孤独症患儿口腔健康状况及影响因素调查

目的 了解孤独症患儿的口腔健康状况及罹患龋齿的影响因素,为孤独症患儿口腔保健提供依据.方法 对126例孤独症患儿进行口腔健康状况检查,并采用全国口腔健康调查问卷对患儿家长进行测评分析.结果 孤独症患儿龋齿患病率为80.9％,患儿家长全国口腔健康调查问卷的口腔保健知识领域得分（62.87±3.90）分,态度领域得分（68.33±3.67）分,行为领域得分（55.10±3.21）分.回归分析显示甜食摄入、饮料摄入、家长是否帮助孩子刷牙、家长是否检查孩子刷牙效果是孤独症患儿罹患龋齿的影响因素.结论 孤独症患儿龋齿患病率较高,其影响因素较多,应对患儿家长进行口腔健康知识教育.     

Intérêt des soins de bouche et du brossage des dents dans la prévention des pneumonies acquises sous ventilation mécanique

Among preventive measures suggested to reduce the incidence of ventilator associated pneumonia (VAP), regular oral care is included in most of the ventilator care bundles. This nursing care usually includes oral rinses with antiseptic solutions, especially with chlorhexidine at different levels of concentration, tooth brushing, associated with repeated oral aspirations. The rational is based on VAP physiopathology: Most of microorganisms responsible for VAP come from oropharyngeal cavity and dental plaque: Oral care with chlorhexidine or other antiseptic and tooth brushing decrease bacterial colonization at this localization. If randomized trials show positive results in cardiac surgery patients, results are more conflicting in other ICU populations. Meta-analyses confirm these results with a probable but modest preventive effect, mainly in cardiac surgery patients, and they show no additional effect of tooth brushing, nor any impact on mortality, duration of mechanical ventilation or length of stay. Oral care is preeminently a basic hygiene and wellbeing care, and plays a minor role in VAP prevention.     

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BackgroundOral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.ObjectivesTo assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.Methods638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.ResultsSubstantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02–58.53, p < 0.001), women’s oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.ConclusionsThe Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.     

安徽省城市和乡村5岁儿童口腔健康行为的调查

目的了解安徽省城乡5岁儿童口腔健康的行为状况,为儿童龋齿的预防提供科学依据。方法采用第3次全国口腔健康流行病的问卷调查方案,调查城市和乡村5岁儿童各216名的口腔健康行为,比较城市和乡村5岁儿童口腔健康行为的差别。结果城市儿童在开始刷牙年龄、每天刷牙次数、父母检查孩子刷牙效率、饮食习惯、口腔治疗、父母口腔保健知识方面明显优于乡村儿童（P〈0．01）。结论城市与乡村5岁儿童及家长的口腔健康行为是影响儿童患龋齿的直接因素。     

糖尿病患者口腔卫生行为及保健知识认知水平调查分析

目的了解糖尿病患者口腔卫生行为及口腔保健知识的认知水平,为临床早期实施口腔保健知识教育提供依据。方法采用自行设计问卷,对100例糖尿病住院患者进行口腔卫生行为及口腔保健知识认知水平调查。结果卫生行为方面：掌握正确刷牙方法、刷牙时间及使用牙线者分别为21％、18％、3％,选用含氟牙膏者为30％,口腔不适时及时就医者占6％;保健知识方面：了解刷牙目的、掌握更换牙刷时间、了解预防龋齿有效的牙膏者分别为23％、7％、20％,从未做过洁牙者占95％,完全不了解糖尿病与口腔疾患之间的相互影响关系者占92％。不同年龄、不同文化程度的患者在卫生行为及保健知识认知方面均存在差异（均P〈0．01）。结论糖尿病患者不良口腔卫生行为率高,保健知识认知率低;患者口腔卫生行为及保健知识认知水平受年龄与文化程度影响;认知水平又直接影响患者的口腔卫生行为。将口腔保健知识纳入糖尿病患者及高危人群健康教育内容之一,使其养成良好的口腔卫生行为,对预防和减少并发症的发生,提高患者生活质量和延长生存时间,都有着非常重要的意义。     

老年人口腔健康调查及其影响因素分析

目的调查老年人群口腔健康现状并分析其影响因素。方法采用牙缺失情况相关调查表、口腔检查表对443例口腔科就诊的老年人进行横断面调查研究。结果443例老年人群中,存在牙缺失270(60.95%)例,75岁以上人群牙缺失比例最高为74.40%(93/125)。缺牙人群中,高血压、糖尿病、冠心病、脑卒中的发病率分别为17.78%(48/270)、12.59%(34/270)、35.56%(96/270)、7.41%(20/270)。性别、年龄、基础疾患(高血压、糖尿病、冠心病、脑卒中)、口腔健康知识(刷牙时牙龈出血是否正常)、口腔健康行为(刷牙频率、牙线使用频率)是影响老年人群牙缺失发生的危险因素。结论老年人群口腔健康状况不容乐观,牙缺失比例较高,口腔健康知识缺乏,口腔健康行为差。护理人员在开展健康教育时,除了分析性别、年龄、基础疾病等方面对老年人口腔健康的影响,还可针对刷牙频率、牙线使用频率、口腔健康知识掌握情况等口腔健康行为进行健康宣教。     

A single-item approach to screening elders for oral health assessment

BACKGROUND: Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important. OBJECTIVES: The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care. METHODS: This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment. RESULTS: A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n = 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n = 93), the item was less effective. DISCUSSION: A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.     

Self-reported knowledge and behaviors related to oral and dental health in Turkish children

AIM: The purpose of the study was to present oral- and dental health-related knowledge and behaviors of children who presented to Akdeniz University Medical Faculty Pediatric Outpatient Clinic between March 1 and May 1, 2006 for non-dental health reasons. METHOD: Data were collected from a total of 173 children. A survey which contained questions about the children's oral and dental health was completed using face-to-face interview technique. RESULTS: Forty-eight percent of the children were 5-6 years old and 68.8% were not going to school. It was determined that 43.3% of the mothers of the children in the study had a primary-school level of education and 74.6% were housewives. It also was determined that 49.1% of the children had never had a cavity, 43.4% stated that they brushed their teeth after meals, and 30.6% stated that they brushed at least once a day. More than sixty percent of the children spent their allowance on chocolate, chips, cola, candy, and other acidic drinks. A significant relationship was found between the children's ages and having a caries in this study. There also was a statistically significant relationship between the parents' tooth-brushing habit and the children's tooth brushing, and between the parents' frequency of tooth brushing and the children's frequency of tooth brushing. CONCLUSION: Based on the results of the study it is recommended that both children and their families be given education about oral and dental health.     

Oral Health in Low-Income Older Adults in Korea

Oral diseases among older adults are prevalent and a major public health problem, but public attention regarding this matter is quite limited. Many older adults experience limited access to oral care services. The study aimed to describe characteristics of oral health conditions, perceived oral health status, and oral health practices and to examine factors related to living status and accessibility to dental health care among 9,660 low-income older adults living in a suburban city in Korea. Approximately 42% of low-income older adults lived alone; 68% perceived their oral health as either excellent or good; and 31% reported difficulty accessing dental services. Lack of accessibility to oral care services was significantly more common in older adults with low incomes, living alone, having poor oral conditions, poor self-perceived oral health, and poor tooth-brushing behavior. Strategies to promote access to dental care services for underserved older adults should be developed to prevent further oral problems and their impact on overall health conditions.     

Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates

Background: Ventilator‐associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth‐brushing has been considered as a clinical intervention to reduce infection rates, however, evidence to inform this needs appraising. Aim: This paper presents a critical review on the effect of chlorhexidine gluconate (CHX) and tooth‐brushing in decreasing rates of VAP in mechanically ventilated adult patients cared for in intensive care settings. Methods: A literature search was conducted using a number of bibliographic databases (n = 6). A number of parameters were used to exclude irrelevant papers. A total n = 17 papers were located and accessed, which were directly related to the field. Eight studies that met the criteria and addressed the study aims were reviewed. Findings: CHX was successful in reducing the rate of VAP and using a combination of CHX and colistine resulted in better oropharyngeal decontamination which reduced and delayed VAP. Chlorhexidine was also effective in reducing dental plaque in patients cared for in intensive care and had the potential to reduce nosocomial infections. Results of studies investigating the use of tooth‐brushing in reducing VAP incidence proved inconsistent, although all recommend tooth‐brushing as important in maintaining good oral hygiene. Conclusions: The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram‐negative bacteria. Tooth‐brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggest that further research is required into the effects of tooth‐brushing.     

Effects of combination oral care on oral health,dry mouth and salivary pH of intubated patients: A randomized controlled trial

Intubated patients are at risk of oral health problems. Although a variety of oral care regimens for intubated patients have been studied, there is a lack of research on the effects of combination oral care that includes tooth brushing, chlorhexidine and cold water. This open‐labelled, randomized, controlled trial aimed to evaluate the effects of combination oral care on oral health status. Participants aged 20 years and older were recruited on the first day after intubation through convenience sampling in a medical intensive care unit. Random assignment was performed using an internet randomization service. The primary outcome was oral health status. Data were collected during May and June 2013. Participants were randomized to one of two groups (23 intervention and 21 control). The final analysis included 18 patients with combination oral care and 17 in the control group. The intervention group had better oral health (effect size = 1.56), less dry mouth and higher salivary pH than the control group. Any additional burden of providing combination oral care to patients who are mechanically ventilated is worthwhile in terms of clinical outcomes.     

刷洗负压吸引法在经口气管插管患者口腔护理中的应用

目的探讨刷洗负压吸引法在经口气管插管患者口腔护理中的应用效果。方法选取ICU经口气管插管的患者82例,随机分为观察组42例和对照组40例,观察组采用刷洗负压吸引法进行口腔护理,对照组采用传统口腔护理方法。比较两组患者口腔感染发生率、呼吸机相关性肺炎（VAP）发生率、牙菌斑发生率和口腔黏膜损伤发生率。结果观察组口腔感染发生率、VAP的发生率和牙菌斑发生率分别为7．14％,2．38％,4．76％,均少于对照组的22．50％,15．00％,32．50％,差异均有统计学意义（x。分别为3．88,4．18,10．55;P〈0．05）。两组口腔黏膜损伤发生率比较差异无统计学意义（P〉0．05）。结论与传统口腔护理方法相比,刷洗负压吸引法能有效保持经口气管插管患者口腔清洁,降低口腔感染、VAP和牙菌斑的发生率。     

Benefits of a school-based health center in a preschool

Although school-based health centers (SBHCs) deliver health care to vulnerable children, their effectiveness has not been well documented. This study compared the benefits of an SBHC with a School Health Survey and selected HEDIS measures in preschool children with and without access to an SBHC. Preschoolers with access to an SBHC (N = 130) and preschoolers without access (N = 131) were compared on (a) HEDIS measures including well-child care, immunizations, dental care, and smoke exposure; (b) measures of access and use of physical and mental health services; (c) satisfaction with health care; (d) barriers and facilitators to care; and (e) health insurance. Significant differences were found in parents' perceptions of children's physical and emotional health, self-esteem, incidence of behavioral problems, difficulty in obtaining care, number of hospitalizations, and satisfaction with care received. Findings suggest that holistic services provided by an SBHC positively impact the health of vulnerable preschool children.     

东莞地区居民口腔保健知识与行为的调查分析

目的调查分析东莞地区居民口腔保健知识与行为并给予健康宣教。方法随机选取2019年1—7月东莞地区常住居民450名,对其口腔保健知识误区进行“个体化”与“群体化”相结合的健康宣教。健康宣教前发放问卷450份,回收419份,有效回收率93.11%;健康宣教后发放问卷450份,回收426份,有效回收率94.67%。结果健康宣教后被调查居民关于“每年至少做1次口腔检查;牙齿好坏是天生的;洁牙对预防牙龈出血没用;吃糖可造成龋齿;漱口是保持口腔清洁的最有效办法”的回答正确人数均高于健康宣教前,差异有统计学意义(P<0.05);健康宣教后,被调查居民关于“刷牙方式、每天刷牙次数、使用牙线情况、使用牙膏情况”的正确行为人数均高于健康宣教前,差异有统计学意义(P<0.05);健康宣教后调查居民关于“就医地点、定期口腔检查、牙痛时做法、牙齿有洞但不痛”的正确就医观念和行为人数高于健康宣教前,差异有统计学意义(P<0.05)。结论东莞地区居民关于口腔健康知识及行为知晓水平仍较低,通过对居民进行口腔健康知识宣教,可有效提高其口腔健康行为,促进身心健康发展。     

Oral health and care in the intensive care unit: state of the science.

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients' comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.     

Patterns of change in self-reported oral health among dentate adults

BACKGROUND: Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time. METHODS: The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period. RESULTS: The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery. CONCLUSION: Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.     

Dental and other health care visits among U.S. adults with diabetes

OBJECTIVE: This study compared yearly dental visits of diabetic adults with those of nondiabetic adults. For adults with diabetes, we compared the frequency of past-year dental visits with past-year visits for diabetes care, dilated eye examinations, and foot examinations. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study using a sample of 105,718 dentate individuals aged > or =25 years, including 4,605 individuals with diabetes who participated in the 1995-1998 Behavioral Risk Factor Surveillance System in 38 states. RESULTS: Dentate adults (i.e., those with at least some natural teeth) with diabetes were less likely than those without diabetes to have seen a dentist within the preceding 12 months (65.8 vs. 73.1%, P = 0.0000). Adults with diabetes were less likely to have seen a dentist than to have seen a health care provider for diabetes care (86.3%); the percentage who saw a dentist was comparable with the percentage who had their feet examined (67.7%) or had a dilated eye examination (62.3%). The disparity in dental visits among racial or ethnic groups and among socioeconomic groups was greater than that for any other type of health care visit for subjects with diabetes. CONCLUSIONS: Promotion of oral health among diabetic patients may be necessary, particularly in Hispanic and African-American communities. Information on oral health complications should be included in clinical training programs. Oral and diabetes control programs in state health departments should collaborate to promote preventive dental services, and the oral examination should be listed as a component of continuous care in the American Diabetes Association's standards of medical care for diabetic patients.     

Oral health during pregnancy

The purpose of this article is to explore how poor oral health affects pregnancy and to review current recommendations for dental care during pregnancy. While nurses are concerned with numerous aspects of the health of pregnant women, the health of maternal and fetal dentition may be overlooked. However, due to recent findings that periodontal disease may be a risk factor for preterm low birthweight, nurses and other maternal healthcare providers are becoming more aware of oral health during pregnancy. It is important to understand that establishing a healthy oral environment is the most important objective in planning the dental care for the pregnant patient. This objective is achieved by adequate plaque control (brushing and flossing) and professional prophylaxis including coronal scaling, root planing, and polishing. Nurses, nurse practitioners, and nurse-midwives should include assessment of maternal dentition and referral for dental problems as part of their prenatal practice. Patients should be encouraged to schedule elective dental treatment during the second trimester but seek prompt care for acute dental problems. Teaching related to oral health during pregnancy should include the importance of proper nutrition to ensure maternal and fetal oral health, including taking prenatal vitamins and eating foods high in protein, calcium, phosphorus, and vitamins A, C, and D. Potential teratogens that may be encountered during dental care should also be discussed. Nurses can be vital in improving perinatal outcomes and maternal/fetal dental health through screening, referral, and education of their pregnant clients.     

Oral Health in People Who Use Methamphetamine

Oral health directly affects systemic health, yet a large proportion of the population has insufficient access to oral health care. People who use methamphetamine are at particularly high risk of having poor oral health due to a combination of pathophysiologic and socioeconomic factors. Nurse practitioners are well positioned to improve access to oral health care for this population through early screening, prompt referral, and targeted harm reduction strategies. The purpose of this article is to enhance nurse practitioner competency in providing oral-systemic health care to vulnerable populations. This article summarizes current knowledge regarding methamphetamine-associated dental decay and explores opportunities for health promotion and harm reduction in this vulnerable population.     

Oral health-related quality of life in older Swedish people with pain problems

Scand J Caring Sci; 2011; 25; 510–516
Oral health‐related quality of life in older Swedish people with pain problems Objectives: The aim of the present paper was to explore the oral health‐related quality of life in old Swedish people with pain problems, with special reference to demography, socio‐economic factors, health, and general health‐related quality of life. Method: Individuals ≥80 years (n = 186) who earlier reported pain problems answered two multi‐item instruments on oral health‐related quality of life (Oral Health Impact Profile, OHIP‐14) and general health‐related quality of life (Short Form Health Survey, SF‐12), respectively. Socio‐demographic and health questions were also inquired. Results: Both the oral and general health‐related quality of life were rated very low. Two thirds (67.2%) reported at least one of the aspects in the OHIP‐14 fairly often, very often or all the time. The mean additive score of the OHIP‐14 was 14.6 (SD 10.5). The mean value of the physical component scale (PCS) of SF‐12 was 25.9 (SD 6.2) and of the mental component scale (MCS) 44.1 (SD 11.5). The OHIP‐14 was consistently and significantly correlated with self‐rated general and oral health, chewing ability and MCS. The associations between self‐rated general and oral health in relation to the OHIP‐14 were independent of possible confounders: OR 3.63 (95% CI 1.58–8.32) and OR 2.68 (95% CI 1.44–4.99), respectively. Conclusion: Old people with pain problems experienced very low oral and general health‐related quality of life. Personnel caring for the oldest with pain problems should be aware that oral health problems can contribute to a low quality of life and that oral care should be included in the general care.