 29(1) 23/7/09, 10:051

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cover 29(1) 23/7/09, 10:052

Page 4: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈Mahidol Dental Journal

Advisory BoardAssociate Professor Dr. Theeralaksna Suddhasthira √Õß»“ µ√“®“√¬å ¥√.∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√

Professor Natthamet Wongsirichat »“ µ√“®“√¬å≥—∞‡¡»√å «ß»å ‘√‘©—µ√

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 1

Original article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

The research and clinical dental arch from of angleûs

classification III in Thais

Nuttaya Chantarasamee

Postgraduate student of masterûs degree

program in Orthodontics, Mahidol University

Pornrachanee Sawaengkit

Department of Orthodontics

Faculty of Dentistry, Mahidol university

Jiraporn Chaiwat

Department of Orthodontics

Faculty of Dentistry, Mahidol University

AbstractObjectives: The purpose of the present study is to define a generalizedequation describing the Thaiûs research and clinical dental arch formsspecified in Angleûs classification III by the applying a computer-curve fittingprogram.Materials and methods: The study is comprised of 40 sets (20 males and20 females) of dental casts expressing Angleûs classification III occlusion.In all models, there are 2 measurement methods 1) the research arch form:twenty-two dental landmarks from the mesial and distal points of each incisaledge of incisor, the cusp tip of canines, premolars, and molars 2) the clinicalarch form: fourteen landmarks on the bracket position. Each method wastriggered and recorded by using the Coordinated Measuring Machine andreported into their corresponding coordinates (X-, and Y-axis). Thosecoordinates were processed through a computer curve-fitting program todefine the parameter of beta function to describe their dental arches.Results: The Thai class III dental arches were shown to represent accuratelymathematic way by the beta function. The coefficient of the determinationbetween the measured arch-shape data and the mathematical arch shapewas expressed by the beta function. The average coefficient was 0.97 in bothmaxillary and mandibular arches. The clinical arch form is more appropriateto be used as a basis for construction of arch wire than the research arch formbut it should include the thickness of bracketûs base. Arch depths of bothresearch and clinical arch forms in class III occlusion were less than class Iocclusion in both maxillary and mandibular arches, whereas arch widths andarch shape were similar. Thai class III arch forms had a wider-look than thatof Caucasians from Braunûs study. Gender differences were not obviouslyfound in both arch size and shape.Conclusion: The beta function has described accurately the Thai Angleûsclassification III dental arch forms as in Angleûs classification I. Due to theprecision of the beta function, further studies should take place about thepost-treatment arch form of class III because it will be the evidence base fora treatment plan.Key Words: arch form, beta function, Angleûs classification III

Correspondence to:

Pornrachanee Sawaengkit

Department of Orthodontics,

Faculty of Dentistry, Mahidol University,

Yothi Street, Rajthevi, Bangkok 10400

Thailand

Tel. 081-646-5851

Received: 10 July 2008

Accepted: 15 October 2008

Page 6: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais2

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 3

IntroductionThe achievement of a stable, functional, and

esthetic arch form has long been one of the primeobjectives of orthodontics. A key aspect in the achievementof this goal is the identification of a suitable arch form touse in the treatment of each case.1, 2 Many clinicianstend to adopt one particular arch form for the treatmentof all malocclusions. The arch form chosen is often theone that creates, in the orthodontistûs opinion, theoptimum esthetic and functional occlusion.3-7 Despitenumerous investigations, there is currently little agreementas to the best size and shape for an ideal orthodonticarch form. It has long been suggested that considerablevariability occurs in the arch forms of different types ofmalocclusions, which, if proved true, may preclude theeffective use of a single ideal arch form for all cases.8-13

For more than 100 years, researchers have beentrying to define the çidealé arch form, frequently using theconcept that the dental arch is symmetric in nature andcan be represented by an algebraic or geometric formula.Shapes investigated have included the ellipse,7, 14, 15

parabola16, 17 and catenary curve18 as well as mathematicformulas such as the cubic spline,19, 20 conic section21

and polynomial function.22, 23 Among these forms, thebeta function with the feasibility coefficient proved tohave a high correlation with the dental arch.24 However,over the years, the great majority of authors haverecognized that there is variability in the size and shapeof human arch form. They stated that the form varieswithin the limits of the normal, according to race, type,temperament etc., of the individuals. Furthermore, theyvary from the difference of dentoalveolar characteristics,in other word, the malocclusions.

As above mentioned, using the concept that thedental arch form is similar to the mathematical formulas.Several formulas have formed the basis for commerciallyproduced arch form. Recently, orthodontic supplycompanies have made available various preformed archwires. In some cases, these wires have fit patientsûarches adequately but in other instances the arch wireshave not corresponded to patientsû arch dimensions. Thepreformed arch wires currently available are unsuitablefor many orthodontic cases, since these arch wires do

not take into account all the variations in the size anddimensions of the human arch. Clinically, it seems morereasonable to have several types of preformed arch wiresavailable and to select the shape that most closelymatches the patientûs pretreatment arch form accordingto his or her ethnicity and type of malocclusion.Furthermore, several types of preformed arch wiresavailable now are more appropriate to Caucasian thanThais or, to some kind of malocclusion to be treated thanothers.

Then, in 2005, Aukvongseree25 studied arch formof Angleûs classification I in Thai and found that the betafunction also accurately describes it as well as theCaucasianûs arch form with the high coefficient ofdetermination. Furthermore, they presented the generalformulas of dental arch forms of Angleûs classification Iin Thais and found that the Thai dental arch forms havea wider-look like than Caucasian arch forms in Bruanûsstudy24 in both maxillary and mandibular arches. However,this study used cusp tips and incisal edges as landmarkswhich were the research arch form, not clinical arch formwhich is the form where the arch wire passes though.Finally, Aukvongseree suggested that the resulting archform (research arch form) can be narrow and it is notappropriate to use this shape directly for construction ofarch wires.

Later, Chantarasamee26 evaluated the clinicalarch form of Angleûs classification I in Thais and comparedthem with the research arch form from Aukvongsereeûsstudy.25 As the research arch form, the result showedthat the beta function accurately described Thai clinicaldental arch forms with high coefficient of determination.The mandibular clinical dental arch forms were significantwider-look like than the mandibular research dental archforms in Aukvongsereeûs study,25 while the maxillaryclinical dental arch forms were not significantly differentfrom the maxillary research dental arch forms. Genderseemed to have some influence on arch size differences,with men showing larger significant difference thanwomen but it was not significantly different. Finally,Chantarasamee suggested that, in construction ofpreformed arch wires, the mathematical equations ofclinical arch forms are more appropriate to use than that

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais4

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

of the research arch forms Finally, due to the variation ofthe human dental arch, the purpose of this study is toquantify the nature of the arch form which specify inAngleûs classification III malocclusion in Thai samplesand to define the mathematical equation of shape of thedental arch which is better suited in the Angleûsclassification III group of Thais.

Materials and methodsMaterials

Twenty male and twenty female subjects who hadnever undergone orthodontic treatment were selectedfrom the Department of Orthodontics, Mahidol Universityand private dental clinics. All models exhibited Angleûsclassification III without molar shift caused by early lossof primary teeth with overjet 0 to -3 mm.. There wasabsence of cuspal attrition, fracture of teeth, restorationextending to contact area, cusp tip or incisal edge. Therewas permanent dentition including second molars withnormal tooth size and shape. Arch length discrepancywas less than 3 mm.. Dental arches of the 40 subjectswere reproduced by using an irreversible hydrocolloidmaterial and transferred to dental models in orthodonticstone.

MethodsIn all models, two series of landmarks were

labeled on each dental cast. The first series of dentallandmarks were mesial and distal points of each incisaledge of incisors, the cusp tips of the canines andpremolars, and the mesiobuccal and distobuccal cusptips of each molar (Figure 1). Twenty-two points were inthis first series which referred for the research arch form.

The second series of dental landmarks were the bracketposition points of each tooth which were the point onbuccal and labial surfaces of teeth that derives fromcross section of long axis of teeth and line which wasperpendicular with long axis of teeth. The last line wasmeasured from incisal edge for incisors and the cusp tipfor other teeth. The distance was 3.5 mm. for upperlateral incisors and lower incisors, whereas 4 mm. for theremaining teeth.27 These points represented positionin bonding brackets. Fourteen points were labeled oneach dental cast which referred the clinical arch form(Figure 2).

During the measurement of dental models usingCoordinate Measuring Machine (LK G 90C), each castwas oriented in the Coordinate Measuring Machine(CMM). The device was used extensively in the precisemachine tool in the Faculty of Engineering, MahidolUniversity. Measurements of dental casts using CMM inthis study were done by technician who was especiallytrained to use CMM. A frictionless air bearing proberecorded the coordinates of a point in space in each ofthe three orthogonal axes to 10-6 meters. The castswere secured to a fixed plane. The touch trigger probewas used to identify each of the measurement points.

Figure 1: The first series of dental landmarks used in this

study.

Figure 2: The second series of dental landmarks used in this study.

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 5

All landmarks were recorded in each dental modelwhile the X-and Y-coordinates of each landmark wereprojected to the Z-plane. The coordinates of the landmarksin three dimensional spaces for each of the 40 sets ofdental casts were recorded in the corresponding X-,Y-, and Z-coordinates automatically by using the LKCamio suit 5.5 program.

Before recording the dental landmarks, the datum(X, Y, and Z plane) was set at the landmarks of the rightsecond molar on each maxillary dental model and at thelandmarks of the left second molar on each mandibularmodel. The coordinates (X and Y) at these points weredefined as zero. A planar projection of each cast wassubsequently obtained by setting the Z-plane from

three-point contact between glass slide and occlusalsurface of each dental model in first series of landmarksmeasured (the research arch form) (Figure 3, 4) andthree-point contact between wire that was bent alongarch form and buccal surface of each dental model in thesecond series of landmarks measured (the clinical archform) (Figure 5, 6). The Z-axis was then perpendicularto this plane.

Error of MethodReplication measurement by the same single

examiner was made on 6 sets of randomly selecteddental casts after a 1 week interval. The X- and Y-coordinates of each landmark were compared between

Figure 3: The construction of the Z-axis. Figure 4: Three points contacted used in constructed of the Z-axis.

Figure 5: The Z- axis was set from the three›point contact

between wire and labial or buccal surface of each

dental model. The Z axis was perpendicular to this

plane.

Figure 6: Three points contacted used in constructed of the

Z-axis.

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais6

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

two separate of measurements. Paired t-test was usedfor calculating systematic error. Dahlbergûs formula28

was used for calculating method error (ME) : ME2

= ∑d2/2n (d, the difference between two measurementsof a pair and n, the number of subjects). The resultsshowed that casual errors of method were small andacceptable. Paired t-tests demonstrated no significantsystematic error differences for all measurements(P < 0.05).

Arch interpolationAn analytical equation of the dental arch shape

was necessary to describe the relationships between thearch width (X-coordinate) and arch depth (Y-coordinate).Many mathematical functions were investigated as to fit.The beta function most closely represents the dentalarch shape24. Two measurements (molar width and archdepth) were required to generate the dental arch shape.

Where Y was the arch depth at arch width (X). Thea-parameter represented the arch depth measured bythe perpendicular distance from the most anterior pointbetween two central incisors to the molar cross-archdimension. The b-parameter was an offset and is set tozero so the arch centerline is at zero, as a referenceposition. The c-parameter was the arch width measuredby the cross-arch distance between landmarks at thesecond molars on both sides. The d- and e-parameterswere factors the control the symmetry (Figure 7). Thebeta function representing the dental arch shape wasgiven by the formula:

Y aX

c

d

= −

14 2

2

1

For the beta function, the coefficients wereestimated using a dedicated computer program, (thecomputer program was created by Department ofMathemetics, Faculty of science, Mahidol University)based on the Differential Algorithm. These also fitstandard beta function equations to the data points foreach of the eighty dental arches. The curves were fit byleast square error methods. That was, the computer wasinstructed to approximate the coefficients of the betafunction of each curve.

Statistical AnalysisAll statistical analyses were performed with SPSS

version 11.5 (SPSS Science, Chicago). Means andstandard deviations in each parameter were calculated.The mathematics function and coefficient of determinationwere used to describe the relationships between therecorded and calculated independent variables. Two-independent t-test was used to describe the meandifference of the parameters (a, c, d and e) between sexand between two Angleûs classification. Paired t-test isused to describe the mean difference of the parameters(a, c, d and e) between landmarks measured on the cusptips and the bracket positions.

ResultsWith the least squares method, the curve-fitting

program would calculate for every existed. The resultswere categorized by the type of landmarks: 1) landmarkson the cusp tips 2) landmarks on the bracket positions.The a-parameter represented the arch depth, and the c-parameter represented the arch width at the distobuccalcusp tips of the second molars or at the bracket positionsof the second molars. While the b-parameter wasautomatically set to null value by the curve fittingprogram, the d- and e-parameters were equal. Finally,the beta function became symmetrical at about thecenterline of the teeth.

Figure 7: The diagram showed the parameter, a; Arch depth

(red line), c; Arch width (green line).

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 7

Descriptive statistics of each parameter of the researchand clinical arch forms of Angleûs classification III

Descriptive statistics of each parameter of theresearch and clinical arch forms of Angleûs classificationIII were shown in Table 1. For the maxillary research archform, average a-parameter was 44.12±2.52, averagec-parameter was 61.21±3.14 and average d-parameterwas 1.67±0.09. For the mandibular research arch form,average a-parameter was 40.19±2.73, average c-parameter was 54.32±2.83 and average d-parameterwas 1.76±0.14. In the maxillary clinical dental archform, average a-parameter was 38.62±2.31, averagec-parameter was 63.59±3.28 and average d-parameterwas 1.65±0.12. Finally, the mandibular clinical dental

arch had average a-parameter of 35.30±2.22, averagec-parameter of 58.61±2.65 and average d-parameterof 1.67±0.10.

Correlation between measured data and calculated datafrom the equations of beta function

The measured data and calculated data of maxillaryand mandibular dental arches has been well-fit based onthe beta function. According to this based sample used,the maxillary and mandibular arches were considered tofit the data well, especially when taking the coefficientsof determination average 0.97 in the both of maxillaryand mandibular arch into account. As seen from the curvefit analysis (Figure 8), for the research arch form, the

Maxillary arch

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calculated datameasured data

Maxillary arch

05

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calculated datameasured data

Mandibular arch

0

5

10

15

20

25

30

35

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Mandibular arch

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mrof hcra hcraeseR mrof hcra hcraeseR mrof hcra lacinilC mrof hcra lacinilC

Figure 8: The superimposition of the measured data (pink dot) and calculated data from the equations of beta function (blue

line) was shown. Above was the research arch form, below was the clinical arch form

Table 1: The mean and standard deviation of each parameter of the research and clinical arch forms of both maxillaryand mandibular arches

Parameters The research arch form The clinical arch formMean Standard deviation Mean Standard deviation

Maxillary archa-parameter 44.12 2.52 38.62 2.31c-parameter 61.21 3.14 63.59 3.28d-parameter 1.67 0.09 1.65 0.12Mandibular archa-parameter 40.19 2.73 35.30 2.22c-parameter 54.32 2.83 58.61 2.65d-parameter 1.76 0.14 1.67 0.10

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais8

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

true values underestimated the calculated values of archwidth, by approximately 0.01 mm. in the maxillary archesand 0.02 mm. in the mandibular arches. The measuredvalues underestimated the calculated values of archdepth, by approximately 0.28 mm. in the maxillaryarches and 0.15 mm. in the mandibular arches. In theclinical arch form, the true values underestimated thecalculated values of arch width, by approximately 0.7mm. in the maxillary arches and 0.4 mm. in the mandibulararches. The measured values underestimated thecalculated values of arch depth, by approximately 1.2mm. in the maxillary arches and 0.4 mm. in the mandibulararches.

Sexual dimorphism of the arch form of Angleûs classificationIII

The comparison of each instance between males

and females are as shown in Table 2 and 3. Nostatistically significant difference of any parameter wasfound between males and females at p-value < 0.05both in the maxillary and mandibular arches except at thea-parameter in the maxillary arch of the research archform. It was found that the maxillary arch depth of malewas significantly greater than female on average 1.90mm. at p-value < 0.05.

Comparisons between the measurements on cusp tipsand bracket positions

The comparisons of the parameters from data-recording on the cusp tips and bracket positions, or otherward, the research and clinical arch form, were shown inTable 4. There was statistically significant difference ofevery parameter between two recorded landmarks at p-value < 0.05 except at the d-parameter in the maxillary

Table 2: Statistical difference of each parameter of the research arch form between sexesParameter Female (n=20) Male (n=20) Mean difference (mm.) t p-value

Mean (mm.) ± SD Mean (mm.) ± SDMaxillary archa-parameter 43.17 ± 2.04 45.07 ± 2.58 1.9 2.544* 0.015c-parameter 61.25 ± 3.37 61.16 ± 2.9 0.08 -0.085 0.933d-parameter 1.64 ± 0.08 1.69 ± 0.10 0.05 1.626 0.112Mandibular archa-parameter 39.84 ± 2.51 40.54 ± 2.88 0.70 0.803 0.427c-parameter 54.10 ± 2.98 54.54 ± 2.66 0.44 0.490 0.627d-parameter 1.77 ± 0.14 1.76 ± 0.14 0.01 0.248 0.805

* significant at p-value < 0.05

Table 3: Statistical difference of each parameter of the clinical arch form between sexesParameter Female (n=20) Male (n=20) Mean difference (mm.) t p-value

Mean (mm.) ± SD Mean (mm.) ± SDMaxillary archa-parameter 38.10 ±1.81 39.15 ± 2.65 1.04 1.425 0.162c-parameter 63.65 ± 3.68 63.53 ± 2.95 0.12 -0.112 0.912d-parameter 1.64 ± 0.11 1.67 ± 0.13 0.03 0.791 0.434Mandibular archa-parameter 35.00 ± 1.71 35.60 ± 2.57 0.60 0.853 0.399c-parameter 58.66 ± 2.60 58.56 ± 2.70 0.10 -0.113 0.910d-parameter 1.68 ± 0.10 1.65 ± 0.10 0.03 -0.939 0.354

* significant at p-value < 0.05

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 9

arch. The results were shown that the a-parameters inboth arches recorded on the cups tips were significantlygreater than those on the bracket positions at p-value <0.05. The c-parameters in both arches recorded on thebracket positions were significantly greater than those onthe cusp tips at p-value < 0.05. The d-parameterrecorded on the cusp tips was significantly greater thanthat on the bracket positions only in the mandibular archat p-value < 0.05, while the maxillary d-parameterrecorded on cusp tips was not significantly different fromthat recorded on bracket positions.

Comparisons between the research class III and class Iocclusion (Aukvongsereeûs study)

The comparisons of the parameters in the Angleûsclassification I from Aukvongsereeûs study25 and the

Angleûs classification III from this study were shown inTable 5. The landmarks measured were cusp tips, sothese parameters referred for the research arch form.The difference of a-parameter between two Angleûsclassifications of both arches was statistically significantat p-value < 0.001. The results has shown that the a-parameter of class III were significantly less than thoseof class I at p-value < 0.001.

Comparisons between the clinical class III and class Iocclusion

For the clinical arch form (landmarks measured atthe bracket positions), the comparisons of the parametersin Angleûs classification I from Chantarasameeûs study26

and Angleûs classification III from this study were shownin Table 6. As in the research arch form, the results has

Table 4: Statistical difference of parameter between recorded at cusp tips and bracket positionsParameter Cusp tips (n=40) Bracket positions Mean difference (mm.) t p-value

(n=40)Mean (mm.) ± SD Mean (mm.) ± SD

Maxillary archa-parameter 44.12 ±2.53 38.62 ± 2.34 5.50 10.083** <0.001c-parameter 61.21 ± 3.14 63.59 ± 3.33 -2.38 -3.293** <0.001d-parameter 1.67 ± 0.09 1.65 ± 0.12 0.01 0.489 0.626Mandibular archa-parameter 40.19 ± 2.73 35.30 ± 2.22 4.89 8.796** <0.001c-parameter 54.32 ± 2.83 58.61 ± 2.65 -4.29 -6.998** <0.001d-parameter 1.76 ± 0.14 1.67 ±0.10 0.10 3.581** <0.001

** significant at p-value < 0.001

Table 5: Statistical difference of each parameter of the research arch form between Angleûs classification I and IIIParameter Class I (n=40) Class III(n=40) Mean difference (mm.) t p-value

Mean (mm.) ± SD Mean (mm.) ± SDMaxillary archa-parameter 46.23 ± 2.07 44.12 ± 2.53 2.11 4.089** <0.001c-parameter 61.47 ± 2.65 61.21 ± 3.14 0.27 0.410 0.068d-parameter 1.67 ± 0.09 1.67 ± 0.09 0.01 0.262 0.794Mandibular archa-parameter 42.02 ± 2.09 40.19 ± 2.73 1.83 1.664* 0.001c-parameter 55.46 ± 2.98 54.32 ± 2.83 1.14 1.751 0.083d-parameter 1.77 ± 0.11 1.76 ± 0.14 0.01 0.394 0.694

* significant at p-value < 0.05, ** significant at p-value < 0.001

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais10

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shown that the a-parameter of class III were significantlyless than those of class I at p-value < 0.05 for bothmaxillary and mandibular arches.

The mathematical equations of the research and clinicalarch forms of Angleûs classification III

The curves were generated by putting the valuesof the mean arch widths, the mean arch depths and themean of d-parameter received from the samples into theequation of beta function. The maxillary and mandibulararch equations for each arch were shown in Table 7.

DiscussionIn this study, the results showed the goodness of

fit of the beta function to represent each of the 40 classIII research and clinical arch forms in both arches, as alsoverified by high coefficient of determination (R2), average0.97 with a standard deviation of 0.01, which was equalto the study of Kmolvisit who evaluated the arch forms of

Angleûs class II division 1. Furthermore, before the abovestudies in Thais, for class I occlusion, Aukwongsereealso present the high accuracy of the mathematicalequation of the beta function to describe the researcharch forms with high coefficient of determination average0.96 with standard deviation 0.05 for maxillary archform and 0.97 with standard deviation 0.01. Theseresults in Thais above were consistent with Braunûsstudy 24, who has been the first to offer the beta functionto describe the Caucasianûs research dental arch forms,with an average correlation coefficient of 0.98 with astandard deviation of 0.02. Then, it is obvious that themathematic equation of beta function can describe boththe research and clinical dental arch forms in Thais andCaucasians with high accuracy.

In comparison for arch shape, which was showedby d-parameter, we found that the Thais class III archforms had maxilla and mandible that were wider-look likethan the Caucasian class III arch forms. The average d-

Table 7: The mathematical equations of the research and clinical arch forms of Angleûs classification IIIThe research dental arch form

The maxillary arch form The mandibular arch form

Yx

= −

47 29 1

4

59 26

2

2

0 78

..

.

Yx

= −

40 99 1

4

53 21

2

2

0 75

..

.

The clinical dental arch formThe maxillary arch form The mandibular arch form

Yx

= −

40 72 1

4

61 9

2

2

0 76

..

.

Yx

= −

37 12 1

4

57 11

2

2

0 6

..

.

Table 6: Statistical difference of each parameter of the clinical arch form between Angleûs classification I and IIIParameter Class I (n=40) Class III(n=40) Mean difference (mm.) t p-value

Mean (mm.) ± SD Mean (mm.) ± SDMaxillary archa-parameter 41.39 ±2.17 38.62 ± 2.34 2.77 5.479** <0.001c-parameter 64.03 ± 2.48 63.59 ± 3.33 0.27 0.672 0.503d-parameter 1.70 ± 0.09 1.65 ± 0.12 0.05 1.954 0.034Mandibular archa-parameter 38.57 ± 1.76 35.30 ± 2.22 3.27 7.309** <0.001c-parameter 59.47 ± 2.17 58.61 ± 2.65 0.86 1.588 0.116d-parameter 1.68 ± 0.09 1.67 ± 0.10 0.02 0.709 0.480

** significant at p-value < 0.001

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The research and clinical dental arch from of angleûs classification III in Thais 11

parameter of research arch forms in this study whichrecorded similar landmarks to Braunûs study24 was 1.67in maxillary arch and 1.77 in mandibular arch comparedto d-parameter of Bruanûs study was 1.8 in both ofmaxilla and mandible which were higher value. Thissuperimposition was showed in Figure 9. And, as showedin previous studies of Aukwongresee and Kmolvisit, bothAngleûs class I and Angleûs classification II division I archforms showed similar findings to Angleûs class III in thisstudy.

For sexual dimorphism of the research arch form(measured from the cusp tips), the significant differencebetween male and female was only in a-parameter inmaxilla or in the maxillary arch depth (Table 2), whichmale had larger maxillary arch depth than female. Theother parameters showed no significant difference. Thisresults were consistent with the study of Ferrarioet al,29, 30 who defined the mathematical formulas ofthe shape of dental arches in human permanent healthydentitions. Gender differences were found majority in themaxillary arch, where they reflected more of a sizediscrepancy than a shape difference. On the other hand,in the clinical arch form, there was no significant differencein all measurements of arch form in both maxilla andmandible between male and female (Table 3). Althoughmales had a larger arch size than females, it is generallyagreed that there was no gender difference in arch forms.This implied that the clinician can use the preformed archwire together in both sexes and no additional stock isneed for gender difference.

Later study in dental arch form, we interested notonly in the research arch form but also the clinical arch

form. The clinical arch form, which was measured at thebracket position, was indeed useful for direct constructionof the preformed arch wire. Therefore, in this study classIII arch form had two measurement methods as previouslystudy. The comparison of the research arch form and theclinical arch form in Angleûs classification III in this studyshowed significant differences in all parameters exceptmaxillary d-parameter which showed no significantdifference. Then, it was almost clearly to say that theresearch arch form was different from the clinical archform in Angleûs class III occlusion in arch width and archdepth. The maxillary and mandibular a-parameters (archdepth) of the research arch form in this study weresignificantly larger value than those of the clinical archform, whereas the c-parameters (arch width) of theresearch arch form in both arches were less value thanthose of the clinical arch form. These results were insense that the landmarks of the research arch form weremeasured at the cusp tips and incisal edges while thelandmarks of the clinical arch form were measured at themid-point of the facial or outer surface of teeth. So, theclinical arch form was in outside of the research arch formexcept the both ends of the arch form which the researcharch form ended at more posterior than the clinical archform.

For arch shape, the d-parameter of the mandibularresearch arch form of class III was significantly largervalue than these of the clinical arch form which showedthe more tapered. Although the maxillary d-parameter ofthe research arch form was no significant difference fromthese of the clinical arch form but it tended to be morevalue. It implied that the research arch form tended to be

Maxillary arch

05

101520253035404550

-40 -20 0 20 40

Thai class IIICaucasian Class III

Mandibular arch

05

101520253035404550

-40 -20 0 20 40

Thai class IIICaucasian class III

Figure 9: The superimposition of class III arch form that were calculated from the formula of beta function from Braunûs study

and this study

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The research and clinical dental arch from of angleûs classification III in Thais12

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

more tapered than the clinical arch from. These resultswere consistent with the previous study of Thai Angleclassification I and classification II division 1.

Figure 10 showed the superimposition betweenthe maxillary and mandibular arches. There was clearlyshown no co-ordination between both maxillary andmandibular research arch forms, while co-ordinationbetween the clinical maxillary and mandibular arch formswas presented. Therefore, it was appropriated to use theclinical arch form as a basis for the construction of archwire but it should include the thickness of the bracketbases in the resulting arch forms.

In comparisons between the class I research arch

form in Aukvongsereeûs study25 and the class III researcharch form in this study (Figure 11 above), all parameterswere showed no significant difference except the maxillaryand mandibular a-parameters (arch depth) which showedthat the depth of class III maxillary and mandibularresearch arch form was less than the class I maxillary andmandibular research form about 0.75 mm. and 0.55mm. respectively. These results were similar to thecomparisons of the class I clinical arch form in previousChantarasameeûs study26 and the class III clinical archform in this study (Figure 11 below). The maxillary archdepth in class III was less than class I could explain bythe minimal overjet in class III whereas the less mandibular

Research arch form

05

101520253035404550

-40 -20 0 20 40

Maxillary archMandibular arch

Clinical arch form

05

1015202530354045

-40 -20 0 20 40

Maxillary archMandibular arch

Figure 11: The superimposition of the arch form of Angleûs classification I and III for the research arch forms (above) and

the clinical arch forms (below)

Figure 10: The superimposition between maxillary and mandibular arch forms.

Research arch form-Maxillary arch

05

1015202530354045

-40 -20 0 20 40

Class IClass III

Research arch form- Mandibular arch

05

1015202530354045

-40 -20 0 20 40

Class IClass III

Clinical arch form- Maxillary arch

05

1015202530354045

-40 -20 0 20 40

Class IClass III

Clinical arch form- Mandibular arch

05

1015202530354045

-40 -20 0 20 40

Class IClass III

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

The research and clinical dental arch from of angleûs classification III in Thais 13

arch depth in class III may be resulted from the dentalcompensation of the lower incisor inclination to mask thetrue maxillary and mandibular relationships.

With c- and d-parameters, there was no significantdifference between the class I and class III in bothresearch and clinical arch forms. It showed that themaxillary and mandibular arch width and shape of bothclass I and class III patients was similar. These resultswere useful for clinician to confidently use the class Ipreformed arch wire for class III patients.

The clinicians can use the resulting mathematicalequations to estimate the form of class III research andclinical arch form of each individual by putting the valuesof a-parameter (arch depth) and c-parameter (archwidth) in these equations. Then, the resulting arch formcan be predicted.

With the similar form of the class I and class IIIarch forms in both maxillary and mandibular arches, theclass I arch wire can be used in class III patients for bothmaxillary and mandibular arches.

ConclusionsThe samples is comprised of forty sets of dental

models (20 males and 20 females), which expressedAngleûs classification III occlusion. The results revealedthat:

1. From the present study, the beta functionaccurately described Thai dental arch forms with highcoefficient of determination, average 0.97 in both maxillaryand mandibular dental arches.

2. The Thais class III arch forms had maxilla andmandible that were wider-look like than the Caucasianclass III arch forms.

3. Gender seemed to have some influence onarch size differences, with men showing larger significantdifference than women but it was not significantlydifferent.

4. The research arch form of Angleûs classificationIII from this study seem to more tapered than the classIII clinical arch form.

5. The research and clinical arch width and shapeof Angleûs classification III from this study were similar tothe arch form of class I in previous studies in Thais. On

the other hand, the maxillary and mandibular researchand clinical arch depths of class III were less than thoseof class I.

6. These results from this study and previousstudies of dental arch forms in both research and clinicalare valuable for understanding the forms of dental archesfor various malocclusion in Thais. And, they are worthy formanufacturer to develope the preformed arch wiresespecially NiTi suitable for various types of malocclusionto be treated in Thais.

AcknowledgementsI would like to express my deepest gratitude to my

advisory committee: Associated Professor PornrachaneeSawaengkit, Clinical Professor Jiraporn Chaiwat,Associated Professor Dr. Montip Tiensuwan, LecturerEkarin Sangthammarat and Mr. Sompop Moonchai fortheir supervision, advice, encouragement, and valuableguidance throughout this research, without theirassistances, this study would not be accomplished.

References1. Angle EH. Treatment of malocclusion of the teeth. Ed

7 Philadelphia 1907; S.S. White Dental Mfg.Co.,1907.

2. Black GV. Descriptive anatomy of the human teeth.Ed.5 Philadelphia 1902;S.S. White Dental Mfg.Co,:130-52.

3. Bonwill WG. A geomettrical and mechanical laws ofarticulation. Tr Odont Soc. Penn 1884-1885:119-33.

4. Hawley CA. Determination of the normal arch and itsapplication to orthodontia. Dental Cosmos1905;47:541-52.

5. McConnaill MA, Scher EA. The ideal form of thehuman dental archade, with some prostheticapplication. D Record 1949;69:285-302.

6. Scott JH. The shape of the dental arch. J Dent Res1957;36:996-1003.

7. Brader AC. Dental arch form related to intra-oralforces: PR-c. Am J Orthod 1972;61:541-61.

8. Hellman M. Dimension versus Form in teeth andtheir bearing on the morphology of the dental arch.

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Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

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Int J Orthodontia 1919;5:615-51.9. Stanton FL. Arch predetermination and a method of

relating the predetermined arch to the malocclusionto show the minimum tooth movement. Int JOrthodontia 1922;8:757-78.

10. Izard G. New method for the determination of thenormal arch by the function of the face. Int JOrthodontia 1927;13:582-95.

11. Williams PN. Determining the shape of the normalarch. Dent Cosmos 1917;59:695-708.

12. White LW. Individualized ideal arches. J Clin Ortho1978;12:779-87.

13. Robnett JH. Segment concept in arch pattern design.Am J Orthod 1980; 77:355-67.

14. Sicher H. Oral anatomy. Ed 2 St. Louis 1952; TheC.V. Mosby Company: 262-3.

15. Currier JH. Human dental arch form. Am J Orthod1969;56:164-79.

16. Wheeler RC. A textbook of dental anatomy andphysiology. Ed 2 Philadelphia 1950; WB Saunderscompany:196-215, 352-406.

17. Burstone CJ. Uses of the computer in orthodonticpractice. J Clin Orthod 1979;13:442-53, 539-51.

18. Musich DR, Ackerman JL. The catenometer: A reliabledevice for estimating dental arch perimeter. Am JOrthod 1973;63:366-75.

19. BeGole EA. Application of the cubic spline functionin the description of dental arch form. J Dent Res1980;59:1549-56.

20. Diggs DB. The quantification of arch form[M.S.D.thesis]. Seattle: University of Washington,1982.

21. Sampson PD. Dental arch shape: a statistical analysisusing conic sections. Am J Orthod 1981;79:535-48.

22. Lu KH. An orthogonal analysis of the form, symmetryand asymmetry of the dental arch. Archs OralBiol1966;11:1057-69.

23. Sanin C, Savara BS, Thomas DR, Clarkson OD. Arclength of the dental arch estimated by multipleregression. J Dent Res 1970;49:885.

24. Braun S, Hnat WP, Fender DE, Legan HL. The formof the human dental arch. Angle Orthod1998;68:29-36.

25. Aukvongseree C. The form of dental arch in Angleûsclassification I in Thai. A thesis submitted in partialfulfillment of the requirements for the degree ofMaster of Science (Orthodontics), Faculty of GraduateStudies, Mahidol University 2005.

26. Chantarasmee N. The clinical dental arch form inAngleûs classification I in Thai. A research of specialtytraining program in Orthodontics, Faculty of Dentistry,Mahidol University 2008 (unpublished).

27. William JK, Cook PA, Isaacson KG, Thom AR. Fixedorthodontic appliances. 1st. ed 1995:48-50.

28. Dahlberg G. Statistical methods for medical andpsychological students. New York: IntersciencePublications; 1940.

29. Benjamin GB,Edward FH. Maxillary arch size andshape in American Blacks and Whites. Angle Orthod2000; 70: 297-302.

30. Qiong N, Jiuxiang L. Comparison of intermaxillarytoothy size discrepancies among differentmalocclusion groups. Am J Orthod Dentofac Orthop1999; 116: 539-44.

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Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients 15

Original article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Long term efficacy of occlusal splint therapy in self-reported bruxists

and temporomandibular disorders patients

Kanjana Chavalertsakul

D.D.S.,

Faculty of Dentistry, Mahidol University,

6 Yothi Street Rajthevi, Bangkok 10400

Thailand

Panupen Sitthisomwong

MS (Oral biology),

Faculty of Dentistry, Mahidol University,

6 Yothi Street Rajthevi, Bangkok 10400

Thailand

Somsak Mitrirattanakul

Ph.D.

Faculty of Dentistry, Mahidol University,

6 Yothi Street Rajthevi, Bangkok 10400

Thailand

AbstractObjective: The aim of this study was to evaluate long-term efficacy ofocclusal splint therapy in bruxists and temporomandibular disorders (TMD)patients.Materials and methods: Two hundred and forty-five bruxists and TMDpatients from the Special Clinic and Gnathology Clinic, Faculty of Dentistry,Mahidol University were interviewed. Forty patients treated with occlusalsplints were selected according to the inclusion criteria. Patients wereinterviewed and then completed questionnaires on demographic data,changes in symptoms and attitude to the usage of occlusal splints. Chi-square was used to analyze the relationship between demographic andsubjectsû attitudes toward the efficacy of their occlusal splints.Results: The subjects were 33 females, 7 males and had been wearingocclusal splints for periods ranging from 6 months to 68 months (mean21.5, SD. 15.7). Thirty six patients or 90% (21 TMD patients and 15bruxists) reported that their symptoms decreased after occlusal splinttherapy. There was a significant relationship between occlusal splint efficacyand subjectsû attitudes (p= 0.01). Demographic data did not related to theefficacy of occlusal splints.Conclusion: As determined by long term evaluation, the occlusal splint canhelp and decrease symptoms whilst patientsû attitude can play a major rolein efficacy of occlusal splint treatment.Key words: occlusal splint, efficacy, bruxist, temporomandibular disorders

correspondence author:

Panupen Sitthisomwong

Faculty of Dentistry, Mahidol University,

6 Yothi Street Rajthevi, Bangkok 10400

Thailand

Phone number: 0-2203-6542

Email address: [email protected]

Received: 1 October 2008

Accepted: 28 November 2008

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Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients16

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients 17

IntroductionTemporomandibular disorders (TMD) is a collective

term referring to a variety of pathogenic conditions thataffect the masticatory musculature, the temporo-mandibular joints (TMJ) or both. The clinical presentationis variable and can include facial pain that is aggravatedby jaw function, tenderness upon joint and musclepalpation, limited mandibular range of motion, deviationor deflection of the mandible when opening the mouth,and TMJ sounds. Occasionally, patients may also complainof tinnitus, earaches, headaches, and dizziness.

Signs and symptoms of TMD are very prevalentamong general population. It is estimated that 40% to75% of non-patient adults have at least one sign, and33% at least one symptom of TMD.1 For symptoms, theratio between female and male is at least 2:1. Thecondition is uncommon in children, prevalence increasingin the late teens and peak prevalence occurring in 35-45 year olds. It has been suggested that sex predilectionsare due to one of three factors: physiological or anatomicaldifferences, behavioral differences, and geneticdifferences.2

In Thailand, studies of TMD are limited comparingto other studies of oral diseases such as dental cariesand periodontitis. The epidemiologic survey of 1,000new dental patients at the dental hospital, Faculty ofDentistry, Prince of Songkla University showed only10.9% of patients reported at least one TMD symptom.3

Another study of 3,000 new dental patients seekingdental treatments at the faculty of Dentistry, MahidolUniversity revealed that 73.1% of patients reported atleast one TMD symptom.4 At present, the epidemiologyof TMD in Thailand is inconclusive.

At present, no sound scientific evidence provesthe etiology of TMD. There are varieties of managementfor TMD which aim to control the etiologic factors. Mostof them are conservative treatment including home careinstruction, physical medicine, pharmacotherapy,behavioral therapy and intraoral appliance therapy. Thereare no studies showed which one is superior to theothers. Each patient must be treated differently dependingon the uniqueness of their problems and the contributingfactors.

The intraoral appliance therapy is widely acceptedin management of many TMD. The most common intraoralappliance that dentists use for management of bruxistsand TMD patients is a stabilization splint or an occlusalsplint.

Occlusal appliances are commonly used in thetreatment of patients with TMD, and their effectivenessin reducing symptoms has been reported to vary between70% and 90%.5 The efficacy of occlusal appliancestherapy is a subject of controversy. Systemic review ofrandomized controlled clinical trial could not reach anydefinitive conclusion about their efficacy for treatingTMD, with the methodologically strongest studies reachingopposing conclusions.6 Earlier reviews have reachedsimilarly equivocal conclusions about their effectiveness.7-

10 Despite the mixed evidence regarding their effectivenessand unclear mechanism of any action, occlusal splintsare used extensively by dentists to treat myofascialpain.11-13

Greene & Laskin14 reported that 40% of patientswith myofascial pain-dysfunction syndrome showed animprovement when treatd with a non occluding splint.Rubinoff et al15 found both non occluding and occludingappliances effective in ameliorating subjective symptomsin myofascial pain patients, but the occluding applianceusage was reported to be more effective in relievingclinical sign. In a controlled study of myofascial painpatients treated with stabilization or control appliances,Dao et al16 found a positive treatment outcome but nodifferences between the groups regarding the effect onpain. Major and Nebbe17 concluded from their review thatocclusal splint therapy did not demonstrate to be thetreatment of choice to manage TMJ pain. The review byMarbach and Raphael7 was also not able to identifyevidence for their long-term efficacy. They recommendedin another study that occlusal splints should not be usedfor musculoskeletal facial pain.8 A systematic review ofrandomized controlled trials on the occlusal treatment ofTMD concluded that occlusal splints may be of somebenefits in the treatment of TMD but few randomizedcontrolled studies have led to inconclusiveresults.6,15,18,19 It is still largely unknown how occlusalsplints work.10

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Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients18

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

On the contrary, a randomized controlled trialcomprising patients referred for treatment of TMD ofmainly arthrogenous origin reported that both symptomsand signs improved significantly with a stabilizationappliance than with a control, non-occlusal appliance.19

In short-term evaluation, the stabilization appliance ismore effective in alleviating symptoms and signs inpatients with TMD of mainly myogenous origin.20 Becauseof these diverse opinions, there obviously is a strongneed for further study to identify if a stabilization applianceis really effective.

Although occlusal splints are often indicated in theinitial and in some long-term treatments of many TMDpatients, we still do not know the long-term efficacy ofthe occlusal splint therapy in management of bruxistsand TMD patients. The aim of this study was to evaluatelong-term efficacy of occlusal splint therapy in bruxistsand TMD patients.

Materials and methodsThis study was designed as a clinical study. This

study was approved by the committee on human rightsrelated to human experimentation Mahidol University.

Subjects in this study were patients in recall list ofSpecial clinic and Gnathology Clinic, Faculty of Dentistry,Mahidol University. They were recalled and screenedaccording to the selected criteria as the following:

1. Patients had signs and symptoms of bruxismand/or orofacial pain/TMD and were treated withstabilization occlusal splints more than 6 months.

2. Patients were treated by Orofacial pain andTemporomandibular disorders specialists.

Patients who can not communicate efficiently inThai language were excluded from the study. The patientswere informed about the aim, time needed and risks ofthis study. After reviewing the information about thestudy, patients, who wanted to enroll in the study, signedthe consent form to accept the research protocols.

Patients were interviewed and then completed thequestionnaires included (1) diagnosis, duration, intensity,and frequency of their facial pain and (2) usage ofocclusal splint including frequency of occlusal splintusage. In the second part, patients were asked to fill in

questionnaires that would reflect the attitude about thereceived management including their expectation.

Patients were asked to rate the pain intensity ona Visual Analog Scale, VAS (the VAS is described as a 10cm line anchored at one end by the phrase çno painé andon the other end by the phrase çunbearable painé). Theywere also asked to report the discomfort associated withthe occlusal splint therapy, the frequency of occlusalsplint usage.

Long term efficacy of occlusal splint therapy in thisstudy was determined subjectively by the specific questionthat çDo you think that occlusal splint was helpful indecreasing your symptoms or not?é. If the patientanswered çyesé, the occlusal splint was efficient.

Descriptive statistics were calculated. Therelationship between occlusal splint efficacy andassociated factors were determined by Chi-square test.

ResultsTwo hundred and forty five patients were included

in this study, 40 patients passed the selected criteria.The subjects were 33 females, 7 males and had beenwearing occlusal splints for periods ranging from 6months to 68 months (mean 21.5, SD. 15.7). The agewas ranged 23-65 years-old with the average age andstandard deviation 42.9 and 12.9 respectively. Theprevalent age group was in 31-40 year old (25%)followed by 41-50 year old and 51-60 year old(22.5% both groups).

Twenty three patients (57.5%) had facial painbefore treatment. This group of patients was called theçpainful groupé. Seventeen patients or 42.5% wasbruxists, the çbruxist groupé. Frequency, intensity andduration of pain were shown in table 1.

In the painful group, there were 21 females and 2males. Majority of this group had mild to moderate pain.The average VAS scale was 2.7 ± 2.3. The maximum painwas 7. Nineteen patients (82.6%) reported duration ofpain at less than 4 hours and frequency of pain at 2-3times per week or less.

In the bruxist group, there were 12 females and 5males. All patients reported frequency of pain at 2-3times per week or less. Sixteen patients (94.1%)

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients 19

reported intensity of pain at score 5 or less (mean 0.6,SD. 1.2) and duration of pain less than 4 hours. In thisstudy, there was no the VAS scale before treatment.

The efficacy of the occlusal splint therapyThirty six patients (90%) thought that the occlusal

splint decreased their symptoms. Majority of patients inboth groups [21 patients (91.3%) in painful group and15 patients (88.2%) in bruxist group] reported that theocclusal splint decreased their pain. There was nosignificant difference between groups. Thirty-eightpatients (95%) still used occlusal splint. Thirty-two(80%) were females and 6 (15%) were males. Twopatients stopped using the appliance because theystopped grinding their teeth and did not have anysymptom. Seventeen patients (73.9%) in painful groupand 15 patients (88.2%) in bruxist group wore theocclusal splint 4-5 days per week or more.

In addition, 10 patients (8 patients were bruxists)thought that occlusal splints could only protect teethfrom wear while the rest of patients believed that occlusalsplints would improve their symptoms. There was asignificant higher efficacy of splint in the group ofpatients who felt that splint will decrease their over allsymptoms than the group of patients who felt that theappliance only protected their dentition from wear (p-value = 0.010).

DiscussionIn this study, majority of patients were female.

Based on clinical populations, chronic TMD occur morefrequently (range from 2:1 to 9: 1) in females than inmales. The higher ratio of females versus males seekingTMD care was consistent with greater health awareness

or interest in symptoms by females than by males.Females tended to report pain on Orofacial region morethan males.21-23 In chronic TMD patients, femalesexhibited significantly more psychosocial distress andimpairment than ones who did not develop chronic TMD.The biopsychosocial differences between males andfemales suggest that some treatments may be morebeneficial for females than for males. The reasons forthis difference were unclear.

From our study, improvement of overall subjectivesymptoms was reported. Patients with pain prior totreatment (91.3%) reported that after using the appliancemore than 6 months their pain decreased. This findingwas supported by the study about the effects of anocclusal splint on chronic signs and symptoms of TMDpatients that revealed the improvement of signs andsymptoms of TMD with the long-term use of the occlusalsplint.24 In contrast, controlled clinical trials concludedthat appliances were not effective.7,16 Marbach & Raphael7

suggested that the positive effect of appliances inuncontrolled studies might be from the methodologicalartifacts, based on the fluctuating course of TMD, thespontaneous improvement with time, and the placeboeffect, and did not recommend the use of appliances forfacial pain.

In the bruxist group, most of them expected thatocclusal splint would stop them from grinding/ clenchingtheir teeth. But there were some patients thought thatocclusal splint could only protect teeth from wear. Theprevious study revealed that occlusal splints worn atnight did not significantly reduce bruxing-clenching activityin bruxing subjects.25 Klineberg26 suggested that occlusalsplints protected the teeth, but did not alter the habit inthe long term. Some studies showed that bruxing activities

Table 1 frequency, intensity and duration of pain in each group.Questions Painful group Bruxist group

% (n= 23) % (n=17)Intensity of pain (VAS scale) at score 5 or less 73.9 (17) 94.1 (16)Frequency of pain at 2-3 times per week or less 82.6 (19) 100 (17)Duration of pain less than 4 hours 82.6 (19) 94.1 (16)The appliance can help and decreased the pain 91.3 (21) 88.2 (15)Wore the appliance 4-5 days per week or more 73.9 (17) 88.2 (15)

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Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients20

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

decreased by approximately 50% during two weeks ofsplint therapy. After withdrawal of treatment, they returnedto baseline levels.27,28 Occlusal splints became wornwhen in use, and wear and tear on the splint indicatescontinuation of the habit; even though patients mightreport that they were no longer aware of clenching theirteeth. Currently, methods of treatment were unknown forexisted that permanently eliminate bruxism. Conservativereversible therapy should be considered as the firstchoice of treatment. Although occlusal appliances didnot cure a patient of bruxing, they could reduce theharmful effects of tooth wear and help reducemusculoskeletal pains.

The result from our study might not show strongevidence to support the efficacy of the occlusal splint dueto limitations in time and number of subjects. Wesuggested that treatment of TMD should always bebased on accurate clinical examination and diagnosis.Basic attention should be given to conservative therapy,including occlusal splint therapy, occlusal adjustmentand physical therapy that facilitates the natural healingcapacity of the musculoskeletal system and to thetreatment that involves patients in the physical andbehavioral management of their problems.

ConclusionAs determined by long term evaluation, the occlusal

splint can help and decrease symptoms whilst patientsûattitude can play a major role in efficacy of occlusal splinttreatment.

AcknowledgementsWe would like to express our sincere thank you to

the following ; Occlusion unit, Special Clinic, GnathologyClinic and Prosthodontics Department Faculty of Dentistry,Mahidol University, for their valuable help in this study.

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4. Laohapan P , Kasetsuwan J. Prevalence of functionaldisorders of masticatory system in dental patients.Mahidol Dental Journal 1986;6:1-11.

5. Clark GT. A critical evaluation of orthopedicinterocclusal appliance therapy: Design, theory andoverall effectiveness. J Am Dent Assoc 1984;108:359-64.

6. Forssell H, Kalso E, Koskela P, Vehmanen R, PuukkaP, Alanen P. Occlusal treatments intemporomandibular disorders: a qualitativesystematic review of randomized controlled trials.Pain 1999;83:549-60.

7. Marbach JJ, Raphael KG. Treatment of orofacial painusing evidence-based medicine: the case for intraoralappliances. In: Campbell, JN(ed) Pain 1996: anupdated review. Seattle: IASP Press 1996:413-22.

8. Marbach JJ, Raphael KG. Future directions in thetreatment of chronic musculoskeletal facial pain:the role of evidence-based care. Oral Surg Oral MedOral Pathol Oral Radiol Endod 1997;83:170-6.

9. Raphael K, Marbach JJ. Evidence-based care ofmusculoskeletal facial pain: implications for theclinical science of dentistry. JADA 1997:128:73-9.

10. Dao TT, Lavigne GJ. Oral splints: the crutches fortemporomandibular disorders and bruxism. Crit RevOral Biol Med 1998;9:345-61.

11. Glass EG, Glaros AG, McGlynn FD. Myofascial paindysfunction: treatments used by ADA members.Cranio 1993;11:25-9.

12. Glass EG, McGlynn FD, Glaros AG. A survey oftreatments for myofascial pain dysfunction. Cranio1991;9:165-8.

13. Pierce CJ, Weyant RJ, Block HM, Nemir DC. Dentalsplint prescription patterns: a survey. JADA1995;126:248-54.

14. Greene CS, Laskin DM. Splint therapy for the myofas-cial pain dysfunction (MPD) syndrome: a comparativestudy. J Am Dent Assoc 1972;84:624-8.

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Kanjana Chavalertsakul Panupen Sitthisomwong Somsak Mitrirattanakul

Long term efficacy of occlusal splint therapy in self-reported bruxists and temporomandibular disorders patients 21

15. Rubinoff MS, Gross A, McCall WD. Conventional andnonoccluding splint therapy compared for patientswith myofascial pain dysfunction syndrome. GenDent 1987;35:502-6.

16. Dao TTT, Lavigne GJ, Charbonneau A, Feine JS, LundJP. The efficacy of oral splints in the treatment ofmyofascial pain of jaw muscles: a controlled clinicaltrial. Pain 1994;56:85-94.

17. Major PW, Nebbe B. Use and effectiveness of splintappliance therapy: Review of literature. Cranio1997;15:159-66.

18. Turk DC, Zaki HS, Rudy TE. Effects of intraoralappliance and biofeedback/stress managementalone and in combination in treating pain and incombination in treating pain and depression inpatients with temporomandibular disorders. JProsthet Dent 1993;70:158-64.

19. Ekberg EC, Vallon D, Nilner M. Occlusal appliancetherapy in patients with temporomandibular disorders.A double blind controlled study in a short-termperspective. Acta Odontol Scand 1998;56:122-8.

20. Ekberg EC, Vallon D, Nilner M. The efficacy ofappliance therapy in patients with temporomandibulardisorders of mainly myogenous origin. A randomized,controlled, short-term trial. J Orofac Pain 2003;17:133-9.

21. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J,Worthington HV. Oro-facial pain in the community:prevalence and associated impact. Community DentOral Epidemiol 2002;30:52›60.

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23. Joseph L, Riley III, Gregg HG. Orofacial pain symptoms:an interaction between age and sex. Pain 2001;90:245-56.

24. Sheikholeslam A, Holmgren K, Riise C. Therapeuticeffects of the plane occlusal splint on signs andsymptoms of craniomandibular disorders in patientswith nocturnal bruxism. J Oral Rehabil1993;20:473›82.

25. Kydd WL and Daly C. Duration of Nocturnal toothcontacts during bruxing. J Prosthet Dent1985;53:717-21.

26. Klineberg, I. Bruxism: aetiology, clinical signs andsymptoms. Aus Prosth J 1994;8:9-17.

27. Pierce CJ and Gale EN. A comparison of differenttreatments for nocturnal bruxism. J Dent Res1988;67:597-601.

28. Rugh JD, Graham GS, Smith JC and Ohrbach RK.Effects of canine versus molar occlusal splintguidance on nocturnal bruxism and craniomandibularsymptomatology. Cranio 1989;3:203-10.

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Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials 23

Original article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Effect of denture cleanser on color stability and flexural strength

of three denture base materials

Khronghatai Kortrakulkij

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

Widchaya Kanchanavasita

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

AbstractObjective: To evaluate the effect of denture cleanser on the color stability andflexural strength of 3 polymeric denture base materials.Materials and methods: Circular discs (20-mm diameter, 2-mm thickness)and rectangular plates (64 mm × 10 mm × 2.5 mm) made of 3 denture basematerials (SR-Triplex Hot, SR-Ivocap Plus and Vitaflex) were stored in eitherdistilled water or Polident solution for 15, 30 and 60 cycles of 5 minutes(n=3). Color stability was determined by the colorimeter and flexural strengthwas determined using the universal testing machine. The data were analyzedseparately for each material using Split-plot ANOVA for color stability, andtwo-way ANOVA for flexural strength at 0.05 significance level.Results: Immersion in either Polident solution or distilled water at anyimmersion periods had no influence on color changes of the materials(p > 0.05). Storage time and storage solution had no effect on the flexuralstrength of SR Ivocap Plus (p > 0.05) while these two factors affected Vitaflexsignificantly (p < 0.05). Only time of storage had an influence on flexuralstrength of SR Triplex Hot (p < 0.05).Conclusion: This study suggests that denture cleanser (Polident) may be thecleanser of choice for patients who use PMMA denture base in terms of colorchanges and flexural strength.Keywords: denture base material, color stability, flexural strength, denturecleanser

correspondence author:

Widchaya Kanchanavasita

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

Received: 22 September 2008

Accepted: 5 February 2009

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Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials24

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials 25

IntroductionColor stability is an important clinical character for

dental restorative materials and is one factor thatprovides information on serviceability of polymeric denturebase.1,2 Discoloration of the polymeric materials may becaused by intrinsic and extrinsic factors. Intrinsic factorsinvolve chemical change within the materials due tooxidation of amine accelerator after exposure to variousenergy sources and long-term immersion in water.Extrinsic factors include staining by adhesion orpenetration of colorants as a result of exposure toexogenous sources in oral cavity such as coffee and tea,beverages and nicotine.3 One or more of these factorsmay contribute to visibly detectable or estheticallyunacceptable color changes of the prosthesis.

Flexural strength is an important mechanicalproperties of the denture base. The denture base mustbe sufficiently strong to allow the prosthesis to withstandfunctional and parafunctional masticatory forces. Midlinefractures of denture base resins are related to flexing anddeformation, leading some to recommend selectivelyincreasing the bulk of material in regions subject todeformation and fractures. However, a denture base thatis too thick can be the cause of discomfort, such asgagging, or dislodgement of the denture when the patientopens mouth wide or yawns, or interfering with thecoronoid process during movement of the mandible andspeech problems. While minimizing the thickness of thedenture base can lead to better patient acceptance, italso increases the potential for fracture making the useof a stronger acrylic resin very important. These factors

have led manufacturers to develop denture base materialswith higher flexural strength.4

Denture wearers show higher prevalence of mutansstreptococci, lactobacilli, staphylococci and yeasts in theoral cavity compared with non-denture wearers. Lack ofdenture hygiene results in malodor, poor aesthetics anddenture stomatitis. Using denture cleansers have beenconsidered to be an efficacious method to preventmicro-organism and denture plaque formation.5

Although there are numerous studies regardingcolor stability and flexural strength of compression-moulding denture base materials, there is a paucity ofevidence on the effects of long-term using denturecleansers on the color stability and flexural strength ofdenture base material. Therefore, the purpose of thisstudy was to investigate the effect of using denturecleanser to soak polymeric denture base materials ontheir long-term color stability and flexural strength.

Materials and methodsThe polymeric denture base materials used in this

study included a compression-moulded acrylic resin, aninjection-moulded acrylic resin and a nylon material(Table 1). Denture cleanser solution was prepared with1 tablet of Polident (Polident 5-minutes, GlaxoSmithKline, USA. Lot number 5T06252A) in 200 ml of distilledwater at 25 °C.

After processing, the specimens were preparedusing carbide bur and finished to the dimensions of 20mm in diameter by 2 mm thickness for color stabilitytesting and 64 mm × 10 mm × 2.5 mm for flexural

Table 1 Denture base materials used in the studyMaterial Type Processing method Manufacturer Lot number

SR Triplex PMMA* Compression-moulded technique, Ivoclar Vivadent, H 12031Hot polymerization up to Liechtenstein

100°C for 45 minSR Ivocap PMMA* Injection-moulded technique, Ivoclar Vivadent, D55588

Plus polymerization for 35 min at 100°C LiechtensteinVitaflex Nylon Injection-moulded technique, pre-heated Thermoplastic 110211

in the furnace for 8 min at 248.8-265.5°C Comfort SystemInc., USA

*PMMA, Poly(methyl methacrylate).

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Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials26

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

strength testing. The surfaces of the specimens werewet polished on the polishing machine using sand paperno. 800, 1000, 1200, 1500, 2000 and 2400,respectively.

The 6 discs of each material were measured fortheir initial color. Three of them were then immersed inPolident solution, the regimen for the immersion beingthat they were immersed in the solution for 5 minutes,rinsed in running water for 30 seconds, and thenimmersed in distilled water for 5 minutes. This wascarried out for 15, 30 and 60 cycles to simulatecleansing of the denture by the patients for 15, 30 and60 times. To investigate the effect of the cleanser, theother three specimens were immersed in distilled waterinstead of Polident solution. After 15, 30 and 60 cyclesof immersion, the specimens were rinsed in runningwater for 30 seconds, blot-dried and measured for theircolor changes by using Colorimeter. The color changesfrom the initial value were reported as ∆E where ∆E = ( ∆L )2 + ( ∆a )2 + ( ∆ b )2 1/2 and ∆L, ∆a and ∆ bare the differences in the respective L, a and b values.

Seven groups of 3 specimens for each materialwere subjected to flexural testing before and afterimmersion in either distilled water or Polident solution at15, 30 and 60 cycles by using a universal testingmachine (Instron Universal Testing machine, model5566, USA) with a constant crosshead speed 5±1 mm/min. Flexural three-point bending strength (σ) inMegaPascal was calculated from σ = 3FL/2bh2 whereF is the maximum load in Newtons exerted on thespecimen, L is the distance (mm.) between the supports,b is the width (mm.) of the specimen, and h is the height

(mm.) of the specimen prior to immersion in solution.The data of the color changes were analyzed using

split-plot ANOVA for each material separately, withimmersion cycles as the ùrepeated-measuresû variableand type of immersion solution as the independentvariable. The flexural strength data were analyzed foreach material separately using two-way ANOVA. Allstatistical analyses were conducted at 5% level ofsignificance.

ResultsThe color changes (∆E) for the denture base

materials immersed in distilled water and Polident solutionfor 15, 30 and 60 cycles are summarized in Table 2.Leveneûs test for homogeneity of variance for eachmaterial was not significant, so this assumption was notviolated. From the tests of between-subjects effects,immersion in either distilled water or Polident solutionhad no significant influence on the color change(p > 0.05). In addition, from the tests of within-subjectseffects, immersion cycles was not significant (p > 0.05)so the time of immersion had no influence on the colorchange.

Flexural strength data are shown in Table 3.Leveneûs test showed that the variance in each testgroup was equal. For each material, the flexural strengthwas affected by immersion solution and immersioncycles differently. For SR Ivocap Plus, storage time andstorage solution had no effect on the flexural strength(p > 0.05) while both factors affected Vitaflex. Theflexural strength of the Vitaflex specimens immersed inPolident solution was significantly higher than those

Table 2 Mean ∆E and standard deviation of the specimens immersed in distilled water and Polident solution for 15,30 and 60 cycles, n=3

Material Immersion 15 cycles 30 cycles 60 cycles Probabilitycycles/solution level

SR Triplex Hot Distilled water 0.37±0.16 0.75±0.28 0.88±0.39 p > 0.05Polident 1.06±0.41 1.19±0.62 1.00±0.37 p > 0.05

SR Ivocap Plus Distilled water 2.04±1.36 2.35±1.47 2.12±1.02 p > 0.05Polident 1.70±0.42 1.21±0.54 0.89±0.72 p > 0.05

Vitaflex Distilled water 1.93±1.41 2.40±2.07 1.98±1.56 p > 0.05Polident 1.09±0.17 1.17±0.42 1.30±0.75 p > 0.05

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials 27

immersed in distilled water for every immersion cycle andsignificantly higher than those before immersion(p < 0.05). For SR Triplex Hot, only 60 immersion cycleshad a significant influence on the flexural strength(p < 0.05).

DiscussionThe sensitivity of human eye in observing color

differences is limited. Johnston and Kao,6 evaluating theassessment of appearance match by visual observationand clinically by colorimetry, stated that the mean colordifference ∆E between compared teeth that were ratedas match in the oral environment was 3.7. The upperlimit of acceptability in subjective visual evaluations hasbeen confirmed by Ruyter et al.7 who suggested that aperceptible discoloration must be referred to as acceptableup to the value of ∆E is equal to 3.3. In those studies,discoloration lower than ∆E equals 3.3 was referred toas acceptable. The color changes of the polymericdenture base materials measured in this study werebelow 3.3, indicating that these changes are not observedclinically.

We found that the color changes of SR Triplex Hotand Vitaflex were unaffected whether the denture cleanserwere used to soak the denture or not. This result was inagreement with Yanus et al.ûs experiment 8 that usingdenture cleansers did not affect color stability ofconventional PMMA and nylon materials. The colorchanges of SR Ivocap Plus may have been the effect ofbutadiene-styrene rubber phase that is included toimprove their resistance to fracture cause by impactforces. It was reported that modification of SR IvocapPlus increases color changes slightly at 24 hours in

ultraviolet light when compared between typical acrylicbut showed slightly changed that would be clinicallyinsignificantly.9

Sato et al.10 stated the denture cleansers did notcause the whitening effect when denture cleansers wereused according to the manufacturersû instructions. Thesefindings are consistent with those of previousinvestigations, which attributed to the whitening effect onchemically cleansed acrylic resin denture base toexcessively high temperature of the water rather than thedenture cleanser itself.

Flexural strength of SR Triplex Hot and Vitaflex wasaffected by storage time. There was significantly differentbetween before (0 cycle) and after immersion (15, 30and 60 cycles) in distilled water and Polident solution.This results from water sorption and solubility of thematerial. When denture base materials are stored in asolution, they absorb water and release solublecomponents. The sorption behavior of denture basematerials depends upon the balance between absorbedwater and loss of plasticizers. At equilibrium, it isassumed that most or all soluble matters have beendissolved and denture base materials are saturated withwater,11 the softness is slowly lost and the materialbecomes rigid12 and causing it to higher flexural strength.13

The amount of water uptake varies for the differentdenture base materials.14 The flexural strength of Vitaflexwas the lowest due to its hydrophilic nature which causesit to absorb a large amount of water and becomes plastic.The flexural strength of Vitaflex was lower when stored indistilled water than in Polident solution. This result mayhave been the higher potassium and sodium ionicconcentration of Polident solution compared to the

Table 3 Mean flexural strength in MPa and standard deviation of the specimens after immersion in distilled waterand Polident solution for 15, 30 and 60 cycles, n=3.

Material Time Solution 0 cycles 15 cycles 30 cycles 60 cyclesSR Triplex Water 67.4 ± 2.9a 68.6 ± 0.5a 71.8 ± 5.7a 76.3 ± 5.1b

Hot Polident 69.3 ± 4.00a 68.4 ± 2.2a 71.4 ± 0.8a

SR Ivocap Water 60.9 ± 0.8m 61.2 ± 0.9m 64.1 ±2.3m 64.6 ± 2.2m

Plus Polident 63.5 ±1.4m 62.2 ±4.1m 63.3 ± 0.5m

Vitaflex Water 20.7 ± 0.4x 21.6 ± 1.1x 23.0 ± 1.2x 23.9 ±1.4x

Polident 26.1 ± 3.8y 25.0 ± 2.8y 26.6 ± 5.2y

Numbers with superscript of the same letter are not significantly different at a = 0.05.

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Khronghatai Kortrakulkij Widchaya Kanchanavasita

Effect of denture cleanser on color stability and flexural strength of three denture base materials28

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

distilled water,15 leading to higher release of solublecomponent and plasticizers. Nylon is promoted as adenture base material on the basis of its flexibility. Theresult of this study agreed with those of Stafford et al.,16

Yunus et al.9 and MacGregor et al.,17 in that nylon wasfound to be more flexible than acrylic resin.

The flexural strength of SR Ivocap Plus was notsignificantly affected by time of storage and storagesolution. It may be the result of butadiene-styrenerubber phase in the material,9 which are hydrophobicand replace the hydrophilic resin, resulting in the decreasein water uptake.

ConclusionWithin the parameters of the present study, the

following conclusions may be made:1. There were no significant difference of color

changes when each polymeric denture base material wasimmersed in either Polident solution or distilled water atany immersion periods.

2. The color changes of all the materials werebelow the perceptible limit of the human eyes

3. The flexural strength was affected for eachmaterial differently. Storage time and storage solutionhad no effect on SR Ivocap Plus but Vitaflex. For SRTriplex Hot, only time of storage had an influence onflexural strength.

4. Nylon materials has lower flexural strengththan PMMA.

References1. Hersek N, Canay S, Uzer G, Yildiz P. Color stability

of denture base acrylic resin in three food colorants.J Prosthet Dent 1999;81:375-8.

2. Buyukilmaz S, Ruyter IE, Nat R, Philos. Color stabilityof denture base polymers. Int J Prosthdont1994;7:372-82.

3. Lai Y, Lui H, Lee S. In vitro color stability, stainresistance, and water sorption of four removablegingival flange materials. J Prosthet Dent2003;89:293-300.

4. Rodford R. Further development and evaluation ofhigh impact strength denture base materials. J Dent1990;18:151-7.

5. Marsh PD, Percival RS, Challacombe SJ. The Influenceof denture- wearing and age on the oral microflora.J Dent Res 1992;71:1374-81.

6. Johnston WM, Kao EC. Assessment of appearancematch by visual observation and clinical colorimetry.J Dent Res 1989;68:819-22.

7. Ruyter IE, Nilner K, Moller B. Color stability of dentalcomposite resin materials for crown and bridgeveneers. Dent Mater 1987;2:246-51.

8. Yunus N, Rashid AA, Azmi LL, Abu-Hassan MI.Some flexural properties of a nylon denture basepolymer. J Oral Rehabit 2005;32:65-71.

9. Craig RG, Powers GM. Restorative Dental Materials.8th ed. St Louis:Mosby Co, 2004;256-84.

10. Sato S, Cavalcante MR, Orsi IA, Paranhos Hde F,Zaniquelli O. Assessment of flexural strength andcolor alteration of heat- polymerized acrylic resinsafter simulated use of denture cleansers. Braz DentJ 2005;16(2):124-8.

11. Braden M, Wright PS. Water sorption and watersolubility of soft lining materials for acrylic dentures.J Dent Res 1983;62:764-8.

12. Aldana L, Marker VA, Kolstad R, Iacopino AM. Effectsof Candida treatment regimens on the physicalproperties of denture resins. Int J Prosthodont1994;7:473-8.

13. Takahashi Y, Chai J, Kawaguchi M. Equilibriumstrength of denture polymers subjected to long-term water immersion. Int J Prosthodont1999;12:348-52.

14. Bates JF, Stafford GD, Huggett R, Handley RW.Current status of pour-type denture base resin. JDent 1977;5:177-89.

15. Graham BS, Jones DW, Sutow EJ. An in vivo and invitro study of the loss of plasticizer from soft polymergel materials. J Dent Res 1991;70:870-3.

16. Strafford GD, Huggett R, McGregor AR, Graham J.The use of nylon as a denture base material. JDent.1986;14:18-22.

17. MacGregor AR, Graham J, Stafford GD, Huggett R.Recent experiences with denture polymers. J Dent1984;12:146.

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Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials 29

Original article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Effect of denture cleanser on surface hardness and roughness

of 3 denture base materials

Tieng Chhnoeum

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University,

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

Widchaya Kanchanavasita

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University,

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

AbstractStatement of problem: Rough surface of prosthesis plays an important rolein the accumulation of plaque while surface hardness indicates its resistanceto wear. As the use of denture cleanser is an alternative method to keep theprosthesis cleaned, it is necessary to know its effect on the surface propertiesof denture base materials.Materials and method: Circular discs (30-mm diameter, 3-mm thickness)of 3 denture base materials (SR-Triplex Hot, SR-Ivocap Plus and Vitaflex)were fabricated using the technique recommended by the manufacturers ofeach material. The specimens (n=3) were stored in either distilled water orPolident solution for 15, 30 and 60 cycles of 5 minutes. The measurementof surface roughness and surface hardness was carried out immediately afterspecimen preparation and after 15, 30 and 60 cycles of immersion,respectively. The data were analyzed using split-plot ANOVA at 0.05significance level.Results: There was no significant changes of the surface roughness of TriplexHot and SR Ivocap Plus when immersed in Polident solution and distilled water(p > 0.05). The roughness of Vitaflex increased with time when immersedin distilled water compared to Polident solution (p < 0.05). Immersion in bothsolutions had no effect on the surface hardness of SR Ivocap Plus (p > 0.05).However, immersion cycles had a significant effect on the surface hardnessof Triplex Hot and Vitaflex (p < 0.05).Conclusion: Immersion of the denture in denture cleanser Polident altered itssurface roughness and surface hardness differently depending on the typesof polymeric material it is made from.Key words: denture base material, surface hardness, surface roughness,denture cleanser

correspondence author:

Widchaya Kanchanavasita

Department of Prosthodontics,

Faculty of Dentistry, Mahidol University,

6 Yothi street, Ratchathewi, Bangkok

10400 Thailand

Received: 22 September 2008

Accepted: 27 January 2009

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Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials30

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials 31

IntroductionKeeping denture out of biofilm can be commonly

done by mechanical method, although this can beineffective because of patientûs lack of motivation.Chemical cleansing is an alternative choice to keep thedental prosthesis clean. The efficacy of denture cleansersin dislodging food debris, biofilm, and tobacco stainsfrom denture surfaces has been previously reported.1,2

Most microorganisms that are present intraorally,especially those responsible for caries, periodontaldisease, and denture-related stomatitis, can only survivein the mouth if they adhere to nonshedding oral surfacesand start forming colonies.3 Bacterial adhesion on harddental surfaces is followed by the accumulation of dentalplaque.4 Surface roughness and the surface free energyplay a key role during this process. Changes in theseclinically important variables might have a significantinfluence on bacterial adhesion and retention. Severalstudies have demonstrated that rough acrylic denturesurfaces are significantly more prone to bacterialaccumulation and plaque formation than smoothsurfaces.4 The result of several in vivo studies suggestedthat a threshold level of surface roughness is Ra=0.2µm. An increase in roughness of a surface beyondthis borderline level resulted in a simultaneous increasein plaque accumulation.5

A major factor that affects a denture base is thatit suffers wear during function or whilst being cleaned. Aswear is due to abrasion, surface hardness is an importantproperty. Hardness is an intrinsic physical property of amaterial indicating its resistance to plastic deformation.It is also the mechanical property most frequently usedto characterize the wear resistance of materials. Amaterial possessing a higher surface hardness is, ingeneral, considered to be more wear resistant.6 Moreover,during hardness measurements, the indenter comes torest when the applied stress is equivalent to the elasticlimit of the material under test, and thus, hardnessmeasurements also give an indication of the elasticlimit.7

Most denture bases are fabricated by thecompression molding technique using powder liquid ofpoly(methyl methacrylate) (PMMA). Although PMMA

has adequate physical and mechanical properties, amajor problem of this material can be seen as thedimensional change during processing, frequently due tothe polymerization shrinkage.8 The problem was overcomeby the introduction of injection molding system thatbelieved to compensate the dimensional error bycontinuous polymer fluid from the injected material.Despite the recommendation that nylon was not forgeneral use, it was considered for special circumstancessuch as unexplainable denture fracture,9-11 for theconstruction of orthodontic appliance12 and may be moreappropriated for polymer allergic patient.

Immersion denture base in denture cleansersolution is very common for the daily uses of the elderlyor disabled patient. However, there is no study about theeffect of denture cleansers on surface roughness andhardness of materials ever done. Therefore, this studyaimed to evaluate the influence of prosthetic cleanserson the surface properties of these materials.

Materials and MethodsThe materials used in this study are shown in table

1. Circular discs which have 30 mm in diameter and 3mm thick were fabricated using the techniquerecommended by the manufacturers of each material. Asthe conventional PMMA, SR-Triplex Hot was fabricatedusing the compression mold method. The powder andliquid were mixed with the ratio of 23.4g:10 ml until thematerial was in dough stage and then filled it in thecompression mold. The mold was subsequently heat-polymerized in boiling water for 45 min at 100°C.

The injection-molded PMMA specimens wereprocessed using the Ivocap flask. Pre-measured capsulesof resin and monomer (20 g polymer, 30 ml monomer)were triturated for 5 minutes before injecting into theflask. Hydraulic pressure was maintained for 5 minutesbefore placing the assembly into boiling water (100°C)for 35 minutes. The assembly was then removed andplaced in cold water for 20 minutes before deflasking.

Nylon material was supplied as a single componentin a cartridge. While nylon was being heated in thefurnace to a temperature of 248.8-265.5°C, the stonemould was also exposed under the heat lamps. The

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Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials32

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

mould was uniformly heated for 10 minutes to atemperature between 204.4 and 232.2°C. The resinmaterial was let melt for approximately 8 minutes in thefurnace. The flask halves were assembled with bracketsand together with the cartridge containing melted nylon;they were placed on the injection unit. The levers of theunit were turned with steady fast motion with continuingpressure until the burst and the springs had compressed,for 3 minutes. The dental flask was bench-coolednaturally for 30 minutes before deflasking. All specimenswere cut and finished to the same dimensions of 30mmin diameter × 3 mm thick. The surfaces of the specimenswere wet polished by sand paper and cleaned by ultrasonicmachine for 25 seconds. Immediately after preparation,the surface roughness and hardness of all specimenswere measured.

Fresh solutions of denture cleanser (Polident 5-minutes, Glaxosmith, Thailand, Lot number 5T06252A)were prepared according to manufacturer instruction byadding one tablet of the cleanser to 200 ml of distilledwater.

The specimens in each group (n=3) of eachmaterial were measured for their initial surface roughnessand hardness. Then they were immersed in Polidentsolution, the regimen for the immersion being that theywere immersed in the solution for 5 minutes, rinsed inrunning water for 30 seconds, and then immersed indistilled water for 5 minutes. This was carried out for 15,30 and 60 cycles to simulate cleansing of the dentureby the patients for 15, 30 and 60 times. To investigatethe effect of the cleanser, the other three specimens

were immersed in distilled water instead of Polidentsolution. After 15, 30 and 60 cycles of immersion, thespecimens were rinsed in running water for 30 seconds,blot-dried and surface roughness and hardness wereremeasured. The surface roughness of each specimenwas measured on 3 areas by the use of a profilometer(Talysurf Series 2, Tylor-Hobson Ltd, Leicester, England),calibrated at sample length of 0.8 mm, 2.4 mm percussionof measure, and the speed of 0.5 mm/s. To ensure thatmeasurements were made in the same place for allspecimens, two reference points were marked on thedenture base of each specimen. The surface hardnesswas assayed by a microhardness tester (FM ARS 9000;Future-Tech Corp., Tokyo, Japan) with a Knoop penetrator.Settings for load and penetration were 50 g and 5seconds. Three penetrations were made randomly on thesurface of each specimen.

The data of this experiment were analyzed usingsplit-plot ANOVA. Statistical analyses were conducted at5% level of significance.

ResultsThe surface roughness and hardness of polymeric

denture base materials before and after immersion indenture cleanser solution and distilled water are shownin Table 2 and 3, respectively. The statistical analysis ofthe data showed that there was no significant changesof the surface roughness of Triplex Hot and SR Ivocapwhen immersed in Polident solution and distilled waterthroughout the 60 cycles (p > 0.05). However, heroughness of Vitaflex increased with time when immersed

Table 1 Denture base materials used in the studyMaterial Type Processing method Manufacturer Lot number

SR Triplex PMMA* Compression-moulded technique, Ivoclar Vivadent, H 12031Hot polymerization up to Liechtenstein

100°C for 45 minSR Ivocap PMMA* Injection-moulded technique, Ivoclar Vivadent, D55588

Plus polymerization for 35 min at 100°C LiechtensteinVitaflex Nylon Injection-moulded technique, pre-heated Thermoplastic 110211

in the furnace for 8 min at 248.8-265.5°C Comfort SystemInc., USA

*PMMA, Poly(methyl methacrylate).

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Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials 33

Table2 Mean and standard deviations of the surface roughness (µm) of the denture base materials (n=3)immersed in Polident 5-minutes solution and distilled water for up to 60 cycles.

MaterialsSR Triplex Hot SR Ivocap Puls Vitaflex

Solution Polident Water Polident Water Polident Water Cycles

0 0.028A,a 0.018A,a 0.042A,a 0.054A,a 0.091A,a 0.174A,m

(0.008) (0.005) (0.012) (0.031) (0.035) (0.029)15 0.024A,a 0.028A,a 0.041A,a 0.051A,a 0.090A,b 0.198A,n

(0.008) (0.009) (0.008) (0.027) (0.045) (0.038)30 0.025A,a 0.034A,a 0.043A,a 0.057A,a 0.088A,c 0.204A,l

(0.001) (0.009) (0.012) (0.023) (0.029) (0.051)60 0.026A,a 0.022A,a 0.042A,a 0.052A,a 0.094A,d 0.228A,o

(0.003) (0.005) (0.008) (0.022) (0.032) (0.058)Means with the same letter were not significantly different at the p=0.05.Within the same materials: capital letters (vertically) showed differences between immersion cycles, small letters (horizontally) show differencesbetween immersion solutions.No comparison made among materials.

Table 3 Mean and standard deviations of the Knoop hardness (Kg/mm2) of the denture base materials (n=3)immersed in Polident 5-minutes solution and distilled water for up to 60 cycles.

MaterialsSR Triplex Hot SR Ivocap Plus Vitaflex

Solution Polident Water Polident Water Polident Water Cycles

0 15.95A,a 16.29M,a 12.58A,a 12.00A,a 6.60A,a 7.59M,a

(0.10) (0.32) (0.93) (2.29) (0.18) (0.16)15 15.84AB,a 16.06MN,a 12.59A,a 13.07A,a 6.66A,a 7.50M,a

(0.10) (0.10) (1.94) (1.55) (0.16) (0.90)30 15.67B,a 15.70N,a 12.00A,a 12.38A,a 6.37B,a 6.83N,a

(0.21) (0.32) (2.65) (2.53) (0.11) (0.41)60 16.71C,a 16.64L,a 12.74A,a 13.03A,a 7.42C,a 7.98O,a

(0.30) (0.25) (2.58) (1.43) (0.28) (0.87)Means with the same letter were not significantly different at the p=0.05.Within the same materials: capital letters (vertically) showed differences between immersion cycles, small letters (horizontally) show differencesbetween immersion solutions.No comparison made among materials.

in distilled water compared to Polident solution(p < 0.05). The hardness of SR Ivocap did not changesignificantly when immersed in both solutions throughoutthe 60 cycles (p > 0.05). However, immersion cycleshad a significant effect on the surface hardness of TriplexHot and Vitaflex (p < 0.05), the hardness increasing atthe end of the 60th cycle.

DiscussionThree denture base materials (SR-Triplex Hot,

SR-Ivocap Plus and Vitaflex) with different type andprocessing method were used in this study to find out theeffect of denture cleanser on their surface hardness byimmersing the specimens into denture cleanser solutionand distilled water for 60 cycles. SR-Triplex Hot is a

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Tieng Chhnoeum Widchaya Kanchanavasita

Effect of denture cleanser on surface hardness and roughness of 3 denture base materials34

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

conventional powder-liquid heat-cured PMMA whileSR-Ivocap Plus is an injection-molding high impactPMMA, and Vitaflex is an injection-molding nylon material.The nylon material is easily stained by coffee solution andtea solution, possesses high water sorption13 anddevelops a rough surface after the patient wears thedenture for a short period of time.9 The inherent flexibilityof nylon was modified and the stiffness was increased bythe use of short glass-fibre reinforcement.14,15 However,this addition may cause more difficulty in finishing thematerial, resulting in rougher surface than PMMA.

The injection-molding method of SR-Ivocap Pluswas developed to improve the impact strength of PMMAdenture base material. However, modification of thematerial by incorporation of the plasticizer is accompaniedby the decrease in the hardness property. In this study,the surface hardness of SR-Ivocap Plus was lower thanTriplex-Hot, and the surface hardness of nylon materialwas the lowest. The surface roughness of nylon materialalso increased when immersed in distilled water than inPolident solution while the surface roughness of PMMAmaterial did not differ when immersed in these solutions.This may be the result of water sorption of the nylonmaterial in which water acts as a plasticizer and softensthe surface. Yu-lin Lai et al. reported that nylon materialwas very hydrophilic and absorb a large amount ofwater.13 Therefore, water sorption of nylon materialcould play an important role in the relatively low surfacehardness and high surface roughness.

When the specimens were stored in the denturecleanser like Polident, the loss of soluble components,such as plasticizer, may have occurred leaving emptyspaces or bubbles.16,17 These bubbles increased in sizewith time, resulting in craters. The crater boundaries laterdiminish and the specimens become smoother.17 Incontrast, when the specimens were immersed in water,the empty spaces did not increase in size, resulting inhigh roughness values. To the authorsû knowledge, nosimilar study available that investigated the effect ofdenture cleanser on the properties of nylon material fordirect comparison.

Rodrigues Garcia et al.18 studied the effect ofdenture cleansers on the surface roughness and hardnessof a microwave-cured acrylic resin and dental alloys bystorage of the denture base materials twice daily indenture cleansers and artificial saliva. The roughnessmeasurements were carried out at baseline, 1st, 15th,and 30th day. It was concluded that immersion ofdenture base materials in commercial cleansers containinghydrogen peroxide did not affect the surface roughnessof PMMA.

Pavarina et al19 investigated the effect ofdisinfectant solutions on the surface hardness of acrylicdenture teeth. They concluded that the absence of anyeffect of immersion solutions on the surface hardness ofthe acrylic denture teeth can be attributed to the cross-linking of the materials. According to OûBrien,20 thecross-linking agent confers two useful properties on thecured denture base resin. Firstly, it reduces the denturebase solubility to organic solvents and secondly, itreduces the tendency of the denture base to craze (formpre-cracks) under stress. The increased hardness of thepowder-liquid PMMA with time may be attributable tofurther polymerization of the PMMA specimen.21 Incontrast, the injection-molding PMMA generally requirea greater monomer content to facilitate flow characteristicsand filling of the mold cavity. This often results inadditional unreacted monomer within a polymerizedresin. In turn, the unreacted monomer may serve as aplasticizer; there reducing the hardness of the polymerizeddenture base resin.

ConclusionWithin the parameters of the present study, it may

be conclude that:1. Immersion of SR-Triplex Hot and SR-Ivocap

Plus in denture cleanser Polident did not alter theirsurface roughness.

2. The roughness of Vitaflex increased with timewhen immersed in distilled water compared to Polidentsolution

3. Immersion in both solutions had no effect onthe surface hardness of SR Ivocap Plus.

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Effect of denture cleanser on surface hardness and roughness of 3 denture base materials 35

References1. Dills SS, Olshan AM, Goldner S, Brogdonl C.

Comparison of the antimicrobial capability of anabrasive paste and chemical-soak denturecleansers. J Prosthet Dent 1988; 60: 467-70.

2. Ödman PA. The effectiveness of an enzyme-containing denture cleanser. Quintessence Int1992;23: 187-90.

3. Bollen CM, Lambrechts P, Quirynen M. Comparisonof surface roughness of oral hard materials to thethreshold surface roughness for bacterial plaqueretention: a review of literature. Dent Mater1997;13:258-69.

4. Quirynen M, Marechal M, Busscher HJ, WeerkampAH, Darius PL, van Steenberghe D. The influence ofsurface free energy and surface roughness on earlyplaque formation. An in vivo study in man. J ClinPeriodontol 1990;17:138-44.

5. Bollen CM, Papaioanno W, Van Eldere J, SchepersE, Quirynen M, van Steenberghe D. The influence ofabutment surface roughness on plaque accumulationand peri-implant mucositis. Clin Oral Implants Res1996;7:201-11.

6. Pintaude G, Tanaka DK, Sinatora A. Effect ofindentation size and microhardness calculation onabrasive wear severity. Scripta. Mater 2001;44:659-63.

7. Dowing EN. Mechanical techniques in materials. 2ed. Englewood Cliffs, NJ: Prentice-Hall, 1998:176-90.

8. Koran A III. Prosthetic applications of polymers. InCraig RG, Powers JM (editors). Restorative Dentalmaterials 11th ed. St Louis:CV Mosby Co, 2002,636-89.

9. Watt DM. Clinical assessment of nylon as a partialdenture base material. Br Dent J. 1955;98:238.

10. Munns D. Nylon as a denture base material. DentPract.1962;13:142.

11. Hallett GEM, Farrell JH. Nylon denture base. DentPract. 1956;6:239.

12. Roberts GH. Nylon in orthodontics: an experiment.Br Dent J. 1956;100:13.

13. Yu-lin, Ho-fu Lui, and Shyh-yuan Lee: In vitro colorstability, stain resistance, and water sorption of fourremovable gingival flange materials. J Prosthet Dent2003;90:293-300.

14. Hargreaves AS. Nylon as a denture base material.Dent Pract. 1971;22:122.

15. MacGregor AR, Graham J, Stafford GD, Huggett R.Recent experiences with denture polymers. J Dent.1984;12:146.

16. Graham BS, Jones DW, Sutow EJ. An in vivo and invitro study of the loss of platizer from soft polymer-gel matrials. J Dent Res 1991;70:870-3.

17. Davenport JC, Wilson HJ, Basker RM. The compatibilityof tissue conditioners with denture cleansers andchlorexidine. J Dent 1978;6:239-46

18. Rodrigues Garcia RC, Joane Augusto de S Jr, RachedRN, Del Bel Cury AA. Effect of denture cleansers onthe surface roughness and hardness of a microwave-cured acrylic resin and dental alloys. J Prosthodont.2004;13:173-8.

19. Pavarina AC, Vergani CE, Machado AL, GiampaoloET, Teraoka MT. The effect of disinfectant solutionson the hardness of acrylic resin denture teeth. J OralRehabil 2003;30:749-52.

20. OûBrien, W.J. Dental Materials and their selection2nd edn, Quintessence Publishing:Chicago, p 79.

21. Lamb DJ, Ellis B, Priestley D: Loss into water ofresidual monomer from autopolymerizing dentalacrylic resin. Biomaterials 1982;3:155-9.

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Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells 37

Original article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

The cytotoxic effect of Andrographis paniculata extract and

Andrographis paniculata gel on human periodontal ligament cells

Sakulwun Noppamassiri

D.D.S. (Second Class Honours)Department of Oral Medicine,Faculty of Dentistry, Mahidol University6 Yothee Road, Rajathevee, Bangkok,10400, Thailand

Mullika Sirirat

Dip. Thai Board of PeriodontologyDepartment of Oral Medicine,Faculty of Dentistry, Mahidol University6 Yothee Road, Rajathevee, Bangkok,10400, Thailand

Rudee Surarit

Ph.D. (Oral Biology)Department of Physiology and Biochemistry,Faculty of Dentistry, Mahidol University6 Yothee Road, Rajathevee, Bangkok,10400, Thailand

Julalux Kasetsuwan

Dip. Thai Board of PeriodontologyDepartment of Oral Medicine,Faculty of Dentistry, Mahidol University6 Yothee Road, Rajathevee, Bangkok,10400, Thailand

Pleumchitt Rojanapanthu

Ph.D. (Pharmaceutics)Department of Pharmacy,Faculty of Pharmacy, Mahidol University447 Sriayuthaya Road, Rajathevee,Bangkok, 10400, Thailand

AbstractObjective: to investigate the cytotoxic effect of Andrographis paniculata (AP)extract and AP gel on human periodontal ligament (PDL) cells.Materials and methods: AP extract, AP gel and gel base at various concentrationswere tested with PDL cells, cultured in Dulbeccoûs Modified Eagle ûs Medium(DMEM) supplemented with 10% fetal bovine serum (FBS). The treated cellsin plastic culture dishes were incubated at 37°C with a humidified atmosphereof 5% CO2 for 48 hours. The cells were subjected to the staining procedurefor the determination of cell cytotoxicity by MTT. The optical density was readby spectrophotometer at 540 nm.Results: AP extract, AP gel and gel base at the concentration of 0.045, 0.45and 0.45 mg/ml, respectively, when tested with PDL cells in DMEM with 10%FBS resulted in almost 100% cell death. The decreased concentrations ofAP extract, AP gel and gel base at 0.0225, 0.225 and 0.225 mg/ml showedthe cell survival of 91.61%, 82.12% and 96.78%, respectively. The lowerconcentrations did not effect the survival of the cells.Conclusion: AP extract and AP gel at the concentration lower than 0.0225and 0.225 mg/ml, respectively were not toxic to human PDL cells.Key words: cytotoxicity, Andrographis paniculata gel, periodontal ligamentcells, Andrographis paniculata extract

Correspondence author:

Sakulwun Noppamassiri

Department of Oral Medicine, Faculty ofDentistry, Mahidol University6 Yothee Road, Rajathevee, Bangkok,10400, Thailand

Tel: 0-2986-9205, 0-2986-9213 ext. 7130Fax: 0-2986-9205Mobile phone 089-163-9945E-mail: [email protected] grant: Faculty of Dentistry, Mahidol

University Grant in academic year 2007Received: 15 December 2008Accepted: 26 March 2009

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Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells38

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells 39

IntroductionPeriodontitis is a chronic inflammatory disease,

caused by putative periodontal pathogens (e.g.Porphyromonas gingivalis, Tannerella forsythia andAggregatibactor actinomycetemcomitans). Host immuneresponses to these bacteria induce inflammation withinthe supporting tissue of teeth, resulting in progressiveattachment loss and alveolar bone loss. Furthermore,several factors that modify host immune responses areequally as important as putative periodontal pathogens.These factors include, but are not limited to, systemicconditions such as diabetes mellitus and compromisedhost defenses, hereditary factors and environmentalfactors such as cigarette smoking and stress.1-3

Andrographis paniculata (AP) is a herbaceousplant in the family Acanthaceae, and known in Thai as FahTalai Joan, Nam Laai Phangphon. The plants are tropicalsmall shrub. The herb has several pharmacologicalactivities including antibacterial activity, anti-inflammatory, antitumor activity, hypotensive effect,antipyretic, antivenom, antigastric ulcer, stimulation ofsmooth muscle, antifilarial activity,4 hepatoprotectiveeffect,5 and immunostimulant effect.6 The leaves extractof Ap when given subcutaneously to rabbits at a dose of10 ml/kg showed no general toxic effect.7 The toxicity ofthe plant powder was studied for 6 months in 96 wisterrats receiving 0.12, 1.2 and 2.4 g/kg/day which wasequivalent to 1, 10 and 20 times the human therapeuticdose (6 g/day/50 kg). There were no abnormalitiesrevealed in growth rate, food consumption, clinical signs,hematological, serum biochemical values orhistopathological changes.8 Currently, this medicinalherb has already been included in the National List ofEssential Drug Committee of Thailand.9 The mostinteresting pharmacological activities of AP treatingperiodontitis are antimicrobial, anti-inflammatory andimmunostimulant activities. This herb consists ofditerpenoid lactone compounds, flavonoid compounds,steroid, phenolic compounds and organic acids. Themain constituents are diterpenoid lactone compoundswhich include andrographolide, dehydroandrographolide,neoandrographolide and deoxyandrographolide.10 It hasbeen reported to be effectively inhibit growth of periodontal

pathogen.7 It has been further developed into gel in orderto be used as a controlled release drug delivery adjunctto scaling and root planing in the treatment of chronicperiodontitis.11-12

The ultimate goal of periodontal therapy is toregenerating the periodontal tissue that are damageddue to the chronic inflammation. During regeneration oflost periodontium, the progenitor cells from the remainingperiodontal tissues must migrate into the affected area,attach to the root surface, proliferate and differentiateinto the cementum, alveolar bone and periodontal ligamentto reconstitution the lost part.13 The evidence thatprogenitor cells for periodontal regeneration are residingin the periodontal ligament was provided in severalstudies.14-16 The periodontal ligament tissue is a highlyspecialized connective tissue which serves to anchor thetooth to the alveolar bone. The major structural componentof the periodontal ligament is collagen. The predominantcell type in the ligament is fibroblasts which serve in themaintenance and remodeling of the ligament.17

To use AP gel in periodontal therapy, it is necessaryto assess the cytotoxicity of AP on the cell types that playthe critical role in the integrity of periodontium. Oneapproach in the assessment of cytotoxicity is to determinethe cellular damage of the cultured cells.

Therefore, the objective of the present study wasto investigate the cytotoxic effect of AP extract and AP gelon the human PDL cells in vitro.

Materials and methodsPreparation of AP extract, AP gel and gel base solution18

AP extract, AP gel and gel base were obtained fromthe Faculty of Pharmacy, Mahidol University. AP extract,AP gel and gel base (90 mg each) were dissolved in 100µl of dimethyl sulfoxide (DMSO, Reidel, Germany) anddiluted with the Dulbeccoûs Modified Eagle ûs Medium(DMEM, Gibco, USA) supplemented with 10% fetalbovine serum (FBS, Hyclone, USA). AP extract (0.0075,0.009, 0.01125, 0.015, 0.0225, 0.045, 0.05625,0.075 and 0.09 mg/ml), AP gel and gel base solution(0.075, 0.09, 0.1125, 0.15, 0.225, 0.45, 0.5625,0.75 and 0.9 mg/ml) were freshly prepared prior to eachexperiment. The final concentration of DMSO in the

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Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells40

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

culture media was not exceed 3 µl/ml which was nottoxic for the PDL cells. The gel base was used as acontrol.

PDL cell cultureThe primary culture PDL cells was performed as

described by Richard and Rutherford.19 Briefly, thehuman PDL cells were obtained by scraping the tissuefrom the middle one-third of the root of premolar or molarteeth extracted for orthodontic purpose. The experimentalprotocol was approved by the ethics committee ofMahidol University (No. MU 2007/086). The tissuewas placed in a sterile Petri dish containing DMEMsupplemented with 10% FBS, amphotericin B (Hyclone,USA) (0.25 µg/ml), penicillin G (Hyclone, USA) (100U/ml) and streptomycin (Hyclone, USA) (100 µg/ml).The treated tissue was cut into small pieces, washedthree times with DMEM and then explanted into themedium in 25 cm2 culture flask. The cells were culturedin an incubator with a humidified atmosphere of 5% CO2

at 37oC. The cell monolayer was grown to subconfluency(80-90%) for 15-20 days. The cells were harvestedby using 0.1% trypsin-versene solution (0.05% EDTA)and subcultured in DMEM with 10% FBS, amphotericinB (0.25 µg/ml), penicillin G (100 U/ml) andstreptomycin (100 µg/ml). The cells obtained frompassage 4-8 were used for the experiments.

Cytotoxicity assayAfter monolayer PDL cells reached more than

90% confluency, cells were trypsinized using 0.1%trypsin-versene solution. The cell density was determinedby a hematocytometer and adjust to approximately2.5×104 cells/ml in DMEM with 10% FBS. Two hundredmicrolitres of the cell suspension were seeded into 96well polystyrene tissue culture plates (Costar, USA)and incubated in an incubator with a humidifiedatmosphere of 5% CO2 at 37°C for 24 hours. The culturemedium was discarded and replaced with 100 µl ofvarious concentrations of AP extract, AP gel and gel basein DMEM containing 10% FBS. The untreated cells wereused as controls. Five wells were included for each

treatment. The cells were incubated under the samecondition for 48 hours and immediately subjected to theMTT assay in order to determine cell viability. For MTTassay as described by Mosmann20, 100 µl of 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetra-zoliumbromide (MTT, Sigma, USA) (5 mg/ml) dissolved inDMEM was added to each well and the plates wereincubated for 2 hours at 37°C. After incubation, the MTTsolution was discarded and traces of the medium wereremoved by blotting the plates on filter papers. Theformazan crystal was solubilized with 100 µl DMSO,leaved for 30 minutes at room temperature and theoptical density (OD) was read at 540 nm by ELISA reader(Model ceries UV 900 Hdi, USA). Three separateexperiments were carried out using PDL cell cultures fromthe different patients.

Statistical analysisThe OD was analyzed by descriptive statistics

(mean and standard deviation). For percentage of PDLsurvival cells compared to the control untreated cells, thedata was calculated using the following equation.

OD of test group - OD of DMSOOD of control group- OD of DMSO

100×

ResultsPDL cell cytotoxicity

The exposure of human PDL cell culture to differentconcentrations of AP extract, AP gel and gel base showedthat cell survival decreased with an increase inconcentrations of AP gel, AP extract and gel base. Thesurvival of cells treated with AP extract at the concentrationof 0.0225 mg/ml was 91.61%, whereas those thattreated with AP gel and gel base at the concentration of0.225 mg/ml were 82.12% and 96.78%, respectively.The cytotoxicity of AP extract was observed at theconcentration higher than 0.0225 mg/ml (Fig. 1), whilethose of AP gel and gel base were at the concentrationhigher than 0.225 mg/ml (Fig. 2). The CD50 (cytotoxicdose) of AP extract, AP gel and gel base to PDL cells were0.033, 0.32 and 0.34 mg/ml, respectively.

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells 41

Survival cells (%)

0

20

40

60

80

100

0 0.02 0.04 0.06 0.08 0.1Concentration (mg/ml)

AP extractCD50

Survival cells (%)

0

20

40

60

80

100

120

0 0.2 0.4 0.6 0.8 1Concentration (mg/ml)

AP gelGel baseCD50

Figure 2: Percentage of PDL survival cells (mean ± standard deviation) after direct exposure to various concentrations of

AP gel and gel base for 48 hrs.

Figure 1: Percentage of PDL survival cells (mean ± standard deviation) after direct exposure to various concentrations of

AP extract for 48 hrs.

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Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells42

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

DiscussionPDL cells play an important role, not only in the

maintaining the integrity of the periodontium but also inpromoting periodontal regeneration. PDL cells consistsof heterogeneous cell populations with fibroblastic,cementoblastic and osteoblastic properties. The evidencethat the progenitor cells for regeneration are residing inthe PDL was provided in studies in which titanium dentalimplants were placed in contact with retained root tipswhose PDL served as a source for cells which couldpopulate the implant surface during healing.13,15 Previousstudies have shown that proper manipulation of PDL cellsis essential for tissue engineering.17-18

One approach to assess the cytotoxicity of the APgel to be used adjunct in the periodontal treatment is todetermine the cytotoxic dose against cultured cells.Thus, in this study the viability of PDL cells was measuredafter treated with AP extract, AP gel and gel base inDMEM with 10% FBS for 48 hours by the colorimetricMTT assay. The MTT assay is based on the capacity ofmitochondrial dehydrogenase enzymes of viable cells toconvert the yellow water-soluble substrate 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide(MTT) into insoluble formazan crystals. The amount offormazan product formed is directly proportional to thecell number. This assay is capable of detecting very smallnumber of viable cells (e.g. 200 cells) in a large numberof samples with a high degree of precision by reading ona scanning multiwell spectrophotometer (ELISA reader).Moreover, the MTT assay can avoid any washing stepsthat increase processing time and sample variation andthe color is stable for a few hours at room temperature.20

The results of this study showed that viable cellnumber was decreased when the concentrations of APextract, AP gel and gel base were increased. The APextract and AP gel at the concentration of 0.045 mg/mland 0.45 mg/ml, respectively and higher resulted inalmost 100% cell death. In contrast, the survival cellswere increased and reached a plateau at the AP extractand AP gel concentration lower than 0.0225 mg/ml and0.225 mg/ml, respectively (Fig. 2). Thus, these resultsindicated the dose dependent cytotoxic effect of APextract and AP gel on PDL cells. AP is one of the most

interesting medicinal herbs because its has severalpharmacological activities. Many types of chemicalcompounds have been isolated from this herbs, includingditerpenoid lactone compounds, flavonoid compounds,steroid, phenolic compounds and organic acids.Andrographolide is a main constituent of diterpenoidlactone compounds in AP.10 Therefore, the concentrationof andrographolide which was determined by using HighPerformance Liquid Chromatography (HPLC) was usedas representative marker of AP containing in AP gel.10

Narakorn12 has reported the antimicrobial effect of AP gelagainst periodontal pathogens with the minimum inhibitoryconcentration (MIC) was 2.015±0.02 mg/ml. UsingHPLC, Kuphasuk et al.23 determined the concentration ofandrographolide in the same AP gel preparation andreported to be 537.708 µg/ml. Moreover, Kuphasuk etal.23-24 investigated the concentration of andrographolidein gingival crevicular fluid at 24 hours after loading AP gel(0.006-0.076 g) in periodontal pockets, theconcentration of 201.964 µg/ml was detected in onlyone tooth from 15 teeth. Recently, Kuphasuk et al.25

have examined the concentration of andrographolide ingingival crevicular fluid, saliva and blood plasma followingthe application of AP gel (0.1-4 mg) into the periodontalpocket after scaling and root planing. The maximumconcentration of andrographolide (10.8582±9.8367µg/ml) in gingival crevicular fluid was detected at the firsthour after application. The andrographolide concentrationwas continued to decrease and after 24 hours application,the concentration of 0.969±2.9638 µg/ml could bedetected in only 2 cases from 12 cases. Theandrographolide in saliva were found upto 1.5 hours atthe concentration of 0.2740±0.5354 µg/ml and couldnot be detected in the plasma. According to the study byGoodson,26 the gingival crevicular fluid (GCF) present ina 5 mm periodontal pocket is replaced about 40 timesan hour, thus, if an antimicrobial agent is placedsubgingivally , its local concentration is rapidly reduced.The results from the present study showed that the lowconcentration of AP gel was not suppressing PDL cellsvitality completely. As mentioned above, this studyimplies that AP gel was harmful to human PDL cells in theshort duration due to the short exposure time with high

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

Sakulwun Noppamassiri Mullika Sirirat Rudee Surarit Julalux Kasetsuwan Pleumchitt Rojanapanthu

The cytotoxic effect of Andrographis paniculata extract and Andrographis paniculata gel on human periodontal ligament cells 43

concentration of the gel when was used as an adjunctwith scaling and root planing.

Although AP gel at the concentration lower than0.225 mg/ml was not toxic to human PDL cells, it couldnot inhibit the periodontal pathogen according to thestudy by Narakorn.12 Narakorn12 has reported theantimicrobial effect of AP gel against periodontal pathogenswith the minimum inhibitory concentration (MIC) was2.015±0.02 mg/ml that was more than the concentrationof AP gel that toxic to PDL cells (0.45 mg/ml). When APgel is loaded subgingivally, it might exerts the antimicrobialactivity as well as the toxicity to PDL cells due to the highconcentration. However, the concentration of AP gel hasbeen shown to rapidly reduce due to GCF clearance.26

Thus, the AP gel at subsequent low concentration mightreach the non-toxic value to PDL cells. Moreover, thestudy has shown that AP gel at 0.5625 mg/ml couldactivated PDL cells migration.18 These concentration isstill more than the concentration of AP gel that toxic toPDL cells in the present study. However, it is possiblethat the disparity in the AP gel preparation might be theresult of the purification process of AP extract that hasbeen improved and produced the higher concentration ofandrographolide in the extract.

From the results of the present study, AP extractand AP gel at the concentration lower than 0.0225 and0.225 mg/ml, respectively will be used in the furtherstudy in order to evaluate the application of AP extractand AP gel on the periodontal regeneration therapy as anadjunct with scaling and root planing.

ConclusionAP extract and AP gel at the concentrations lower

than 0.0225 and 0.225 mg/ml, respectively were nottoxic to human PDL cells.

AcknowledgementsThis study was supported by Faculty of Dentistry,

Mahidol University Grant in academic year 2007. TheFaculty of Pharmacy, Mahidol University supplied the APextract, AP gel and gel base throughout the study. Theauthors thank Mrs. Suwanna Koasuwannawong andMiss Ratchaporn Sirichan, staffs in Research Unit,

Faculty of Dentistry, Mahidol University for their suggestionon cell culture protocol.

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∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Microleakage of two fluoride-releasing pit and fissure sealants

Praphasri Rirattanapong

M.Sc. (Pediatric Dentsitry),

Cert. in Orthodontics

Department of Pediatric Dentistry, Faculty

of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi, Bangkok

10400 Thailand

Katkao Vongsavan

Grad. Dip. in Clin. Sc. (Pediatric Dentistry),

Cert. in Training Orthodontics

Department of Pediatric Dentistry, Faculty

of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi, Bangkok

10400 Thailand

Rudee Surarit

M.Sc. (Biochemistry), Ph.D. (Oral Biology)

Department of Physiology, Faculty of

Dentistry, Mahidol University

6 Yothi Street, Ratchathewi, Bangkok

10400 Thailand

AbstractObjective: The purpose of this study was to evaluate the degree ofmicroleakage exhibited by two fluoride-releasing sealants.Materials and methods: Thirty third

molars were randomly divided into 3groups. There were 10 teeth for each group. Sample groups were determinedto 3 types of sealant : Group 1 - Non-fluoride-releasing resin sealant :ConciseTM , 3M ESPE, USA), Group 2 › Fluoride-releasing resin sealant :ClinproTM, 3M ESPE, USA) and Group 3 › Glass ionomer sealant : Fuji VII

GC Corp., Japan). The specimens were thermocycled for 2,000 cyclesbetween 5 °C and 55 °C, dwell time of 15 s. All specimens were immersedin 2% methylene blue solution for 24 hours. Each specimen was sectioned.Microleakage evaluation of dye penetration between sealing material andenamel were measured under polarized microscope at 25 × magnification.Data were analyzed using Kruskal- Wallis and Mann-Whitney U test.Results: The microleakage of non-fluoride-releasing resin sealant andfluoride-releasing resin sealant were not significantly different. Themicroleakage of glass ionomer sealant was significantly greater than of thoseresin sealants.Conclusion: Microleakages of glass ionomer sealant was significantly greaterthan those of resin-based sealant.Key words: Concise, Clinpro, Fluoride-releasing resin sealant, Fuji VII, Glassionomer sealant, Microleakage, Non-fluoride-releasing resin sealant

Correspondence author :

Praphasri Rirattanapong

Department of Pediatric Dentistry

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi, Bangkok

10400 Thailand

Tel: 02-203-6450

Fax: 02-203-6450

Email: [email protected]

Received: 26 November 2008

Accepted: 30 April 2009

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à«πª√–°Õ∫ ÿ¥∑⓬§◊Õ ‡∫π‚´Õ‘π‡¡∏‘≈Õ’‡∑Õ√å (benzoin

methyl ether) ´÷Ë߇ªìπµ—«‡√àß„Àâ “√·¢Áßµ—«¥â«¬· ßÕ—≈µ√“

‰«‚Õ‡≈∑ (ultraviolet activated)13 ‡¡◊ËÕµ‘¥µ“¡º≈‡ªìπ‡«≈“

2 ªï æ∫«à“ “¡“√∂≈¥°“√ºÿ∫π¥â“π∫¥‡§’Ȭ«‰¥â∂÷ß√âÕ¬≈– 99

„πøíπ·∑â ·≈–√âÕ¬≈– 87 „πøíππÈ”π¡14

µàÕ¡“¡’°“√æ—≤π“‡æ◊ËÕ„À≥⫗ ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

™π‘¥∑’ˇ°‘¥ªØ‘°‘√‘¬“°“√·¢Áßµ—«¥â«¬· ß∑’Ë¡Õ߇ÀÁπ‰¥â (visible

light cured) ‡æ◊ËÕ§«“¡ –¥«°¢Õß∑—πµ·æ∑¬å„π°“√

°”À𥇫≈“∑”ß“π √à«¡°—∫°“√„™âæ≈—ßß“π„™â· ß ’πÈ”‡ß‘π

(blue light energy) ‡ªìπµ—«°√–µÿâπ ∑”„Àâ¡’º≈‘µ¿—≥±å«— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπÕ’°À≈“°À≈“¬™π‘¥‡°‘¥¢÷Èπ¡“

¡’°“√·∫àß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ‡ªìπ 3 √ÿàπ

(generation) §◊Õ™π‘¥·¢Áßµ—«¥â«¬· ßÕ—≈µ√“‰«‚Õ‡≈∑ ™π‘¥

·¢Áßµ—«¥â«¬µ—«‡Õß (autopolymerizing) ·≈–™π‘¥·¢Áßµ—«

¥â«¬· ß∑’Ë¡Õ߇ÀÁπ‰¥â „πªí®®ÿ∫—πÕ“®°≈à“«‰¥â«à“«— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’Ë¡’°“√‡µ‘¡ø≈ŸÕÕ‰√¥åÀ√◊Õ«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘πª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å (fluoride

releasing resin sealant) ®—¥‡ªìπ«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

√ÿàπ∑’Ë 415,16

°“√‡µ‘¡ø≈ŸÕÕ‰√¥å≈ß„π«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ ¡’

®ÿ¥ª√– ߧå‡æ◊ËÕ¬—∫¬—Èß°“√ Ÿ≠‡ ’¬·√à∏“µÿ(inhibit deminera-

lization) ·≈–‡æ‘Ë¡°“√ – ¡°≈—∫¢Õß·√à∏“µÿ(promote

remineralization) √«¡∑—Èß°“√‡°‘¥º≈÷°ø≈ŸÕÕ‚√Ֆ擉∑∑å

(fluoroapatite crystal) ∑’Ë·¢Áß·√ߢ÷Èπ ·≈–≈¥°“√≈–≈“¬

¢Õߺ‘«‡§≈◊Õ∫øíπ17 °“√π”‡Õ“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥

‡√´‘π∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å (fluoride releasing resin

sealant) ¡“·∑π∑’Ë«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ¥—È߇¥‘¡∑’Ëπ‘¬¡

„™â„π§≈‘π‘°∑—Ë«‰ª ´÷Ë߇ªìπ«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’ˉ¡àª≈¥

ª≈àÕ¬ø≈ŸÕÕ‰√¥å (non-fluoride releasing resin sealant)

´÷Ëß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ§«√¡’Õ—µ√“°“√¬÷¥µ‘¥∑’Ë¥’°«à“

À√◊Õ„°≈⇧’¬ß°—∫«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ¥—È߇¥‘¡·≈– “¡“√∂

ª≈àÕ¬ø≈ŸÕÕ‰√¥å‰¥â‡ªìπ‡«≈“π“π17 ¡’√“¬ß“π¢Õß Morphis

·≈–§≥–„πªï§.».2000 √ÿª«à“°“√‡µ‘¡ø≈ŸÕÕ‰√¥å≈ß„π

µ‘¥«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ‰¡à‰¥â∑”„Àâ§ÿ≥ ¡∫—µ‘°“√¬÷¥µ‘¥

Ÿ≠‡ ’¬‰ª18 √“¬ß“π¢Õß Jensen·≈–§≥–„πªï§.».1990

æ∫«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘πª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å

¡’Õ—µ√“°“√¬÷¥µ‘¥∑’Ë Ÿß°«à“‡≈Á°πâÕ¬‡¡◊ËÕ‡∑’¬∫°—∫«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘π∑’ˉ¡àª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å„π√–¬–‡«≈“

1 ªï19 ·µà√“¬ß“π¢Õß Lygidakis ·≈–§≥–„πªï§.».1990

√ÿª«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘πª≈¥ª≈àÕ¬ø≈ŸÕÕ-

‰√¥å ¡’Õ—µ√“°“√¬÷¥µ‘¥∑’ËπâÕ¬°«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

Page 52: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

ª√–¿“»√’ √‘√—µπæß…å §—¥‡§â“ «ß…å «√√§å ƒ¥’ ÿ√“ƒ∑∏‘Ï

°“√√—Ë«´÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Õß™π‘¥48

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

™π‘¥‡√´‘π∑’ˉ¡àª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å„π√–¬–‡«≈“ 4 ªï20 ·≈–

°“√»÷°…“¢Õß Morphis √ÿª«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

™π‘¥‡√´‘πª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å ·≈–«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕß

øíπ™π‘¥°≈“ ‰Õ‚Õ‚π‡¡Õ√å(fluoride glass sealant)

‡ª√’¬∫‡∑’¬∫°—∫«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘π∑’ˉ¡àª≈¥

ª≈àÕ¬ø≈ŸÕÕ‰√¥å æ∫«à“ ‰¡à¡’§«“¡·µ°µà“ß°—πÕ¬à“ß¡’π—¬

”§—≠∑’ˇ«≈“ 3 ‡¥◊Õπ 6 ‡¥◊Õπ 12 ‡¥◊Õπ21 √ÿª‰¥â«à“ °“√

»÷°…“∑’ˇ°’ˬ«¢âÕß°—∫§ÿ≥ ¡∫—µ‘°“√¬÷¥µ‘¥¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡

√àÕßøíπ·∫∫ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥åπ—Èπ¬—ߧߡ’º≈ √ÿª∑’Ë·µ°

µà“ß°—πÕÕ°‰ª„πÀ≈“¬Ê¥â“π Õ’°∑—È߬—߉¡à¡’√“¬ß“πº≈∑’Ë

¬◊π¬—π·πàπÕπ«à“°“√‡µ‘¡ø≈ŸÕÕ‰√¥å¡’º≈°√–∑∫µàÕ§ÿ≥ ¡∫—µ‘

°“√¬÷¥µ‘¥Õ¬à“߉√ ‚¥¬„πªí®®ÿ∫—π¡’º≈‘µ¿—≥±å«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å™π‘¥„À¡à §◊Õ

§≈‘π‚ª√ (ClinproTM) ´÷Ëß¡’≈—°…≥–‡ªìπÕÕ·°π‘°ø≈ŸÕÕ‰√¥å

∑’Ë≈–≈“¬‰¥â„ππÈ”(soluble oraganic fluoride force) ¡’ ’™¡æŸ

·¢Áßµ—«¥â«¬· ß∑’Ë¡Õ߇ÀÁπ‰¥â ‡¡◊ËÕ·¢Áßµ—«®–‡ª≈’Ë¬π®“° ’™¡æŸ

‡ªìπ ’¢“«™à«¬„À⠗߇°µ°“√·¢Áßµ—«¢Õß«— ¥ÿ‰¥â –¥«°¬‘Ëߢ÷Èπ

·≈–πÕ°®“°π—Èπ¬—ß¡’§«“¡Àπ◊¥µË”´÷Ë߇ªìπ§ÿ≥ ¡∫—µ‘∑’Ë¥’¢Õß

«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπÕ’°¥â«¬22

¡’°“√æ—≤π“„™â«— ¥ÿÕ’°™π‘¥Àπ÷Ëß∑’Ë¡’§«“¡ “¡“√∂„π

°“√‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ §◊Õ °≈“ ‰Õ‚Õ‚π‡¡Õ√å´’‡¡πµå

(glass-ionomer cement) ‡π◊ËÕß®“° “¡“√∂‡ªìπ·À≈àß

°—°‡°Á∫ (reservoir) ·≈–ª≈àÕ¬ø≈ŸÕÕ‰√¥å ‡Àµÿº≈∑’ˇ≈◊Õ°„™â

§◊Õ “¡“√∂‡°‘¥æ—π∏–‡§¡’°—∫º‘«‡§≈◊Õ∫øíπ ·≈–ª≈àÕ¬

ø≈ŸÕÕ‰√¥å‰¥â ·µà¡’¢âÕ¥âÕ¬§◊Õ °“√¬÷¥µ‘¥°—∫º‘«øíπ‰¡à¥’23-25

°“√„™âß“π∑’ˬÿà߬“°26,27

¡’À≈“¬°“√»÷°…“‡°’ˬ«°—∫°“√ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å

¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥°≈“ ‰Õ‚Õ‚π‡¡Õ√凪√’¬∫

‡∑’¬∫°—∫«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥Õ◊ËπÊ æ∫«à“«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥°≈“ ‰Õ‚Õ‚π‡¡Õ√å “¡“√∂∑”Àπâ“∑’ˇªìπ

·À≈àߥŸ¥°≈—∫¢Õßø≈ŸÕÕ‰√¥å ·≈–ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Ÿà™àÕß

ª“°„πª√‘¡“≥µË”Ê ‡æ◊ËÕªÑÕß°—πøíπºÿ‰¥â¥’°«à“«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥Õ◊ËπÊ28

‰¥â¡’°“√º≈‘µøŸ®‘‡´‡«àπ (Fuji VII) ´÷Ë߇ªìπº≈‘µ¿—≥±å

«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥„À¡à ‡ªìπ√Ÿª·∫∫Àπ÷ËߢÕß

°≈“ ‰Õ‚Õ‚π‡¡Õ√å´’‡¡πµå “¡“√∂π”¡“ª√—∫„À¡à„π

§≈‘π‘°‰¥âÀ≈“¬≈—°…≥–°“√„™âß“π‚¥¬‡©æ“–°“√„™â‡ªìπ

«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ ‡π◊ËÕß®“°¡’§ÿ≥ ¡∫—µ‘∑πµàÕ§«“¡

™◊Èπ„π™àÕߪ“°‰¥â ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å‰¥â„πª√‘¡“≥¡“°

¡’°“√‰À≈·ºà‰¥â¥’ ·≈–‡°‘¥°“√·≈°‡ª≈’ˬπª√–®ÿ√–À«à“ßµ—«

«— ¥ÿ·≈–º‘«‡§≈◊Õ∫øíπ∑”„À⇰‘¥°“√¬÷¥µ‘¥29

„πªï§.». 2007 Ganesh ·≈– Shobha ‰¥â»÷°…“§à“

§«“¡ “¡“√∂„π°“√ªÑÕß°—π°“√√—Ë«´÷¡„π¿“«–∑’ˉ¡à¡’°“√

ªπ‡ªóôÕππÈ”≈“¬¢Õß«— ¥ÿ™π‘¥§Õπ‰´ å ·≈–øŸ®‘‡´‡«àπ æ∫«à“

øŸ®‘‡´‡«àπ¡’°“√√—Ë«´÷¡¡“°°«à“§Õπ‰´ åÕ¬à“ß™—¥‡®π30

°“√«‘®—¬§√—Èßπ’È¡’«—µ∂ÿª√– ߧå‡æ◊ËÕ»÷°…“º≈°“√√—Ë«´÷¡

¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’Ë “¡“√∂ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å

‰¥â Õß™π‘¥

«— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√∑¥≈Õßπ”øíπ°√“¡´’Ë∑’Ë “¡∑’ˉ¡à¡’√Õ¬ºÿ À—° ∫Ÿ√≥– À√◊Õ欓∏‘

¿“æ„¥Ê ·≈– ¡’À≈ÿ¡√àÕßøíπ·¬°‡ªìπÀ≈ÿ¡∑“ߥâ“π„°≈â

°≈“ß·≈–‰°≈°≈“ßÕ¬à“ß™—¥‡®π ®”π«π 30 ´’Ë ‡°Á∫„πµŸâ‡¬Áπ

∑’ËÕÿ≥À¿Ÿ¡‘ 4 Õß»“‡´≈‡ ’¬ ‚¥¬·™à‰«â„ππÈ”‡°≈◊Õ ·∫àßøíπ

ÕÕ°‡ªìπ 3 °≈ÿà¡ °≈ÿà¡≈– 10 ´’Ë ‚¥¬«‘∏’°“√ ÿࡵ—«Õ¬à“ß

·∫∫ ÿà¡ ‡æ◊ËÕπ”¡“Õÿ¥À≈ÿ¡√àÕßøíπ¥â«¬«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕß

øíπ 3 ™π‘¥ °≈ÿà¡∑’Ë 1 : «— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘π∑’Ë

‰¡àª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å › §Õπ‰´ å (ConciseTM, 3M ESPE,

St.Paul, MN, USA) °≈ÿà¡∑’Ë 2 : «— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

™π‘¥‡√´‘π∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å › §≈‘π‚ª√ (ClinproTM,

3M ESPE, St.Paul, MN, USA) ·≈– °≈ÿà¡∑’Ë 3 : «— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥°≈“ ‰Õ‚Õ‚π‡¡Õ√å › øŸ®‘‡´‡«àπ (Fuji

VII, GC Corp., Tokyo Japan) ‚¥¬∑”§«“¡ –Õ“¥øíπ°àÕπ

∑”°“√∑¥≈Õߥ⫬‡§√◊ËÕß∑”§«“¡ –Õ“¥√–∫∫Õ—≈µ√â“‚´π‘§

(Ultrasonic Sonicator model vibraclean 300, MDT

CORPOLATION, CA, USA)

À≈—ß®“°∑’Ë∑”§«“¡ –Õ“¥øíπ·≈â«π”øíπ¡“Õÿ¥À≈ÿ¡

√àÕßøíπ¥â«¬«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ·µà≈–™π‘¥µ“¡°≈ÿà¡∑’Ë

·∫à߉«â ‚¥¬∑”µ“¡§”·π–π”¢Õß∫√‘…—∑ (µ“√“ß∑’Ë 1) π”

øíπ∑’ˉ¥â‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ·≈â«¡“·™à„ππÈ”°≈—Ëπ∑’ËÕÿ≥À¿Ÿ¡‘

37 Õß»“‡´≈‡´’¬ ‡ªìπ‡«≈“ 24 ™—Ë«‚¡ß „πµŸâ§«∫§ÿ¡Õÿ≥À¿Ÿ¡‘

À≈—ß®“°π—Èππ”øíπ¡“ºà“π°“√‡ª≈’ˬπ·ª≈ßÕÿ≥À¿Ÿ¡‘√âÕπ

‡¬Áπ·∫∫®—ßÀ«–(Thermocycling machine, Mongkutûs

Institute of Technology Ladkrabang, Bangkok, Thailand)

∑’ËÕÿ≥À¿Ÿ¡‘√–À«à“ß 5±2 ·≈– 55±2 Õß»“‡´≈‡ ’¬ √Õ∫≈–

30 «‘π“∑’ ®”π«π 2000 √Õ∫ ‡æ◊ËÕ‡ªìπ°“√®”≈Õß ¿“«–

„π™àÕߪ“° À≈—ß∑”°“√‡§≈◊Õ∫À≈ÿ¡·≈–√àÕßøíπ

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

ª√–¿“»√’ √‘√—µπæß…å §—¥‡§â“ «ß…å «√√§å ƒ¥’ ÿ√“ƒ∑∏‘Ï

°“√√—Ë«´÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å Õß™π‘¥ 49

Table 1 Materials and techniques used in the study

Materials Composition Procedures

ConciseTM (Light Cure - Triethylene glycol dimethacrylate 1. Etched enamel with 35% phosphoric resin sealant, - Bisphenol A diglycidylether acid for 15 seconds.3M ESPE, St.Paul, -dimethacrylate 2. Rinsed for 15 seconds using an airMN,USA, Lot No. - Benzoyl peroxide syringe.20070709) - Tertialry amine of dimethyl- 3. Dried the etched surface until the

paratoluidine enamel displays a white, frosty- Silica appearance.- Titanium dioxide 4. Applied sealant by using a brush and- Stable iron oxides followed by an explorer to avoid the

appearance of bubbles.5. Light activation for 20 seconds.

ClinproTM (fluoride - Triethylene glycol dimethacrylate 1. Etched enamel with 35% phosphoriccontaining resin - Bisphenol A Diglycidyl methacrylate acid for 15 seconds.sealant, 3M ESPE, - Ethyl 4-(dimethylamino)benzoate 2. Rinsed for 15 seconds using an airSt.Paul, MN, USA., - Diphenyliodonium hexafluorophosphate syringe.Lot No. 20070416 ) - DL-Camphorquinone 3. Dried the etched surface until the

- Buthylated hydroxytoulene enamel displays a white, frosty- Dichorodimethylsilane reaction product appearance.with silica 4. Applied sealant by using a brush and- Tetrabutylammonium tetrafluoroborate followed by an explorer to avoid the- Titanium Dioxide appearance of bubbles.- Rose bengal sodium 5. Light activation for 20 seconds.

Fuji VII (glass Power 1. Applied GC Dentin Conditioner for 20ionomer sealant, GC - Alumino-silicate glass seconds.Fuji, Tokyo, Japan, Liquid 2. Rinsed teeth with water for 20 seconds.Lot No. 0407011) - Polyacrylic acid 3. Dried by gently blowing using an air

- Distilled water syringe. Best result are obtained whenprepare surfaces appear moist(glistening).4. Took the mixed material (power/liquiddispensing and mixing accordingmanufacturer) using a suitable placementinstrument or brush and applied to thetooth surface. Then used a brush tospread a thin film of GC Fuji VII directlyover the occlusal surface and into the pitand fissures.5. Light activation for 20 seconds.6. Applied GC Fuji VII varnish (blow dry)to the sealed area and the margins usinga cotton pellet.

Page 54: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

ª√–¿“»√’ √‘√—µπæß…å §—¥‡§â“ «ß…å «√√§å ƒ¥’ ÿ√“ƒ∑∏‘Ï

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¬°‡«âπ∫√‘‡«≥ 1 ¡¡.Àà“ß®“°¢Õ∫‚¥¬√Õ∫¢Õß«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ ·≈–ªî¥√Ÿ‡ªî¥ª≈“¬√“°¥â«¬¢’Ⱥ÷ÈßÕ√√∂ª√–‚¬™πå

(Utility wax) ‡æ◊ËÕªÑÕß°—π°“√√—Ë«´÷¡®“°∫√‘‡«≥Õ◊Ëπ∑’ˉ¡à

‡°’ˬ«¢âÕß·™àøíπ„π “√≈–≈“¬ 2% ‡¡∑‘π≈’π ∫≈Ÿ (methylene

blue) ‡ªìπ‡«≈“ 24 ™¡. ‡æ◊ËÕ®”≈Õß°“√∑’Ë¡’πÈ”≈“¬·∑√°‰ª

µ“¡™àÕß«à“ß√–À«à“ߺ‘«‡§≈◊Õ∫øíπ·≈–«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕß

øíπ ‡Õ“¢’Ⱥ÷ÈßÕÕ°·≈â«π”øíπ¡“≈â“ßπ”øíπ¡“µ—¥„π·π«¥â“π

„°≈â·°â¡-„°≈â≈‘Èπ (bucco-lingual direction) ¥â«¬‡§√◊ËÕß

µ—¥øíπ (Accutom-50, Streuers, Compenhagen, Denmark)

‚¥¬∑”°“√µ—¥ºà“πÀ≈ÿ¡„°≈â°≈“ß (mesial pit) ·≈– À≈ÿ¡

‰°≈°≈“ß (distal pit) ™‘Èπ à«π∑’˵—¥¡“®–‰¥â‡ªìπ 3 ™‘Èπµ—«Õ¬à“ß

∑”°“√ ÿࡵ—«Õ¬à“ß (random sampling) ‡æ’¬ß 1 ™‘Èπ

µ—«Õ¬à“ß„π·µà≈– ’Ë ¡“«—¥√–¬–°“√√—Ë«´÷¡¿“¬„µâ

°≈âÕß®ÿ≈∑√√»πå‚æ≈“‰√´å (Polarized Light microscope,

Nikon Model eclipse E400 pol, Tokyo, Japan) °”≈—ß

¢¬“¬‡≈π å„°≈â«—µ∂ÿ 25 ‡∑à“35

°“√«—¥°“√√—Ë«´÷¡ (Microleakage scoring)

π”™‘Èπ à«πµ—«Õ¬à“ß „π·µà≈–°≈ÿà¡ ¡“«—¥√–¬–°“√√—Ë«

´÷¡µ“¡«‘∏’¢Õß Zyskind ·≈–§≥–31 ‚¥¬¥Ÿ¥â«¬

°≈âÕß®ÿ≈∑√√»πå‚æ≈“‰√ å °”≈—ߢ¬“¬ 25 ‡∑à“ ·≈â«π”

°≈âÕß∂à“¬√Ÿª¥‘®‘µÕ≈∫—π∑÷°¿“æ(Nikon Coolpix 900, Tokyo,

Japan) À≈—ß®“°π—Èππ”√Ÿª¡“«‘‡§√“–Àå„π§Õ¡æ‘«‡µÕ√å¥â«¬

‚ª√·°√¡Õ‘¡‡¡® ‚ª√ æ≈— (Image-Pro Plus, Media

Cybernetics, MD, USA)«—¥√–¬–°“√√—Ë«´÷¡¢Õß “√‡¡∏‘≈’π ∫≈Ÿ

„µâ«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡·≈–√àÕßøíπ„π·µà≈–¥â“π‡∑’¬∫°—∫√–¬–º‘«

—¡º— √–À«à“ß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡·≈–√àÕßøíπ°—∫º‘«‡§≈◊Õ∫øíπ

(enamel surface/sealant interface) ¢Õߥâ“π¥—ß°≈à“« ¥—ß

· ¥ß„π√Ÿª∑’Ë 1 ·≈â«π”§à“Õ—µ√“°“√√—Ë«´÷¡∑’ˉ¥â¡“À“§à“‡©≈’ˬ

·≈–§à“‡∫’ˬ߇∫π¡“µ√∞“π ¥—ß· ¥ß„πµ“√“ß∑’Ë 2

°“√∑¥ Õ∫§«“¡‡™◊ËÕ∂◊Õ¢ÕߺŸâ«—¥º≈°“√∑¥≈Õß

(Intraexaminer reliability)

ÿà¡™‘Èπ à«πµ—«Õ¬à“ß (sample)¡“ 10 µ—«Õ¬à“ß (30%

¢Õßµ—«Õ¬à“ß∑—ÈßÀ¡¥) ‚¥¬«‘∏’ ÿࡵ—«Õ¬à“ß·∫∫ ÿà¡ ¡“«—¥

√–¬–°“√√—Ë«´÷¡µ“¡«‘∏’¥—ß√Ÿª∑’Ë 1 ‚¥¬ ÿà¡ ≈—∫µ—«Õ¬à“ß¡“«—¥´È”

µ—«Õ¬à“ß≈– 2 §√—Èß ·≈â«π”§à“¡“∑¥ Õ∫§«“¡‡™◊ËÕ∂◊Õ¢ÕߺŸâ

«—¥º≈°“√∑¥≈Õß (Intraexaminer reliability) ‚¥¬„™â ·æ√å

∑’‡∑ µå (Pair-T test) ‡ªìπ ∂‘µ‘∑¥ Õ∫

Figure 1: The diagram of the microleakage scoring of pit and fissure sealants

A and C = The length of sealant - tooth interface (mm) B and D = The length of dye penetration (mm) Scoring

of microleakage = B+D/A+C

Table 2 Mean± standard deviation of the ratio of

microleakage of pit and fissure sealants

Group Mean± SD

1. ConciseTM 0.024 ± 0.022 a

2. ClinproTM 0.009 ± 0.014 a

3. Fuji VII 0.679 ± 0.277 b

Mean microleakage with the same letters are not significantly different

(p>0.05)

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(Intraexaminer reliability) º≈ª√“°Ø«à“ §à“°“√√—Ë«´÷¡∑’ˉ¥â

®“°°“√«—¥§√—Èß∑’Ë 1 ·≈–§√—Èß∑’Ë 2 ‰¡à·µ°µà“ß°—πÕ¬à“ß¡’π—¬

Ӥѭ

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«‘ π’¬å ¬Ÿ æ∫«à“ «— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π‰¡àª≈¥

ª≈àÕ¬ø≈ŸÕÕ‰√¥å(§Õπ‰´ å) ·≈– «— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥

‡√´‘πª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å(§≈‘π‚ª√) ¡’§à“Õ—µ√“°“√√—Ë«´÷¡

∑’ˉ¡à·µ°µà“ß°—π (p > 0.05) ·µà«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

°≈“ ‰Õ‚Õ‚π‡¡Õ√å¡’§à“Õ—µ√“°“√√—Ë«´÷¡∑’Ë¡“°°«à“«— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑—Èß Õß™π‘¥Õ¬à“ß¡’π—¬ ”§—≠

(p < 0.05) ¥—ß· ¥ß„π√Ÿª∑’Ë 2-4

∫∑«‘®“√≥宓°°“√∑¥≈Õßæ∫«à“§à“Õ—µ√“°“√√—Ë«´÷¡¢Õß«— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑’ˉ¡àª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å·≈–

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ª≈àÕ¬ø≈ŸÕÕ‰√¥å ¥—ßπ—Èπº≈°“√∑¥≈Õßπ’È®÷ß· ¥ß„Àâ‡ÀÁπ‰¥â

«à“°“√‡µ‘¡ø≈ŸÕÕ‰√¥å‡¢â“‰ª„π«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥

‡√ ‘π‰¡à àߺ≈µàÕ§à“°“√√—Ë« ÷¡¢Õß«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ

°“√»÷°…“π’Èæ∫«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥

°≈“ ‰Õ‚Õ‚π‡¡Õ√å¡’§à“Õ—µ√“°“√√—Ë«´÷¡¡“°°«à“«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑’ˉ¡àª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å·≈–«— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√´‘π∑’˪≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥åÕ¬à“ß

¡’π—¬ ”§—≠ ÷Ëß Õ¥§≈âÕß°—∫º≈°“√»÷°…“¢Õß Ovrebö ·≈–

§≥–∑’Ëæ∫«à“¡’°“√√—Ë«´÷¡Õ¬à“ß¡“°„π«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕß

øíπ°≈ÿà¡°≈“ ‰Õ‚Õ‚π‡¡Õ√å 34

Figure 2: Photograph from polarizing light microscope of

ConciseTM revealed no leakage

(S = ConciseTM , E = Enamel)

Figure 3: Photograph from polarizing light microscope of

ClinproTM revealed no leakage

(S = ClinproTM , E = Enamel)

Figure 4: Photograph from polarizing light microscope of

Fuji VII showed dye penetration.

(S = Fuji VII , E = Enamel)

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‡∑à“π—Èπ

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°“√ √â“߇√ ‘π ·∑Á° (resin tag) ∑”„Àâ¬÷¥µ‘¥·∫∫‡™‘ß°≈

(mechanical bond) 37 ∑”„Àâ«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥

°≈“ ‰Õ‚Õ‚π‡¡Õ√å¡’Õ—µ√“°“√√—Ë«´÷¡∑’Ë¡“°°«à“«— ¥ÿ‡§≈◊Õ∫

À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘π∑—Èß∑’ˉ¡àª≈¥ª≈àÕ¬·≈–ª≈¥ª≈àÕ¬

ø≈ŸÕÕ‰√¥å

∫∑ √ÿª®“°°“√∑¥≈Õß„πÀâÕߪؑ∫—µ‘°“√π’È √ÿª‰¥â«à“ «— ¥ÿ

‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ°≈“ ‰Õ‚Õ‚π‡¡Õ√å¡’§à“Õ—µ√“ à«π°“√

√—Ë«´÷¡¡“°°«à“«— ¥ÿ‡§≈◊Õ∫À≈ÿ¡√àÕßøíπ™π‘¥‡√ ‘π∑—Èß·∫∫‰¡à

ª≈¥ª≈àÕ¬·≈–ª≈¥ª≈àÕ¬ø≈ŸÕÕ‰√¥å

‡Õ° “√Õâ“ßÕ‘ß1. King NM, Shaw L, Murray JJ. Caries susceptibility of

permanent first and second molars in children aged5-15 years. Community Dent Oral Epidemiol1980;8:151-8.

2. Bohannan HM. Caries distribution and the case forsealants. J Public Health Dent 1983; 43: 200-4.

3. Bohannan HM, Disney JA, Graves RC, Bader JD,Klein SP, Bell RM. Indication for sealant use in acommunity-based preventive dentistry program. JDent Educ 1984; 48 : 45-55.

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∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Perceived stress in dental students of Mahidol University

Weera Sukhumthummarat

DDS.

Department of Oral Medicine

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi

Bangkok 10400 Thailand

Pornpoj Fuangtharnthip

DDS., Ph.D. (Dental Science)

Department of Hospital Dentistry

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi

Bangkok 10400 Thailand

Somsak Mitrirattanakul

DDS., Ph.D. (Oral Biology)

Occlusion Unit

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi

Bangkok 10400 Thailand

Nitipun Jeeraphat

DDS., Grad. Dip. in Clin. Sc.

(Prosthodontics)

Department of Prosthodontics

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi

Bangkok 10400 Thailand

AbstractObjective: The purpose of this study was to investigate the perceived stressof dental students from their study using a self-assessment questionnairewith a happiness-sadness scale.Materials and Methods: The survey included 228 dental students fromMahidol University who were enrolled in academic year 2006. Happiness-sadness score (HS score) was calculated from the happiness-sadnessscale and was statistically analyzed.Results: Basic-science students gave a significant higher positive HS score,representing happy feeling, towards overall learning environment thanclinical students (p = 0.001). As well, significantly higher positive HS scoretowards laboratory courses was found in the group of basic-sciencestudents, when compared to those of pre-clinical and clinical students(p < 0.001). Dental students of all groups expressed their HS score closeto zero, representing neutral feeling, for didactic courses. Negative HS score,representing stress and sorrowful feeling, was found in clinical subjects andlikely became greater as the students came into a higher academic year.Although no statistic significance was found, female students seemed to behappier than male students considering overall learning environment(p = 0.07). Regarding the causes of perceived stress, çcurriculumé,çassignmentsé, çstudents themselvesé and çinstructorsé were raised forleading causes of stress in their study. Interestingly, çpatientsé was quotedto be the top cause of stress for their clinical study. Most of the dentalstudents thought that çstudents themselvesé and çfriendsé were the key tohappiness in their dental study.Conclusion: This study demonstrates that most of the dental students inMahidol University still face stress and sadness in their study, especially inclinical practice. Key factors leading to their stress and sadness clearlyinvolve çcurriculumé, çassignmentsé, çstudents themselvesé, çpatientséand çinstructorsé.Key words: Perceived stress, dental student, self assessment.

Corresponding author:

Pornpoj Fuangtharnthip

Department of Hospital Dentistry

Faculty of Dentistry, Mahidol University

6 Yothi Street, Ratchathewi

Bangkok 10400 Thailand

Email: [email protected]

received: 2 September 2008

accepted: 30 April 2009

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µ—Èß·µàªï·√°¢Õß°“√‡√’¬π∑—πµ·æ∑¬»“ µ√å8 à«π°“√»÷°…“

„πª√–‡∑»≠’˪ÿÉπ‡°’Ë¬«°—∫§«“¡‡§√’¬¥∑’ˇ°‘¥¢÷Èπ„π°“√‡√’¬π

¢Õßπ—°»÷°…“∑—πµ·æ∑¬å æ∫«à“π—°»÷°…“∑—πµ·æ∑¬å‡æ»

™“¬¡’§«“¡‡§√’¬¥„π°“√‡√’¬π¡“°°«à“π—°»÷°…“∑—πµ·æ∑¬å

‡æ»À≠‘ß ·≈–π—°»÷°…“∑’ˇ≈◊Õ°‡¢â“»÷°…“„π§≥–∑—πµ

·æ∑¬»“ µ√凪ìπÕ—π¥—∫ 1 ¡’§«“¡‡§√’¬¥πâÕ¬°«à“π—°»÷°…“∑’Ë

‡≈◊Õ°„πÕ—π¥—∫√Õß≈ß¡“ πÕ°®“°π’È ¬—ßæ∫«à“π—°»÷°…“

∑—πµ·æ∑¬å∑’ˉ¥âÕÕ°°”≈—ß°“¬‡ªìπª√–®”À√◊Õ °“√‡¢â“√à«¡

∑”°‘®°√√¡„π™¡√¡µà“ßÊ¢Õß¡À“«‘∑¬“≈—¬¡’√–¥—∫§«“¡

‡§√’¬¥µË”°«à“ ·≈–¡’√–¥—∫§«“¡ ÿ¢¡“°°«à“π—°»÷°…“

∑—πµ·æ∑¬å∑’ˉ¡à‰¥âÕÕ°°”≈—ß°“¬9

‚¥¬∑—Ë«‰ª·≈â« æ∫«à“°“√∑’Ëπ—°»÷°…“∑—πµ·æ∑¬å

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‡«≈“π“πÊ ‚¥¬‰¡à‰¥â√—∫°“√·°â‰¢À√◊Õ√—°…“ Õ“®∑”„À⇰‘¥

Õ“°“√¢Õß‚√§‡§√’¬¥‰¥â ‡™àπ Õ“°“√µ◊Ëπµ√–Àπ° Õ“°“√

´÷¡‡»√â“ Õ“°“√À«“¥°≈—« ‡ªìπµâπ10,11 √«¡‰ª∂÷ßÕ“®∑”„Àâ

‡°‘¥Õ“°“√πÕπ‰¡àÀ≈—∫ À—«„®‡µâπ‡√Á« §«“¡ÕàÕπ≈â“ Õ“°“√

«‘߇«’¬π»’√…– ·≈–Õ“® àߺ≈µàÕ√–∫∫∑“߇¥‘πÕ“À“√‰¥âÕ’°

¥â«¬ §«“¡‡§√’¬¥∑’ˇ°‘¥¢÷Èπ “¡“√∂°√–µÿâπ„Àâπ—°»÷°…“‡°‘¥

§«“¡æ¬“¬“¡„π°“√∑”ß“π¡“°¢÷Èπ À√◊ÕÕ“®∑”„Àâπ—°»÷°…“

¡’ª√– ‘∑∏‘¿“æ„π°“√∑”ß“π≈¥≈߉¥â‡™àπ°—π12

§«“¡ “¡“√∂„π°“√∑πµàÕ§«“¡‡§√’¬¥∑’ˇ°‘¥¢÷Èπ¢Õß

π—°»÷°…“∑—πµ·æ∑¬å à«π„À≠àÕ¬Ÿà¿“¬„µâ§«“¡‡™◊ËÕ·≈–

∑—»π§µ‘¢Õß·µà≈–∫ÿ§§≈3 æ◊Èπ∞“π∑“ߥâ“π —ߧ¡·≈–

«—≤π∏√√¡¢Õßπ—°»÷°…“‡Õ߇ªìπªí®®—¬À≈—°∑’Ë¡’º≈‡ªìπÕ¬à“ß

¡“°µàÕ§«“¡ “¡“√∂„π°“√∑πµàÕ§«“¡‡§√’¬¥∑’ˇ°‘¥¢÷Èπ

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∑’ˇ°‘¥¢÷Èππ’ȇªìπªí®®—¬Àπ÷Ëß∑’Ë∑”„Àâ¡πÿ…¬å‰¥â√Ÿâ ÷°∂÷ߧ«“¡ ÿ¢

·≈–§«“¡∑ÿ°¢åÕ’°¥â«¬

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∑ÿ°¢å∑’ˇ°‘¥¢÷Èπ¢Õßπ—°»÷°…“∑—πµ·æ∑¬å„πª√–‡∑»‰∑¬¬—ß¡’Õ¬Ÿà

πâÕ¬ ∑—Èßπ’È ª√–‡∑»‰∑¬¡’≈—°…≥–¢Õß√–∫∫°“√»÷°…“

«—≤π∏√√¡·≈–ª√–‡æ≥’„π·∫∫¢Õßµπ‡ÕßÀ≈“¬ª√–°“√

∑“ߧ≥–ºŸâ»÷°…“®÷߇ÀÁ𧫓¡®”‡ªìπ„π°“√»÷°…“‡√◊ËÕß

§«“¡√Ÿâ ÷°µàÕ°“√‡√’¬π„π§≥–∑—πµ·æ∑¬å¢Õßπ—°»÷°…“

∑—πµ·æ∑¬å‰∑¬ °“√»÷°…“π’È¡’®ÿ¥¡ÿàßÀ¡“¬∑’Ë®– ”√«®§«“¡

√Ÿâ ÷° ÿ¢-∑ÿ°¢å¢Õßπ—°»÷°…“§≥–∑—πµ·æ∑¬»“ µ√å

¡À“«‘∑¬“≈—¬¡À‘¥≈ ‚¥¬„™â·∫∫ Õ∫∂“¡ª√–‡¡‘πµπ‡Õß

·≈– ‡°≈§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å (happiness-sadness scale)

∑—Èßπ’È ‡æ◊ËÕ„À⺟âµÕ∫·∫∫ Õ∫∂“¡ “¡“√∂· ¥ß§«“¡√Ÿâ ÷°

¢Õßµπ‡Õ߉¥âÕ¬à“ß™—¥‡®π

«— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“§≥–ºŸâ»÷°…“ ”√«®§«“¡√Ÿâ ÷°¢Õßπ—°»÷°…“§≥–

∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ªï°“√»÷°…“ 2549

∑’ˇ°’ˬ«°—∫∫√√¬“°“»·≈–°“√‡√’¬π„π«‘™“∑—πµ·æ∑¬»“ µ√å

‚¥¬„™â·∫∫ Õ∫∂“¡ª√–‡¡‘πµπ‡Õß∑’Ë¡’ ‡°≈§«“¡√Ÿâ ÷°

ÿ¢-∑ÿ°¢å ºŸâ‡¢â“√à«¡„π°“√ ”√«®‰¥â√—∫øíߧ”™’È·®ß∂÷ß

«—µ∂ÿª√– ߧå¢Õß°“√ ”√«® §”Õ∏‘∫“¬√Ÿª·∫∫¢Õß°“√ ”√«®

«‘∏’°“√µÕ∫·∫∫ Õ∫∂“¡ ·≈– Õ∫∂“¡§«“¡ ¡—§√„®

·∫∫ Õ∫∂“¡ª√–‡¡‘πµπ‡Õß

·∫∫ Õ∫∂“¡ª√–‡¡‘πµπ‡Õ߇æ◊ËÕ ”√«®§«“¡√Ÿâ ÷°

ÿ¢-∑ÿ°¢å ®–·∫à߇ªìπ 3 À¡«¥„À≠à §◊Õ À¡«¥∑’Ë 1. ¢âÕ¡Ÿ≈

ª√–«—µ‘¢ÕߺŸâµÕ∫·∫∫ Õ∫∂“¡ ª√–°Õ∫¥â«¬ «—π‡¥◊Õπªï‡°‘¥

‡æ» ¿Ÿ¡‘≈”‡π“ °“√®∫°“√»÷°…“„π√–¥—∫¡—∏¬¡»÷°…“ ·≈–

§–·ππ‡°√¥‡©≈’ˬ – ¡ (GPA) „πªí®®ÿ∫—π À¡«¥∑’Ë 2

‡°≈§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å ‡æ◊ËÕ ”√«®§«“¡√Ÿâ ÷° ÿ¢À√◊Õ∑ÿ°¢åµàÕ

∫√√¬“°“»·≈–°“√‡√’¬π„π«‘™“∑—πµ·æ∑¬»“ µ√å ‚¥¬

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«’√– ÿ¢ÿ¡∏√√¡√—µπå æ√æ®πå ‡øóòÕß∏“√∑‘æ¬å ¡»—°¥‘Ï ‰¡µ√’√—µπ–°ÿ≈ 𑵑æ—π∏å ®’√–·æ∑¬å

§«“¡√Ÿâ ÷°‡§√’¬¥¢Õßπ—°»÷°…“∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈58

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

·∫àßÕÕ°‡ªìπÀ—«¢âÕ ¥—ßπ’È ∫√√¬“°“»°“√‡√’¬π‚¥¬√«¡ °“√

‡√’¬π¿“§∑ƒ…Æ’ °“√‡√’¬π¿“§ªØ‘∫—µ‘°“√ °“√‡√’¬π∑“ß

§≈‘π‘° À¡«¥∑’Ë 3 “‡Àµÿ¢Õߧ«“¡√Ÿâ ÷° ÿ¢À√◊Õ∑ÿ°¢å ‡ªìπ

§”∂“¡ª≈“¬‡ªî¥„À⺟âµÕ∫·∫∫ Õ∫∂“¡‡≈◊Õ°∫Õ°∂÷ß “‡Àµÿ

∑’Ë∑”„À⇰‘¥§«“¡√Ÿâ ÷° ÿ¢À√◊Õ∑ÿ°¢å„π·µà≈–À—«¢âÕ ‚¥¬ºŸâµÕ∫

·∫∫ Õ∫∂“¡ “¡“√∂µÕ∫‰¥â¡“°°«à“Àπ÷Ëß “‡Àµÿ À√◊Õ‰¡à

‡≈◊Õ°µÕ∫‡≈¬°Á‰¥â

‡°≈§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å (√Ÿªª√–°Õ∫∑’Ë 1)

‡°≈§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å ¡’§«“¡¬“«∑—Èß ‘Èπ 20

‡´πµ‘‡¡µ√ ‚¥¬®ÿ¥‡√‘Ë¡µâπÕ¬Ÿà∑’Ë°÷Ëß°≈“ߢÕß ‡°≈ √–∫ÿ„Àâ

‡ªìπµ”·ÀπàߢÕߧ«“¡√Ÿâ ÷° 燩¬é §◊Õ‰¡à√Ÿâ ÷°∑—È߇ªìπ∑ÿ°¢åÀ√◊Õ

‡ªìπ ÿ¢ À“°ºŸâµÕ∫·∫∫ Õ∫∂“¡¡’§«“¡√Ÿâ ÷°‡©¬Ê °—∫

ª√–‡¥Áπ∑’Ë Õ∫∂“¡π—Èπ „À⺟âµÕ∫·∫∫ Õ∫∂“¡¢’¥‡ âπµ√ß

≈ß¡“„π·π«¥‘Ëß∫√‘‡«≥®ÿ¥°÷Ëß°≈“ßπ—Èπ À“°ºŸâµÕ∫

·∫∫ Õ∫∂“¡√Ÿâ ÷°¡’§«“¡ ÿ¢„πª√–‡¥Áπ∑’Ë Õ∫∂“¡ ºŸâµÕ∫

·∫∫ Õ∫∂“¡‰¥â√—∫§”·π–π”„Àâ≈“°‡ âπ®“°®ÿ¥°÷Ëß°≈“߉ª

µ“¡·∂∫¢Õß ‡°≈∑“ߥâ“π¢«“ ÷Ëß¡’§«“¡¬“« 10 ‡´πµ‘‡¡µ√

‰°≈‡∑à“∑’ˇ°‘¥¡’§«“¡√Ÿâ ÷° ÿ¢ ‚¥¬§«“¡√Ÿâ ÷° ç ÿ¢é ∑’Ë™à«ß

°≈“ß ‡°≈∑“ߥâ“π¢«“ À¡“¬∂÷ß ¡’§«“¡ ÿ¢ Õ‘Ë¡„® ¥’„®∑’Ë

‰¥âª√– ∫°—∫ ‘Ëßπ—È𠧫“¡√Ÿâ ÷° ç ÿ¢∑’Ë ÿ¥é ∑“ߢ«“ ÿ¥ ‡°≈

À¡“¬∂÷ß §«“¡√Ÿâ ÷°¥’„® ÿ¢„®‡ªìπÕ¬à“ß∑’Ë ÿ¥ ·≈–√Ÿâ ÷°

√Õ§Õ¬Õ¬“°„Àâ ‘Ëßπ—Èπ°≈—∫¡“À“Õ’°

„π∑“ßµ√ß°—π¢â“¡ „Àâ≈“°‡ âπ®“°®ÿ¥°÷Ëß°≈“߉ª

µ“¡·∂∫¢Õß ‡°≈∑“ߥâ“π ⓬ ÷Ëß¡’§«“¡¬“« 10

‡´πµ‘‡¡µ√‡∑à“°—π ‡¡◊ËÕ√Ÿâ ÷° ç∑ÿ°¢åé„πª√–‡¥Áπ∑’Ë Õ∫∂“¡

‚¥¬§«“¡√Ÿâ ÷° ç∑ÿ°¢åé ∑’Ë™à«ß°≈“ß ‡°≈∑“ߥâ“π´â“¬ À¡“¬

∂÷ß √Ÿâ ÷°‡ªìπ∑ÿ°¢å‡¡◊ËÕµâÕ߇º™‘≠°—∫ ‘Ëßπ—Èπ ·≈–‡¡◊ËÕºà“πæâπ

‘Ëßπ—Èπ‰ª‰¥â §«“¡√Ÿâ ÷°∑ÿ°¢å°Á®–‡≈◊ÕπÀ“¬‰ª à«π§«“¡√Ÿâ ÷°

ç∑ÿ°¢å∑’Ë ÿ¥é ∑“ß â“¬ ÿ¥ ‡°≈ À¡“¬∂÷ߧ«“¡√Ÿâ ÷°∑ÿ°¢å

Õ¬à“ß∑’Ë ÿ¥ ·¡â ‘Ëß∑’Ë∑”„À⇰‘¥§«“¡∑ÿ°¢åπ—Èπºà“πæâπ‰ª·≈â«

§«“¡√Ÿâ ÷°∑ÿ°¢å°Á¬—ߧßÕ¬Ÿà ¡’§«“¡√Ÿâ ÷°À«“¥°≈—« ‡ªìπ°—ß«≈

·≈–∑ÿ°¢å„®¬‘Ëß ‡¡◊ËÕ∑√“∫«à“ ‘Ëßπ—Èπ°”≈—ß®–°≈—∫¡“Õ’°

∑—Èßπ’È ‡æ◊ËÕ§«“¡‡¢â“„®·≈–§«“¡§ÿâπ‡§¬¢ÕߺŸâµÕ∫

·∫∫ Õ∫∂“¡ §≥–ºŸâ»÷°…“‰¥âæ‘¡æå —≠≈—°…≥å·∑π√–¥—∫

§«“¡√Ÿâ ÷°‰«âª√–°Õ∫ ‡°≈ ·≈–„À⺟âµÕ∫·∫∫ Õ∫∂“¡≈Õß

¢’¥‡ âπµ“¡§«“¡√Ÿâ ÷°®“° ∂“π°“√≥å ¡¡ÿµ‘°àÕπ 2-3

‡Àµÿ°“√≥å°àÕπ‡√‘Ë¡∑”·∫∫ Õ∫∂“¡µàÕ‰ª

°“√‡°Á∫·≈–°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈

π”¢âÕ¡Ÿ≈®“°·∫∫ Õ∫∂“¡∑’ˇ°’ˬ«¢âÕß°—∫¢âÕ¡Ÿ≈

ª√–«—µ‘·≈– “‡Àµÿ¢Õߧ«“¡√Ÿâ ÷° ÿ¢·≈–∑ÿ°¢å¡“«‘‡§√“–Àå

„π‡™‘ßæ√√≥π“ (descriptive analysis) ¢âÕ¡Ÿ≈„π à«π¢Õß

‡°≈§«“¡√Ÿâ ÷°∂Ÿ°«—¥§«“¡¬“«®“°®ÿ¥°÷Ëß°≈“߇æ◊ËÕ· ¥ß

§à“§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å (happiness-sadness score) ‚¥¬

„À⧫“¡¬“«®“°∑“ߥâ“π¢«“¢Õß®ÿ¥°÷Ëß°≈“ß¡’§à“‡ªìπ∫«°

·≈–§«“¡¬“«∑“ߥâ“π´â“¬®“°®ÿ¥°÷Ëß°≈“ß¡’§à“‡ªìπ≈∫ À“°

ºŸâµÕ∫·∫∫ Õ∫∂“¡¢’¥‡ âπµ√ߥ‘Ëß∑’Ë®ÿ¥°÷Ëß°≈“ß „Àâ§à“‡ªìπ

»Ÿπ¬å ‚¥¬·∫àß°≈ÿࡺŸâµÕ∫·∫∫ Õ∫∂“¡ ÕÕ°‡ªìπ 3 °≈ÿà¡

§◊Õ°≈ÿà¡π—°»÷°…“«‘™“«‘∑¬“»“ µ√å æ◊Èπ∞“π (basic science)

‰¥â·°à π—°»÷°…“™—Èπªï∑’Ë 1 °≈ÿà¡π—°»÷°…“«‘™“°àÕπ§≈‘π‘° (pre-

clinic) ‰¥â·°à π—°»÷°…“™—Èπªï∑’Ë 2 ·≈– 3 ·≈–°≈ÿà¡π—°»÷°…“

«‘™“§≈‘π‘° (clinic) ‰¥â·°à π—°»÷°…“™—Èπªï∑’Ë 4 ªï∑’Ë 5 ·≈– 6 π”

§à“§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å∑’ˉ¥â¡“À“§à“‡©≈’ˬ (mean) ·≈–

§«“¡‡§≈◊ËÕπ§≈“¥¡“µ√∞“π¢Õß§à“‡©≈’ˬ (standard error

of mean) ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ß√–À«à“ß°≈ÿà¡¢ÕߺŸâ

µÕ∫·∫∫ Õ∫∂“¡ ‡æ◊ËÕÀ“ªí®®—¬∑’ËÕ“®¡’§«“¡ —¡æ—π∏å ‚¥¬

„™â‚ª√·°√¡ ∂‘µ‘ SPSS 14.0 ∑’Ë√–¥—∫π—¬ ”§—≠∑’Ë§à“ p=0.05

„™â°“√∑¥ Õ∫§à“∑’ (t-test) °“√«‘‡§√“–À姫“¡·ª√ª√«π

∑“߇¥’¬« (one-way analysis of variance)

0 +10-10

Figure 1: Happiness-sadness scale

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

«’√– ÿ¢ÿ¡∏√√¡√—µπå æ√æ®πå ‡øóòÕß∏“√∑‘æ¬å ¡»—°¥‘Ï ‰¡µ√’√—µπ–°ÿ≈ 𑵑æ—π∏å ®’√–·æ∑¬å

§«“¡√Ÿâ ÷°‡§√’¬¥¢Õßπ—°»÷°…“∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ 59

º≈°“√»÷°…“¡’ºŸâ ¡—§√„®‡¢â“√à«¡°“√ ”√«®∑—Èß ‘Èπ ®”π«π 228 §π

ª√–°Õ∫¥â«¬‡æ»™“¬ 90 §π §‘¥‡ªìπ√âÕ¬≈– 39.5 ·≈–

‡æ»À≠‘ß 138 §π §‘¥‡ªìπ√âÕ¬≈– 60.5 Õ“¬ÿ‡©≈’ˬ± à«π

‡∫’ˬ߇∫π¡“µ√“∞“π¢Õß°≈ÿà¡π—°»÷°…“∑’˵Õ∫·∫∫ Õ∫∂“¡

‡∑à“°—∫ 20.94±1.89 ªï ‚¥¬®”·π°µ“¡‡æ»·≈–™—Èπªïµà“ßÊ

¥—ß„πµ“√“ß∑’Ë 1

§«“¡√Ÿâ ÷°µàÕ∫√√¬“°“»°“√‡√’¬π‚¥¬√«¡ (µ“√“ß∑’Ë 2

·≈–√Ÿªª√–°Õ∫∑’Ë 2)

‡¡◊ËÕπ”§à“‡©≈’ˬ¢Õߧ«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å µàÕ∫√√¬“°“»

°“√‡√’¬π‚¥¬√«¡ ¡“‡ª√’¬∫‡∑’¬∫°—∫¢âÕ¡Ÿ≈ à«π∫ÿ§§≈µà“ßÊ

Õ—π‰¥â·°à ‡æ» §–·ππ‡©≈’ˬ – ¡ ·≈– ∂“π∑’˵—ÈߢÕß

∂“π»÷°…“√–¥—∫¡—∏¬¡ª≈“¬ æ∫«à“ „π∑ÿ°°≈ÿà¡ ¡’§à“

§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å ¡’§à“‡ªìπ∫«°‡≈Á°πâÕ¬ µ—Èß·µà 0.81 ∂÷ß

1.74 ‚¥¬π—°»÷°…“‡æ»À≠‘ß¡’·π«‚πâ¡§à“§«“¡√Ÿâ ÷° ÿ¢-

∑ÿ°¢å Ÿß°«à“π—°»÷°…“™“¬ ·¡â‰¡àæ∫«à“¡’§«“¡·µ°µà“ßÕ¬à“ß¡’

π—¬ ”§—≠∑“ß ∂‘µ‘ (p = 0.07) º≈°“√ ”√«®‰¡àæ∫§«“¡

·µ°µà“ߢÕß§à“§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å¢Õßπ—°»÷°…“∑’Ë¡’‡°√¥

§–·ππ‡©≈’ˬ – ¡‡∑à“°—∫À√◊Õ¡“°°«à“ 3.00 ‡¡◊ËÕ‡∑’¬∫

°—∫π—°»÷°…“∑’Ë¡’‡°√¥‡©≈’ˬ – ¡πâÕ¬°«à“ 3.00 Õ’°∑—Èßπ—°

»÷°…“∑’Ë®∫ ∂“π»÷°…“√–¥—∫¡—∏¬¡ª≈“¬®“°‡¢µæ◊Èπ∑’Ë

°√ÿ߇∑æ·≈–ª√‘¡≥±≈ „Àâ§à“§«“¡√Ÿâ ÷° ÿ¢-∑ÿ°¢å‰¡à·µ°

µà“ß®“°π—°»÷°…“∑’Ë®∫ ∂“π»÷°…“√–¥—∫¡—∏¬¡ª≈“¬®“°

‡¢µæ◊Èπ∑’Ë®—ßÀ«—¥Õ◊ËπÊ

Table 1 Groups of dental students classified by academic year and gender

Group Academic year Gender Total

Male Female

Basic science 1st year 17 27 44

Pre-clinic 2nd year 15 35 50

3rd year 12 19 31

Total pre-clinic 27 54 81

Clinic 4th year 17 11 28

5th year 14 7 21

6th year 15 39 54

Total Clinic 46 57 103

Total 90 138 228

Table 2 Happiness-sadness score for overall learning environment classified by various factors

Factors Happiness-sadness score P value

(Mean ± SEM)

Gender

Male 0.81 ± 0.40 0.07

Female 1.74 ± 0.30

GPA

< 3.00 0.97 ± 0.55 0.92

≥ 3.0 1.03 ± .31

High school graduated

Bangkok and suburb area 1.33 ± 0.29 0.79

Other provinces 1.46 ± 0.41

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§≈‘π‘° (1.55±0.38) ·≈–°≈ÿà¡π—°»÷°…“«‘™“§≈‘π‘°

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¡’§à“‡©≈’ˬ§«“¡ ÿ¢-∑ÿ°¢å Ÿß°«à“°≈ÿà¡π—°»÷°…“«‘™“§≈‘π‘°

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Figure 2: Happiness-sadness score for overall learning environment

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Figure 3: Happiness-sadness score for didactic courses

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¡’§à“‡©≈’ˬ‡∑à“°—∫ 0.41±0.49 ·≈– -0.34±0.44 µ“¡≈”¥—∫

‚¥¬§«“¡·µ°µà“ߢÕß§à“‡©≈’ˬ¥—ß°≈à“«‡ªì𧫓¡·µ°µà“ß∑’Ë

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Figure 5: Happiness-sadness score for clinical courses

Figure 4: Happiness-sadness score for laboratory courses

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µ—«ºŸâªÉ«¬ ‡ªì𠓇ÀµÿÕ—π¥—∫·√°¢Õߧ«“¡√Ÿâ ÷°∑ÿ°¢å„π°“√

‡√’¬π∑“ߧ≈‘π‘°

Table 3 Causes of happiness and sadness for dental students

Overall learning environment

Causes of sadness (n= 72) Number* (%) Causes of happiness (n= 110) Number* (%)

1. Curriculum 36 (50.0) 1. Friends 38 (34.5)

2. Students themselves 16 (22.2) 2. Students themselves 28 (25.5)

3. Instructors 9 (12.5) 3. Curriculum 13 (11.8)

4. Learning environment 6 (8.3) 4. Family 8 (7.3)

5. Family 3 (4.2) 4. Instructors 8 (7.3)

6. Friends 2 (2.8) 6. Learning environment 5 (4.5)

Happiness and sadness for didactic courses

Causes of sadness (n= 146) Number* (%) Causes of happiness (n= 65) Number* (%)

1. Curriculum 97 (66.4) 1. Students themselves 40 (61.5)

2. Students themselves 31 (21.2) 2. Curriculum 13 (20.0)

3. Instructors 15 (10.3) 3. Instructors 10 (15.4)

4. Lecture room 3 (2.1) 4. Friends 2 (3.1)

Happiness and sadness for laboratory courses

Causes of sadness (n= 109) Number* (%) Causes of happiness (n= 108) Number* (%)

1. Students themselves 41 (37.6) 1. Friends 42 (38.9)

2. Instructors 38 (34.9) 2. Students themselves 36 (33.3)

3. Curriculum /assignments 24 (22.0) 3. Curriculum 26 (24.1)

4. Friends 6 (5.5) 4. Learning environment 4 (3.7)

5. Instructors 3 (2.8)

Happiness and sadness for clinical courses

Causes of sadness (n= 100) Number* (%) Causes of happiness (n= 35) Number* (%)

1. Patients 38 (38.0) 1. Students themselves 25 (71.4)

2. Curriculum /assignments 36 (36.0) 2. Patients 4 (11.4)

3. Instructors 35 (35.0) 3. Instructors 2 (5.7)

4. Students themselves 17 (17.0) 4. Supporting staff, equipment 2 (5.7)

5. Others (supporting staff, 9 (9.0) 5. Others (Friends, Curriculum) 2 (5.7)

equipment, friends)*One responder could give more than one causes.

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‰¥â√—∫§«“¡ ÿ¢·≈–°”≈—ß„®®“°Õ“®“√¬åºŸâ Õπ

®“°°“√»÷°…“‡°’ˬ«°—∫ “‡Àµÿ¢Õߧ«“¡‡§√’¬¥®“°

∫√√¬“°“»°“√‡√’¬π∑“ß∑—πµ·æ∑¬»“ µ√å (dental envi-

ronment stress) „πµà“ߪ√–‡∑» æ∫«à“ ª√‘¡“≥ß“π∑’˵âÕß∑”

§«“¡¬“°ßà“¬¢Õßß“π ∫√√¬“°“»°“√‡√’¬π√Ÿâ ∂“π°“√≥å

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π—°»÷°…“∑—πµ·æ∑¬å‰∑¬„π§√—Èßπ’È ®÷ßæÕ √ÿª‰¥â«à“ π—°»÷°…“

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‡√’¬πÀ≈—° Ÿµ√∑—πµ·æ∑¬»“ µ√剥âÕ¬à“ß¡’§«“¡ ÿ¢

°‘µµ‘°√√¡ª√–°“»¢Õ¢Õ∫§ÿ≥ ”π—°ß“π°Õß∑ÿπ π—∫ πÿπ°“√ √â“ß

‡ √‘¡ ÿ¢¿“æ ( ) ∑’Ë π—∫ πÿπ∑ÿπ„π°“√ ”√«®§√—Èßπ’È

‡Õ° “√Õâ“ßÕ‘ß1. Cooper CL, Watts J, Kelly M. Job satisfaction, mental

health, and job stressors among general dentalpractitioners in the UK. Br Dent J 1987;162:77-81.

2. Heath JT, Macfarlane TV, Umar MS. Perceivedsources of stress in dental students. Dent Update1999;26:94-8.

3. Westerman GH, Grandy TG, Ocanto RA, Erskine CG.Perceived sources of stress in the dental schoolenvironment. J Dent Educ 1993;57:225-31.

4. Rajab LD. Perceived sources of stress among dentalstudents at the University of Jordan. J Dent Educ2001;65:232-41.

5. Sanders AE, Lushington K. Sources of stress forAustralian dental students. J Dent Educ

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

«’√– ÿ¢ÿ¡∏√√¡√—µπå æ√æ®πå ‡øóòÕß∏“√∑‘æ¬å ¡»—°¥‘Ï ‰¡µ√’√—µπ–°ÿ≈ 𑵑æ—π∏å ®’√–·æ∑¬å

§«“¡√Ÿâ ÷°‡§√’¬¥¢Õßπ—°»÷°…“∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ 65

1999;63:688-99.6. Yap AU, Bhole S, Teo CS. A cross-cultural comparison

of perceived stress in the dental school environment.J Dent Educ 1996;60:459-64.

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8. Humphris G, Blinkhorn A, Freeman R, Gorter R,Hoad-Reddick G, Murtomaa H, et al. Psychologicalstress in undergraduate dental students: baselineresults from seven European dental schools. Eur JDent Educ 2002;6:22-9.

9. Sugiura G, Shinada K and Kawaguchi Y. Psychologicalwell-being and perceptions of stress amongstJapanese dental students. Eur J Dent Educ2005;9:17-25.

10. Knudsen W. The quality of life of dental students. IntDent J 1978;28:327-31.

11. Grandy TG, Westerman GH, Lupo JV, Comb CG.Stress symptoms among third-year dental students.J Dent Educ 1988;52:245-9.

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13. Acharya S. Factors affecting stress among Indiandental students. J Dent Educ 2003;67: 1140-8.

14. Àπ૬∑–‡∫’¬π·≈–ª√–‡¡‘πº≈°“√»÷°…“ §≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈. §Ÿà¡◊Õπ—°»÷°…“∑—πµ·æ∑¬å ªï°“√»÷°…“ 2549. §≥–∑—πµ·æ∑¬»“ µ√å¡À“«‘∑¬“≈—¬¡À‘¥≈;2549

15. Gorter R, Freeman R, Hammen S, Murtomaa H,Blinkhorn A, Humphris G. Psychological stress andhealth in undergraduate dental students: fifth yearoutcomes compared with first year baseline resultsfrom five European dental schools. Eur J Dent Educ.2008;12(2):61-8.

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µâ“π‡°≈Á¥‡≈◊Õ¥µàÕ°“√‡ ’¬‡≈◊Õ¥√–À«à“ß·≈–À≈—ß°“√∫”∫—¥∑“ß∑—πµ°√√¡ º≈

¢Õß°“√À¬ÿ¥¬“‡æ◊ËÕ°“√√—°…“∑“ß∑—πµ°√√¡ ·≈–°“√æ‘®“√≥“°“√À¬ÿ¥¬“µâ“π

‡°≈Á¥‡≈◊Õ¥°àÕπ°“√∫”∫—¥∑“ß∑—πµ°√√¡

√À— §”: ¬“µâ“π‡°≈Á¥‡≈◊Õ¥, °“√ºà“µ—¥, ¿“«–‡≈◊Õ¥ÕÕ°

µ‘¥µàÕ‡°’ˬ«°—∫∫∑§«“¡:

‡∫≠®¡“» Õ¿‘æ—π∏ÿå

¿“§«‘™“»—≈¬»“ µ√å

§≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈

6 ∂ππ‚¬∏’ ‡¢µ√“™‡∑«’ °∑¡. 10400

«—π√—∫‡√◊ËÕß: 6 µÿ≈“§¡ 2551

«—π¬Õ¡√—∫µ’æ‘¡æå: 30 ‡¡…“¬π 2552

∫∑§«“¡ª√‘∑—»πå

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

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‡∫≠®¡“» Õ¿‘æ—π∏ÿå Õ“∑‘µ¬“ ‡®√‘≠ ÿ¢‡°…¡

¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡68

« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552Review article

∑—πµ·æ∑¬»“ µ√å¡À‘¥≈MAHIDOL DENTAL JOURNAL

Antiplatelet drugs in dentistry

Benjamas Apipan

M.D.

Department of Surgery, Faculty of

Dentistry, Mahidol University

Artidtaya Charoensukasem

DDS

Wisetchaichan Hospital, Angthong

AbstractAntiplatelet drugs are widely used today for prevention of

thromboembolic diseases. Dentists are more and more frequently confrontedwith patients treated by these medications so they should know aboutantiplatelet drugs in order to safely take care of the patients. This articlereviews the various antiplatelet drugs that are used in Thailand nowadays ,focusing on their mechanisms of action, their indications, their adverseeffects, perioperative bleeding risks , thrombotic risks associated withdiscontinuing the medications and the perioperative management ofantithrombotic therapy patient in the dental setting.Keywords: Antiplatelet drugs, surgery, bleeding disorders.

correspondence authors:

Benjamas Apipan

Department of Surgery, Faculty of

Dentistry, Mahidol University Thailand

Recieved: 6 October 2008

Accepted: 30 April 2009

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¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡ 69

ªí®®ÿ∫—π∑—πµ·æ∑¬å¡’‚Õ°“ ®–æ∫ºŸâªÉ«¬∑’Ë¡“√—∫°“√

√—°…“∑“ß∑—πµ°√√¡∑’Ë¡’ª√–«—µ‘‰¥â√—∫¬“µâ“π‡°≈Á¥‡≈◊Õ¥‰¥â

∫àÕ¬ ‡π◊ËÕß®“°¬“°≈ÿà¡π’È„™â°—πÕ¬à“ß·æ√àÀ≈“¬‡æ◊Ëՙ૬

ªÑÕß°—π·≈–≈¥Õÿ∫—µ‘°“√°“√Õÿ¥µ—π¢ÕßÀ≈Õ¥‡≈◊Õ¥·¥ß

‚¥¬¡’¢âÕ∫àß„™â„πºŸâªÉ«¬‚√§À≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å(coronary

artery disease) ºŸâªÉ«¬∑’Ë¡’¿“«–‡ ’ˬߵàÕ°“√‡°‘¥°≈â“¡‡π◊ÈÕ

À—«„®¢“¥‡≈◊Õ¥ ‡™àπ ‡∫“À«“π ·≈– ¿“«–‰¢¡—π„π‡≈◊Õ¥ Ÿß

ºŸâªÉ«¬‚√§ ¡Õߢ“¥‡≈◊Õ¥(cerebrovascular disease) ·≈–

ºŸâªÉ«¬‚√§À≈Õ¥‡≈◊Õ¥ à«πª≈“¬ (peripheral vascular

disease)1 ∑—πµ·æ∑¬å‰¡à “¡“√∂À≈’°‡≈’ˬ߰“√√—°…“ºŸâªÉ«¬

∑’Ë¡’‚√§∑“ß√–∫∫∑’Ë¡’ª√–«—µ‘„™â¬“µâ“π‡°≈Á¥‡≈◊Õ¥‰¥â ¥—ßπ—Èπ

°“√‡√’¬π√Ÿâ·≈–‡¢â“„®√Ÿª·∫∫°“√„™â¬“√«¡∑—Èß°≈‰°°“√

ÕÕ°ƒ∑∏‘Ï¢Õ߬“‡æ◊ËÕ®–‰¥â‡µ√’¬¡ºŸâªÉ«¬°àÕπ√—∫°“√√—°…“

∑“ß∑—πµ°√√¡„Àâ∂Ÿ°µâÕ߇ªìπ ‘Ëß®”‡ªìπ

∫∑∫“∑¢Õ߇°≈Á¥‡≈◊Õ¥„π°“√Àâ“¡‡≈◊Õ¥

‡°≈Á¥‡≈◊Õ¥¡’Àπâ“∑’Ë ”§—≠„π°“√Àâ“¡‡≈◊Õ¥√–¬–·√°

(primary hemostasis) „π¿“«–∑’ËÀ≈Õ¥‡≈◊Õ¥Õ¬Ÿà„π ¿“æ

ª°µ‘À≈Õ¥‡≈◊Õ¥®– √â“ß “√∑’˵â“π°“√‡°“–°≈ÿà¡¢Õ߇°≈Á¥

‡≈◊Õ¥‰¥â·°à prostacyclin (PGI2) ·≈– nitric oxide ÷Ëß®–µâ“π

°“√‡°“–°≈ÿà¡¢Õ߇°≈Á¥‡≈◊Õ¥‚¥¬‡æ‘Ë¡√–¥—∫¢Õß cyclic

adenosine monophosphate (c-AMP) ·≈– cyclic guanosine

monophosphate (c-GMP) „π‡°≈Á¥‡≈◊Õ¥ À≈—߇´≈≈åºπ—ß

À≈Õ¥‡≈◊Õ¥∂Ÿ°∑”≈“¬‡°≈Á¥‡≈◊Õ¥®–¡“‡°“–√«¡°—π‡æ◊ËÕ

Àâ“¡‡≈◊Õ¥ ‡°≈Á¥‡≈◊Õ¥®–¡’¢—ÈπµÕπ°“√∑”ß“π1-6¥—ßπ’È

(√Ÿª∑’Ë 1)

1. ¢—ÈπµÕπ°“√‡°“–µ‘¥ºπ—ßÀ≈Õ¥‡≈◊Õ¥ (platelet

adhesion) ‡¡◊ËÕ‡°‘¥°“√©’°¢“¥¢ÕßÀ≈Õ¥‡≈◊Õ¥ ‡°≈Á¥‡≈◊Õ¥

®– —¡º— °—∫ collagen ∑’˺π—ßÀ≈Õ¥‡≈◊Õ¥ ·≈–®–∂Ÿ°°√–µÿâπ

„À⇰‘¥°“√‡ª≈’ˬπ·ª≈ß¡“°¡“¬¿“¬„π‡´≈≈å ºπ—ßÀ≈Õ¥

‡≈◊Õ¥®–À≈—Ëß von Willebrand factor ÕÕ°¡“∑”Àπâ“∑’ˬ÷¥

√–À«à“ß glycoprotein Ib (GPIb) ∫πº‘«¢Õ߇°≈Á¥‡≈◊Õ¥·≈–

collagen ∫πºπ—ßÀ≈Õ¥‡≈◊Õ¥∑’Ë©’°¢“¥

2. ¢—ÈπµÕπ°“√∂Ÿ°°√–µÿâπ (platelet activation)

‡¡◊ËÕ‡°≈Á¥‡≈◊Õ¥®—∫°—∫ºπ—ßÀ≈Õ¥‡≈◊Õ¥ ‡°≈Á¥‡≈◊Õ¥®–∂Ÿ°

°√–µÿâπ¥â«¬ “√µà“ßÊ ´÷Ëß¡“®“°‡°≈Á¥‡≈◊Õ¥‡ÕßÀ√◊Õ‡´≈≈å

¢ÕßÀ≈Õ¥‡≈◊Õ¥∑’Ë∫“¥‡®Á∫‡™àπ thrombin, serotonin ·≈–

epinephrine ´÷Ëß®–‰ª‡°“–∫πµ—«√—∫(receptor)∫πº‘«‡°≈Á¥

‡≈◊Õ¥·≈–°√–µÿâπ„Àâ‡Õπ‰´¡å phospholipase C ‡ª≈’ˬπ

phosphatidylinositol diphosphate (PIP2) „À⇪ìπ inositol

triphosphate (IP3) ·≈– diacylglycerol (DG) ÷Ëß IP3 ®–‰ª

°√–µÿâπ„Àâ¡’°“√À≈—Ëß·§≈‡´’¬¡ÕÕ°®“° endoplasmic

Figure 1: Mechanisms of platelet activation at a site of vascular injury and mechanism of antiplatelet drugs. PIP2=

phosphatidylinositol diphosphate, IP3=inositol triphosphate, DG= diacylglycerol, PKC=protein kinase C,

PLA2=phospholipase A2, AA= arachinoic acid, TXA2=thromboxane A2, COX= cyclooxygenase, TS= thromboxane

synthase, Gi= G-protein(inhibitory form), AC= adenyl cyclase, ATP=adenosine triiphosphate, ADP=adenosine

diphosphate, c-AMP= cyclic adenosine monophosphate, ⊕ = stimulate, › = inhibit

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

reticulum à«π DG ®–‰ª°√–µÿâπ‡Õπ‰´¡å protein kinase C

(PKC) ¡’º≈µàÕ‡π◊ËÕß∑”„Àâ glycoprotein IIb/IIIa receptor

ª√“°Ø∑’˺‘«‡°≈Á¥‡≈◊Õ¥ πÕ°®“°π—Èπ·§≈‡ ’¬¡∑’ˇæ‘Ë¡¡“°

¢÷Èπ„π‡°≈Á¥‡≈◊Õ¥®–°√–µÿâπ„Àâ‡Õπ‰´¡å phospholipase A2

(PLA2) ¬àÕ¬ ≈“¬ºπ—ߢÕßµ—«‡Õ߉¥â°√¥ arachinoic Õ‘ √–

´÷Ëß®–∂Ÿ°¬àÕ¬ ≈“¬µàÕ‰ª‡ªìπ thromboxane A2 ‚¥¬Õ“»—¬

‡ÕÁπ‰´¡å cyclooxygenase (COX) ·≈– thromboxane

synthase thromboxane A2 ®–®—∫°—∫µ—«√—∫∫π‡°≈Á¥‡≈◊Õ¥

(Gi-protein, inhibitory form) ÷Ëß®–‰ª¬—∫¬—È߇ÕÁπ‰´¡å adenyl

cyclase ¡’º≈„Àâª√‘¡“≥¢Õß c-AMP ≈¥≈ß´÷Ëß®–∑”„Àâ

ª√‘¡“≥·§≈‡ ’¬¡‡æ‘Ë¡¡“°¢÷Èπ„π‡´≈≈å ª√‘¡“≥·§≈‡ ’¬¡∑’Ë

Ÿß¢÷Èπ„π‡°≈Á¥‡≈◊Õ¥‡ªìπµ—«°“√ ”§—≠∑’Ë∑”„À⇰≈Á¥‡≈◊Õ¥∂Ÿ°

°√–µÿâπ ‡°≈Á¥‡≈◊Õ¥ª°µ‘®–¡’√Ÿª‰¢à ‡¡◊ËÕ∂Ÿ°°√–µÿâπ®–‡ª≈’ˬπ

√Ÿª√à“ß‚¥¬ªØ‘°‘√‘¬“√–À«à“ß actin ·≈– myosin ¥÷ߺ‘«

‡¢â“À“®ÿ¥»Ÿπ¬å°≈“ß∑”„À⇰‘¥√Ÿª√à“ß·∫∫ pseudopods

3. ¢—ÈπµÕπ°“√À≈—Ëß “√®“°granule (platelet

secretion) ‡ªìπ¢—ÈπµÕπÀπ÷Ëß∑’ˇ°‘¥®“°°“√°√–µÿâπ‡°≈Á¥‡≈◊Õ¥

‡°≈Á¥‡≈◊Õ¥®–À≈—Ëß “√∑’ËÕ¬Ÿà¿“¬„π granule ÕÕ°¡“¡“°¡“¬7

䴉ᡈ thromboxane A2, adenosine diphosphate ( ADP )

·≈– ·§≈‡ ’¬¡Õ‘ÕÕπ œ≈œ ´÷Ëß “√‡À≈à“π’È®–‰ª®—∫°—∫µ—«√—∫

∫π‡°≈Á¥‡≈◊Õ¥·≈–°√–µÿâπ‡°≈Á¥‡≈◊Õ¥µ—«Õ◊Ëπʇªìπ«ß®√µàÕ‰ª

4. ¢—ÈπµÕπ‡°≈Á¥‡≈◊Õ¥®—∫°≈ÿà¡ (platelet aggrega-

tion) ‡¡◊ËÕ‡°≈Á¥‡≈◊Õ¥∂Ÿ°°√–µÿâπ ®–¡’°“√‡ª≈’ˬπ·ª≈߇°‘¥

¢÷Èπ∑’ˇ¬◊ËÕÀÿ⡇´≈≈å (plasma membrane) ‚¥¬®–¡’ glyco-

protein IIb/IIIa receptor ‡æ‘Ë¡¡“°¢÷Èπ glycoprotein π’È®–

®—∫°—∫ fibrinogen à«πÕ’°·¢πÀπ÷ËߢÕß fibrinogen ®–®—∫°—∫

glycoprotein IIb/IIIa receptor ¢Õ߇°≈Á¥‡≈◊Õ¥Õ’°µ—«Àπ÷Ëß ¡’

º≈„À⇰≈Á¥‡≈◊Õ¥®—∫°—π‡Õß·≈–°≈ÿà¡¢Õ߇°≈Á¥‡≈◊Õ¥®–‰ªÕÿ¥

µ—πÀ≈Õ¥‡≈◊Õ¥∑’Ë©’°¢“¥

¬“µâ“π‡°≈Á¥‡≈◊Õ¥

¬“µâ“π‡°≈Á¥‡≈◊Õ¥∑’Ë¡’„™â„πªí®®ÿ∫—π·∫àß°≈ÿࡵ“¡°≈‰°

À√◊Õµ”·ÀπàߢÕß°“√ÕÕ°ƒ∑∏‘Ï¥—ßπ’È6,7(√Ÿª∑’Ë 1)

1. ¬“µâ“π‡°≈Á¥‡≈◊Õ¥∑’Ë¢—¥¢«“ß°“√∑”ß“π¢Õß

‡Õπ‰´¡å cyclooxygenase (cyclooxygenase Inhibitor)

∑”„Àâ°√¥ arachinoic ‰¡à “¡“√∂‡ª≈’ˬπ‡ªìπ thromboxane

A2 ÷Ë߇ªìπ “√µ—«Àπ÷Ëß∑’Ë°√–µÿâπ„Àâ¡’°“√‡°“–°≈ÿà¡°—π¢Õß

‡°≈Á¥‡≈◊Õ¥ ‰¥â·°à aspirin

2. ¬“µâ“π‡°≈Á¥‡≈◊Õ¥∑’ËÕÕ°ƒ∑∏‘Ï¢—¥¢«“ß°“√®—∫

¢Õß “√°√–µÿâπ∑’Ë ADP receptor ∑”„Àâ ADP ‰¡à “¡“√∂

°√–µÿâπ„Àâ¡’°“√‡°“–°≈ÿà¡°—π¢Õ߇°≈Á¥‡≈◊Õ¥ ‰¥â·°à¬“„π

°≈ÿà¡Õπÿæ—π∏ÿå¢Õß thienopyridine ‰¥â·°à ticlopidine ·≈–

clopidogrel

3. ¬“µâ“π‡°≈Á¥‡≈◊Õ¥∑’Ë¢—¥¢«“ß°“√∑”ß“π¢Õß

‡Õπ‰´¡å phosphodiesterase ∑”„Àâª√‘¡“≥ c-AMP „π‡°≈Á¥

‡≈◊Õ¥‡æ‘Ë¡¢âπ ¡’º≈„Àâª√‘¡“≥·§≈‡´’¬¡„π‡°≈Á¥‡≈◊Õ¥‰¡à

‡æ‘Ë¡¢÷Èπ·≈–¬—∫¬—Èß°“√‡°“–°≈ÿà¡¢Õ߇°≈Á¥‡≈◊Õ¥ ‰¥â·°à

dipyridamole ·≈– cilostazol

4. ¬“µâ“π‡°≈Á¥‡≈◊Õ¥∑’Ë¢—¥¢«“ß°“√®—∫¢Õ߇°≈Á¥

‡≈◊Õ¥∑’Ë glycoprotein IIb/IIIa receptor ∫π‡°≈Á¥‡≈◊Õ¥

∑”„À⇰≈Á¥‡≈◊Õ¥‰¡à “¡“√∂®—∫°—∫ fibrinogen ‰¥â·°à

abciximab, tirofiban ·≈– eptifibatide ∑—Èß 3 ™π‘¥¡’‡©æ“–

©’¥‡¢â“À≈Õ¥‡≈◊Õ¥¥”‡∑à“π—Èπ

¬“µâ“π‡°≈Á¥‡≈◊Õ¥√Ÿª√—∫ª√–∑“π∑’Ë¡’„™â·æ√àÀ≈“¬

„πª√–‡∑»‰∑¬ ‰¥â·°à aspirin, clopidogrel (PlavixR) ·≈–

ticlopidine (TiclidR) ÷Ë߇ªìπ¬“∑’ËÕ¬Ÿà„π∫—≠™’¬“À≈—°·Ààß™“µ‘

ªï æ» 2551 ·≈–¬—ß¡’ dipyridamole (PersantinR) ·≈–

cilostazol (PletaalR)´÷Ë߇ªìπ¬“∑’ËÕ¬ŸàπÕ°∫—≠™’¬“À≈—°8

¬“∑’Ëπ‘¬¡„™â¡“°∑’Ë ÿ¥ §◊Õ aspirin ¡“§¡‚√§À—«„®·Ààß

À√—∞Õ‡¡√‘°“ (The American Heart Association) ·π–π”

„Àâ„™â aspirin ª√‘¡“≥µË”„πºŸâªÉ«¬∑’Ë¡’¿“«–‡ ’ˬߵàÕÀ≈Õ¥

‡≈◊Õ¥·≈–À—«„®9 dipyridamole ‰¥â∂Ÿ°∂ÕπÕÕ°®“°∫—≠™’¬“

À≈—°·Ààß™“µ‘µ—Èß·µàªï 2547 ‡π◊ËÕß®“°ª√– ‘∑∏‘¿“æ¢Õ߬“

µË” cilostazol ‰¡à∂Ÿ°®—¥‰«â„π∫—≠™’¬“À≈—°·Ààß™“µ‘ ‡π◊ËÕß®“°

¡’À≈—°∞“π°“√„™âπâÕ¬·≈–¡’¬“Õ◊Ëπ∑’Ë„™â‰¥âÕ¬à“߇撬ßæÕ·≈â«10

„π∑“ߪؑ∫—µ‘ π‘¬¡„™â clopidogrel ¡“°°«à“ ticlopidine

‡π◊ËÕß®“° “¡“√∂∫√‘À“√¬“«—π≈– 1 §√—Èß·≈–æ∫Õ“°“√‰¡à

æ÷ߪ√– ߧ宓°°“√„™â¬“πâÕ¬°«à“ µ“√“ß∑’Ë 1 √ÿª¢âÕ∫àß™’È

¢âÕÀâ“¡„™â ·≈–Õ“°“√‰¡àæ÷ߪ√– ߧå¢Õ߬“µâ“π‡°≈Á¥‡≈◊Õ¥

™π‘¥√—∫ª√–∑“π∑’Ë¡’„™â„πª√–‡∑»‰∑¬

º≈¢Õß°“√„™â¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫°“√‡ ’¬‡≈◊Õ¥√–À«à“ß

·≈–À≈—ß°“√ºà“µ—¥

º≈‡ ’¬∑’Ë ”§—≠¢Õß°“√„™â¬“µâ“π‡°≈Á¥‡≈◊Õ¥„πºŸâªÉ«¬

»—≈¬°√√¡§◊Õ ¿“«–‡≈◊Õ¥ÕÕ° ÷ËßÕ“®¡’§«“¡√ÿπ·√ßπâÕ¬

À√◊Õ¡“°¢÷ÈπÕ¬Ÿà°—∫™π‘¥¢Õß°“√ºà“µ—¥·≈–ªí®®—¬ à߇ √‘¡Õ◊ËπÊ

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« ∑—πµ ¡À‘¥≈ ªï∑’Ë 29 ‡≈à¡∑’Ë 1, 2552

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¬“µâ“π‡°≈Á¥‡≈◊Õ¥°—∫ß“π∑“ß∑—πµ°√√¡ 71

Table 1 Antiplatelet drugs approved to use in Thailand8,11

Class and agents Indication Contraindication Adversed reactioncyclooxygenase inhibitorsaspirin -acute myocardial infarction NSAID GI bleeding

-primary and secondary prophylaxis hypersensitivity, Intracranial bleedingof myocardial infarction and stroke active peptic GI toxicity,-prevention of thromboembolism after ulcer, severe hypersensitivityplacement of intracoronary stent hepatic/renal

diseasethienopyridineclopidogrel - use as aspirin in aspirin intolerance severe hepatic diarrhea, skin rash

or aspirin hypersensitivity disease ,- in combination with low-dose aspirin pregnancy,after the insertion of a coronary artery lactationstent to prevent stent thrombosis- recurrent thrombotic events afteraspirin use- in atrial fibrillation orantiphospholipid syndrome thatcannot use an anticoagulant or ananticoagulant is not necessary- patients with multiple thromboticrisk factors that cannot be controlledin a short period- to use in combination with aspirinother than the indication in No. 2 add no benefit but increase the risk ofbleeding

ticlopidine The same as clopidogrel severe hepatic diarrhea, skin rashdisease , thrombocytopenia,pregnancy, neutropenia,Lactation Raised lipid levels,

Liver dysfunctionCilostazol(12) -peripheral arterial insufficiency Congestive Headache, diarrhea,

( intermittent claudication) heart failure palpitation,tachycardia

‡™àπ‚√§ª√–®”µ—«¢ÕߺŸâªÉ«¬∑’Ë¡’º≈µàÕ°“√À¬ÿ¥‡≈◊Õ¥ ‰¥â·°à

‚√§µ—∫ ‚√§‰µ ·≈–‚√§‡≈◊Õ¥ ¡’√“¬ß“π°“√‡ ’¬‡≈◊Õ¥∑’Ë¡’§«“¡

”§—≠∑“ߧ≈‘π‘°√–À«à“ßºà“µ—¥„πºŸâª«¬∑’ˉ¡àÀ¬ÿ¥¬“µâ“π

‡°≈Á¥‡≈◊Õ¥„π°“√ºà“µ—¥À—«„®13-15·≈–°“√ºà“µ—¥µàÕ¡≈Ÿ°

À¡“°16 ·µà¬—߉¡àæ∫√“¬ß“π°“√ Ÿ≠‡ ’¬‡≈◊Õ¥∑’Ë¡’§«“¡

”§—≠∑“ߧ≈‘π‘°„π°“√∫”∫—¥∑“ß∑—πµ°√√¡ Lockhart ·≈–

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°—π‡°‘π 12 ™—Ë«‚¡ß À√◊ÕºŸâªÉ«¬µâÕß°≈—∫¡“À“∑’ËÀâÕß©ÿ°‡©‘π

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Brennan ·≈–§≥–18 ‰¥â∑”°“√«‘®—¬·∫∫ randomized

controlled ‚¥¬∂Õπøíπ 1 ´’Ë„πºŸâªÉ«¬ 36 §π æ∫«à“‰¡à¡’

§«“¡·µ°µà“ß°—π¢Õß¿“«–‡≈◊Õ¥ÕÕ°„πºŸâªÉ«¬∑’ˉ¥â√—∫

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‡¡◊ËÕ∂Õπøíπ 1 ´’Ë

Madan ·≈–§≥–19‰¥â»÷°…“·∫∫ cohort ∂÷ß¿“«–

‡≈◊Õ¥ÕÕ°®“°°“√∑”ºà“µ—¥‡≈Á°„π™àÕߪ“°∑’Ë “¡“√∂∑”

‡ªìπºŸâªÉ«¬πÕ°‡™àπ ∂Õπøíπ ºà“µ—¥øíπ§ÿ¥ °“√Ωíß√“°‡∑’¬¡

°“√µ—¥ªÿÉ¡°√–¥Ÿ°„πºŸâªÉ«¬∑’Ë√—∫ª√–∑“π aspirin ¢π“¥ 75-

100 ¡°.‡ªìπª√–®” 51 √“¬ ‚¥¬‰¡àÀ¬ÿ¥ aspirin æ∫«à“

bleeding time °àÕπºà“µ—¥ 2.86 ± 0.54 π“∑’ ·≈–¡’‡æ’¬ß 1

√“¬∑’Ë¡’‡≈◊Õ¥ÕÕ°¡“°·µà “¡“√∂À¬ÿ¥‡≈◊Õ¥‰¥â‚¥¬«‘∏’Àâ“¡

‡≈◊Õ¥‡©æ“–∑’Ë ·≈–‰¡à¡’‡≈◊Õ¥ÕÕ°º‘¥ª°µ‘À≈—ßºà“µ—¥ ·≈–

√ÿªº≈°“√»÷°…“«à“ “¡“√∂∑”ºà“µ—¥‡≈Á°„π™àÕߪ“°„π

ºŸâªÉ«¬∑’Ë√—∫ª√–∑“π aspirin ¢π“¥µË”‡ªìπª√–®”‰¥â‚¥¬‰¡à

µâÕßÀ¬ÿ¥¬“

Ardekain ·≈–§≥–20‰¥â»÷°…“·∫∫ randomized

controlled ‡ª√’¬∫‡∑’¬∫√–À«à“ß°“√À¬ÿ¥¬“·≈–‰¡àÀ¬ÿ¥¬“

„πºŸâªÉ«¬∑’ˉ¥â√—∫ aspirin 100 ¡‘≈≈‘°√—¡‡ªìπª√–®”·≈–¡“

√—∫°“√∂Õπøíπ∑—Èß·∫∫¬“°·≈–·∫∫ßà“¬ æ∫«à“‰¡à¡’¿“«–

‡≈◊Õ¥ÕÕ°¡“°º‘¥ª°µ‘∑’ˉ¡à “¡“√∂À¬ÿ¥‡≈◊Õ¥‰¥â‚¥¬«‘∏’

Àâ“¡‡≈◊Õ¥‡©æ“–∑’Ë∑—Èß√–À«à“ß·≈–À≈—ß°“√∂Õπøíπ„πºŸâªÉ«¬

∑—Èß 2 °≈ÿà¡ ·≈– √ÿªº≈°“√»÷°…“‡™àπ‡¥’¬«°—∫ Madan ·≈–

§≥–

Louis ·≈–§≥–21‰¥â√“¬ß“πºŸâªÉ«¬‚√§ Cerebral

Autosomal Dominant Arteriopathy with Subcorticol Infarcts

and Leuko encephalopathy(CADASIL) ∑’ˉ¥â√—∫ ticlopidine

‡ªìπª√–®”‚¥¬·æ∑¬å‡©æ“–∑“ß√–∫∫ª√– “∑‰¡à·π–π”

„ÀâÀ¬ÿ¥¬“°àÕπ∂ÕπøíπÀ≈“¬´’Ë ∑—πµ·æ∑¬å‰¥â∂Õπøíπ¿“¬„µâ

¬“™“‡©æ“–∑’Ë‚¥¬„™â‡´Õ√宑‡´≈(surgical) √à«¡°—∫°“√„™â

øíπª≈Õ¡™—Ë«§√“«™π‘¥„ à∑—π∑’„π°“√Àâ“¡‡≈◊Õ¥ ‰¡àæ∫°“√

‡°‘¥‡≈◊Õ¥ÕÕ°¡“°º‘¥ª°µ‘¿“¬À≈—ß°“√∂Õπøíπ

Lafont ·≈–§≥–22‰¥â∑”°“√»÷°…“·∫∫‰ª¢â“ßÀπâ“

(prospective study) ‚¥¬∂Õπøíπ‰¡à‡°‘π 3 ´’Ë„π¥â“π

(quadrant) ‡¥’¬«°—π·≈–„™â “√Àâ“¡‡≈◊Õ¥‡©æ“–∑’Ë„πºŸâªÉ«¬∑’Ë

‰¥â√—∫¬“°≈ÿà¡ thienopyridines Õ¬à“߇¥’¬«À√◊Õ¬“°≈ÿà¡

thienopyridines √à«¡°—∫ aspirin „πºŸâªÉ«¬ 563 §π æ∫«à“

¡’‡æ’¬ß13§π (2.3%) ∑’˵âÕß°≈—∫¡“À“„À¡à·≈–‡ªìπ‡æ’¬ß

‡≈◊Õ¥ÕÕ°‡≈Á°πâÕ¬‡∑à“π—Èπ

„πªí®®ÿ∫—π¬—߉¡àæ∫°“√»÷°…“∑’Ë· ¥ß„Àâ‡ÀÁπ«à“°“√

∂Õπøíπ‚¥¬‰¡àÀ¬ÿ¥ aspirin ∑”„À⇰‘¥‡≈◊Õ¥ÕÕ°¡“°

√–À«à“ß·≈–À≈—ß∂Õπøíπ23 Richard ·≈–§≥–24 ‰¥â»÷°…“

æ∫«à“°“√„™â clopidogrel 75 ¡‘≈≈‘°√—¡µàÕ«—π‡ªìπª√–®”∑”

„Àâ¡’ bleeding time ‡æ‘Ë¡ 1.5-1.7 ‡∑à“¢Õß§à“ª°µ‘ „π

ªí®®ÿ∫—π¬—߉¡àæ∫√“¬ß“π‡°’Ë¬«°“√ Ÿ≠‡ ’¬‡≈◊Õ¥¡“°®π¡’

§«“¡ ”§—≠∑“ߧ≈‘π‘°„π¢≥–„Àâ°“√√—°…“∑“ß∑—πµ°√√¡

„πºŸâªÉ«¬∑’ˉ¥â clopidogrel À√◊Õ ticlopidine ·µà‡ªìπ∑’ˬա√—∫

°—π«à“®–∑”„Àâ¡’‚Õ°“ ‡≈◊Õ¥ÕÕ°¡“°°«à“ aspirin16 ·≈–

¬—߉¡àæ∫°“√»÷°…“‡ª√’¬∫‡∑’¬∫ (controlled study) ∑’Ë

‡°’ˬ«¢âÕß°—∫°“√‡ ’¬‡≈◊Õ¥„πºŸâªÉ«¬∑“ß∑—πµ°√√¡∑’ˉ¥â√—∫

¬“µâ“π‡°≈Á¥‡≈◊Õ¥ 2 ™π‘¥√à«¡°—π§◊Õ aspirin ·≈– clopidogrel

´÷Ëß„™â°—π¡“°À≈—ß„ àÕÿª°√≥å∂à“ßÀ≈Õ¥‡≈◊Õ¥ (stent) „π

À≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å

º≈¢Õß°“√À¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥

°“√À¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥·¡â‡ªìπ‡æ’¬ß™à«ß —ÈπÊ

7-10 «—π ¬àÕ¡‡æ‘Ë¡‚Õ°“ °“√‡°‘¥°≈â“¡‡π◊ÈÕÀ—«„®µ“¬

·≈– ¡Õߢ“¥‡≈◊Õ¥ ‡æ√“–‡æ‘Ë¡‚Õ°“ °“√Õÿ¥µ—π®“°≈‘Ë¡

‡≈◊Õ¥(thrombosis)¢ÕßÀ≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å·≈–À≈Õ¥

‡≈◊Õ¥ ¡Õß ‚¥¬‡©æ“–ºŸâªÉ«¬‡§¬¡’°≈â“¡‡π◊ÈÕÀ—«„®µ“¬À√◊Õ

¡Õߢ“¥‡≈◊Õ¥¡“°àÕπ·≈–‰¥â√—∫¬“µâ“π‡°≈Á¥‡≈◊Õ¥‡æ◊ËÕ

ªÑÕß°—π·∫∫∑ÿµ‘¬¿Ÿ¡‘

Collet ·≈–§≥–25‰¥â∑”°“√»÷°…“¬âÕπÀ≈—ß

(retrospective study) „πºŸâªÉ«¬ 475 √“¬∑’ˇ¢â“‚√ß欓∫“≈

‡π◊ËÕß®“°°≈â“¡‡π◊ÈÕÀ—«„®µ“¬‡©’¬∫æ≈—π æ∫¡’ 11 √“¬

(2.3%) ∑’Ëߥ aspirin 3-15 «—π (‡©≈’ˬ 9.4±3.2) ∑ÿ°√“¬

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‰¥â√—∫ aspirin Õ¬à“ßµàÕ‡π◊ËÕß·≈–‰¡à¡’Õ“°“√‡©≈’ˬ 3.8±2.9

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ºà“µ—¥∑“ß∑—πµ°√√¡

Ferrari ·≈–§≥–26 ‰¥â∑”°“√»÷°…“·∫∫ cohort ∂÷ß

§«“¡‡°’ˬ«¢âÕߢÕß°“√‡°‘¥ acute coronary syndrome °—∫

°“√À¬ÿ¥√—∫ª√–∑“π aspirin „πºŸâªÉ«¬∑’ˇªìπ‚√§À≈Õ¥

‡≈◊Õ¥‚§‚√π“√’¬å æ∫«à“„π®”π«πºŸâªÉ«¬ 1236 §π∑’ˇ°‘¥

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Biondi-Zoccai ·≈–§≥–27‰¥â∑”°“√∑∫∑«π

«√√≥°√√¡ ·≈–∑” meta-analysis ºŸâªÉ«¬∑’ˉ¥â aspirin

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«à“‡°‘¥‚√§·∑√° âÕπ¢Õß√–∫∫À—«„®·≈–À≈Õ¥‡≈◊Õ¥‡æ‘Ë¡¢÷Èπ

3 ‡∑à“ ·≈–‚Õ°“ ‡ ’ˬ߮–‡æ‘Ë¡¢÷Èπ„π√“¬∑’ˉ¥â√—∫°“√∑”

À—µ∂°“√¢¬“¬À≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å (percutaneous

transcoronary angioplasty ; PTCA) √à«¡°—∫°“√ Õ¥Ωíߢ¥

≈«¥§È”¬—πºπ—ßÀ≈Õ¥‡≈◊Õ¥ (stent) ¡’√“¬ß“π°“√Õÿ¥µ—π

¢Õߢ¥≈«¥§È”¬—πºπ—ßÀ≈Õ¥‡≈◊Õ¥®“°≈‘Ë¡‡≈◊Õ¥ (stent

thrombosis) ®“°°“√À¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥´÷Ë߇ªìπº≈„Àâ

‡°‘¥¿“«–°≈â“¡‡π◊ÈÕÀ—«„®µ“¬·≈– Ÿ≠‡ ’¬™’«‘µ∂÷ß 64 %

‚¥¬ºŸâªÉ«¬¡’Õ—µ√“µ“¬∂÷ß 9-45%28,29

Burger ·≈–§≥–30‰¥â∑∫∑«π«√√≥°√√¡ ·≈–∑”

meta-analysis º≈¢Õß°“√À¬ÿ¥·≈–‰¡àÀ¬ÿ¥ aspirin ¢π“¥

µË”Ê´÷Ëß„Àâ„πºŸâªÉ«¬‚√§À≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å ‚¥¬»÷°…“∂÷ß

§«“¡‡°’ˬ«¢âÕߢÕß°“√À¬ÿ¥ aspirin °àÕπºà“µ—¥·≈–¿“«–

·∑√°´âÕπ¢Õß√–∫∫À≈Õ¥‡≈◊Õ¥·≈–À—«„® ·≈–§«“¡

‡°’ˬ«¢âÕß¿“«–‡≈◊Õ¥ÕÕ°º‘¥ª°µ‘√–À«à“ß°“√ºà“µ—¥∂Ⓣ¡àÀ¬ÿ¥

aspirin º≈ª√“°Ø«à“‰¡àæ∫°“√»÷°…“‡ª√’¬∫‡∑’¬∫ (con-

trolled study) ‡æ◊ËÕ¥Ÿ¿“«–·∑√° âÕπ¢Õß√–∫∫À≈Õ¥‡≈◊Õ¥

·≈–À—«„®√–À«à“ß°“√À¬ÿ¥·≈–‰¡àÀ¬ÿ¥ aspirin ·µà¡’°“√

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·∑√°´âÕπ¢Õß√–∫∫À≈Õ¥‡≈◊Õ¥·≈–À—«„® 10.2% ™à«ß

‡«≈“À≈—ßÀ¬ÿ¥ aspirin ®π‡°‘¥¿“«–·∑√° âÕπ ”À√—∫ acute

coronary syndrome 8.5 ± 3.6 «—π ”À√—∫°“√Õÿ¥µ—π¢Õß

À≈Õ¥‡≈◊Õ¥ ¡Õß (ischemic stroke) 14.3 ± 11.3 «—π ·≈–

”À√—∫°“√Õÿ¥µ—π¢ÕßÀ≈Õ¥‡≈◊Õ¥ à«πª≈“¬ (acute peri-

pheral vascular event) 5.8 ± 18.1 «—π ·≈–„π®”π«π

ºŸâªÉ«¬ 93 √“¬∑’ˇ°‘¥ªí≠À“ ¡’ 14 √“¬∑’ËÀ¬ÿ¥¬“‡æ◊ËÕ

∑”°“√∫”∫—¥∑“ß∑—πµ°√√¡ ·≈–æ∫«à“¿“«–‡≈◊Õ¥ÕÕ°º‘¥

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‡≈◊Õ¥®π‡°‘¥Õ—πµ√“¬„π°“√ºà“µ—¥ ¡Õß·≈–µàÕ¡≈Ÿ°À¡“°

à«π°“√ºà“µ—¥„π™àÕߪ“° “¡“√∂À¬ÿ¥‡≈◊Õ¥‰¥â‚¥¬«‘∏’Àâ“¡

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Maulaz ·≈–§≥–31‰¥â∑” case control study æ∫«à“

°“√À¬ÿ¥ aspirin „πºŸâªÉ«¬‡§¬¡’À≈Õ¥‡≈◊Õ¥ ¡ÕßÕÿ¥µ—π

∑”„À⇰‘¥°“√Õÿ¥µ—π¢ÕßÀ≈Õ¥‡≈◊Õ¥ ¡ÕßÀ√◊Õ transient

ischemic attack ‡æ‘Ë¡¢÷Èπ‚¥¬¡’ odds ratio ∂÷ß 3.4 ‡¡◊ËÕ

‡ª√’¬∫‡∑’¬∫°—∫°≈ÿà¡∑’ˉ¡à‡§¬¡’À≈Õ¥‡≈◊Õ¥ ¡ÕßÕÿ¥µ—π·≈–

‡°‘¥¿“¬„π 9.5 ± 7 «—π ·≈–‡™àπ‡¥’¬«°—π Sibon ·≈–

§≥–32‰¥â∑”°“√»÷°…“¬âÕπÀ≈—ß æ∫«à“ 4.49% ¢ÕߺŸâªÉ«¬

320 §π∑’Ë¡“‚√ß欓∫“≈¥â«¬‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß

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6-10 «—π

∫∑«‘®“√≥å¢âÕ¡Ÿ≈∑’ˉ¥â√«∫√«¡∑—ÈßÀ¡¥¢Õ߬“µâ“π‡°≈Á¥‡≈◊Õ¥¡“

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Intensive Care) ‰¡à·π–π”„ÀâÀ¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥°àÕπ

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Society) ‰¡à·π–π”„ÀâÀ¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥°àÕπ°“√∑”

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ᾷŒ

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πÕ√å∏‡« ∑å¢Õߪ√–‡∑»Õ—ß°ƒ… (The North West Medicines

Information Centre) ‰¡à·π–π”„ÀâÀ¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥

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association) ‰¡à·π–π”„ÀâÀ¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥ 2 ™π‘¥

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Àπ⓬◊π¬—π37,38 ‚¥¬‰¡à§«√À¬ÿ¥ aspirin ·≈– clopidogrel

°àÕπ 12 ‡¥◊Õπ„πºŸâªÉ«¬∑’Ë„ ࢥ≈«¥‡§≈◊Õ∫πÈ”¬“ (drug-

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„πºŸâªÉ«¬∑’Ë„ ࢥ≈«¥‚≈À–‰¡à‡§≈◊Õ∫πÈ”¬“ (bare-metal

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Figure 2: Algorithm for surgical preparation of patients who are taking antiplatelet and need a surgery with bleedig risk.

Questionable?Secondary prophylaxis

Medical consultation

Resume taking the drug after surgery as

soon as possible

No, high risks/p stent placement

During 12 months after drug-eluting stent During 6 weeks after bare-metal stent

Postpone surgery orstop clopidogrel / continue aspirin

treatment in hospital under medical

supervision

Traumatic surgery with risk of bleeding

History takingType and indication for

Antiplatelet drugs

Yes, low risk Primary prophylaxis

Can the patient stop taking the drug for 7-10 days?

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À√◊Õ‰¡àÀ¬ÿ¥¬“µâ“π‡°≈Á¥‡≈◊Õ¥°àÕπ„Àâ°“√√—°…“∑“ß∑—πµ-

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‚≈À‘µ«‘∑¬“‡∫◊ÈÕßµâπ. æ‘¡æå§√—Èß∑’Ë 2. °√ÿ߇∑æ¡À“π§√:

‚§√ß°“√µ”√“«‘∑¬“≈—¬·æ∑¬»“ µ√åæ√–¡ß°ÿƇ°≈â“;

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ªÉ«¬‚√§À≈Õ¥‡≈◊Õ¥‚§‚√π“√’¬å∑’ˉ¥â√—∫¬“µâ“π°“√

∑”ß“π¢Õ߇°≈Á¥‡≈◊Õ¥ ¡“√—∫°“√ºà“µ—¥∑’ˉ¡à„™à°“√ºà“µ—¥

À—«„®. „π: Critical Review in Anesthesia Series I :

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ª√–°Õ∫°“√ª√–™ÿ¡ 44 th Siriraj Scientific Congress

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°Õß∑—æ‡√◊Õ :46- 55

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not adhering to aspirin among 50279 patients atrisk for coronary artery disease. Eur Heart J 2006;27: 2667›74.

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6. °√≥’∑’ËÕ¬Ÿà„π¢—ÈπµÕπ°“√®—¥æ‘¡æå ∑“ß∫√√≥“∏‘°“√®– àßµâπ©∫—∫ (artwork) „À⺟â√—∫º‘¥™Õ∫‡æ’¬ß§π‡¥’¬«µ√«®æ‘ Ÿ®πå

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8. ºŸâπ‘æπ∏å∑ÿ°∑à“πµâÕß≈ß≈“¬¡◊Õ™◊ËÕ„π°“√¡Õ∫≈‘¢ ‘∑∏‘Ï·≈–¬◊π¬—π«à“∫∑§«“¡µâπ©∫—∫∑’Ë àß¡“µ’æ‘¡æåπ—Èπ‰¥â àß¡“µ’

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9. ∫∑§«“¡∑’Ë≈ßµ’æ‘¡æå„π«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈ ∂◊Õ‡ªìπ≈‘¢ ‘∑∏‘Ï¢Õߧ≥–∑—πµ·æ∑¬»“ µ√å

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‡°≥±å√—∫‡√◊ËÕߢÕß«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈«—µ∂ÿª√– ߧå¢Õß«‘∑¬“ “√

1. ‡æ◊ËÕ‡º¬·æ√৫“¡√Ÿâ∑’ˉ¥â®“°°“√«‘®—¬À√◊Õ»÷°…“§âπ§«â“∑“ß«‘™“°“√¥â“π∑—πµ·æ∑¬»“ µ√å ·≈– “¢“«‘™“«‘∑¬“»“ µ√å°“√·æ∑¬å∑’ˇ°’ˬ«¢âÕß2. ‡æ◊ËÕ à߇ √‘¡ π—∫ πÿπß“π«‘®—¬ ·≈–°“√§âπ§«â“∑’Ë¡’§ÿ≥§à“‡æ◊ËÕ§«“¡°â“«Àπâ“∑“ß«‘™“°“√3. ‡æ◊ËÕ‡ªìπ ◊ËÕ —¡æ—π∏å∑“ß«‘™“°“√√–À«à“ß∑—πµ·æ∑¬å ·≈–ºŸâÕ◊Ëπ„π “¢“«‘™“∑’ˇ°’ˬ«¢âÕß„Àâ°â“«∑—π°“√‡ª≈’ˬπ·ª≈ߧ«“¡√Ÿâ∑’Ë¡’°“√æ—≤π“µ≈Õ¥‡«≈“4. ‡æ◊ËÕ‡º¬·æ√à‡°’¬√µ‘§ÿ≥¢Õß ∂“∫—π ¡“§¡»‘…¬å‡°à“§≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈«‘∑¬“ “√π’ȉ¥â√—∫∑ÿπÕÿ¥Àπÿπ®“°§≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈

§”·π–π” ”À√—∫ºŸâπ‘æπ∏å∫∑§«“¡°“√ àß∫∑§«“¡‡æ◊ËÕµ’æ‘¡æå∑’Ë

∫√√≥“∏‘°“√«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈Àπ૬ à߇ √‘¡æ—≤π“∑“ß«‘™“°“√ µ÷° 4 ™—Èπ 9

¡À“«‘∑¬“≈—¬¡À‘¥≈ §≥–∑—πµ·æ∑¬»“ µ√å6 ∂ππ‚¬∏’ ‡¢µ√“™‡∑«’ °√ÿ߇∑æ¡À“π§√ 10400

‚∑√»—æ∑å 0-2660-7769 ‚∑√ “√ [email protected]

√Ÿª·∫∫∫∑§«“¡ª√–‡¿∑¢Õß∫∑§«“¡¡’¥—ßπ’È1. ∫∑«‘∑¬“°“√ (original article) ‰¥â·°à √“¬ß“πº≈ß“π«‘®—¬„À¡à∑’ˇªìπª√–‚¬™πå √“¬ß“π°“√ ”√«®∑“ß√–∫“¥«‘∑¬“ √“¬ß“πºŸâªÉ«¬ (case

report) ∑’Ëπà“ π„® ·≈–√“¬ß“π ‘Ëߪ√–¥‘…∞åÀ√◊Õ√“¬ß“π‡∑§π‘§ (technical report) ∑’Ë¡’ª√–‚¬™πåµàÕ«‘™“™’æ∑—πµ·æ∑¬å ÷Ë߉¡à‡§¬µ’æ‘¡æå„π«‘∑¬“ “√„¥ Ê ¡“°àÕπ2. ∫∑§«“¡ª√‘∑—»πå (review article) ‡ªìπ∫∑§«“¡∑’Ë√«∫√«¡§«“¡√Ÿâ®“°µ”√“ Àπ—ß ◊ÕÀ√◊Õ«‘∑¬“ “√„À¡àÀ√◊Õ®“°º≈ß“π·≈–ª√– ∫°“√≥å¢Õß

ºŸâπ‘æπ∏å¡“‡√’¬∫‡√’¬ß¢÷Èπ ‚¥¬¡’°“√«‘‡§√“–Àå «‘®“√≥å ‡ª√’¬∫‡∑’¬∫ ‡æ◊ËÕ„À⇰‘¥§«“¡≈÷°´÷ÈßÀ√◊Õ‡°‘¥§«“¡°√–®à“ß„π‡√◊ËÕßπ—Èπ¡“°¬‘Ëߢ÷Èπ3. ª°‘≥°– (miscellany) ‰¥â·°à3.1 √“¬ß“π摇»… (special report) ‡ªìπ√“¬ß“π —Èπ Ê ∑“ß«‘™“°“√∑’ˇ°’ˬ«¢âÕß°—∫∑—πµ·æ∑¬å Õ“®¡’≈—°…≥–‡ªìπ∫∑«‘‡§√“–Àå «‘®“√≥å À√◊Õ∫∑§«“¡

«‘™“°“√∑’ˇªìπª√–‚¬™πå ∫∑§«“¡∑∫∑«π§«“¡√Ÿâ ‡√◊ËÕß·ª≈¬àÕ§«“¡®“°«‘∑¬“ “√µà“ߪ√–‡∑» °“√· ¥ß§«“¡§‘¥‡ÀÁπ «‘®“√≥å ·π–𔇧√◊ËÕß¡◊Õ µ”√“À√◊ÕÀπ—ß ◊Õ„À¡à ∑’Ëπà“ π„® À√◊Õ¢à“«°“√ª√–™ÿ¡∑—Èß√–¥—∫™“µ‘·≈–√–¥—∫π“π“™“µ‘

3.2 «‘∑¬“°“√ªí®®ÿ∫—π (current concept) ‡ªìπ·π«§‘¥À√◊Õ«‘∑¬“°“√∑’ˬ÷¥∂◊Õ·≈–„™â„πªí®®ÿ∫—π Õ“®‡ªìπ‡√◊ËÕß„¥‡√◊ËÕßÀπ÷Ëß„π “¢“«‘™“µà“ß Ê ∑’ˇªìπª√–‚¬™πå ‚¥¬°“√‡¢’¬π À√◊Õ·ª≈‡√’¬∫‡√’¬ß®“°«‘∑¬“ “√©∫—∫Õ◊Ëπ∑’ˇªìπ∑’ˬա√—∫„π‡√◊ËÕß¡“µ√∞“π

3.3 ∂“¡ºŸâ‡™’ˬ«™“≠ (ask the expert) ‡ªìπ°“√µÕ∫ªí≠À“∑“ß«‘™“°“√À√◊Õªí≠À“ß“π„π§≈‘π‘°¢ÕߺŸâÕà“π ‚¥¬ºŸâ‡™’ˬ«™“≠‡©æ“– “¢“«‘™“π—ÈπÊ À√◊Õπ”‡Õ“ªí≠À“∑’Ëπà“ π„®®“°°“√∂“¡µÕ∫„π√–À«à“ß°“√ª√–™ÿ¡«‘™“°“√µà“ß Ê ¡“µ’æ‘¡æå‡æ◊ËÕ„À⺟â∑’ˉ¡à‰¥â‡¢â“√à«¡ª√–™ÿ¡‰¥â¡’‚Õ°“ √—∫∑√“∫

3.4 ®¥À¡“¬∂÷ß “√“≥’¬°√ (letter to the editor) ‡ªìπ§”∂“¡À√◊Õ¢âÕ§‘¥‡ÀÁπ∑“ß«‘™“°“√∑’ˇªìπª√–‚¬™πåµàÕºŸâÕà“π·≈–«‘™“™’æ‚¥¬ à«π√«¡3.5 ∫∑¬àÕ√“¬ß“π«‘®—¬ À√◊Õ∫∑«‘®“√≥åÀπ—ß ◊Õ„À¡à∑’Ëπà“ π„®

°“√‡µ√’¬¡∫∑§«“¡(‡√‘Ë¡„™âµ—Èß·µà ªï∑’Ë 27 ©∫—∫∑’Ë 1 æ.». 2550 ‡ªìπµâπ‰ª)

1. µâπ©∫—∫µâÕ߉¡àæ—∫·≈– àß¡“∑“߉ª√…≥’¬å≈ß∑–‡∫’¬π‡æ◊ËÕªÑÕß°—π°“√ Ÿ≠À“¬ æ√âÕ¡∑—Èß·∫∫øÕ√å¡°“√ àßµâπ©∫—∫‡æ◊ËÕ¢Õ„Àâæ‘®“√≥“≈ßµ’æ‘¡æå‚¥¬ àßµâπ©∫—∫ 1 ™ÿ¥ ”‡π“ 4 ™ÿ¥ ‰¡àµâÕ߇¬Á∫°√–¥“… „™â§≈‘ªÀπ’∫¡“‡ªìπ™ÿ¥ Ê ”À√—∫¿“æª√–°Õ∫·≈–µ“√“ß àß®”π«π 3 ™ÿ¥ æ‘¡æå‚¥¬„™â‚ª√·°√¡WORD ·∫∫Õ—°…√§Õ‡¥’¬π‘« (Cordia New) ¢π“¥ 16 ·≈–¡’√–¬–Àà“ß√–À«à“ß∫√√∑—¥ Õß™àÕß (double spacing) æ‘¡æåÀπⓇ¥’¬«≈ß∫π°√–¥“…æ‘¡æå —Èπ¢π“¥‡Õ ’Ë (A4) æ‘¡æå„ÀâÀà“ß®“°¢Õ∫°√–¥“… 2.5 ‡´πµ‘‡¡µ√∑ÿ°¥â“π æ√âÕ¡„ àÀ¡“¬‡≈¢Àπâ“°”°—∫∑“ß¡ÿ¡¢«“∫π∑ÿ°Àπâ“ §«“¡¬“«¢Õß∫∑§«“¡§«√Õ¬Ÿà√–À«à“ß 10-20 Àπâ“°√–¥“…æ‘¡æå —Èπ ´÷Ëß√«¡√Ÿª¿“æ·≈–µ“√“ߥ⫬ ‚¥¬®”π«π√Ÿª¿“æ·≈–µ“√“ß∑—ÈßÀ¡¥‰¡à§«√‡°‘π 10 Àπâ“

2. ∫∑§«“¡¿“…“‰∑¬„Àℙⵗ« –°¥µ“¡æ®π“πÿ°√¡©∫—∫√“™∫—≥±‘µ¬ ∂“π (©∫—∫≈à“ ÿ¥ªï æ.». 2542) »—æ∑å¿“…“Õ—ß°ƒ…∑’Ë„™âªπ°—∫¿“…“‰∑¬„Àâ·ª≈‡ªìπ¿“…“‰∑¬ §«√‡¢’¬π§”‡¥‘¡°”°—∫‰«â„π«ß‡≈Á∫‡©æ“–§√—Èß·√°∑’Ë°≈à“«∂÷ß À“°§”„¥∑’Ë√“™∫—≥±‘µ¬ ∂“π∫—≠≠—µ‘‰«â·≈â«„Àℙ⻗æ∑å∫—≠≠—µ‘π—Èπ ∂Ⓣ¡à‰¥â∫—≠≠—µ‘‰«â„Àℙ⫑∏’°“√‡¢’¬π∑—∫»—æ∑å¿“…“‰∑¬µ“¡À≈—°‡°≥±å°“√∑—∫»—æ∑å·≈–«ß‡≈Á∫§”‡¥‘¡°”°—∫‰«â‡©æ“–§√—Èß·√°‡™àπ‡¥’¬«°—π(À“¢âÕ¡Ÿ≈‡æ‘Ë¡‡µ‘¡‰¥â®“° www.royin.go.th) °“√„™âµ—«‡≈¢„π∫∑§«“¡ „Àℙ⇩擖‡≈¢Õ“√∫‘°‡∑à“π—Èπ

3. Àπ૬¡“µ√∞“π°“√«—¥ (Unit of Measurement) ‰¥â·°à Àπ૬¢Õߧ«“¡¬“« §«“¡ Ÿß πÈ”Àπ—° ª√‘¡“µ√ ‡ªìπµâ𠧫√„™â√–∫∫‡¡µ√‘° (metricunits) Õÿ≥À¿Ÿ¡‘§«√„™â‡ªìπÕß»“‡´≈‡´’¬ §«“¡¥—π§«√„™â‡ªìπ¡‘≈≈‘‡¡µ√ª√Õ∑ (¡¡.ª√Õ∑) °“√«—¥∑“ß‚≈À‘µ (hematologic) ·≈–∑“߇§¡’§≈‘π‘° (clinicalchemistry) §«√„™âÀπ૬‡ªìπ√–∫∫‡¡µ√‘° Àπ૬°“√«—¥Õ◊Ëπ Ê §«√„™â·∫∫¡“µ√∞“π “°≈π‘¬¡ §”¬àÕ·≈– —≠≈—°…≥儙⇩擖§”¬àÕ¡“µ√∞“π (standardabbreviation) ‰¡à§«√„™â§”¬àÕ„π™◊ËÕ‡√◊ËÕß·≈–∫∑§—¥¬àÕ §”‡µÁ¡¢Õߧ”¬àÕ§«√Õâ“߉«âµàÕ∑⓬§”¬àÕ§√—Èß·√°„π‡π◊ÈÕ‡√◊ËÕß ¬°‡«âπ‡ªìπÀπ૬¡“µ√∞“π„π°“√«—¥°“√√–∫ÿ´’Ëøíπ Õ“®„™â°“√‡√’¬°™◊ËÕÕ¬à“߇¥’¬« ‡™àπ øíπ‡¢’È¬«∫π´â“¬ (À√◊Õ upper left canine „π∫∑§«“¡¿“…“Õ—ß°ƒ…) À√◊Õ„™â —≠≈—°…≥嵓¡√–∫∫ FDItwo-digit notation ·≈–¡’™◊ËÕ„π«ß‡≈Á∫µàÕ∑⓬‡©æ“–§√—Èß·√°∑’Ë°≈à“«∂÷ß ‡™àπ øíπ #31 (øíπµ—¥´’Ë°≈“ß≈à“ߴ⓬)

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‰¡à„™â§”¬àÕ §«“¡¬“« ‰¡à§«√‡°‘π 100 µ—«Õ—°…√2. ™◊ËÕºŸâπ‘æπ∏å „Àâ„™â™◊ËÕ·≈–π“¡ °ÿ≈‡∑à“π—Èπ ∂â“¡’ºŸâπ‘æπ∏åÀ≈“¬∑à“π„À⇢’¬πµ“¡≈”¥—∫§«“¡ ”§—≠¢Õß°“√√à«¡∑”ß“π«‘®—¬3. «ÿ≤‘°“√»÷°…“ „Àâ„ à§ÿ≥«ÿ≤‘ Ÿß ÿ¥¢ÕߺŸâπ‘æπ∏åµàÕ∑⓬™◊ËÕºŸâπ‘æπ∏å§π≈–‰¡à‡°‘π 2 ‚¥¬„™âµ—«¬àÕ¢Õߪ√‘≠≠“·≈–§ÿ≥«ÿ≤‘µ“¡∑’ˉ¥â¡“„π°√≥’

∑’Ë®∫®“°µà“ߪ√–‡∑»„Àℙ⿓…“π—Èπ Ê4. ∑’ËÕ¬Ÿà ¢ÕߺŸâπ‘æπ∏å·µà≈–§π §«√„™â∑’ËÕ¬Ÿà¢ÕßÀπ૬ߓπÀ√◊Õ ∂“∫—π„ à„Àâ≈–‡Õ’¬¥ ∂Ⓣ¡à‰¥â —ß°—¥Àπà«¬ß“π„¥„Àâ„™â∑’ËÕ¬Ÿà§≈‘π‘°5. „Àâæ‘¡æ委«à“ 絑¥µàÕ‡°’ˬ«°—∫∫∑§«“¡é „Àâ¡’™◊ËÕºŸâπ‘æπ∏å‡æ’¬ß§π‡¥’¬« π“¡ °ÿ≈ µ”·Àπàß ∂“π∑’Ë∑”ß“π À¡“¬‡≈¢‚∑√»—æ∑å∑’Ë

∑”ß“π ‚∑√»—æ∑å¡◊Õ∂◊Õ ‚∑√ “√ √«¡∑—ÈßÕ’‡¡≈å (E-mail) ∑’Ë “¡“√∂µ‘¥µàÕ‰¥â –¥«°·≈–√«¥‡√Á«

Page 90: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

6. „Àâæ‘¡æ委«à“ ç·À≈à߇ߑπ∑ÿπ:é ∂â“¡’·À≈àß∑ÿπ π—∫ πÿπ°“√»÷°…“„Àâ„ à¥â«¬ „Àâ∫Õ°√“¬≈–‡Õ’¬¥‡√’¬ßµ“¡≈”¥—∫¥—ßπ’È ™◊ËÕ∑ÿπ ™◊ËÕ ∂“∫—π∑’Ë„Àâ∑ÿπ ªï∑’ˉ¥â√—∫∑ÿπ À¡“¬‡≈¢¢Õß∑ÿπ«‘®—¬ (∂â“¡’)

7. „Àâæ‘¡æ委«à“ ç«—π√—∫‡√◊ËÕß:é „Àâ„ à«—π∑’Ë∫√√≥“∏‘°“√¡’Àπ—ß ◊ÕµÕ∫√—∫‡√◊ËÕß8. „Àâæ‘¡æ委«à“ ç«—π¬Õ¡√—∫µ’æ‘¡æå:é „Àâ„ à«—π∑’Ë∫√√≥“∏‘°“√¡’Àπ—ß ◊Õ¬Õ¡√—∫µ’æ‘¡æå9. „Àâæ‘¡æ委«à“ ç∫∑§—¥¬àÕé ∫∑§—¥¬àÕ§«√‡¢’¬π„À≥℮§«“¡∑—ÈßÀ¡¥¢Õ߇√◊ËÕß ®–µâÕ߉¡à¡’¢âÕ √ÿª®“°°“√«‘®“√≥å ‰¡àµâÕßÕâ“ßՑ߇հ “√ √Ÿª¿“æ

À√◊Õµ“√“ß ”À√—∫øíπ∑’Ë√–∫ÿ‡ªìπ´’Ë„À⇢’¬π‡ªìπ™◊ËÕ·∑π°“√„™â —≠≈—°…≥å ‰¡à„™â»—æ∑å¿“…“Õ—ß°ƒ…„Àâ·ª≈À√◊Õ‡¢’¬π∑—∫»—æ∑凪ìπ¿“…“‰∑¬·≈–‰¡àµâÕ߫߇≈Á∫¿“…“‡¥‘¡ ∫∑§—¥¬àÕ§«√‡¢’¬π‡ªìπÀ—«¢âÕ¥—ßπ’È

«—µ∂ÿª√– ß§å §«√°≈à“«∂÷ß®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√»÷°…“√«¡∑—ÈßÕâ“ß∂÷ß ¡¡µ‘∞“π¢Õß°“√»÷°…“«— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“ §«√°≈à“«∂÷ß«— ¥ÿÀ√◊ÕºŸâªÉ«¬∑’Ëπ”¡“»÷°…“ ®”π«π ™π‘¥ ª√–‡¿∑ «‘∏’°“√»÷°…“ À√◊Õ«‘∏’°“√

∑¥≈Õß ·≈– ∂‘µ‘∑’Ëπ”¡“„™âº≈°“√»÷°…“ §«√ª√–°Õ∫¥â«¬º≈∑’ˉ¥â®“°°“√»÷°…“∑¥≈Õß·≈–§à“ ∂‘µ‘ (∂â“¡’°“√«‘‡§√“–Àå)∫∑ √ÿª §«√°≈à“«∂÷ߺ≈°“√»÷°…“∑’Ë ”§—≠∑’ˉ¥â®“°°“√∑¥≈Õß

10. „Àâæ‘¡æ委«à“ ç√À— §”: é §«√¡’ 3-6 §”´÷Ëß¡’ª√“°ØÕ¬Ÿà„π∫∑§—¥¬àե⫬ „Àâ‡√’¬ß§” ”§—≠µ“¡Õ—°…√ ·≈–§—Ëπ¥â«¬‡§√◊ËÕßÀ¡“¬®ÿ≈¿“§ (,) à«π∑’Ë Õß æ‘¡æ凪ìπ¿“…“Õ—ß°ƒ… ‚¥¬æ‘¡æå¢âÕ§«“¡∑’˵√ß°—∫¿“…“‰∑¬„π à«π∑’ËÀπ÷Ëß∑ÿ°ª√–°“√ ‰¥â·°à1. ™◊ËÕ‡√◊ËÕß¿“…“Õ—ß°ƒ…„Àâ¢÷Èπµâπ¥â«¬µ—«æ‘¡æå„À≠à πÕ°π—Èπµ—«æ‘¡æå‡≈Á° ¬°‡«âπ™◊ËÕ‡©æ“–‡ªìπµ—«æ‘¡æå

„À≠à‰¥â2. ™◊ËÕºŸâπ‘æπ∏å „Àâ„™â™◊ËÕµ—«µ“¡¥â«¬π“¡ °ÿ≈‡∑à“π—Èπ3. «ÿ≤‘°“√»÷°…“ ‚¥¬„™âµ—«¬àÕ¢Õߪ√‘≠≠“·≈–§ÿ≥«ÿ≤‘∑’ˇªìπ “°≈4. ∑’ËÕ¬Ÿà ¢ÕߺŸâπ‘æπ∏å·µà≈–§π µàÕ®“°√À— ‰ª√…≥’¬å„À℠৔«à“ çThailandé ¥â«¬5. „Àâæ‘¡æ委«à“ çcorrespondence author: é æ√âÕ¡™◊ËÕ·≈–∑’ËÕ¬ŸàºŸâπ‘æπ∏å∑’Ë„™âµ‘¥µàÕ‡°’ˬ«°—∫∫∑§«“¡6. „Àâæ‘¡æ委«à“ çresearch grant: é æ√âÕ¡·À≈à߇ߑπ∑ÿπ∑’Ë π—∫ πÿπ°“√«‘®—¬7. „Àâæ‘¡æ委«à“ çreceived:é §◊Õ«—π∑’Ë∫√√≥“∏‘°“√¡’Àπ—ß ◊ÕµÕ∫√—∫‡√◊ËÕß8. „Àâæ‘¡æ委«à“ çaccepted:é §◊Õ«—π∑’Ë∫√√≥“∏‘°“√¡’Àπ—ß ◊Õ¬Õ¡√—∫µ’æ‘¡æå9. „Àâæ‘¡æ委«à“ çAbstracté §«√¡’§«“¡¬“«‰¡à‡°‘π 250 §” „À⇢’¬π‡ªìπÀ—«¢âÕ Ê ¥—ßπ’È objective, materials and methods, results,

conclusion10. „Àâæ‘¡æ委«à“ çkey words:é §«√¡’ 3-6 §” ‡√’¬ßµ“¡≈”¥—∫·≈–¡’§«“¡À¡“¬µ√ß°—∫√À— §”¿“…“‰∑¬ à«π∑’Ë “¡ ‡π◊ÈÕ‡√◊ËÕßæ‘¡æ凪ìπ¿“…“‰∑¬À√◊ÕÕ—ß°ƒ…°Á‰¥âÀ—«¢âÕ¢Õ߇π◊ÈÕ‡√◊ËÕßæ‘¡æå„À♑¥À—«·∂«´â“¬¡◊Õ ÿ¥ ·µà≈–À—«¢âÕ„Àâ¢÷Èπ°√–¥“…·ºàπ„À¡à ‚¥¬‡√’¬ß≈”¥—∫À—«¢âÕ¢Õ߇π◊ÈÕ‡√◊ËÕߥ—ßπ’È1. ∫∑π” (introduction)‡ªìπ à«π°≈à“«π”‚¥¬Õ“»—¬°“√µ√«®‡Õ° “√ (Literature Review) ¢âÕ¡Ÿ≈®“°√“¬ß“π«‘®—¬ §«“¡√Ÿâ ·≈–À≈—°∞“πµà“ß Ê ®“°Àπ—ß ◊ÕÀ√◊Õ«‘∑¬“

“√∑’ˇ°’ˬ«¢âÕß°—∫‡√◊ËÕß∑’Ë»÷°…“ ·≈–°≈à“«∂÷߇Àµÿº≈À√◊Õ§«“¡ ”§—≠¢Õߪí≠À“„π°“√»÷°…“ ¡¡µ‘∞“π¢Õß°“√»÷°…“ µ≈Õ¥®π«—µ∂ÿª√– ߧå¢Õß°“√»÷°…“„Àâ™—¥‡®π ¢Õ∫‡¢µ ·≈–«‘∏’°“√¥”‡π‘π°“√«‘®—¬ §«√¡’°“√°≈à“«Õâ“ß∂÷ß∫∑§«“¡À√◊Õ‡Õ° “√∑’ˇ°’ˬ«¢âÕß°—∫‡√◊ËÕß∑’Ë°”≈—ß∑”°“√«‘®—¬ ‡æ◊ËÕ· ¥ß§«“¡ —¡æ—π∏å¢Õßß“π∑’ˇ πÕ„π∫∑§«“¡π’È°—∫§«“¡√Ÿâ‡¥‘¡‡∑à“∑’Ë∑√“∫°—πÕ¬Ÿà ‡ªìπ à«π¢Õß∫∑§«“¡∑’Ë∫Õ°‡Àµÿº≈ 𔉪 Ÿà°“√»÷°…“ ·µà‰¡àµâÕßµ√«®‡Õ° “√ (LiteratureReview) ∑’ˉ¡à‡°’ˬ«°—∫®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√»÷°…“ §«√‡ªìπ à«π∑’ËÕ∏‘∫“¬„À⺟âÕà“π√Ÿâ«à“®–µÕ∫§”∂“¡Õ–‰√ „Àâ√«¡«—µ∂ÿª√– ߧå¢Õß°“√»÷°…“‡ªìπ√âÕ¬·°â«„π à«π∑⓬¢Õß∫∑π” ·µà‰¡àµâÕß„ àº≈°“√»÷°…“·≈– √ÿª

2. «— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√»÷°…“ (materials and methods)·¬°‡ªìπ 2 À—«¢âÕ„À≠à §◊Õ2.1 «— ¥ÿÕÿª°√≥å (materials)°≈à“«∂÷ß√“¬≈–‡Õ’¬¥¢Õß«— ¥ÿÕÿª°√≥å ™◊ËÕ‡§¡’¿—≥±å ·À≈àß∑’Ë¡“ ≈—°…≥–‡©æ“–À√◊Õ√“¬≈–‡Õ’¬¥¢ÕßÕÿª°√≥凧√◊ËÕß¡◊Õ‡§√◊ËÕß„™âµà“ß Ê —µ«å∑¥≈Õß

À√◊ÕºŸâªÉ«¬∑’Ë„™â‡ªìπ°≈ÿࡵ—«Õ¬à“ß„π°“√»÷°…“∑¥≈Õß °“√«‘®—¬´÷Ëß∑¥≈Õß„π¡πÿ…¬åÀ√◊Õ —µ«å∑¥≈Õß „Àâ∫Õ°√“¬≈–‡Õ’¬¥¢Õß ‘Ëßπ”¡“»÷°…“ Õ“∑‘ ºŸâªÉ«¬ §πª°µ‘™π‘¥¢Õß —µ«å æ◊™ œ≈œ √«¡∂÷ß®”π«π·≈–≈—°…≥–‡©æ“–¢Õßµ—«Õ¬à“ß∑’Ë»÷°…“ ‡™àπ ‡æ» Õ“¬ÿ πÈ”Àπ—° œ≈œ

°“√«‘®—¬´÷Ëß∑¥≈Õß„π¡πÿ…¬åÀ√◊Õ —µ«å∑¥≈Õß ºŸâπ‘æπ∏姫√√–∫ÿ„Àâ‡ÀÁπ«à“‰¥âªØ‘∫—µ‘µ“¡·π«∑“ßÀ√◊ÕÀ≈—°‡°≥±å¥â“π®√‘¬∏√√¡‡°’ˬ«°—∫°“√»÷°…“«‘®—¬·≈–°“√∑¥≈Õß„π¡πÿ…¬åÀ√◊Õ —µ«å∑¥≈Õß·≈– “¡“√∂· ¥ßÀ≈—°∞“π«à“‰¥âºà“π°“√æ‘®“√≥“¢Õߧ≥–°√√¡°“√®√‘¬∏√√¡¢ÕßÀπ૬ߓπ·≈â«

2.2 «‘∏’°“√»÷°…“ (methods)µâÕßÕ∏‘∫“¬∂÷ß«‘∏’°“√∑¥≈Õß °“√ —߇°µÀ√◊Õ«‘∏’°“√∑’ˉ¥â¢âÕ¡Ÿ≈¡“ ¢—ÈπµÕπµà“ß Ê ¢Õß°“√∑¥≈Õß ¡“µ√°“√∑’Ë„™â»÷°…“ «‘∏’°“√‡°Á∫¢âÕ¡Ÿ≈ «‘∏’

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ ·≈– ∂‘µ‘∑’Ëπ”¡“„™â«‘‡§√“–Àå¢âÕ¡Ÿ≈ ‚¥¬„Àâ≈–‡Õ’¬¥æÕ∑’˺ŸâÕà“π “¡“√∂∑”°“√∑¥≈Õß´È”‰¥â3. º≈°“√»÷°…“ (results)‡ªìπ°“√· ¥ßº≈∑’ˉ¥â®“°°“√»÷°…“∑¥≈Õß·≈–«‘‡§√“–Àåº≈ß“π §«√®”·π°º≈ÕÕ°‡ªìπÀ¡«¥À¡Ÿà·≈– —¡æ—π∏å°—∫«—µ∂ÿª√– ߧå¢Õß°“√»÷°…“

∂⓺≈‰¡à´—∫´âÕπ‰¡à¡’µ—«‡≈¢¡“° ∫√√¬“¬‡ªìπ√âÕ¬·°â« ·µà∂⓵—«‡≈¢¡“° µ—«·ª√¡“° §«√„™â¿“æª√–°Õ∫ µ“√“ß °√“ø À√◊Õ·ºπ¿Ÿ¡‘·ª≈§«“¡À¡“¬¢Õߺ≈∑’˧âπæ∫À√◊Õ«‘‡§√“–Àå ·≈– √ÿª‡ª√’¬∫‡∑’¬∫°—∫ ¡¡ÿµ‘∞“π∑’Ë«“߉«â (√–«—ß°“√∫√√¬“¬¢âÕ¡Ÿ≈∑’˪√“°Ø„π¿“æÀ√◊Õµ“√“ߴȔՒ°„π‡π◊ÈÕ‡√◊ËÕß)

4. ∫∑«‘®“√≥å (discussion)°“√‡¢’¬π∫∑«‘®“√≥åπ—Èπ “¡“√∂«‘®“√≥剥ⵗÈß·µà«—µ∂ÿª√– ß§å ¡¡ÿµ‘∞“π¢Õß°“√«‘®—¬ º≈∑’ˉ¥â®“°°“√»÷°…“‡À¡◊ÕπÀ√◊Õ·µ°µà“߉ª®“°º≈ß“π

∑’Ë¡’ºŸâ√“¬ß“π‰«â°àÕπÀ√◊Õ‰¡à Õ¬à“߉√ ‡æ√“–‡Àµÿ„¥®÷߇ªìπ‡™àππ—Èπ ‡æ◊ËÕ„Àâ¡’§«“¡‡¢â“„®À√◊Õ‡°‘¥§«“¡√Ÿâ„À¡à∑’ˇ°’ˬ«¢âÕß°—∫ß“π«‘®—¬π—Èπ √«¡∑—ÈߢâÕ¥’ ¢âÕ‡ ’¬¢Õß«— ¥ÿÕÿª°√≥å·≈–«‘∏’°“√ ‡ πÕ·π–§«“¡§‘¥‡ÀÁπ„À¡à Ê ªí≠À“µà“ß Ê ∑’ˉ¥â®“°°“√»÷°…“∑¥≈Õߧ√—Èßπ’È «‘®“√≥åº≈∑’ˉ¡àµ√ßµ“¡∑’˧“¥À«—ßÕ¬à“߉¡àªî¥∫—ß·≈–™’È„Àâ‡ÀÁπ·π«∑“ß∑’Ë®–𔉪„™â„À⇰‘¥ª√–‚¬™πå¥â«¬

5. ∫∑ √ÿª (conclusion)‡ªìπº≈‚¥¬¬àÕ¢Õß°“√»÷°…“ º≈∑’ˉ¥âµ√ß°—∫«—µ∂ÿª√– ߧ尓√«‘®—¬À√◊Õ‰¡à ¢âÕ √ÿª®“°°“√«‘®“√≥å „Àâ¢âÕ‡ πÕ·π–∑’Ëπ”º≈°“√«‘®—¬‰ª„™â

Page 91: πµ·æ∑¬»“ µ√ å¡À ‘¥≈ · « ∑—πµ ¡À ‘¥≈ ª ï∑’Ë 29 ‡≈ à¡∑ ’Ë 1, 2552 Nuttaya Chantarasamee Pornrachanee Sawaengkit Jiraporn Chaiwat

ª√–‚¬™πåÀ√◊Õ„Àâª√–‡¥Áπ§”∂“¡°“√«‘®—¬ ”À√—∫°“√«‘®—¬µàÕ‰ª6. °‘µµ‘°√√¡ª√–°“» (acknowledgements)¡’‡æ’¬ß¬àÕÀπⓇ¥’¬« ‡ªìπ à«π∑’Ë°≈à“«¢Õ∫§ÿ≥µàÕÕߧå°√ Àπ૬ߓπ À√◊Õ∫ÿ§§≈∑’Ë„À⧫“¡™à«¬‡À≈◊Õ√à«¡¡◊Õ„π°“√«‘®—¬ §”·π–π”°“√„ à™◊ËÕ

§π™à«¬¡“° Ê ∑”„Àâ∫∑§«“¡¥âÕ¬§«“¡¿Ÿ¡‘∞“π‡æ√“–ºŸâÕà“π®–Õπÿ¡“π«à“ß“π à«π„À≠à¡’§π™à«¬∑—ÈßÀ¡¥7. ‡Õ° “√Õâ“ßÕ‘ß (references)‡ªìπ√“¬™◊ËÕ‡Õ° “√µà“ß Ê ∑’˺Ÿâπ‘æπ∏åÕâ“ßՑ߉«â„π∫∑§«“¡ ‚¥¬„ ൗ«‡≈¢Õ“√∫‘°À≈—ߢâÕ§«“¡À√◊ÕÀ≈—ß™◊ËÕ∫ÿ§§≈‡®â“¢ÕߢâÕ§«“¡∑’ËÕâ“ß∂÷ß „ÀâÕâ“ßÕ‘ß

¥â«¬µ—«‡≈¢∑’ˇªìπµ—«¬° (superscript) À≈—ߢâÕ§«“¡ ´÷Ë߇√’¬ßÀ¡“¬‡≈¢1,3,6 À√◊ÕÀ¡“¬‡≈¢1-3 ™‘¥´â“¬‡ ¡Õ·≈–‰¡àµâÕß„ à«ß‡≈Á∫ ‡√’¬ßµ“¡≈”¥—∫°àÕπÀ≈—ß∑’Ë°≈à“«∂÷ß„π∫∑§«“¡ ∂⓵âÕß°“√Õâ“ßÕ‘ß´È”„Àâ„™âÀ¡“¬‡≈¢‡¥‘¡ ‰¡à„ÀℙⰓ√Õâ“ßÕ‘ß®“°∫∑§—¥¬àÕ·≈–¢âÕ¡Ÿ≈∑’ˬ—߉¡à‰¥â√—∫°“√µ’æ‘¡æå

°“√‡¢’¬π‡Õ° “√Õâ“ßÕ‘ß √“¬™◊ËÕ¢Õ߇հ “√Õâ“ßÕ‘ß„Àâ‡√’¬ß≈”¥—∫µ√ßµ“¡À¡“¬‡≈¢∑’ËÕâ“ßÕ‘ß„π‡π◊ÈÕ‡√◊ËÕß ‚¥¬„™â°“√Õâ“ßÕ‘ßµ“¡√–∫∫·«π§Ÿ‡«Õ√å(Vancouver system) ™◊ËÕ«“√ “√„Àâ„™â™◊ËÕ¬àÕµ“¡√Ÿª·∫∫°“√‡¢’¬πÕâ“ßÕ‘ß„π 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“ߥ—ßπ’È

7.1 °“√Õâ“ßÕ‘ß«“√ “√∂⓺Ÿâπ‘æπ∏å‰¡à‡°‘π 6 §π „Àâ„ à™◊ËÕ∑ÿ°§π ∂â“¡“°°«à“ 6 §π„Àâ„ à 6 §π·√°µ“¡¥â«¬ çet al.é ∂Ⓡªìπ¿“…“Õ—ß°ƒ… À√◊Õ ç·≈–§≥–é ∂Ⓡ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‘¡æ凪ìπªï§√‘ µå»—°√“™)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 «“√ “√¿“…“‰∑¬™◊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∑∏»—°√“™)∏’√≈—°…≥å ÿ∑∏‡ ∂’¬√, ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈, ≥—∞æß»å ‘√‘π∑«—≤πå, «’√–»—°¥‘Ï ‰æ√—™‡«∑¬å, ª√–¿“°√ ®”πߪ√– “∑æ√. ª√– ‘∑∏‘¿“æ

¢Õ߬“™“Õ“√嵑‡§π·≈–¬“™“≈‘‚¥‡§π„π°“√ºà“µ—¥øíπ°√“¡§ÿ¥≈à“ß´’Ë∑’Ë “¡. « ∑—πµ ¡À‘¥≈ 2548;25:59-66.7.1.3 ºŸâπ‘æπ∏å∑’ˇªìπÕߧå°√ µ—«Õ¬à“ß™◊ËÕÕߧå°√. ™◊ËÕ∫∑§«“¡. ™◊ËÕ«“√ “√ ªï∑’Ëæ‘¡æå;ªï∑’Ë:Àπâ“∑’ËÕâ“ßÕ‘ß. µ—«Õ¬à“ߧ≥–ºŸâ‡™’ˬ«™“≠®“° ¡“§¡Õÿ√‡«™·Ààߪ√–‡∑»‰∑¬. ‡°≥±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∑’ˇªìπºŸâ‡¢’¬π™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕÀπ—ß ◊Õ §√—Èß∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå;ªï∑’Ëæ‘¡æå:Àπâ“∑’ËÕâ“ß∂÷ß. µ—«Õ¬à“ß¡π— ‚√®πå«π“°“√, ÿ∑—» √—°ª√– ‘∑∏‘Ï°Ÿ≈. øíπ§ÿ¥ æ‘¡æå§√—Èß∑’Ë 1. °√ÿ߇∑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∑’ˇªìπÕߧå°√™◊ËÕÕߧå°√. ™◊ËÕÀπ—ß ◊Õ. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå;ªï∑’Ëæ‘¡æå. µ—«Õ¬à“ßÕߧå°√ºŸâ∫√‘À“√§≥–∑—πµ·æ∑¬»“ µ√å·Ààߪ√–‡∑»‰∑¬. øíπ¥’¡’„™âµ≈Õ¥™’«‘µ. °√ÿ߇∑æ¡À“π§√:‚√ßæ‘¡æå∫√‘…—∑™—µ‡µÕ√å·Õπ¥åՑߧå;2538.Virginia Law Foundation. The medical and legal implication of AIDS. Chalottevill:The Foundation;1987.7.2.3 ºŸâπ‘æπ∏å∑’ˇªìπºŸâ‡¢’¬π·≈–∫√√≥“∏‘°“√ „πµ”√“À√◊Õ texbook™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ∫∑∑’ËÕâ“ßÕ‘ß. „π:™◊ËÕ∫√√≥“∏‘°“√, (∂Ⓡ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. °√ÿ߇∑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∫√√≥“∏‘°“√, (∂Ⓡªìπ¿“…“Õ—ß°ƒ…„™â In ) ∫√√≥“∏‘°“√. ™◊ËÕÀπ—ß ◊Õ. §√—Èß∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå: ”π—°æ‘¡æå;ªï∑’Ë

æ‘¡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. °√ÿ߇∑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;1995:465-78.7.3 °“√Õâ“ßÕ‘ß«‘∑¬“π‘æπ∏å

™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ‡√◊ËÕß (ª√–‡¿∑ª√‘≠≠“). ¿“§«‘™“,§≥–. ‡¡◊Õß:¡À“«‘∑¬“≈—¬;ªï∑’ˉ¥âª√‘≠≠“. µ—«Õ¬à“ß™ÿµ‘¡“ «à“ß. º≈¢Õ߬“ ’øíπø≈ŸÕÕ‰√¥å∑’˺ ¡‰´≈‘∑Õ≈µàÕª√‘¡“≥‡™◊ÈÕ¡‘«·∑π å ‡µ√Á悵§Õ°‰´·≈–·≈§‚µ·∫´‘‰≈ (ª√–°“»π’¬∫—µ√∫—≥±‘µ).

∑—πµ°√√¡ ”À√—∫‡¥Á°, ¡À“«‘∑¬“≈—¬¡À‘¥≈. °√ÿ߇∑æ¡À“π§√:¡À“«‘∑¬“≈—¬¡À‘¥≈;2547-2548.

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Rassameemasmaung S. Effects of porphyromonas gingivalis on human gingival fibroblasts (Doctor of philosophy). Oral biolgy, MahidolUniversity. Bangkok:Mahidol University;2002.

7.4 °“√Õâ“ßՑ߇√◊ËÕß∑’ˇ πÕ„π°“√ª√–™ÿ¡«‘™“°“√7.4.1 Àπ—ß ◊Õª√–°Õ∫°“√ª√–™ÿ¡™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ‡√◊ËÕß. ™◊ËÕ°“√ª√–™ÿ¡.ªï ‡¥◊Õπ «—π; ∂“π∑’Ë®—¥ª√–™ÿ¡;ªï∑’Ëæ‘¡æå. µ—«Õ¬à“ßRoyce JC. Finches of Du page County. Page read at 2 nd Annual conference on practical bird-watching. 1986 May 24-26;Midland

University,Illinois:Flat Prairie;1986.7.4.2 √“¬ß“π∑’ˉ¥âæ‘¡æ凪ìπ™ÿ¥™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ‡√◊ËÕß. ª√–‡∑»∑’Ëæ‘¡æå. ‡¡◊Õß∑’Ëæ‘¡æå. ”π—°æ‘¡æå;ªï∑’Ëæ‘¡æå µ—«Õ¬à“ß°Õß∑—πµ “∏“√≥ ÿ¢, °√¡Õπ“¡—¬, °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√ ”√«® ¿“«–∑—πµ ÿ¢¿“æ·Ààß™“µ‘§√—Èß∑’Ë 5 æ.». 2543-2544.

ª√–‡∑»‰∑¬. °√ÿ߇∑æ¡À“π§√. ‚√ßæ‘¡æå∫√‘…—∑ “¡‡®√‘≠æ“≥‘™¬å (°√ÿ߇∑æ) ®”°—¥;2545.Fluoride and human health. WHO Monograph;1970. Series no. 59.7.4.3 √“¬ß“π √ÿªº≈°“√ª√–™ÿ¡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 Publishing;1998:35-49.7.5 °“√Õâ“ßÕ‘ß∫∑§«“¡„πÀπ—ß ◊Õæ‘¡æå

™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ‡√◊ËÕß. ™◊ËÕÀπ—ß ◊Õæ‘¡æå «—π‡¥◊Õπªï∑’Ëæ‘¡æå; à«π∑’Ë:‡≈¢Àπâ“ (‡≈¢§Õ≈—¡πå). µ—«Õ¬à“߇æ≈‘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 °“√Õâ“ßՑ߇հ “√§Õ¡æ‘«‡µÕ√å∫∑§«“¡®“°√Ÿª·∫∫Õ‘‡≈Á°∑√Õπ‘° å ¡’ 2 °≈ÿࡥ⫬°—π§◊Õ

7.6.1 ·À≈àߢâÕ¡Ÿ≈Õ‘‡≈Á°∑√Õπ‘° åª√–‡¿∑ online ‰¥â·°à ‚Œ¡‡æ®/‡«Á∫‰´µå™◊ËÕºŸâπ‘æπ∏å. ™◊ËÕ‡√◊ËÕß. ™◊ËÕ«“√ “√ (™π‘¥¢Õß ◊ËÕ) ªï∑’Ëæ‘¡æå («—𠇥◊Õπ ªï ∑’˧âπ¢âÕ¡Ÿ≈);ªï∑’Ë (‡≈à¡∑’Ë) : (®”π«π¿“æ). ·À≈àߢâÕ¡Ÿ≈ µ—«Õ¬à“ß

Morse SS. Factors in the emergence of infections diseases. 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 ·À≈àߢâÕ¡Ÿ≈Õ‘‡≈Á°∑√Õπ‘° åª√–‡¿∑‰¡à online ‰¥â·°à ·ºàπ CD-ROM, diskettes, other computer databases µ—«Õ¬à“ßCDI,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 °“√Õâ“ßÕ‘ßÕÿª°√≥å‚ µ∑—»π«— ¥ÿ

™◊ËÕ‡√◊ËÕß («’¥‘∑—»πå). ‡¡◊Õß∑’˺≈‘µ:·À≈àߺ≈‘µ;ªï∑’˺≈‘µ. µ—«Õ¬à“ßHIV+/AIDS : the facts and the future (videocassette). St. Louis (MO):Mosby-year Book;1995.

¿“æª√–°Õ∫ (Illustrations)¿“æª√–°Õ∫∑ÿ°ª√–‡¿∑

1. µâÕß¡’™◊ËÕ (title) ∑’Ë —Èπ°√–™—∫ ¡’‡≈¢°”°—∫µ“¡≈”¥—∫∑’ËÕâ“ß∂÷ß„π∫∑§«“¡Õ“®‡ªìπ √Ÿª«“¥ (drawing) ¿“æ∂à“¬ (photograph) ·ºπ¿Ÿ¡‘ (diagram)°√“ø (graph) µâÕßæ‘¡æ凪ìπ¿“…“Õ—ß°ƒ…‡∑à“π—Èπ ·≈–„™â‡≈¢Õ“√∫‘°

2. ™◊ËÕ·≈–§”∫√√¬“¬ (legend) „Àâæ‘¡æ儵⿓æ‡∑à“π—Èπ ‚¥¬‡√’¬ßµ“¡≈”¥—∫¿“æ„π°√–¥“…·¬°·ºàπµà“ßÀ“°®“°‡π◊ÈÕ‡√◊ËÕߢÕß∫∑§«“¡ ™◊ËÕ ’ «‘∏’¬âÕ¡ ·≈–§à“°”≈—ߢ¬“¬ „Àâ·®â߉«â„πµÕπ∑⓬¢Õߧ”∫√√¬“¬¿“æ À√◊ÕÕ“®· ¥ß‡ªìπ‡ âπ· ¥ß¢π“¥ (bar) ‰«â„π¿“æ°Á‰¥â —≠≈—°…≥å ≈Ÿ°»√ µ—«Õ—°…√„π¿“槫√‡ÀÁπ‰¥â™—¥‡®π

3. µâÕ߇«âπ∑’Ë«à“ß„π‡π◊ÈÕ‡√◊ËÕ߉«âæÕ‡ªìπ∑’ˇ¢â“„® æ√âÕ¡°—∫‡¢’¬π·®â߉«â„π°√Õ∫«à“

„ à¿“æ∑’Ë 1

4. ¿“æ∂à“¬ „Àℙ≥â∑—Èß¿“æ ’À√◊Õ¢“«¥” „π°√≥’‡ªìπ¿“æ∂à“¬„ÀâÕ—¥¥â«¬°√–¥“…¡—π¢π“¥ 8.9×14 ´¡. (‚ª °“√å¥) ·≈–¿“æ∂à“¬µâÕß™—¥‡®π¥â“πÀ≈—ߢÕß¿“æ„À⇢’¬π¥â«¬¥‘π Õ„™âπÈ”Àπ—°¡◊ÕæÕª√–¡“≥‡æ√“–∂Ⓡ¢’¬πÀπ—°¡◊Õ‡°‘π‰ª®–∑”„Àâ√Õ¬‡¢’¬πª√“°Ø¥â“πÀπâ“¿“æ §ÿ≥¿“æ¢Õß√Ÿª¿“æÕ“®¥âÕ¬≈ß §«√∫Õ°™◊ËÕ‡√◊ËÕß ™◊ËÕºŸâ‡¢’¬π À¡“¬‡≈¢µ“¡≈”¥—∫¢Õß¿“æ·≈–∑”‡§√◊ËÕßÀ¡“¬· ¥ß¢Õ∫∫π¢Õß¿“æ·≈–„ à´Õß·¬°µà“ßÀ“° (∑—Èßπ’ȉ¡àµâÕßµ‘¥¿“æ∂à“¬°—∫ ‘Ëß„¥ Ê „Àâ„ à´Õß·¬°µà“ßÀ“°) °√≥’‡ªìπ¿“æ·∫∫¥‘®‘∑—≈ (digital) §«√¡’·øÑ¡¢âÕ¡Ÿ≈·¬°µà“ßÀ“°‰¡à§«√ Õ¥·∑√°„π‡π◊ÈÕ‡√◊ËÕß ‚¥¬„™â√Ÿª·∫∫„¥°Á‰¥â ‡™àπ (tiff, 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¿“扡àπâÕ¬°«à“ 300 ¥’æ’‰Õ (dpi) ¿“æ‚æ≈“≈Õ¬¥å ‰¡à§«√„™â‡π◊ËÕß®“°¿“æ‰¡à™—¥‡®π

5. ¿“æ√—ß ’ „Àâ∂à“¬√Ÿª®“°øî≈塇հ´‡√¬åµâπ©∫—∫‡ ’¬°àÕπ ·≈â«π”‰ªÕ—¥‡ªìπ¿“梓«-¥” ‰¡à§«√Õ—¥¿“殓°øî≈塇հ´‡√¬å ‡æ√“–®–‰¥â¿“æ∑’˺‘¥®“°§«“¡‡ªìπ®√‘ß ·≈–‰¡à§«√π”¿“æ√—ß ’‰ª°√“¥¿“æ (scan) ‡æ◊ËÕ·ª≈߇ªìπ¿“æª√–°Õ∫√Ÿª·∫∫¥‘®‘∑—≈

6. °√≥’¿“æ≈“¬‡ âπ °√“ø À√◊Õ·ºπ¿Ÿ¡‘ „À⇢’¬πÀ√◊Õæ‘¡æå≈ß∫π°√–¥“…¡—𠧫√„™âÀ¡÷° ’¥” ·≈–µâÕß¡’§”∫√√¬“¬·°πµ—Èß (ordinate) ·≈–·°ππÕπ (abscissa)

7. ‰≈¥å ®–µâÕßÕ—¥¡“‡ªìπ¿“æ°àÕπ8. °“√„™â¿“æª√–°Õ∫∑’Ë¡“®“°·À≈àßÕ◊Ëπ µâÕ߉¥â√—∫Õπÿ≠“µ®“°‡®â“¢Õß ·≈–‡¢’¬π°”°—∫‰«â

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µ“√“ß (Tables)1. µâÕß∑”µ“√“ß·¬°µà“ßÀ“°®“°‡π◊ÈÕ‡√◊ËÕß ‚¥¬æ‘¡æåÀπâ“≈– 1 µ“√“ß ‚¥¬‡«âπ∑’Ë«à“ß„π‡π◊ÈÕ‡√◊ËÕßæ√âÕ¡∑—È߇¢’¬π·®â߉«â„π°√Õ∫ ·≈–æ‘¡æ凪ìπ

¿“…“Õ—ß°ƒ…‡∑à“π—Èπ2. µâÕß¡’™◊ËÕ (title) ∑’Ë —Èπ ◊ËÕ‡π◊ÈÕÀ“¢Õßµ“√“ß ¡’‡≈¢°”°—∫µ“¡≈”¥—∫∑’ËÕâ“ß∂÷ß„π∫∑§«“¡ „Àâæ‘¡æå‡Àπ◊Õµ“√“ß §”∫√√¬“¬µ“√“ß„Àâæ‘¡æåµàÕ

®“°™◊ËÕµ“√“ß·≈–§«√¡’‡©æ“–∑’Ë ”§—≠·≈–®”‡ªìπ3. ‡™‘ßÕ√√∂ (footnote) „µâµ“√“ß∫√√¬“¬§”¬àÕ —≠≈—°…≥å À√◊Õ‡§√◊ËÕßÀ¡“¬∑’˪√“°Ø„πµ“√“ß µ≈Õ¥®π§à“∑¥ Õ∫∑“ß ∂‘µ‘ (∂â“¡’) Õ¬à“ߧ√∫

∂â«π ‡™‘ßÕ√√∂‰¡à§«√„™â‡≈¢°”°—∫‡æ√“–Õ“® —∫ π°—∫‡≈¢°”°—∫¢Õ߇հ “√Õâ“ßÕ‘ß „Àℙ⇪ìπ —≠≈—°…≥å µ—«Õ¬à“ß ‡™àπ *, +, #, ** ‡ªìπµâπ4. ‰¡àµâÕß¡’‡ âπ¥‘Ëß·≈–‡ âπ¢«“ß„πµ“√“ß ‰¡àµâÕß¡’°√Õ∫µ“√“ß

°“√æ‘®“√≥“°≈—Ëπ°√ÕߺŸâπ‘æπ∏姫√µ√–Àπ—°∂÷ߧ«“¡ ”§—≠„π°“√‡µ√’¬¡∫∑§«“¡„Àâ∂Ÿ°µâÕßµ“¡√Ÿª·∫∫¢Õß∫∑§«“¡∑’Ë«‘∑¬“ “√°”Àπ¥ µ≈Õ¥®πµ√«® Õ∫§«“¡∂Ÿ°

µâÕß·πàπÕπæ√âÕ¡∑—Èßæ‘ Ÿ®πåÕ—°…√„Àâ‡√’¬∫√âÕ¬‡ ’¬°àÕπ °àÕπ∑’Ë®– àß∫∑§«“¡π’È„Àâ°—∫∫√√≥“∏‘°“√°“√æ‘®“√≥“ ®–‰¥â√—∫°“√æ‘®“√≥“°≈—Ëπ°√Õß‚¥¬ºŸâ∑√ߧÿ≥«ÿ≤‘„π “¢“«‘™“π—Èπ Ê Õ¬à“ßπâÕ¬ 2 ∑à“π ‚¥¬„™â‡«≈“ª√–¡“≥ 4 ∂÷ß 8 —ª¥“Àå

®“°π—Èπ®–·®âߺ≈°“√æ‘®“√≥“„À⺟⇢’¬π∑√“∫µâπ©∫—∫∑’ˉ¥â√—∫°“√æ‘®“√≥“‡æ◊ËÕ®–µ’æ‘¡æå„π«‘∑¬“ “√ ∫√√≥“∏‘°“√®–®—¥ àß∫∑§«“¡„À⺟âπ‘æπ∏巰≢ߓπ „π°√≥’∑’˺Ÿâ∑√ߧÿ≥«ÿ≤‘‡ πÕ·π–

„Àⷰ≢ „Àⷰ≢À√◊Õ™’È·®ß‡æ‘Ë¡‡µ‘¡®π‡ªìπ∑’ˇ√’¬∫√âÕ¬°àÕπ®÷ß®–µ’æ‘¡æå ·≈–µâÕß à߇հ “√∑—ÈßÀ¡¥°≈—∫§◊π¡“µ“¡‡«≈“∑’Ë°”Àπ¥ ¡‘©–π—Èπ®–∂◊Õ«à“∑à“π‰¡à≈ßµ’æ‘¡æå·≈â«

°√≥’∑’Ë∫∑§«“¡‰¥â√—∫°“√æ‘®“√≥“„Àâµ’æ‘¡æå ∫√√≥“∏‘°“√®–·®âß„À⺟âπ‘æπ∏å àß∫∑§«“¡µâπ©∫—∫∑’Ë·°â‰¢§√—Èß ÿ¥∑⓬ æ√âÕ¡·ºàπ∫—π∑÷° (diskette)¢π“¥ 3.5 π‘È« À√◊Õ·ºàπ´’¥’√Õ¡ (CD ROM) ∑’Ë∫√√®ÿ‡π◊ÈÕÀ“·≈–¢âÕ¡Ÿ≈∑’Ë¡’Õ¬Ÿà„π∫∑§«“¡∑—ÈßÀ¡¥∑’ˉ¥â·°â‰¢·≈â« ∑—Èßπ’ȺŸâπ‘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) „À⺟â√—∫º‘¥™Õ∫‡æ’¬ß§π‡¥’¬«µ√«®æ‘ Ÿ®πåÕ—°…√·≈–§«“¡∂Ÿ°µâÕß∑“ß«‘™“°“√‡æ’¬ß§√—È߇¥’¬« (À“°ºŸâ√—∫º‘¥™Õ∫‰¡à àߧ◊πµ“¡‡«≈“∑’Ë°”Àπ¥ ®–∂◊Õ«à“∑à“π‰¡à≈ßµ’æ‘¡æå·≈â«) À≈—ß®“°π—Èπ∑“ß∫√√≥“∏‘°“√®–µ√«®„Àâ 2-3§√—Èß ‚¥¬‰¡àºà“πºŸâπ‘æπ∏å‡æ◊ËÕ§«“¡√«¥‡√Á«„π°“√µ’æ‘¡æå

”À√—∫∫∑§«“¡∑’ˉ¡à‰¥â√—∫°“√µ’æ‘¡æå®–¡’°“√·®âߺ≈æ√âÕ¡§◊πµâπ©∫—∫∫∑§«“¡π—Èπ·°àºŸâπ‘æπ∏å ∑“ß°Õß∫√√≥“∏‘°“√¢Õ ß«π ‘∑∏‘Ï∑’Ë®–‰¡àæ‘®“√≥“∫∑§«“¡´÷Ëß¡’°“√‡µ√’¬¡∫∑§«“¡‰¡à∂Ÿ°µâÕß

≈‘¢ ‘∑∏‘χæ◊ËÕ„À⇪ìπ‰ªµ“¡°ÆÀ¡“¬≈‘¢ ‘∑∏‘Ï ºŸâπ‘æπ∏å∑ÿ°∑à“πµâÕß≈ß≈“¬¡◊Õ™◊ËÕ„π·∫∫øÕ√å¡„∫¡Õ∫≈‘¢ ‘∑∏‘Ï∫∑§«“¡„Àâ·°à«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å

¡À‘¥≈æ√âÕ¡°—∫∫∑§«“¡µâπ©∫—∫ πÕ°®“°π’È ºŸâπ‘æπ∏å∑ÿ°∑à“πµâÕ߬◊π¬—π«à“∫∑§«“¡µâπ©∫—∫∑’Ë àß¡“µ’æ‘¡æåπ—Èπ‰¥â àß¡“µ’æ‘¡æ凩擖„π«‘∑¬“ “√ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈‡æ’¬ß·Àà߇¥’¬«‡∑à“π—Èπ ‚¥¬®–‰¡àæ‘®“√≥“∫∑§«“¡∑’ˉ¥â√—∫µ’æ‘¡æå„π«‘∑¬“ “√Õ◊Ëπ¡“°àÕπ À√◊Õ∫∑§«“¡∑’Ë°”≈—߇ πÕ‡æ◊ËÕµ’æ‘¡æå„π«‘∑¬“ “√Õ◊Ëπ Ê ‰¡à«à“®–‡ªìπ°“√√Õµ’æ‘¡æåÀ√◊ÕÕ¬Ÿà√–À«à“ߢ∫«π°“√‡ πÕ≈ßµ’æ‘¡æå À√◊Õ·¡â«à“∫∑§«“¡π—ÈπÕ“®®–‡µ√’¬¡‡ªìπ¿“…“‡¥’¬«°—πÀ√◊Õµà“ß¿“…“°Áµ“¡¬°‡«âπ∫∑§«“¡¥—ß°≈à“«Õ¬Ÿà„πÀ≈—°‡°≥±å«à“¥â«¬°“√µ’æ‘¡æå´È” (multiple publication)

∫∑§«“¡∑’Ë≈ßµ’æ‘¡æå„π«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈ ∂◊Õ‡ªìπ≈‘¢ ‘∑∏‘Ï¢Õߧ≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ Àâ“¡ºŸâ„¥π”‰ª¥—¥·ª≈ß §—¥≈Õ°À√◊Õ‡º¬·æ√à‡æ◊ËÕ°“√„¥ Ê ‚¥¬‰¡à‰¥â√—∫Õπÿ≠“µ®“°∫√√≥“∏‘°“√«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈

‡π◊ÈÕÀ“∫∑§«“¡À√◊Õ¢âÕ§‘¥‡ÀÁπ„¥ Ê „π«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈ ∂◊Õ‡ªì𧫓¡§‘¥‡ÀÁπ¢ÕߺŸâ‡¢’¬π‚¥¬‡©æ“–‡∑à“π—Èπ °Õß∫√√≥“∏‘°“√‰¡à®”‡ªìπµâÕ߇ÀÁπæâÕߥ⫬‡ ¡Õ‰ª

®¥À¡“¬Õπÿ≠“µ„Àâµ’æ‘¡æå‡Õ° “√ ß«π ‘∑∏‘Ï∂â“À“°¡’°“√„™â¿“æÀ√◊Õµ“√“ß∑’ˉ¥â√—∫°“√µ’æ‘¡æ剫â°àÕπ„π«‘∑¬“ “√Õ◊Ëπ·≈– ß«π ‘∑∏å (¬°‡«âπ„π°√≥’‡ªìπ°“√Õâ“ßÕ‘ß) ºŸâπ‘æπ∏åµâÕߢÕÕπÿ≠“µ

‡®â“¢Õß≈‘¢ ‘∑∏‘χªìπ≈“¬≈—°…≥åÕ—°…√ æ√âÕ¡∑—Èß· ¥ßÀπ—ß ◊Õ∑’ˉ¥â√—∫°“√¬‘π¬Õ¡µàÕ∫√√≥“∏‘°“√ °àÕπ∑’Ë∫∑§«“¡®–‰¥â√—∫°“√µ’æ‘¡æå°“√Õâ“ߧ”查 (quotations) ®–µâÕ߇¢’¬π‰«â„π‡§√◊ËÕßÀ¡“¬ —≠ª√–°“» (quotation marks) æ√âÕ¡°—∫√–∫ÿ‡Õ° “√Õâ“ßÕ‘ß ∑—Èßπ’È∂â“¡“°°«à“ 5

∫√√∑—¥®–µâÕ߉¥â√—∫Õπÿ≠“µ®“°ºŸâπ‘æπ∏åµâπ©∫—∫√Ÿª¿“æ¡πÿ…¬å (photograph of person) ∂â“¿“æπ—Èπ¡’‚Õ°“ ∑’Ë®–∫àß∫Õ°‰¥â«à“‡ªìπ∫ÿ§§≈„¥®–µâÕß· ¥ßÀ≈—°∞“π°“√‰¥â√—∫Õπÿ≠“µ®“°‡®â“¢Õß

√Ÿª¿“æ«à“Õπÿ≠“µ„À⇺¬·æ√à‰¥â ”‡π“æ‘¡æå

ºŸâπ‘æπ∏å∫∑§«“¡®–‰¥â√—∫ ”‡π“æ‘¡æå (reprint) ‡√◊ËÕß≈– 20 ™ÿ¥ ·≈–«‘∑¬“ “√ 1 ‡≈à¡ À“°ºŸâπ‘æπ∏åµâÕß°“√ ”‡π“æ‘¡æå¡“°°«à“π’È À√◊ÕµâÕß°“√ ”‡π“æ‘¡æ凪ìπ¿“æ ’ À√◊ÕµâÕß°“√«‘∑¬“ “√¡“°°«à“π’È ®–µâÕß·®âß„Àâ∫√√≥“∏‘°“√«‘∑¬“ “√∑√“∫‡ªìπ≈“¬≈—°…≥åÕ—°…√æ√âÕ¡°“√ àß∫∑§«“¡©∫—∫·°â‰¢§√—Èß ÿ¥∑⓬ ·≈–µâÕ߬‘π¬Õ¡‡ ’¬§à“„™â®à“¬ à«π∑’ˇ°‘π 20 ™ÿ¥À√◊Õ ”‡π“æ‘¡æ凪ìπ¿“æ ’ À√◊Õ«‘∑¬“ “√„π à«π∑’ˇ°‘𠵓¡¢âÕ°”Àπ¥¢Õß‚√ßæ‘¡æå

§”·π–π” ”À√—∫ºŸâÕà“πºŸâÕà“π “¡“√∂· ¥ß§«“¡§‘¥‡ÀÁπ‡°’Ë¬«°—∫∫∑§«“¡„π«‘∑¬“ “√·≈–¢âÕ‡ πÕ·π–Õ◊Ëπ Ê ‰¥â ‚¥¬ àß∑“߉ª√…≥’¬å ‚∑√ “√ À√◊Õ E-mail ∂÷ß

∫√√≥“∏‘°“√«‘∑¬“ “√µ“¡∑’ËÕ¬Ÿà¢â“ß∫π°“√µ‘¥µàÕ‚¶…≥“·≈–°“√ ¡—§√ ¡“™‘°

°“√µ‘¥µàÕ‚¶…≥“ °“√ —Ëß´◊ÈÕ ·≈–°“√ ¡—§√‡ªìπ ¡“™‘°«‘∑¬“ “√∑—πµ·æ∑¬»“ µ√å¡À‘¥≈ °√ÿ≥“µ‘¥µàÕ∫√√≥“∏‘°“√µ“¡∑’ËÕ¬Ÿà¢â“ß∫πÕ—µ√“§à“«‘∑¬“ “√

°”Àπ¥ÕÕ°«‘∑¬“ “√ªï≈– 3 ©∫—∫ (¡.§.›‡¡.¬., æ.§.› .§., °.¬.›∏.§.) ®”Àπà“¬„πª√–‡∑»√“§“©∫—∫≈– 150 ∫“∑ (√«¡§à“ àß) à«π∑’Ë®”Àπà“¬µà“ߪ√–‡∑»√“§“©∫—∫≈– 400 ∫“∑ (√«¡§à“ àß)

°“√™”√–§à“«‘∑¬“ “√·≈–§à“ ¡“™‘°„Àâ™”√–‡ªìπ∏π“≥—µ‘ —Ëß®à“¬ ª≥. π“¡‡ªÑ“ „ππ“¡ ç§ÿ≥»‘√‘≈—°…≥å æ√À¡«‘ ÿ∑∏‘Ïé ·≈– àß¡“∂÷ß∫√√≥“∏‘°“√µ“¡∑’ËÕ¬Ÿà¢â“ß∫π

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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 JournalAcademic Promotion and Development Unit, Bld. 4, Fl. 9Faculty of Dentistry, Mahidol University6 Yothi Road, Ratchathewi DistrictBangkok 10400

Tel. 0-2660-7769 Fax. 0-2660-7767Email: [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 concerningnew 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. Theyshould 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 introducingmedical 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 journalsrecognized 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 answersfrom 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 besubmitted along with a submission form for consideration for publication via a registered mail to protect against loss. Each copy of the manuscript shouldbe clipped, not stapled. The manuscript should be 10-20 pages including illustrations and tables of no more than 10 pages. The manuscript must bedouble-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 Thaiwith the original words provided in parentheses only the first time they appear. Words that have been coined by the Royal Academy must be used. Wordsthat have not been coined must be transliterated in accordance with the criteria for transliteration set by the Royal Academy with the original wordsparenthesized 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 mustbe in mercury millimeter. A hematologic measurement and a measurement of clinical chemistry should also be in metric unit. Other measurementsshould follow the universal standard. Only standard abbreviations and symbols must be employed. No abbreviations should appear in the title orabstract. 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. Formanuscripts 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 namein 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 noabbreviations 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 accordingto 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. Ifthe 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 obtainedthe degree.

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4. Address: All authors should provide the detailed address of their organization. If they are not affiliated with any institution, their clinicaddress must be given.

5. Corresponding author: One author must be designated as the corresponding author. The last name, position, professional affiliation, officephone, 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. Insteadthey 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).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 caseletters.

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. IntroductionThis 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 withreferences to other articles to relate the present study to the known prior knowledge. In other words, it should address reasons leading to the study andinform readers what questions the study is trying to answer. Thus, the introduction should review only pertinent literature and leave out those outside thescope and objectives of the study. Neither should it report results and conclusion of the study.

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

2.1 MaterialsThe 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 ofrelevant details, for instance, whether the samples are patients or normal persons, animal and plant types, number of samples as well as other specificcharacteristics 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’sethical board.

2.2 MethodsThe 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 forrepeated experimentation.

3. ResultsThis 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 presentedusing illustrations, tables, graphs, or charts with the interpretation of the findings in comparison with the suggested hypotheses. (Be careful not toreiterate the results given in the illustrations or tables in the text.)

4. DiscussionDiscussion 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 readersto understand and obtain novel knowledge created by the study. The author may discuss advantages and disadvantages of materials and methodsemployed in the study. New ideas or problems from the study can also be put forward. The author should discuss unexpected findings candidly andoffers recommendations on how those findings can be of any use.

5. ConclusionThe 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.

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6. AcknowledgementsThis 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 mayassume that most of the study has been carried out with assistance from others.)

7. ReferencesReferences 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 samenumbers 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 ofjournals 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 JournalsReferences 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 forpublication 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 JournalsReferences 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√–¿“°√ ®”πߪ√– “∑æ√. ª√– ‘∑∏‘¿“æ¢Õ߬“™“Õ“√嵑‡§π·≈–¬“

™“≈‘‚¥‡§π„π°“√ºà“µ—¥øíπ°√“¡§ÿ¥≈à“ß´’Ë∑’Ë “¡. « ∑—πµ ¡À‘¥≈ 2548;25:59-66.

7.1.3 Organizational authorsJournal 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‡™’ˬ«™“≠®“° ¡“§¡Õÿ√‡«™·Ààߪ√–‡∑»‰∑¬. ‡°≥±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 authorsBook 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. °√ÿ߇∑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 authorsBook references with organizational authors should be written as follows: name of organization. title of book. city of publication:publisher; year

of publication., e.g.,

Õߧå°√ºŸâ∫√‘À“√§≥–∑—πµ·æ∑¬»“ µ√å·Ààߪ√–‡∑»‰∑¬. øíπ¥’¡’„™âµ≈Õ¥™’«‘µ. °√ÿ߇∑æ¡À“π§√:‚√ßæ‘¡æå∫√‘…—∑™—µ‡µÕ√å·Õπ¥åՑߧå;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 editorsReferences 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. °√ÿ߇∑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 chaptersThe 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. °√ÿ߇∑æ¡À“π§√:‚√ßæ‘¡æå‡∑Á°´å·Õπ¥å‡®Õ√åπ—≈æ—∫≈‘‡§™—Ëπ®”°—¥;2548:99-146.

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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 referencesDissertation 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.,

™ÿµ‘¡“ «à“ß. º≈¢Õ߬“ ’øíπø≈ŸÕÕ‰√¥å∑’˺ ¡‰´≈‘∑Õ≈µàÕª√‘¡“≥‡™◊ÈÕ¡‘«·∑π å ‡µ√Á悵§Õ°‰´·≈–·≈§‚µ·∫´‘‰≈ (ª√–°“»π’∫—µ√∫—≥±‘µ). ∑—πµ°√√¡ ”À√—∫

‡¥Á°, ¡À“«‘∑¬“≈—¬¡À‘¥≈. °√ÿ߇∑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 documentsReferences 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:FlatPrairie;1986.

7.4.2 Reports published in seriesThe 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√–‡∑»‰∑¬.

°√ÿ߇∑æ¡À“π§√. ‚√ßæ‘¡æå∫√‘…—∑ “¡‡®√‘≠æ“≥‘™¬å (°√ÿ߇∑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 ofproceedings;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 PlaqueControl;1998 May 9-12;Berne, Switzerland. Chicago:Quintessence publication; 1998:35-49.

7.5 Newspaper article referencesNewspaper 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 referencesElectronic references are of two groups:

7.6.1 Online references from homepages and websitesOnline 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. Version2.0 San Diego:CMEA;1995.

7.7 Audio-visual aid referencesAudio-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 bedrawings, photographs, diagrams or graphs.

2. Titles and legends must be typed underneath the illustrations which are submitted on separate pages. Color names, dying techniques, andmagnification rates may be provided after legends or designated as bars within the illustrations. Symbols, arrows, or letters within the illustrations mustbe 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.,

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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) arerequired. 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 markon 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 mustbe 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 beobtained 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.

Tables1. 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 ProcessIt 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 longerwants 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 ondiskette 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 checkingfor academic accuracy. (If the author does not return the proofread manuscript within a set period, the Journal will assume the author no longerwants to publish his or her manuscript.) The Editor will not send the manuscript to the author for proofreading again but more proofreading will becarried 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 theright not to consider manuscripts that have not been prepared in accordance with the Journal’s guidelines.

CopyrightTo 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 onlyand is not currently under consideration elsewhere and the research reported will not be submitted for publication elsewhere no matter in what languagesthe 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 orutilized 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 sharedby the Journal’s editorial board.

Permission and WaiversPermission 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.

ReprintsAuthors 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 additionalreprints, journals, and color illustrations based on the price fixed by the publishing house.

Readers’ CommentsReaders’ 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 SubscriptionContact the Editor at the above address for advertising, order and subscription.

Subscription RatesMahidol 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 PaymentPlease mail an order form with money order payable to “Ms. Sirilux Promvisut” to the Editor at the address provided above.

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∫√‘…—∑ ‡∑Á° å ·Õπ¥å ‡®Õ√åπ—≈ æ—∫≈‘‡§™—Ëπ ®”°—¥

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