集束化干预策略在口腔科儿童全麻患者治疗中的应用价值分析

目的 探讨集束化干预策略在口腔科全麻患儿治疗中的应用价值。方法 选取2020年11月1日-2021年7月31日在首都医科大学附属北京朝阳医院就诊,需接受全身麻醉下口腔综合治疗的3～6岁患儿共60例患者为研究对象。随机分为干预组30例和对照组30例。两组患儿均在全身麻醉状态下行口腔综合治疗,干预组采用集束化干预策略,对照组采用常规干预策略。比较两组患儿儿科畏惧症、口腔健康知识、治疗情况、治疗效果、患者满意度。结果 干预组患儿术后改良中文版儿童牙科畏惧调查表(CFSS-DS)评分较对照组明显降低（P<0.001）;干预组术前准备时间较对照组减少,差异有统计学意义（P<0.001）;干预组术后口腔健康知识、信念改善较对照组显著（P<0.001）,干预组儿童刷牙及饮食习惯改善较对照组明显,且菌斑指数（plaque index,PLI）下降较对照组有统计学差异（P=0.01）;干预组护理满意度显著高于对照组（P<0.05）。结论 集束化干预策略能够有效缩短术前准备时间,提高全麻治疗效率;增加患儿舒适感,培养患儿口腔健康习惯及观念,提高患儿及监护人就诊满意度。     

Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial: The Caries Detection in Children–1 study

BackgroundVisual inspection (VIS) with radiographic examination (RAD) is the recommended diagnostic strategy for detecting caries in children; however, this recommendation is based on accuracy studies. The authors conducted a clinical trial to compare the detection and subsequent treatment of carious lesions in primary molars performed with VIS alone and with RAD.MethodsChildren (3-6 years old) were randomly assigned to 2 groups according to the diagnostic strategy used for caries detection on primary molars: VIS or RAD. Participants were diagnosed and treated according to the management plan related to the allocated group. The primary outcome was the number of new operative interventions during the 2-year follow-up period. Other secondary outcomes were also compared. Comparisons were performed with Mann-Whitney test using an intention-to-treat approach.ResultsOf the 252 children included and randomized, 216 were followed-up after 2 years (14.3% attrition rate). There was no difference between the groups for the primary outcome (P = .476). For the secondary outcomes, the RAD group had more restoration replacements (P = .038) and more restorations performed since the beginning of the study (P = .038) compared with the VIS group. In addition, the RAD group had a higher number of false-positive results than the VIS group (P < .001).ConclusionsSimultaneous use of VIS and RAD for caries diagnosis in primary molars of children who seek dental treatment does not provide additional benefits compared with VIS alone.Practical ImplicationsDentists should perform VIS only, not RAD, for detecting carious lesions in preschool-aged children.ClinicalTrials.gov: NCT02078453.     

Silver Diamine Fluoride: Extending the spectrum of Preventive Dentistry,a literature review

Dental caries continues to be a severe oral health problem despite a decrease in its prevalence over the past few decades. The contemporary philosophy of caries management has shifted from the traditional approach to a newer medical one, that frequently includes utilization of fluoridated and antimicrobial agents. Among these different agents, Silver Diamine Fluoride (SDF)¹ has gained significant recognition. Dr Nishino and Dr Yamaga in Japan, pioneered its application to arrest caries. It is an alkaline, colourless solution composed of diamine-silver and fluoride ions having silver's antibacterial and fluoride's remineralising property. It has been used successfully to arrest and prevent caries in deciduous and permanent teeth, prevent recurrence of secondary caries and treat dentinal hypersensitivity. No adverse systemic effects due to SDF have been noted although black discolouration following its application has raised concerns. When used wisely it is an effective, sustainable and inexpensive option for children with high caries risk, for individuals who cannot endure conventional modalities of restorative treatment and those with special health-care needs. The current review is an insight into the clinical significance and application of SDF based on published literature.     

Antibacterial activity and ion release of bonding agent containing amorphous calcium phosphate nanoparticles

ObjectiveRecurrent caries at the margins is a primary reason for restoration failure. The objectives of this study were to develop bonding agent with the double benefits of antibacterial and remineralizing capabilities, to investigate the effects of NACP filler level and solution pH on Ca and P ion release from adhesive, and to examine the antibacterial and dentin bond properties.MethodsNanoparticles of amorphous calcium phosphate (NACP) and a quaternary ammonium monomer (dimethylaminododecyl methacrylate, DMADDM) were synthesized. Scotchbond Multi-Purpose (SBMP) primer and adhesive served as control. DMADDM was incorporated into primer and adhesive at 5% by mass. NACP was incorporated into adhesive at filler mass fractions of 10%, 20%, 30% and 40%. A dental plaque microcosm biofilm model was used to test the antibacterial bonding agents. Calcium (Ca) and phosphate (P) ion releases from the cured adhesive samples were measured vs. filler level and solution pH of 7, 5.5 and 4.ResultsAdding 5% DMADDM and 10–40% NACP into bonding agent, and water-aging for 28 days, did not affect dentin bond strength, compared to SBMP control at 1 day (p > 0.1). Adding DMADDM into bonding agent substantially decreased the biofilm metabolic activity and lactic acid production. Total microorganisms, total streptococci, and mutans streptococci were greatly reduced for bonding agents containing DMADDM. Increasing NACP filler level from 10% to 40% in adhesive increased the Ca and P ion release by an order of magnitude. Decreasing solution pH from 7 to 4 increased the ion release from adhesive by 6–10 folds.SignificanceBonding agents containing antibacterial DMADDM and remineralizer NACP were formulated to have Ca and P ion release, which increased with NACP filler level from 10% to 40% in adhesive. NACP adhesive was “smart” and dramatically increased the ion release at cariogenic pH 4, when these ions would be most-needed to inhibit caries. Therefore, bonding agent containing DMADDM and NACP may be promising to inhibit biofilms and remineralize tooth lesions thereby increasing the restoration longevity.     

临夏州东乡族838名中小学生龋齿患病现状分析

目的了解临夏州东乡族7～14岁学生龋齿患病情况,为开展学校卫生工作和制定预防控制策略提供依据。方法对临夏州东乡族7岁、9岁、12岁和14岁4个年龄组838名中小学生龋患现状进行对比分析。结果临夏州东乡族7～14岁中小学生总龋患率为26.49%,女生龋患率高于男生(χ2=18.08,P0.001)。龋齿患病集中在小学阶段,尤其是小学低年级学生。与2010年相比,东乡族中小学生总乳龋患率下降4.45个百分点,但差异无统计学意义(χ2=3.451,P0.05);男女生分别下降6.07个百分点和3.18个百分点,其中男生下降差异有显著性(χ2=9.157,P0.05)。结论临夏州东乡族中小学生龋齿患病率明显下降,女生高于男生,但龋齿患病率仍然较高,应引起有关部门的高度重视,加强口腔卫生健康教育。     

人天然牙的高分辨X线微区衍射分析

通过使用X线微区衍射法直接对人天然牙表面正常牙釉质、牙本质及龋坏组织三个测量点进行检测,以测试X'pert Pro型衍射仪对人天然牙正常和早期龋损组织晶体结构改变的检测能力.结果显示,牙磷灰石由多种物相构成,是一种生物混晶,主要物相为羟基磷灰石,龋坏组织中可能有新物相的形成.从正常牙釉质到牙本质再到龋坏组织,晶体a轴逐渐增大,c轴基本不变.晶体晶胞参数计算结果:正常牙釉a=9.550(A),c=6.883(A);正常牙本质a=9.554(A),c=6.883(A);龋坏组织a=9.558(A),c=6.884(A).晶粒尺寸计算结果:正常牙釉质D002=27.600 nm;正常牙本质D002=16.561 nm;龋坏组织D002=13.163 nm.结晶性:正常牙釉质＞正常牙本质＞龋坏组织.结果表明采用新型高分辨X线衍射仪可以非常方便地对牙齿进行X线衍射微区分析.     

Nanomechanical and chemical characterization of incipient in vitro carious lesions in human dental enamel

OBJECTIVE: The research was designed to examine the growth of in vitro carious lesions in dental enamel using nanoindentation and time-of-flight secondary ion mass spectroscopy (TOF-SIMS). This was intended to give maps of mechanical properties and chemistry over the cross-section of the lesions. METHODS: Incipient carious lesions were grown on the buccal faces of 20 human premolars by exposure to acid for 3, 5, 7 or 14 days. The lesions were then cut in cross-section normal to the exposed surface. The lesions' cross-sections were then examined using nanoindentation and TOF-SIMS. RESULTS: The earliest lesions (3 days of acid exposure) showed little evidence of lesion growth, but the 5, 7 and 14 days of exposure all gave lesions with a weak, demineralized interior, but a stronger, less demineralized surface zone. The thickness of the surface zone was found to diminish with the length of exposure to acid, but it was still present even after 14 days of exposure. CONCLUSION: The results indicate that carious lesions develop subsurface and that the surface zone forms by a coupled diffusion process. Mechanically the lesion has a strong surface layer, but a very weak interior which makes the lesion vulnerable to mechanical loading. However, the presence of a surface zone that retains a high mineral content and is mechanically strong suggests that lesion development can be arrested and possibly reversed even when the lesions are relatively mature.     

Evaluation of a new caries detecting dye for primary and permanent carious dentin

OBJECTIVE: This study evaluated the clinical efficacy of a new caries detecting dye using a laser fluorescence device (DIAGNOdent). METHOD: Primary and permanent teeth with dentin caries were stained with Caries Check (CC), containing 1% acid red in polypropylene glycol (MW=300) or Caries Detector (CD), containing 1% acid red in propylene glycol (MW=76). Primary-CC, primary-CD, permanent-CC and permanent-CD groups were prepared. In the CC groups, stained dentin was completely removed. In the CD groups, pink-stained dentin was retained according to the manufacturers' instructions. Cavities before and after caries removal were measured with the DIAGNOdent. Data were analyzed using ANOVA and Fisher's PLSD multiple comparison test at alpha=0.05. Regression analyses were performed between DIAGNOdent readings and scores obtained from the clinical parameters. RESULTS: For all groups, there were no significant differences in the DIAGNOdent readings before treatment. The DIAGNOdent readings after caries removal were: primary-CC (16.0+/-17.6), primary-CD (9.6+/-5.2), permanent-CC (11.0+/-7.0) and permanent-CD (7.1+/-3.8). Significant differences were identified between the permanent-CC and primary-CD, and permanent-CC and permanent-CD subgroups but not for the primary subgroups. Correlation coefficients between DIAGNOdent readings and clinical parameters were low. CONCLUSIONS: When dentin stained with Caries Check was completely removed, the DIAGNOdent readings were higher than those recorded when palely-stained pink dentin was retained with the Caries Detector, with significant difference observed for the permanent teeth. Caries Check may be used clinically to avoid excessive removal of caries-affected or sound dentin in permanent teeth but not in primary teeth.     

The potential for sodium hexametaphosphate (SHMP) found in common children drinks to limit acid production in the oral biofilm

OBJECTIVE: Sodium hexametaphosphate (SHMP) is a widely used industrial preservative commonly found in children's drinks. In this paper we examined the effect of SHMP incorporated into children's drinks on acid production by the oral biofilm by monitoring salivary concentrations of lactic acid. MATERIALS AND METHOD: Twelve healthy adult subjects with an average age 36 years (range 26-54 years) consumed 10 ml from four children's beverages (Coca Cola and three types of Sunny Delight supplemented with SHMP) and a standard solution of sucrose. Saliva was collected at intervals following exposure of the oral biofilm to the drinks and the clearance of carbohydrates and the appearance of lactate was measured using standard enzymatic techniques. RESULTS: All the carbohydrates derived from the drinks were cleared from saliva within 15 min of consumption. Comparison of two drinks [Sunny D Normal and Sunny C] with the same carbohydrate, but different SHMP concentrations suggested that SHMP in these beverages had no significant effect on acid production. CONCLUSIONS: In this clinical study the role of SHMP, incorporated in common beverages, did not inhibit acid production from carbohydrates.