儿童牙科畏惧症调查研究

目的　探讨儿童牙科畏惧症(dentalfear,DF)发病情况及其相关因素。方法　采用Venham临床焦虑及合作行为级别评定量表对2 0 5例牙病患儿进行调查及统计分析。结果　不同年龄、不同性别儿童DF发病率无统计学差异,不同居住地、母亲文化程度不同、牙科经历不同、口腔卫生状况不同的儿童DF发病率有统计学差异。结论　直接不良的牙科经历是儿童DF发生的主要原因。牙科医生除熟练掌握专业知识以减少操作中患儿的痛苦外,熟悉并充分运用儿童心理学知识,改善牙科就诊环境,加强儿童口腔卫生知识的宣传教育,对减少和减轻儿童牙科畏惧症的发生有积极的意义。     

儿童牙科畏惧症调查分析

目的 探讨儿童牙科畏惧症(dental fear,DF)的发生情况及产生原因.方法 采用临床焦虑及合作行为级别评定量表对300例儿童牙病患者进行调查及统计分析.治疗前问卷式调查、填表,治疗后由经治医师记录患儿DF发生情况.结果 300例儿童牙病患者中DF患者245例,发生率为81.67%,不同性别儿童DF发生率无统计学差异,年龄不同、牙科经历不同、口腔卫生状况不同的儿童DF发生率有统计学差异.结论 儿童DF发病率较高,与患儿年龄、不良的牙科经历、口腔卫生状况等因素有关.儿童DF直接影响儿童牙病的防治工作.     

儿童口腔科患者就诊配合度的影响因素

儿童口腔科最常见的问题是患儿由于牙科焦虑或者行为管理问题不能配合治疗,对口腔诊疗的正常进行造成极大的影响。本文将从医护、患儿、监护人3个方面对可能造成患儿就诊不合作的因素进行综述,以期为临床工作中了解患儿不配合的原因提供参考。     

初诊儿童牙科不合作行为分析

目的 探讨初次到牙科就诊的儿童其不合作行为与儿童气质、龋病严重程度等因素的相关性,以期制定个性化的牙科治疗方案,预防和应对初诊儿童的牙科不合作行为.方法 从2007年12月-2008年12月初次到儿童口腔科就诊的儿童中随机抽取195名3～7岁儿童为研究对象,对儿童进行口腔检查和实施相应的治疗措施,并对治疗过程中儿童的牙...     

牙科急诊患儿的行为特点和临床分析

目的：分析影响牙科急诊患儿治疗时与医生合作行为的因素，并探讨这些因素与患儿合作的关系，总结出使患儿合作的经验。方法：观察255例急诊患儿在治疗过程中的表现，并调查可能影响患儿行为的因素。结果：牙科急诊患儿合作程度在不同年龄、性别、陪伴者间有显著性差异，而不同病因的患儿合作程度无显著性差异。结论：影响儿童治疗时与医生合作的行为因素多种多样，在儿童牙科急诊中掌握患儿的心理状态非常重要。     

牙科治疗中不合作儿童的气质研究

目的:通过对牙科治疗中合作与不合作儿童气质的比较分析,了解不合作儿童的气质特点。方法:对87例3～7岁接受牙科治疗的儿童进行气质调查,合作组52例,不合作组35例。气质量表用中国标准化的《中国学龄前儿童气质量表(CPTS)》,采用SPSS10.0统计软件包对2组儿童的气质类型及各气质维度得分分别进行两独立样本的秩和检验(Mann-whitney法)及t检验。结果:(1)2组儿童气质类型构成有显著性差别(P<0.05),不合作组儿童麻烦型气质比例(20.0%)显著高于合作组(3.8%)。(2)不合作组儿童适应性和心境2个气质维度得分高于合作组,差异有统计学意义(P<0.05)。结论:牙科治疗中儿童的合作程度与儿童的气质有关;适应缓慢、心境消极及麻烦型气质儿童出现不合作的比例明显增高。     

儿童牙科畏惧症对充填术疗效的影响

儿童到口腔科就诊时 ,经常对牙科治疗怀有不同程度的害怕和紧张心理 ,出现哭闹和不合作而逃避治疗 ,表现为牙科畏惧症 ,给治疗带来困难及危险 ,严重影响治疗效果。本文通过龋病治疗后银汞合金脱落率来观察儿童牙科畏惧症对治疗效果的影响。1　临床资料选择儿童口腔门诊患儿 199名 ,男 111名 ,女 88名 ,年龄 3～ 9岁 ,均为乳磨牙邻面中龋及深龋共计 378牙。其中81例哭闹、不合作的患儿为实验组 ,患牙 15 2个 ;另外 118例不哭闹、较合作的患儿为对照组 ,患牙 2 2 6个。2　方法患牙常规去龋 ,制备邻牙合面洞 ,75 0ｍＬ/Ｌ乙醇棉球消毒窝洞 ,隔…     

儿童牙科畏惧症的调查分析

目的:对不同年龄组口腔疾病患儿就诊时的临床表现及发生畏惧症的相关因素进行调查分析,为临床预防和降低儿童牙科畏惧症的发生提供参考。方法:依据牙科畏惧症评判标准,对571例在儿童口腔科门诊接受治疗的患儿进行评判与分析。结果:不同年龄患儿牙科畏惧症发生率不同,年龄越小发生率越高,差异显著(χ2=52.0864,P<0.001);男孩与女孩牙科畏惧症发生率不同,但统计学上差异不显著(χ2=1.6595,P>0.01);不同带养方式牙科畏惧症的发生率不同,差异显著(χ2=27.7085,P<0.001);母亲受教育程度不同,牙科畏惧症的发生率不同,差异显著(χ2=14.3434,P<0.001)。以往的牙科经历、其他儿童的言行、陌生的医生及诊疗环境等,都可导致牙科畏惧症的发生。结论:儿童牙科畏惧症的发生由综合性因素造成,需要通过患儿、家长、医护人员的共同努力,来降低其发生率。     

成都地区儿童牙病患者就诊及治疗

对儿童牙科门诊患者诊断和治疗种类的调查分析 ,能有效地反应儿童口腔卫生的状况以及儿童牙科临床治疗的技术水平和改进的情况。北欧[1 ,2 ] 、美国[3] 、日本[4 ] 和中国[5] 学者作过此类调查分析 ,依据调查结果评价本国本地区儿童牙科技术的变化和进步。现将位于成都市城区中心地段的四川省第四人民医院 1994、1997年度就诊的儿童牙病患者就诊及临床治疗情况作如下报道。1　材料和方法1.1　资料选择选择四川省第四人民医院口腔科首次就诊 4～ 14岁患儿完整的病历记录 ,1994年 4 5 3份 ,1997年 4 4 5份。1.2　调查项目将首诊主诉牙分别归纳…     

240例儿童牙科畏惧症的临床初步分析

目的：调查儿童患者牙科畏惧症的发生情况及影响因素。方法：采用改良的儿童畏惧调查量表-牙科分量表（CFSS-DS）和行为分级法对240例儿童牙病患者进行调查及统计分析,比较不同分组因素下儿童患者畏惧水平。结果：CFSS-DS平均评分值为15.78±3.90。240例患儿的术前评分值在年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生这几方面有显著性差异（P〈0.05）,性别和精神状态无显著性差异。患儿的畏惧率为75.83%,术中行为分级受患儿年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生和精神状态这五方面有显著性差异（P〈0.05）。结论：了解不同因素下患儿术前和术中的畏惧情况,以期将儿童DF降到最低程度,提高诊疗质量,更好地维护儿童的口腔状况。     

Relationship between apical periodontitis and marginal bone loss at individual level from a general population

Aim: To study the relationship between the presence of apical periodontitis in root-filled teeth and marginal bone loss (MBL) in individual subjects from a general population. Materials and methods: The study was conducted on a sample of 1,152 dentate individuals (participants in an epdemiological investigation) who were subjected to clinical and radiographic investigations. The presence of root fillings and apical periodontitis were registered. MBL was measured mesially and distally at all roots. The MBL index of the subject was defined as the mean MBL value at all measurable points in the same individual. Multiple regression analysis was adopted to calculate the influence of the presence of apical periodontitis and potential confounders on the dependent variable, MBL index. Results: There was a significant correlation between MBL and the percentage of root-filled teeth and the percentage of root-filled teeth with apical periodontitis. The results of the multiple regression analysis showed that the relative frequency of root-filled teeth with apical periodontitis was significantly higher in subjects with more MBL, irrespective of age, number of remaining teeth, relative frequency of root-filled teeth and smoking habits. Conclusions: A significant association between the presence of apical and marginal periodontitis in individual subjects was found. The mechanisms behind the associations between these diseases are unknown and this cross-sectional observational study did not permit distinction between cause and effect. It is hoped that future cohort studies may provide more knowledge about the biological actions behind the relationship between apical and marginal disease.Key words: Apical periodontitis, bone loss, epidemiology, marginal periodontitis     

Association between Chronic Apical Periodontitis and Coronary Artery Disease

Introduction

Studies have shown that periodontal disease is independently associated with coronary artery disease. However, this same association has not been demonstrated with chronic apical periodontitis. The goal of this study was to establish the relationship between chronic apical periodontitis and coronary artery disease.

Methods

This cross-sectional study included 103 patients who underwent coronary angiography at the University Hospital Presidente Dutra, Federal University of Maranhão, São Luís–Maranhão, Brazil. The patients answered a structured questionnaire and underwent physical and laboratory examinations. For each patient, a full-mouth set of periapical radiographs was taken. To compare numerical data, Student's t test for independent samples or the Mann-Whitney U test (nonparametric) was used. The homogeneity of variance was assessed by using Levene's test. For comparison of categorical data, the chi-square test or Fisher's exact test was used. The logistic regression analysis was performed to identify the independent predictors of coronary artery disease. The criterion for statistical significance was set at 5%. Statistical analysis was conducted by using SAS version 6.11 software.

Results

The study comprised 103 patients (52 men, 51 women; mean age, 61.9 years); 31.1% were literate, and 55.3% were married. In the study sample, the prevalence of chronic apical periodontitis was 41.7% and of coronary artery disease, it was 65%. The patients with chronic apical periodontitis had a 2.79 times higher risk of developing coronary artery disease.

Conclusions

In these study patients, chronic apical periodontitis was independently associated with coronary artery disease.     

High prevalence of apical periodontitis amongst smokers in a sample of Spanish adults

Aim To study the prevalence of apical periodontitis in smoker and nonsmoker patients. Methodology In a cross‐sectional study, the records of 180 subjects, 109 smokers and 71 nonsmokers, were examined. All participants underwent a full‐mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen’s Kappa test, analysis of variance and logistic regression. Results Apical periodontitis in at least one tooth was found in 74% of smokers and in 41% of nonsmokers (P < 0.01; odds ratio = 4.2; 95% C. I. = 2.2–7.9). Amongst smoker patients 5% of the teeth had apical periodontitis, whereas in nonsmoker subjects 3% of teeth were affected (P = 0.008; odds ratio = 1.5; 95% C. I. = 1.1–2.1). The percentage of root filled teeth in smoker and nonsmoker patients was 2.5% and 1.5%, respectively (P < 0.05; odds ratio = 1.7; C. I. 95% = 1.0–2.6). Conclusions In this study population, smoking was significantly associated with a greater frequency of root canal treatment and with an increased prevalence of apical periodontitis.     

Attitudes to dental care among parents of uncooperative vs. cooperative child dental patients

The aim of this cross-sectional questionnaire study was to investigate four aspects of parents' attitudes to dental care (knowledge, child's oral health behavior, priorities and responsibility). One study group (n = 50) of parents of uncooperative child dental patients (aged 8-12 yr) was compared to a reference group (n = 113) of parents of ordinary child dental patients of similar age, and to a second study group (n = 36) of parents of uncooperative younger child patients (aged 4-7 yr). Study group parents had significantly lower socio-economic status and a higher level of dental fear as compared to parents of ordinary child patients. We found indications of a poorer dental knowledge and a differing responsibility-taking profile among study group parents. Their children also had sweets more often. As compared to parents of younger children, the older study group parents had lower socio-economic status and showed a lower responsibility-taking related to the child's treatment refusal. In conclusion, parents of uncooperative children differ from parents of ordinary child dental patients, not only in socio-economic status and dental fear, but also in aspects such as dental knowledge and responsibility-taking. These differences were partly related to the child's age.     

Clinical Factors Associated with Apical Periodontitis Visible on Cone-beam Computed Tomography but Missed with Periapical Radiographs: A Retrospective Clinical Study

IntroductionCone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis, which is often missed in periapical (PA) radiographs. This study aimed to identify preoperative predictors correlated with the presence of apical periodontitis visible only in CBCT images and to investigate the important characteristics of such lesions.MethodsIn total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled in this study. The patients’ clinical charts were reviewed retrospectively to collect information regarding their symptoms and diagnoses. Periapical lesions were assessed using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex, and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal diagnosis) were assessed to determine their relationships with the presence of apical periodontitis visible only in CBCT images.ResultsApical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs and CBCT images, respectively. In a multivariate logistic regression analysis, pulp necrosis was significantly correlated with the presence of apical periodontitis visible only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911–15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds ratio = 2.843; 95% confidence interval, 0.990–8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars were significant factors of lesions visible only in CBCT images (P < .05).ConclusionsPulp necrosis was a preoperative predictor of apical periodontitis visible only in CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic stages.     

Herpesviruses in asymptomatic apical periodontitis lesions: an immunohistochemical approach

INTRODUCTION: Human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have been recently detected in samples from apical periodontitis lesions by means of molecular biology techniques and a role in the pathogenesis of this disease has been suggested. The present study was designed to survey asymptomatic primary apical periodontitis lesions for the presence of HCMV- and/or EBV-infected cells by means of immunohistochemistry. METHODS: Apical periodontitis lesions were obtained from 35 patients [26 human immunodeficiency virus (HIV) -seronegative patients and nine HIV-seropositive patients] after tooth extraction and subjected to immunohistochemical analysis using monoclonal antibodies specific for HCMV and EBV. RESULTS: Fifteen of the 35 apical periodontitis lesions were positive for the target herpesviruses. Overall, EBV was found in 31% of the samples and HCMV in 23%, with 14% of the lesions showing EBV and HCMV dual infection. No association was found between HCMV or EBV with any particular histopathological type of apical periodontitis (P > 0.05). HCMV was significantly more frequent in apical periodontitis lesions from HIV-positive patients (67%) than in lesions from HIV-negative patients (8%) (P = 0.001). EBV was detected in 44% of lesions from HIV-positive patients and in 27% of lesions from HIV-negative patients, but this difference was not significant (P = 0.91). CONCLUSION: Our results showed that cells infected by HCMV and EBV can be found in apical periodontitis lesions, with a higher prevalence in HIV-positive patients. The specific role that these viruses play in the pathogenesis of apical periodontitis remains to be described.     

显微根尖手术联合MTA治疗难治性慢性根尖周炎的研究

目的:研究在显微根尖手术治疗难治性慢性根尖周炎时应用MTA的可行性、特点、成功率及相关影响因素。方法:分析2013年1月~2015年12月间本院牙体牙髓科完成的显微根尖外科手术106例计146颗难治性慢性根尖周炎患牙的临床资料,其中上颌前牙75例、下颌前牙13例、上颌前磨牙6例、下颌前磨牙4例、上颌磨牙4例、下颌磨牙4例。手术包括根尖切除、根尖倒预备、根尖倒充填主要步骤,术后1年回访,通过临床症状和放射学检查评估疗效,并对预后影响因素进行卡方检验分析。结果:显微根尖外科手术联合MTA应用的1年成功率达95.9％(140/146),根据患者性别、年龄、牙位、根尖病灶范围分别统计手术疗效,组间差异均无统计学意义。失败5例6颗患牙,主要原因为根折及合并重度牙周炎。结论:在治疗难治性慢性根尖周炎时采用显微根尖手术联合MTA应用可取得满意效果;显微根尖手术是治疗慢性根尖周炎的有效手段。     

Investigation of interleukin‐13 gene polymorphisms in individuals with chronic and generalized aggressive periodontitis in a Taiwanese (Chinese) population

Wu Y‐M, Chuang H‐L, Ho Y‐P, Ho K‐Y, Tsai C‐C. Investigation of interleukin‐13 gene polymorphisms in individuals with chronic and generalized aggressive periodontitis in a Taiwanese (Chinese) population. J Periodont Res 2010; 45: 695–701. © 2010 John Wiley & Sons A/S Background and Objective: The interleukin‐13 (IL‐13) ?1112 C/T polymorphisms have been analyzed previously in a North European population of patients with aggressive periodontitis. The present study was carried out to investigate the association of polymorphisms in the IL‐13 gene with susceptibility to periodontitis in a Taiwanese population. Material and Methods: The genotyping of IL‐13 ?1112 C/T polymorphisms in 60 patients with aggressive periodontitis, 204 patients with chronic periodontitis and 95 healthy controls was carried out using the polymerase chain reaction–restriction fragment length polymorphism technique. Genotypes and allele frequencies among study groups were compared using Fisher’s exact test (p < 0.05). Pearson’s chi‐square test was used for analysis of the Hardy–Weinberg equilibrium. Results: The distributions of CC genotypes and C alleles between patients with aggressive periodontitis and healthy controls were significantly different (p = 0.034 and 0.046). After adjustment for age, gender, betel nut chewing and smoking status using logistic regression analysis, the odds ratio (OR) was 6.45 [95% confidence interval (CI) = 1.99–23.72, p = 0.003] for aggressive periodontitis. However, the CC genotype was only significantly associated with the risk of aggressive periodontitis in the nonsmoking group (OR = 4.48, 95% CI = 1.31–16.93, p = 0.020). Conclusion: The CC genotype or C allele appears to increase the risk of developing aggressive periodontitis in Taiwanese subjects.     

Treatment outcome in subgroups of uncooperative child dental patients: an exploratory study

Objectives. The principal aims of this study were to evaluate the treatment outcome in subgroups of uncooperative child dental patients and to test the validity of these subgroups, which were based on fear and personality characteristics. Design. An exploratory, intervention study using quantified questionnaire, interview and observation data. Sample and methods. Eighty‐six 4 to 12‐year‐old uncooperative child dental patients (of whom 81 were divided retrospectively into four subgroups) and their accompanying parents were followed up during treatment at a specialist paediatric dental clinic in Sweden. Treatment was based on behaviour management techniques, supported by nitrous oxide/oxygen sedation if necessary. At baseline, parents answered a questionnaire including questions on child dental and general fear, temperament and behaviour, and parental dental fear, emotional stress, locus of control, parenting efficacy and attitudes to dental care, some of which were repeated post‐treatment. The treating dentist rated child behaviour according to the acceptance of a maximum of 14 treatment steps at each visit. Results. Approximately 90% of all children managed to undergo the dental treatment. Child dental fear and parental emotional stress decreased during treatment. Externalizing, impulsive children showed lower acceptance. In fearful, inhibited children, integrated use of sedation appeared to facilitate acceptance. Validity of the subgroups characterized as ‘fearful, extrovert, outgoing’, ‘fearful, inhibited’ and ‘externalizing, impulsive’ was supported, while heterogeneity within the group of ‘non‐fearful, extrovert, outgoing’ children made validation difficult. Conclusion. Fear and personality characteristics may serve as diagnostic aids when planning treatment of uncooperative child dental patients. Controlled outcome studies using differentiated treatment methods for children with different fear and personality profiles are needed.     

Treatment of a Large Cystlike Inflammatory Periapical Lesion Associated with Mature Necrotic Teeth Using Regenerative Endodontic Therapy

Introduction

Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament–like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy.

Methods

A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials.

Results

After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals.

Conclusions

Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.