Traumatic ulcers and pain in adults during orthodontic treatment

In the present investigation the frequency of oral ulcers and pain in 79 adults orthodontic patients was recorded. Only four of all patients had never had oral ulceration during treatment, but 83% of the patients characterized the trouble as minor. About 47% of the patients said that ulcers caused by the fixed appliance were the most annoying part of the treatment, and 38% said that activation of the appliance caused the most discomfort. In about 63% of the patients there was less pain when the treatment had lasted for some months, and in 24% there was no significant change in the discomfort. The pain following activation lasted for only 2-3 days (71%), but 20% had pain for more than 3 days, and five individuals felt pain constantly. The recurrence of aphthous ulceration (RAU) was not significantly affected during the orthodontic treatment, and in only one case was there an increase in the occurrence of herpes labialis.     

正畸治疗疼痛的研究进展

疼痛是正畸治疗中最常见的问题之一,随着患者对治疗舒适度要求的增加,如何认识正畸治疗中的疼痛特点,如何减轻正畸治疗的疼痛程度,成为正畸医师关注的研究热点.本文就正畸治疗时疼痛的特点和减轻疼痛方法的研究进展作一综述.     

儿童固定正畸治疗与疼痛的相关分析

目的：分析固定正畸治疗后患儿的疼痛情况,以期指导正畸的I临床工作和术后护理。方法：随机选取335例进行固定矫治器治疗的儿童患者,采用视觉模拟评分法（VAS）在治疗后2h、6h、夜间、24h、2d、3d及7d分别测量其术后疼痛情况,进行评分及统计分析。结果：正畸治疗2h后疼痛开始加重,其后24h内疼痛程度于夜间达到最高水平,第2d开始疼痛减轻,第7d基本恢复正常状态。咀嚼与否及前后牙的疼痛情况基本相似。结论：VAS法可有效分析儿童接受正畸治疗后的疼痛情况,为医生临床工作和治疗后护理提供有益的指导。     

正畸疼痛的研究进展

疼痛是组织损伤或潜在组织损伤所引起的不愉快感觉和情感体验。正畸疼痛会对患者的依从性造成负面影响,也使得许多患者抵制正畸治疗。该文总结了现有的研究中关于正畸疼痛的研究进展,并针对在临床工作中医生和患者可能会产生的疑问寻找可靠的答案。     

耳穴压豆法减轻正畸治疗疼痛的临床效果观察

目的:观察耳穴压豆法减轻正畸治疗牙周疼痛的临床效果.方法:选择初次正畸治疗患者40人,初次戴入矫治弓丝后随机分为实验组和对照组,每组20人.实验组上弓丝后即加用耳穴磁疗法;对照组复诊时用耳穴磁疗法,观察记录患者牙周疼痛的发生率、疼痛的持续时间,并对其进行统计学分析.结果:应用耳穴压豆法的正畸患者疼痛发生率明显降低,持续时间也明显减少(P＜0.05).结论:耳穴压豆法能有效减轻正畸治疗时的牙周疼痛.     

A longitudinal evaluation of pulpal pain during orthodontic tooth movement

Objectives – To examine the longitudinal changes in pulpal sensitivity to electrical stimulation and the relationship to pulpal sensitivity as measured by electrical stimulation and subjective reports of tooth pain after archwire insertion. Design – Non‐randomized, prospective trial, with matched controls. Setting and Sample Population – Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Eighteen adult subjects of age 13–37 years. Nine experimental subjects planned for orthodontic treatment. Nine control subjects matched for gender and age who did not have orthodontic treatment. Experimental Variable – Fixed orthodontic appliances and initial archwire placement in experimental subjects compared with `no treatment' control subjects. Outcome Measure – Subjective assessments of orthodontic tooth pain were made using visual analogue scales. Electrically evoked detection and pain thresholds were determined using a computer‐controlled tooth stimulator. Data were gathered at five time points: after bracket placement (baseline), 1 h after placement of initial archwires, 1 day after archwire placement, 1 week after archwire placement, and 1 month after archwire placement. Comparable time intervals were used for the `no treatment' control subjects. Results – Subjective ratings of treatment‐evoked tooth pain in the experimental group were the greatest at the post‐archwire day 1 observation and progressively decreased for the remaining observations. Control subjects reported little pain at any of these observation times. The detection and pain threshold changes from baseline showed no statistical differences over time or between groups. While not statistically significant, a trend was noted where reports of greater orthodontic tooth pain were associated with increased sensitivity to electrical stimulation (i.e. lower detection and pain thresholds). Conclusion – Orthodontic patients experience significant pain and discomfort 1 day after initial archwire placement (i.e. activation). Future research should investigate whether self‐reports of treatment‐evoked tooth pain intensity are associated with pulpal sensitivity.     

A combined surgical and orthodontic treatment of class III furcations

Abstract Oral hygiene in furcation defects of upper molars is difficult to achieve. In this case report, a combined surgical and orthodontic treatment procedure is presented to facilitate access and plaque control in furcation areas of upper molars with class-III furcation defects. After endodontic treatment and root resection in an upper 1st molar, the remaining mesiobuccal and palatal roots were separated and aligned orthodontically within the dental arch, as one-rooted teeth. The new morphological position of the roots greatly facilitated oral hygiene and may offer a better long-term prognosis.     

The relationship between normative orthodontic treatment need and oral health-related quality of life

OBJECTIVES: The first objective was to assess whether having had orthodontic treatment affected the levels of oral health-related quality of life impacts in Brazilian adolescents. A second objective was to assess the relationship between a normative clinical measure of orthodontic treatment need and two measures of oral health-related quality of life. METHODS: A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents' perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.     

��������������ؽ����Ҳ����ռ�����β���

颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。     

Effect of somatosensory amplification and trait anxiety on experimentally induced orthodontic pain

The perception of pain varies considerably across individuals and is affected by psychological traits. This study aimed to investigate the combined effects of somatosensory amplification and trait anxiety on orthodontic pain. Five‐hundred and five adults completed the State Trait Anxiety Inventory (STAI) and the Somatosensory Amplification Scale (SSAS). Individuals with combined STAI and SSAS scores below the 20th percentile (LASA group: five men and 12 women; mean age ± SD = 22.4 ± 1.3 yr) or above the 80th percentile (HASA group: 13 men and seven women; mean age ± SD = 23.7 ± 1.0 yr) were selected and filled in the Oral Behaviors Checklist (OBC). Orthodontic separators were placed for 5 d in order to induce experimental pain. Visual analog scales (VAS) were administered to collect ratings for occlusal discomfort, pain, and perceived stress. Pressure pain thresholds (PPT) were measured. A mixed regression model was used to evaluate pain and discomfort ratings over the 5‐d duration of the study. At baseline, the LASA group had statistically significantly higher PPT values for the masseter muscle than did the HASA group. During the experimental procedure, the HASA group had statistically significantly higher discomfort and pain. A significant difference in pain ratings during the 5 d of the study was found for subjects in the HASA group. Higher OBC values were statistically significantly positively associated with pain. Somatosensory amplification and trait anxiety substantially affect experimentally induced orthodontic pain.     

音乐缓解正畸治疗性疼痛的临床研究

目的 探讨音乐对正畸治疗性疼痛的缓解作用。方法 根据随机对照原则将初戴固定矫治器的165例患者分为音乐组和空白组,音乐组采用音乐干预正畸性治疗疼痛,空白组不采用任何干预疼痛的措施。应用视觉模拟评分法（VAS）评估受试者的正畸治疗性疼痛强度,并分析受试者的年龄、性别、情绪及人格对音乐缓解正畸疼痛效果的影响。结果 有效调查率为85.45％。音乐组的正畸治疗性疼痛低于空白组（P<0.05）。音乐组和空白组中情绪不稳定患者较情绪稳定患者疼痛明显,内向型人格患者较外向型人格患者疼痛明显（P<0.05）。音乐组中女性患者较男性患者疼痛明显（P<0.05）。结论 音乐对正畸治疗性疼痛的缓解有较好的效果。音乐缓解正畸治疗性疼痛男性优于女性,外向型人格优于内向型人格,情绪稳定者优于不稳定者。     

正畸治疗中牙根吸收的影响因素

牙根吸收是正畸治疗中的常见并发症，其直接影响治疗效果及牙齿的健康。正畸治疗诱导的牙根吸收是无法完全避免的，它的影响因素也非常复杂。控制牙根吸收，首先要了解其病因，本文将对牙根吸收的影响因素作一综述。     

Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment

Abstract  – The dental records made on presentation of 1367 consecutive patients (731 females and 636 males) for orthodontic treatment at a private orthodontic practice between 1998 and 2002 were examined for data relating to trauma to the permanent incisors. The results showed that 10.3% of these patients had suffered from dental trauma before the onset of orthodontic treatment. The highest prevalence of dental trauma was determined in the 11–15 years age group, corresponding to the dental developmental stage of the late mixed dentition. The most frequently affected teeth were the maxillary central incisors (79.6%), and the most common types of trauma were fracture of enamel–dentin without pulpal involvement (42.7%) and fracture of enamel (33.8%). Compared to patients with normal overjet and adequate lip coverage, the frequency of dental trauma was significantly higher in patients with increased overjet and adequate lip coverage ( P  = 0.028) or with increased overjet and inadequate lip coverage ( P  = 0.003). The results of the present study indicate that a significant percentage of candidates for orthodontic treatment, and especially those with increased overjet and inadequate lip coverage, suffer trauma to their permanent incisors before the onset of orthodontic treatment. It might also be concluded that preventive orthodontic treatment of such patients should be initiated and completed before the age of 11, i.e. in the early to middle mixed dentition.     

青少年正畸患者在治疗中合作行为的研究

目的了解青少年正畸患者在治疗过程中的心理及行为表现,为建立合作评定量表形成理论建构(即量表组成的框架或结构).方法在全国范围内选取184名正规专科正畸医师为对象进行问卷调查及临床晤谈,收集正畸患者在治疗中与合作情况有关的表现,最后对不合作的典型行为排序,将不同地域的三组(北京、上海、其它)各20例的排序结果进行地区差异比较.结果青少年患者合作行为表现不但体现在如何对待矫治装置、口腔卫生、时间观念等,还包括心理状态、个性特征及家庭和社会环境等多方面,归结为自律性、主动性、自觉性以及人际关系等,同时又具有青少年时期的特殊性.不同地域的不合作行为基本相似.结论1、合作行为量表的理论建构应为四方面内容自律性、主动性、自觉性和人际关系等.2、在此基础上建立的青少年正畸患者合作行为量表在全国范围应用是实际可行的.     

正畸治疗能否达到儿童患者期望值的调查

目的：调查儿童患者正畸治疗后与口腔健康相关的生活质量的变化,并观察这种变化能否满足病人的希望。方法：随机挑选正畸临床212例儿童患者,分别在正畸治疗前后填写汉语化的儿童感知问卷（Child Perception Questionnaire,CPQ1）,并在治疗前填写一份关于治疗结果期望的问卷。结果：男孩与女孩在治疗前的CPQ分数和期望得到的效果没有统计学差异,治疗结束后病人的CPQ分数比治疗前显著降低,与病人期望的CPQ分数没有显著差异。结论：正畸治疗后与口腔健康相关的生活质量可显著提高,能满足病人的需要。     

正畸疼痛的影响因素及临床表现

目的探讨正畸治疗中患者疼痛的影响因素、临床表现;为预防和治疗提供方法依据。方法对59例接受正畸治疗的患者进行综合问卷随访调查,将患者按年龄(青少年组和成人组)和性别分组,影响因素为社会主观因素(心理焦虑恐惧、文化程度、职业)和自然客观因素(畸形程度);临床表现由无疼痛、疼痛开始的部位、强度、时间、持续时间、结束时间表示。χ2检验和方差统计分析比较各年龄组和男女性别组的不同影响因素和临床表现的差异。结果青少年组正畸重度疼痛与心理焦虑恐惧、文化程度、职业各项均无关(P>0.05),而与畸形程度相关(P<0.05);畸形越明显疼痛越严重。成人则相反,其疼痛与社会因素均相关(P<0.05),而与本身的畸形程度无相关(P>0.05);在青少年组和成人组中,男女各项因素比较均无显著相关(P>0.05)。结论正畸治疗患者疼痛在青少年与患者病变本身的严重程度有关,与社会因素无关;而成人则主要与社会主观因素有关与病变本身相关不明显。年龄是而性别不是正畸疼痛的影响因素。     

Modified IOTN: an orthodontic treatment need index for use in oral health surveys

This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.     

Normative and self-perceived orthodontic treatment need in Nigerian school children

Abstract

Objective. The aim of this study was to assess the normative and self-perceived need for orthodontic treatment in Nigerian children, and to evaluate distribution of orthodontic treatment need according to gender and age. Materials and methods. The sample consisted of 441 randomly selected school children, aged 11–18 years in Benin City, Nigeria. The subjects were further sub-grouped according to gender (229 males and 212 females) and age (246 11–13 years old and 195 14–18 years old). The Dental health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) were used to assess orthodontic treatment need normatively. Self-perceived need was evaluated by asking the subjects to rate their dental aesthetics on the Aesthetic Component scale of IOTN. Chi-square tests were used to evaluate gender and age differences in distribution of treatment need. Results. A definite need for orthodontic treatment was found among 21.5% (grades 4–5 of DHC) and 6.3% (grades 8–10 of AC) of the subjects; 3.9% of the subjects perceived a definite need for orthodontic treatment (grades 8–10 of AC). There were no statistically significant gender and age differences in distribution of orthodontic treatment need among the subjects (p > 0.05). Conclusion. The study revealed a need for orthodontic treatment in slightly more than one fifth (21.5%) of this sample of Nigerian children. The sample population has a lower need on aesthetic grounds and their normative and self-perceived orthodontic treatment needs were not influenced by gender and age.     

Clinical significance of Actinobacillus actinomycetemcomitans in young individuals during orthodontic treatment

Abstract The aim of the present study was: (I) to assess longitudinally the occurrence of Actinobacillus actinomycetemcomitans (Aa) in young subjects wearing fixed orthodontic appliances compared to matched appliance-free controls: (2) to determine whether the presence of the micro-organism at baseline could influence the periodontal status assessed 3 years later. 70 subjects. 27 male and 43 female. aged between 12 and 20 years participated in the study: 35 subjects under orthodontic treatment with fixed appliances for at least 6 months, and 35 appliance-free individuals matched for age and gender. All subjects were free of clinically demonstrable loss of attachment. They all received oral hygiene instructions 2× during the 2 months preceding the first clinical and microbiological examination. No subgingival instrumentation was performed between baseline and the 3-year examination. Clinical parameters included gingival bleeding index (GBI). pocket probing depth (PPD) and measurements of attachment level (AL). Statistically significant differences were reported regarding frequency of detection of Aa between both groups at each examination. The %s of orthodontic subjects infected with Aa at the baseline and at the 3-year examination were 86% and 80%, respectively, while the corresponding figures for control subjects were 16.6% and 26.6%. The frequency distribution of %s of Aa in the total anaerobic subgingival flora among control subjects remained fairly stable, whereas the proportion of orthodontic subjects yielding Aa at a concentration 1.0% dropped significantly from 32% at baseline to 19% at the 3-year visit. Calculations of the relative risk for increasing GBI and PPD in both groups when Aa was present at baseline, revealed that the orthodontic subjects positive for Aa had a negligible relative risk of experiencing worse periodontal conditions compared to orthodontic patients where Aa was not detected at baseline. In contrast, control subjects initially infected with Aa presented with a risk for increased GBI 6.6×higher than that for subjects without Aa. In conclusion, the present study confirmed previous cross-sectional findings reporting that young individuals with an integer periodontium wearing fixed orthodontic appliances harbor Aa with a statistically significant greater frequency than appliance-free matched controls. However, although orthodontic patients exhibited more inflammation, their deteriorated clinical conditions could not be accounted for by the sole presence of Aa in their sulci. In contrast, appliance-free young subjects initially infected with Aa had a higher risk of experiencing more gingival inflammation than subjects without the bacterium during a 3-year observation period.     

�����в۽��μ������Ч����

结合作者的临床经验、临床科研及相关文献,从矫治器的使用、矫治技术的实施等方面阐述如何在自锁托槽矫治器的使用过程中实现高效矫治。同时对自锁托槽矫治器的使用效果、矫治代价及主动自锁与被动自锁的特点等问题进行讨论。