Oral care of elderly patients: nurses' knowledge and views

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have 'some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.     

The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery

Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular.Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia.The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession.This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.     

Sources and patterns of referrals of oral cancer: role of general practitioners

Referrals of patients with oral squamous cell carcinomas to an oral medicine clinic were assessed with regard to the sources, delays, and pattern of referrals from general medical practitioners and general dental practitioners. Slightly more patients were referred by dental practitioners than by medical practitioners, but general medical practitioners were far more likely to see advanced tumours and to request an urgent second opinion or suggest a diagnosis of malignant disease. The greatest delay overall was caused by the patients in seeking advice from their practitioner, particularly those who attended a general medical practitioner. Both groups of practitioners requested a hospital opinion within roughly a month--a reasonable interval. Subsequent delays were minimal. Delays occur mainly because the patients are slow in seeking professional advice and, in general, do not appear to have been reduced over the decade since a previous British study on referral patterns was carried out. This study emphasises the importance of educating patients about oral cancer since it is they who appear to be mainly responsible for the delays in diagnosis. The results also help to dispel the myth that general medical practitioners might be less competent at diagnosis and referral of patients with oral cancer than are dental practitioners, though we are aware of misdiagnoses from both groups.     

改良口腔护理对急性白血病化疗致口腔粘膜炎的防治

目的 评估改良口腔护理对急性白血病化疗患者口腔并发症的防治效果.方法 34例白血病患者随机分为改良口腔护理组和常规口腔护理组.在化疗前后不同时间对患者检查口腔及牙齿情况,寻找潜在感染病灶.在化疗第1、7、14、21、28d用牙龈指数评价牙周状态.结果 改良口腔护理组牙龈指数、口腔并发症均明显低于常规护理组.结论 改良口腔护理对急性白血病化疗口腔并发症有一定的防治作用,值得进一步推广与改进.     

Oral hygiene awareness among female Saudi school children

OBJECTIVE: To evaluate the oral hygiene habits and utilization of professional dental health services by all the children in the primary schools, and to compare the differences in oral hygiene awareness (OHA) and dental health status of schoolchildren who are exposed to dental health education and those who are not. METHODS: Participants included 400 Saudi children, randomly selected from the primary female schools in Al-Kharj, Kingdom of Saudi Arabia on April 2007. Two hundreds children (age 9-11) from the 25 schools, who were exposed to the dental health education program on April 2006, were randomly selected as the study group. Two hundred children (age 9-11) from the schools, which were not exposed to such program were also randomly selected as the control group. The required information about oral hygiene awareness was collected through an especially designed questionnaire. RESULTS: Tooth brushing for 2 times a day or after meals were more common among schoolchildren of study group, than schoolchildren of control group. A significant difference (p=0.00) was observed between study group and control group, with regard to never brush their teeth. There was no significant difference between study group and control group with respect to using dental floss, using mouthwash, and in relation to never visiting a dentist for check up. The main reason cited by study group, and by control group for visiting the dentist was that they had severe toothache. Both groups presently consume more sweetened soft drinks. A significant (p=0.00) higher frequency of good dental status was observed in the study group, as compared with that of the control group. CONCLUSION: The school which applied this program, showed improved OHA of children as compared with the control group. Systematic school-based oral health promotion programs are urgently needed in the Kingdom to target lifestyles and health needs of children.     

Diazepam tolerance: effect of age, regular sedation, and alcohol

The dose of intravenous diazepam required for sedation was estimated in a series of 78 patients aged 17-85 years given the drug for dental and endoscopic procedures. Multiple regression analysis showed a significant correlation (r = 0.71; p less than 0.001) between dose and age, body weight, the taking of regular sedation, and the taking of more than 40 g alcohol daily, but there were no differences in the doses required between men and women, smokers and non-smokers, inpatients and outpatients, or dental and endoscopy patients. Patients aged 80 required an average dose of 10 mg and patients aged 20 an average dose of 30 mg, and the dose required was much higher in those receiving regular sedation or having a high alcohol intake. Plasma total and free diazepam concentrations were measured in the second half of the series of patients (n = 37). Plasma concentrations required for sedation fell twofold to threefold between the ages of 20 and 80 and were significantly higher in those taking regular sedation or alcohol. Differences in the acute response to diazepam appeared to be due to differences in the sensitivity of the central nervous system (pharmacodynamic tolerance) rather than to differences in pharmacokinetic factors.     

自行调节式口腔矫治器治疗OSAHS的效果

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者使用口腔矫治器的治疗效果。方法58例经多导睡眠监测图监测(PSG)检查确诊为OSAHS,排除上气道器质性阻塞病变;不能耐受CPAP、外科手术或治疗效果不佳者使用口腔矫治器,观察治疗效果。结果患者初戴,感觉良好,无其它不适,6个月后随诊,56例达到正常,睡眠呼吸暂停低通气紊乱指数(AHI)<5;2例AHI降低50%。非快速眼动(N-REM)睡眠时间(%)、快速眼动(REM)、睡眠时间(%)、最长呼吸暂停时间(秒)、平均呼吸暂停时间(秒)、呼吸暂停指数(AI)、低通气指数(HI)、醒觉时间(分)治疗前后有显著性差异(P<0.01)。结论患者戴用舒适、有效,副作用小且少,兼顾了有效性和舒适性,是一种较好的口腔矫治器。     

外伤移位前牙两种固定方法的疗效比较

目的评估片段弓固定法与高强纤维夹板固定法在外伤移位前牙固定术中的临床效果。方法将34例因训练和运动导致上前牙移位和半脱位的门诊军人随机分成两组,分别采用片段弓固定法与高强纤维夹板固定法进行复位固定,8周后通过临床和X线检查,比较其临床应用效果。结果两组34例患者固位效果稳固、无松脱,牙龈组织健康;去除固定后检查外伤牙均无松动,无叩痛;X线检查未见牙槽骨及牙根吸收现象。在即刻效果的美观、舒适方面高强纤维夹板固定法优于片段弓固定法。结论对于外伤所致的上前牙移位和半脱位患者,两种固定法均可有效的固定松动患牙;高强纤维夹板固定法更为美观和舒适,是松动牙固定较为理想的选择。     

口服咪达唑仑清醒镇静术在儿童牙科充填治疗中的应用效果评价

目的评价口服咪达唑仑在儿童牙科充填治疗过程中的镇静效果。方法本研究为随机、双盲、对照临床实验,选择5～10岁(平均7.3岁)需进行牙科充填治疗的患儿40名,随机分为两组。试验组术前20分钟口服咪达唑仑(0.5mg/kg),空白对照组术前20分钟口服安慰剂 VitminC 液5ml,两组患儿均配合使用儿童专用束缚带和无痛局麻注射泵。治疗过程拍摄录像,双盲评价治疗依从性和治疗过程中的患儿精神状态情况。同时通过询问患儿,评价顺行性遗忘情况。结果两组患儿治疗过程中的行为和生理指标都有显著性差异,尤其是治疗依从性方面,咪达唑仑组与对照组比较有非常显著性差异(P<0.001)。结论口服咪达唑仑用于儿童牙科治疗镇静术是安全和有效的。同时,由于口服药易于被儿童接受的特点,必将促进这一方法在临床的快速推广。     

牙体牙髓病治疗中阿替卡因肾上腺素的麻醉效果

目的探究牙体牙髓病治疗中阿替卡因肾上腺素的麻醉效果观察。方法资料随机选自2011年3月-2013年3月在该院诊治的牙体牙髓病患者96例,按照随机数字表方法将患者随机分为两组,每组48例,予以利多卡因联合麻醉患者作对照组．予以阿替卡因联合肾上腺素麻醉作研究组,分析两组患者的麻醉效果、疼痛和面部表情情况。结果研究组麻醉效果优患者,多于对照组的麻醉效果优患者,比较差异有统计学意义（P〈0．05）;研究组的麻醉总优良率,多于对照组比较差异有统计学意义（P〈0．05）。研究组的完全无痛患者,多于对照组完全无痛患者,比较差异有统计学意义（P〈0．05）。研究组的面部表情的评分,优于对照组的面部表情评分,比较差异有统计学意义（P〈0．05）。结论针对牙体牙髓病患者予以阿替卡因联合肾上腺素治疗成效显著,能够明显降低疼痛效果,并提升麻醉的效果,具有一定临床应用价值。     

不同消毒方法对口腔印模尺寸稳定性的影响

在临床口腔修复过程中,制取口腔印模是必不可少的步骤,口腔印模尺寸稳定性直接影响修复体的制作精度,从而影响口腔修复的质量.在临床制取口腔印模后,印模表面会残留大量患者体液,出于医院感染防控需求,要求对印模进行消毒处理.但消毒本身会可能带来理化变化,从而影响口腔印模的尺寸稳定性.影响印模尺寸稳定性的因素较多,其中以消毒影响较大.本文就现有的印模消毒方法对印模尺寸稳定性的影响作一综述.     

A Surgery-first approach in surgical-orthodontic treatment of mandibular prognathism--a case report

The conventional approach in orthodontic surgery treatment of dentofacial anomalies requires a varied period of pre-surgical orthodontic treatment. This presurgical period is considered to be important for adequate surgical treatment and stable results. This period is usually long bothersome for patients because dental decompensation is required and there is consequent deterioration of aesthetics and function, especially in cases of skeletal Class III occlusion. At Chang Gung Craniofacial Center, a surgery-first approach (SFA), i.e. minimal pre-surgical orthodontics, is one of the treatment choices for Class III patients. In this report, we present a 19-year-old man with mandibular prognathism, an anterior open bite and severe dental crowding treated with SFA. The patient received orthognathic surgery a week after bracing of the teeth. The operation and recovery were uneventful as well as the following orthodontic treatment. The total treatment time was only four months, much shorter than with the conventional approach. The patient benefitted from immediate improvement of the facial profile after surgery, and a much shorter total treatment, and the results were not compromised. We believe in selected cases, SFA is a good and effective treatment alternative.     

儿童牙科畏惧症心理干预的临床疗效观察

目的探讨心理干预对儿童牙科畏惧症（DA）疗效的影响。方法采用Corah's牙科畏惧症评分法,筛选出316例DA儿童患者,分为干预组和对照组。干预组在进行常规牙科治疗的同时采用心理干预;对照组则为常规的牙科治疗。结果干预组DA程度明显降低,与牙科治疗前以及对照组比较都有显著性差异(P＜0.01)。牙科治疗后干预组脉搏减慢例数多于对照组,脉搏加快例数少于对照组,差异有显著性（P＜0.05）。心理干预后男性比女性疗效要好(P＜0.05)。结论心理干预方法治疗儿童DA是有效的。     

肌内注射氯氨酮咪达唑仑镇静技术在儿童牙科门诊手术中的应用

目的提出一种新的儿童牙科治疗镇静技术并评价其安全性和有效性。方法选择需要进行小的牙科门诊手术(舌系带延长术和小外伤缝合术)2～7岁的儿童37人采用镇静技术,给予氯氨酮(3mg/kg),咪达唑仑(0.05mg/kg)。必要时再给氯氨酮(1mg/kg)。术中术后观察心率、血压,呼吸频率,氧饱和度并记录药物副作用和评价患儿的治疗依从性。结果32名患儿在第一次注射后即取得了较好的镇静满意度。另外5名患儿在进行第2次注射后也取得了成功。一般注射后5分钟药物开始起效,持续时间大约半个小时,结论肌内注射氯氨酮和咪达唑仑是一种安全、有效的儿童牙科镇静技术。这一技术因其效果良好和易于推广而具有广阔的发展前景。     

拔牙和不拔牙矫治对牙弓宽度影响的研究

目的:对25例拔牙(4个第一前磨牙)患者和25例不拔牙患者正畸治疗前后的研究模型的上颌和下颌的前牙弓和后牙弓的宽度进行测量,以检验拔牙矫治是否会导致牙弓的狭窄,并进而影响其美学效果.方法:在尖牙和磨牙区唇颊面的最突出的位置进行牙弓宽度测量,将尖牙间和磨牙间的宽度测量数据,进行统计分析.结果:在两组病例中,下颌尖牙间和磨牙间的宽度相同,在拔牙病例中尖牙间宽度比不拔牙宽度多0.93mm(P＜0.01).结论:拔牙矫治与不拔牙矫治相比,前者不会导致牙弓狭窄.     

Living wills: would sick people change their minds?

Patients admitted acutely to a geriatric medical unit were interviewed on admission about their opinions on cardiopulmonary resuscitation (CPR). They underwent a general examination and their mental health was documented by completing the geriatric depression scale. Those who did not wish CPR in the event of a cardiac arrest were questioned again on recovery. Of 216 patients admitted, only three objected to answering the questions and after the other exclusion criteria were applied, 100 patients were included in the study. A total of 92% of patients wished CPR in the event of a cardiac arrest. The 8% who did not wish CPR contained more people scoring high on the geriatric depression scale. After recovery, three of that eight had changed their minds and wished CPR if required. Patients who are acutely unwell may make decisions that are influenced by their condition at this point in time and it is important to recognize that these decisions may not be maintained. In this study, consultant geriatricians did not reflect their patients'' desires in making decisions about who should receive CPR if required.     

微创技术在老年患者牙种植术中的临床应用

目的 研究分析微创技术在老年患者牙种植术中的临床应用效果.方法 选取我院2012年1～12月期间收治的40例60岁以上的老年牙种植患者作为研究对象,随机分为两组,治疗A组与治疗B组.其中治疗A组患者采用微创技术牙种植术,治疗B组患者采用常规的埋植术.两组患者各植入20枚种植体,术后观察两组患者的手术用时、疼痛评价以及牙槽骨的吸收情况.结果 两组患者术后均没有出现牙周炎、牙槽骨吸收严重等不良情况,但是治疗A组患者的手术用时与疼痛评价情况明显优于治疗B组的患者.结论 微创技术在老年患者牙种植术中用时短、疼痛少,对老年心脑血管疾病患者的影响小,安全、便捷,值得临床推广应用.     

Analysis of 1202 orthopantograms to evaluate the potential of forensic age determination based on third molar developmental stages

A total of 1202 orthopantograms of young dental patients were analyzed to assess the correlation of third molar root development with chronological age. The investigated patients were treated at a university dental clinic on an outpatient basis, included a variety of demographic characteristics (600 males and 602 females, 28% of other than central European background), and were 15-24 years old when the radiographs were obtained. Radiographs in which more than one third molar were either missing due to agenesia or extraction, or not evaluable because of deep destruction or marked tilting, were not included in the analysis. Our findings show that the growth patterns of third molars, based on seven defined stages of root development, did correlate with chronological age; age estimation when applied to a specific individual would involve a margin of error of +/- 2-4 years. There were no significant differences between the left and right jaw segments, but the stage of root development was generally more advanced in the upper than in the lower third molars. Root development was also more advanced among boys than among girls of the same age. There were no apparent differences in growth patterns based on national/ethnic background. While only 2.5% of 18-year-olds revealed fully developed third molars in all four quadrants, this percentage leaped to 38.4% among the 21-year-olds. To summarize, while the developmental stage of third molars is not per se a highly useful indicator of chronological age in juveniles and young adults, it is nevertheless a valuable supplementary parameter given the scarcity of other available age indicators.     

北京市西城区龋病的社区诊断

按多阶段分层随机抽样原则在西城区目标社区中抽取35～74岁居民1162名,由3名医生做龋齿检查。受检人群中患冠龋925人,冠龋患病率为79．6％,龋面均为24．39。受检人群根龋指数为3．5％。在牙齿水平上,接受冠龋检查的32536颗牙齿中有7267颗患冠龋,冠龋治疗需要率为22．3％;接受根龋检查的16604颗牙齿中有4317颗患根龋,根龋治疗需要率为26．0％。在个体水平上,龋面均与根龋指数呈显著相关性（P〈0．01）。男女之间龋面均和根龋指数的差异均无统计学意义。说明北京市西城区目标社区中老年人龋齿患病严重,需建立社区口腔卫生服务体系来控制龋齿的发生。