老年心血管病患者心电监护下拔牙306例临床分析

目的；对老年心血管病患者心电监护下拔牙问题进行分析研究。方法：对306例老年心血管病患者采取一系列安全措施：筛选病例，服用心血管病专科药，心理诱导，心电监护，麻醉，拔牙，详细记录术前、术中心率、血压变化。结果：拔牙顺利完成患者283例，占92．48％。因各种原因暂停手术拔牙患者23例，占7．52％。结论：老年心血管病患者拔牙具有一定危险性，但严格掌握其适应证禁忌证，安装心电监护，术前、术中采取必要的安全措施，其拔牙可以顺利完成。     

老年人一次多个牙拔除的体会

目的：通过对60岁以上老年人进行局麻下一次多个牙拔除的临床观察，研究老年病人安全、有效的一次多个牙拔除方法。方法：将心理治疗手段用于拔牙全过程，结合无痛麻醉、快速拔牙技术，进行老年人患牙的一次性拔除。结果：59例病人进行无监测局麻下拔牙，除个别病人出现短暂的头晕、心慌外，所有病人均顺利完成拔牙手术。结论：当老年人无全身性疾病或处于心血管疾病的相对稳定期时，都可以经受一次多个牙的拔除。     

咪达唑仑在老年高血压患者拔牙术中的应用观察

目的：评价低流量咪达唑仑静脉泵入技术，对于老年高血压患者拔牙过程中血压升高的控制。方法：单盲、随机、对照临床实验。对照组和试验组各50例，分别给予心理疗法和咪达唑仑泵入控制血压，比较基础值、就诊后、拔牙前、拔牙中和拔牙后的血压变化。血压的数值变化采用均值t检验，拔牙过程中血压的波动比较，采用变异系数（CV）。结果：就诊后，2组患者血压都比基础值有明显升高，主要是收缩压的升高。采取心理疗法后血压降低不明显，整个拔牙过程维持在较高水平。采用咪达唑仑泵入技术后，血压对比基础值和对照组都有明显降低，但波动幅度较对照组大。结论：低流量咪达唑仑静脉泵入可以有效控制老年高血压病人拔牙时的血压升高。     

高校社区多民族老年患者拔牙特点分析

目的:探讨高校社区多民族老年患者拔牙特点。方法:对拔牙患者实施心理辅导和卫生宣教,局麻术、拔牙术和术后护理医嘱相结合的方法。结果:232例患者拔牙的主要原因是龋病和牙周病;女性因龋病拔牙的概率高于男性,而男性因牙周病拔牙的概率高于女性,男女在拔牙原因构成比比较,经χ2检验有显著性差异(P<0.05);232例患者全部顺利完成拔牙术。结论:高校社区多民族老年拔牙患者需更多的心理辅导和卫生宣教,完善的局麻和熟练拔牙技术是多民族老年患者安全拔牙的保证。     

抗凝血与抗血小板治疗老年患者拔牙的临床研究

目的：观察抗凝血治疗和抗血小板治疗的老年患者拔牙术后出血及拔牙创的愈合,评价拔牙术后明胶海绵加缝合创口的止血效果。方法：老年患者分为抗凝血治疗需要拔牙组、抗血小板治疗需要拔牙组和随机选择需要拔牙的老年患者作正常对照。抗凝血治疗组拔牙前均进行凝血酶原时间国际标准化率检测。三组均采用局部纱布压迫止衄,比较拔牙术后出血情况,拔牙术后出血的病人采用局部明胶海绵加缝合创口处理。结果：抗凝血治疗与其他2组出血有显著性差异,3组均未出现局部不可控制的出血;3组创口愈合没有明显差别。结论：接受抗凝血治疗和抗血小板治疗的老年病人,在不停药和不减少药物剂量的情况下可以行拔牙术,明胶海绵加上局部缝合可达到止血目的。     

影响老龄患者拔牙安全性的多因素分析

目的：研究多种因素对老年患者拔牙安全性的影响。方法：对我科门诊60—85岁老年患者2580例的拔牙资料，包括拔牙原因、数量、全身疾病状况、心理因素等进行分析。结果：老年患者的拔牙心理、合并心血管病患者RPP值、糖尿病患者血糖值、医生的操作等，是影响老年患者拔牙安全的主要因素。结论：老年患者在消除焦虑、心脑血管病、糖尿病相对稳定，熟练的医生操作，均可安全完成拔牙手术。     

炎症期拔牙后即刻种植：禁忌症或适应症？

目的：探讨炎症期拔牙后即刻种植的可能性及手术技巧，为即刻种植手术适应症的科学界定提供参考依据。方法：12例患者各一枚前牙或前磨牙拔除后即刻种植。拔牙原因为慢性牙周炎、慢性根尖周炎及根管内吸收伴感染等。术后随访l—2年，观察种植体周围炎、GI、种植体稳定性及X线变化等临床指标，评价临床疗效。结果：除1例种植体周骨壁侧穿失败外，其余11枚种植体均获临床成功。结论：由于121腔内血运丰富，抗感染能力强，加之拔牙后激活的炎性反应，故除急性期外，炎症期拔牙并非即刻种植绝对手术禁忌症。非翻瓣式一期法术式及微创手术操作，有利于避免术后感染。     

心理诱导对成人拔牙患者收缩压乘心率值的影响

目的 了解心理治疗对减少拔牙患者术后心血管方面变化的作用。方法 将98例普通拔牙病人分2组,对实验组病人拔牙前进行心理诱导,并将该组病人术前、术后的心率、血压及收缩压乘心率值(rate-pressure product,RPP)与对照组比较。结果 实验组拔牙病人术后RPP值和对照组术后HPP值差异有显著性(P<0.05)。结论 对拔牙病人术前术中进行心理诱导,可以减少其术后心血管方面的反应。     

拔牙患者牙科焦虑心理研究

目的：研究拔牙患者牙科焦虑心理产生的原因。方法：术前对100例拔牙患者完成问卷，用改良的牙科焦虑量表(corah dental anxiety scale，DAS)和类视力量表(visual anxiety scale，VAS)划界分为高牙科焦虑组和低牙科焦虑组。结果：病人对疼痛的期待存在较大的偏差，高焦虑组更明显。结论：疼痛是病人最恐惧的因素，消除疑虑和减轻疼痛是拔牙术中首要解决的问题。     

拔牙病人的心理护理

拔牙病人有各种心理反映,有的难以用语言表达。为使病人早日康复,除手术者在操作时动作轻柔、准确、迅速外,还必须对病人进行有针对性的心理护理。病人的一般心理状态一、恐惧心理:①怕疼、怕打针:几乎所有儿童都有这种心理,即使成年人,也有些望针生畏,触针发抖的,想既不打麻药针,又无疼感。②怕血:有的病人看到自己身体的某一部位出血,就吓得不知所措。③怕术后并发症:如出血、感染等。④孕妇怕流产。二、怀疑心理:怀疑医生技术不高,总想托人找年纪大技术高的医生为自己拔牙。三、矛盾心理:既想及早拔牙解除痛苦,又害怕拔牙,就诊前顾虑重重。当愿望即将实现时,又感到很为难,恐惧心理一时又难以控制。这种既张     

150例低危老年高血压患者拔牙安全性的临床分析

目的:通过监测低危高血压患者拔牙过程中各时间点的血压波动,分析高血压患者拔牙的安全性。方法:选择患有单纯性高血压(符合《中国高血压病防治指南》规定的低危标准),且需实施简单拔牙术的150例患者。其中100例手工测量术前10 min、麻醉后即刻、拔牙后即刻、拔牙后30 min共4个时间点的血压和心率,另50例在心电监护仪的监测下拔牙。分析高血压患者拔牙过程中的血压波动情况。结果:在严密监控下,150例研究对象中,有3例在麻醉后出现收缩压高于180 mmHg或舒张压高于100 mmHg,终止拔牙术,转内科治疗至血压稳定后择期拔除。其余病例术中、术后血压和心率波动均在正常范围,未发生心血管意外或创口出血、感染等并发症。结论:通过规范选择适应证,完善的术前检查,术中轻柔操作,并注意密切监测血压、心率变化,社区医院对大部分低危的高血压患者拔牙是安全的。     

Reasons for dental extractions in children

PURPOSE: The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years. RESULTS: First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types. CONCLUSIONS: This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.     

硝酸甘油控制老年患者拔牙术中血压升高的疗效评价

目的对老年患者拔牙术中出现血压明显增高时舌下含服硝酸甘油控制血压的疗效进行评价。方法选择90例拔牙术中血压明显增高的老年患者，分为观察组和对照组，观察组60例含服硝酸甘油，对照组30例含服开搏通，分别比较2组在3分钟、6分钟、9分钟时的降压有效率及心率的变化并进行统计学分析。结果观察组在3分钟、6分钟、9分钟时的降压有效率分别高于对照组，心率变化两组比较差别无统计学意义。结论拔牙术中血压明显增高时舌下含服硝酸甘油降压起效快、剂量容易调控、使用安全、方便。     

牙残片对牙种植修复的影响

目的：评价种植位点牙槽骨内的牙残片对种植修复的影响.方法：随机选择延期牙种植患者400例,对种植术中发现有牙残片的病例进行统计分析.结果：发现牙残片17例,其中磨牙最多,龋病为最常见拔牙原因.多数X线片明确存在牙残片影像,多数病例需要植骨,已完成修复的病例无失败.自然愈合或应用某些材料的拔牙创都可以正常愈合,但牙残片类似于某些对拔牙创愈合有不良影响的材料,可造成炎性反应.结论：牙残片对拔牙创愈合和种植修复过程有不良影响,但对最终修复成功率的影响尚不明确.     

Periodontal reasons for tooth extraction in an adult population in Jordan

This survey studies the reasons for periodontal extraction of permanent teeth in an adult Jordanian population. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. Of these, the 26 dentists who participated in this study were asked to record teeth extracted and give reasons for extraction. Personal and demographic information and clinical details were obtained from 898 patients aged from 20 to 60 years. A total of 1,098 teeth were extracted during the 3-month study period. The results of this study revealed that dental caries (56.4% overall) was the main reason for tooth extraction, especially in 20-39 year olds. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. Other reasons for tooth loss accounted for only 20.2% of the series. Advanced periodontal disease represented by pocketing were the dominant pathology when tooth loss occurred as the result of periodontal disease. As far as the type of tooth was concerned, the most frequently extracted teeth were molars followed by premolars, regardless of whether their loss was the result of the caries or the periodontal disease. This study suggests that caries and its consequences are responsible for more tooth loss in patients less than 40 years of age while extraction because of periodontal problems increases with age, and more commonly related to pocketing.     

Tooth loss in a sub-urban Nigerian population: causes and pattern of mortality revisited

AIM: To determine the current causes and pattern of tooth loss in Ile-Ife Nigeria. DESIGN: A retrospective review of records of dental extraction patients. SETTING: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. PARTICIPANTS: All patients that had dental extractions between January 1996 and December 2002. METHOD: Patients' case records were analysed for demographics, reason(s) for dental extraction, tooth/teeth extracted, method of extraction and complication(s). MAIN OUTCOME MEASURE: Reasons for tooth extraction and the pattern of tooth loss. RESULTS: 6348 (12.3%) of hospital attendees aged 4-102 years (mean 35 +/- 16.8 years) had extraction of 8338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. CONCLUSION: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive measures was highlighted.     

老年糖尿病患者拔牙术前血糖控制目标与预后相关性的初步分析

目的观察老年糖尿病患者在空腹血糖>8.88 mmol/L且≤10.00 mmol/L条件下行拔牙术的安全性。方法本研究为前瞻性队列研究,纳入2018年10月至2019年10月就诊于北京大学口腔医学院·口腔医院口腔颌面外科心电监护门诊的老年糖尿病拔牙患者100例,男性53例,女性47例,年龄(75.8±8.0)岁(65~95岁)。拔牙术前空腹血糖>8.88 mmol/L且≤10.00 mmol/L的50例患者为观察组;空腹血糖≤8.88 mmol/L的50例患者为对照组,两组糖化血红蛋白(glycosylated hemoglobin,HbA1c)均≤8.5%。分别观察拔牙术后24 h、1周拔牙窝处有无疼痛、肿胀、溢脓、瘘口及全身发热,观察术后1个月拔牙窝周围组织愈合情况。采用SPSS 25.0软件对拔牙术前血糖控制目标与预后的相关性进行统计学分析。结果观察组和对照组患者术前的空腹血糖分别为(6.92±0.99)和(9.88±0.68)mmol/L,HbAlc分别为(6.76±0.83)%和(7.69±0.75)%。两组患者的年龄、性别、糖尿病病史、拔牙牙位、牙龈指数、牙齿松动度等差异均无统计学意义(P>0.05)。术后24 h,对照组与观察组拔牙窝愈合良好的患者均占94%(47/50),两组均有3例患者拔牙窝局部疼痛,但可耐受,周围组织均无红肿表现。术后1周检查创口愈合良好,术后1个月创口完全愈合。两组患者拔牙术后创口愈合状况差异无统计学意义(P>0.05)。结论拔牙术前空腹血糖≤10.00 mmol/L且HbA1c≤8.5%可作为老年糖尿病患者常规拔牙或口腔小手术的安全参考值。