其他

口腔正畸就诊患者乙型肝炎标志物阳性的前S1抗原检测；我国儿童口腔科医师临床诊疗工作调查分析；白血病患儿牙科治疗的临床探讨；艾滋病患者的口腔门诊护理体会；儿童口腔科进修生教学的探讨     

儿童口腔舒适化治疗的医疗安全考量

儿童作为口腔科治疗中的特殊群体,对疼痛的耐受程度受多种因素影响。口腔科治疗中若不能选择合适的行为管理和疼痛缓解方式,强制治疗会使患儿留下心理阴影,容易导致强烈的反抗和逃避行为,为后续治疗带来困难。随着社会进步及口腔医学的整体发展,儿童舒适化治疗被越来越多的医务人员和患者重视并接受。口腔门诊镇静镇痛治疗增加了患儿牙病治疗的依从性,缓解其口腔科恐惧心理,利于其心理健康发育。由于儿童舒适化治疗涉及多个学科和领域,在提供便利的同时也存在着诸多方面的风险和挑战。文章总结了儿童口腔舒适化治疗的不同镇静镇痛方式以及目前存在的争议,希望能对儿童口腔医生和麻醉医生的工作有所帮助。     

儿童口腔医学进修医师综合能力的提升方案探究

随着社会对儿童口腔健康的关注度不断提高,儿童口腔保健的需求迅速扩大,进入专业的儿童口腔科进修已成为越来越多基层医生的选择。如何优化进修医师的培养流程,在其有限的进修时间里,在最大程度上提高其关于儿童口腔诊疗的理论知识、临床技能、诊疗思维、医患沟通能力、临床科研能力及发现问题解决问题的能力,需要不断的尝试和创新。本文就进修医师临床能力及其科研能力的提高的教学模式进行总结,以有利于培训合格的儿童口腔医生,提高基层医院及诊所儿童口腔医学诊疗水平。     

儿童口腔病舒适化治疗中应用STA无痛麻醉仪的效果评价

目的探讨在儿童口腔病舒适化治疗中应用STA无痛麻醉仪的临床效果评价。方法选择我院儿童口腔科102例儿童口腔病患儿作为研究对象,在儿童口腔疾病舒适化治疗中结合使用STA无痛麻醉仪,观察临床治疗前后患儿的心理状态、舒适度变化及其治疗后患儿NRS疼痛评分,进行综合评价。结果患儿经治疗后焦虑程度(21.88±1.32)、抑郁程度(20.05±2.80)评分明显比治疗前更轻,前后比较差异具有统计学意义(P<0.05)。患儿治疗后的舒适度评分包括生理维度(13.91±1.04)、心理维度(31.08±1.65)、精神维度(26.10±1.37)、社会文化和环境维度(21.79±2.17)、整体舒适度(92.88±2.60)明显比治疗前更高,前后比较差异具有统计学意义(P<0.05)。治疗后患儿NRS疼痛评分(3.88±0.56)显著低于治疗前的(7.45±1.22),前后比较差异具有统计学意义(P<0.05)。结论在儿童口腔病舒适化治疗过程中结合使用STA无痛麻醉仪,可有效改善患儿的心理状态,提高患儿的舒适度,值得在临床上推广应用。     

呼吸道疾病对儿童颌面部生长发育的影响

目的:通过对不同年龄段的儿童口腔及颔面部形态的对比研究,观察呼吸道疾病对儿童口腔及颌面部生长发育的影响,为口腔科医生在临床上关注因呼吸道堵塞而造成儿童口、颌面部的发育异常提供借鉴。方法:跟踪2岁、6岁、12岁、25岁不同年龄组的男女患者从病史回顾、治疗过程及最终结果来说明呼吸道疾病对儿童口腔及颌面部的影响。结果:通过临床观察发现呼吸道疾病中的腺样肥大是引起患者口腔及颌面部发育异常的最主要的原因,且较多患儿在早期出现呼吸异常时家长并未意识到,反而认为孩子睡觉打鼾张口呼吸是正常现象或是因为睡觉的姿势不对,孩子的反复感冒也误认为是抵抗力弱所致,更要引起重视的是一些耳鼻喉科医生或口腔科医生对此疾病所带来的严重后果还认识不足,使患儿错过了较佳治疗时机。结论:腺样体肥大可导致儿童颌面部发育异常,为使儿童健康生长,应对腺样体肥大的儿童采取早期手术或其他治疗方法。     

儿童口腔科住院医师规范化培训的几点思考

住院医师规范培训是医学生毕业后教育的重要组成部分.由于儿童在牙科治疗时配合性欠佳且儿童牙病治疗与成人存在差异,住院医师在儿科除接受儿童口腔专业知识和技能的培训外,还需掌握儿童心理学及与儿童沟通技巧,因此培养儿童口腔医师的任务更加艰巨.儿童口腔科住院医师规范化培训的主要目标即为切实提高住院医师的执业素质、医患沟通和实际诊疗能力,快速培养出具有专业素质的儿童口腔医学人才.如何在最短的时间内让住院医师学会接诊儿童患者的技巧,掌握儿科常见病的治疗方法,使在其今后的工作岗位上能够从容面对儿童患者,成为具有一定儿童口腔专业技能的口腔全科医师,是儿童口腔科规范化培训的重点.     

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。     

2003年儿童口腔科从业医师现状调查

目的:调查2003年儿童口腔科从业医师的现状,为相关数据库的建立提供依据。方法:对参加第五届全国儿童口腔医学会议的医师进行问卷调查,并分析139份有效回卷。结果:儿童口腔科医师中女性明显多于男性;平均年龄为(38.2±8.7)岁;本科及本科以上学历者占89.9%;从业时间越长、学历越高、工作单位专业水平越高者自我专业水平评估越高。结论:儿童口腔医师队伍初具规模,年龄及学历结构合理,但总人数不足,分布不均衡。     

儿童口腔医生对乳牙有瘘型根尖周炎治疗方法选择的问卷调查分析

目的    基于问卷调查分析儿童口腔医生对乳牙有瘘型根尖周炎治疗方法的选择及其原因。方法    选择2020年9—10月参加上海、西安等地及其周边地区有关儿童口腔诊疗专业培训及国内儿童口腔专业学术会议的来自全国各地的儿童口腔医生448名，通过调查问卷分析儿童口腔医生性别、工作单位、工作时间、学历等对乳牙有瘘型根尖周炎治疗方法选择的影响。结果    本次调查共发放问卷448份，回收有效问卷374份，问卷有效率为83.48%。其中，有276名（73.8%）儿童口腔医生选择根管治疗术，98名（26.2%）儿童口腔医生选择牙拔除术。不同性别儿童口腔医生对于治疗方法的选择差异无统计学意义（χ2 = 0.0001，P = 0.987）；而不同工作单位、工作时间及学历的儿童口腔医生选择治疗方法的差异均具有统计学意义（χ2值分别为14.009、10.538、11.194，均P < 0.05）。选择根管治疗术的276名儿童口腔医生中，79.71%的医生认为通过根管治疗可消除感染，延长患牙保存时间；81.16%的医生会选择多次法根管治疗；选择Vitapex糊剂的医生（53.99%）明显多于选择抗生素糊剂（25.36%）和氧化锌丁香油糊剂（20.65%）的医生；36.23%的儿童口腔医生对于乳牙有瘘型根尖周炎对继承恒牙的影响认识不足。结论    国内儿童口腔医生受到工作单位、工作时间及学历的影响，对于乳牙有瘘型根尖周炎的治疗方法的选择有所差异。部分医生对于乳牙根尖周炎对继承恒牙的影响认识不足，需要加强学习。     

浅谈口腔科儿童就诊时的心理状态

从(?)来对近200名4-7岁口腔科就诊儿童的心理(?)分析如下: (1) 不合作型:患儿对治疗惧怕,来源可能是他人的错误介绍或经过疼痛的治疗。虽牙病疼痛,表现为宁可忍受疼痛却不肯接受治疗的不合作型。 (2) 牙痛剧烈,强烈要求治疗,也能积极配合     

Children's fear and behavior in private pediatric dentistry practices

PURPOSE: This study assessed the proportion of children with dental fear, the proportion of children with negative behavior and the relationship of children's dental fear and children's negative behavior in private pediatric dentistry practices in western Washington state. METHODS: A total of 421 children seen in 21 private pediatric dentistry practices in western Washington State participated. The average age of the children was 6.8+/-2.8 years (range=0.8-12.8 years). An average of 21 children were studied per practice (range=7-25 children). Dental fear was measured using the parents' version of the Dental Subscale of the Child Fear Survey Schedule (CFS). Behavior of the child during treatment was rated using the Frankl scale. Additional data were collected regarding the child's previous experiences and parental fear. RESULTS: The children's average item score on the 15-item CFS was 2+/-0.7, corresponding to a total score of 29.6 out of 75, where 75 indicates maximum fear. The proportion of children with dental fear, defined as an average item score of > or = 2.5 (corresponding to a total score of > or = 38), was 20% (85/421, 95% CI=16.3, 24%). The proportion of children who displayed negative behavior during treatment was 21% (95% CI=17.5, 24%). A prevalence ratio of 2.4 was calculated to describe the relationship between children's behavior during treatment and children's dental fear prior to dental treatment. Multivariate logistical regression analysis showed children with dental fear, younger children, and children exposed to treatment involving local anesthesia have higher odds of displaying negative behavior. CONCLUSIONS: The proportion of children with dental fear in private pediatric dentistry practices was 20%, and the proportion of children with negative behavior during treatment was 21%. Children with negative behavior had greater odds of having dental fear and children with dental fear had greater odds of having negative behavior. Screening for dental fear may allow pediatric dentists to prepare children more adequately for positive treatment experiences.     

Dental anxiety among young Israeli male adults as related to treatment received during childhood

OBJECTIVES: To evaluate dental fear and anxiety among young male adults treated during childhood either by a certified pediatric dentist or a general dental practitioner. METHODS: A structured questionnaire that included information regarding issues related to dental fear and anxiety (Intake Interview Questionnaire and the Dental Anxiety Scale) was completed by 497 young male army recruits (18 years old). RESULTS: During childhood, 59 (11.9%) of the participants were treated on a regular basis by a certified pediatric dentist and 344 (69.2%) by a general dental practitioner. Sporadic care (not regular care) by general dental practitioners was given to 94 participants (18.9%). Average level of dental anxiety among participants treated by certified pediatric dentists was 7.9 compared to 8.2 (general dentists) and 8.7 (sporadic care by general dentists). There were no significant differences between the groups. However, significant differences were found in the prevalence of high dental anxiety between participants treated by a regular dentist in childhood and those treated sporadically (15.4% vs. 23.4%, respectively). Negative emotions were common. Environmental etiologic factors were infrequently reported. CONCLUSIONS: The general level of dental anxiety among young Israeli males was normal. No relation was found between level of dental anxiety and the professional education of the treating dentist in childhood. Regular dental care in childhood has more effect on preventing the development of high dental anxiety than the professional education of the early caregiver.     

A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients

Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.     

Behavior of dentists and child patients during treatment

This study is part of a larger research project which aims to analyze children's dental fear by making a detailed analysis of the behavioral interactions between dentists and anxious child patients. The behavior of 12 high- and 12 low-anxious children was recorded on videotape during two dental visits in which the children were treated by either experienced or inexperienced dentists. Results indicated a relation between the dentist's experience in treating anxious children and the behavior of child patients. In general, children treated by experienced dentists showed more fear-related behaviors. Furthermore, the behavior of the dentist was related to both his experience and the fear level of the child patient. Experienced dentists showed more communicative behaviors than the inexperienced dentists, but all dentists communicated more with high- than with low-anxious children. Experienced dentists worked faster than inexperienced dentists, but treatment of the high-anxious children was not more time-consuming than treatment of the low-anxious children.     

Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old

PURPOSE: This study aimed to determine the percentage of general and pediatric dentists in Connecticut that were aware of, and practice, the current AAPD guidelines for the age one dental visit and to determine the services they provide to 0-2-yr-old patients. METHODS: A survey was mailed to Connecticut general and pediatric dentists seeking information on practice type, years in practice, training, ages of children seen, procedures performed and opinions regarding the age one dental visit. RESULTS: The response rate was 42% for general dentists and 84% for pediatric dentists, giving a sample of 113 and 60 dentists, respectively. All responding pediatric dentists reported seeing 0-2-yr-olds as compared to 42% of general dentists. Although not statistically significant, general dentists who were female or in practice less than 10 years were more likely to see 0-2-yr-olds. The majority of pediatric dentists reported performing all procedures surveyed, however, only just over half of general dentists provided topical fluoride or restorative care. Among pediatric dentists, 98% were aware of the AAPD guidelines and 92% agreed with them compared to 41% and 45% of general dentists respectively. CONCLUSIONS: Nearly all Connecticut pediatric dentists are caring for 0-2-yr-olds compared to 42% of Connecticut general dentists.     

Geographic distribution of pediatric dentists in private practice in the United States

PURPOSE: The objectives of this study were to: (1) determine the geographic distribution of pediatric dentists in private practice across the United States; and (2) compare state-based pediatric dental practitioner-to-children ratios. METHODS: Enumeration of pediatric dental practitioners was derived from the American Academy of Pediatric Dentistry's 2000-01 Membership Directory by including all active and fellow members who were in private practice in the United States. Population information for the 50 states and District of Columbia was obtained from Census 2000 data available on the US Census Bureau's Web site. RESULTS: A total of 2,913 pediatric dentists were in private practice in the United States, with the largest number located in California (333), Texas (238), and New York (202), and the smallest number located in Maine (3) and North Dakota (4). There were 4.03 pediatric dental practitioners for every 100,000 US children younger than 18 years of age. Connecticut and Massachusetts had almost twice (7.7) as many pediatric dental practitioners per 100,000 children as the national average. On the other hand, Maine had only one fourth (1) the number of pediatric dental practitioners per 100,000 children as the national average. CONCLUSIONS: Marked differences exist between the various states in their pediatric dental practitioner-to-children ratio.     

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle-sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12- and 15-year-old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12-year-olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six- and 12-year-olds who had experienced caries were more likely to report dental fear than were caries-free children. Among 6-year-olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.     

A short-term follow-up of treatment outcome in groups of uncooperative child dental patients.

AIM: To evaluate the short-term follow-up outcome in four subgroups of uncooperative child dental patients referred to a specialist paediatric dental clinic in Sweden. METHODS: Seventy children, classified into four groups (based on fear, temperament, behaviour and verbal intelligence), were followed-up at their public dental clinics after termination of specialist dental treatment. Questionnaire assessments of children's dental and general fear, parental dental fear, emotional stress, locus of control and parenting efficacy were made by parents pre and post treatment and at follow-up and were analysed within and between groups. At follow-up, parents rated their children's coping and procedure stress, while treatment acceptance was rated by the dentists. RESULTS: Decreases in child dental fear were maintained at follow-up, although a third of children still had moderate or high dental fear. For those children who had been classified into the externalising, impulsive group, an increased risk of non-acceptance (RR=3.7) was indicated. The risk of dental fear at follow-up was increased for the group of fearful, inhibited children (RR=3.8). For the study group as a whole a poorer follow-up outcome could be predicted by avoidance behaviour (OR 12.9-16.6) and moderate or high post treatment dental fear (OR 6.5- 21.3). CONCLUSIONS: Fearful, inhibited child dental patients may need, due to dental fear, extra attention even after successful dental treatment at a specialist clinic. Externalising, impulsive children constitute a special challenge for dentistry. The continued need for adjusted management after termination of specialist treatment can be predicted from avoidance behaviour and post treatment dental fear scores.     

儿童口腔科医师实施行为管理相关问题调查分析

目的 对儿童口腔科医师在门诊工作中与行为管理有关的工作内容及医生的工作压力进行调查，并就相关因素进行分析。方法 对参加第五届全国儿童口腔医学会议的139名医生进行问卷调查，并对有关因素进行分析。结果 在大学附属医院工作的医生更倾向于进行母子分离、过去一个月内44．6％的医生接诊过有行为问题的儿童。获得了具体各种行为管理方法应用情况的资料。另外51．5％的医生感觉门诊工作有比较大的压力。结论 目前儿童口腔医生在镇静全麻等特定方法的应用上还有待加强，工作压力所可能导致的对健康的影响不容忽视。     

Indiana infant-toddler dental care survey.

The purpose of this project was to survey Indiana dentists concerning dental care for Indiana infants and toddlers. Dental care issues covered were the age for a child's first dental visit, frequency of rampant or nursing caries cases examined, and dental referral sources for infants and toddlers. The survey also helped determine the dentist's perception of parents' attitudes toward services recommended by the dentist. A twelve question survey was mailed to 2006 general and pediatric dentists in the State of Indiana. The results of the survey were: 1. A large percentage of Indiana dental practitioners do not recommend the first dental visit or examine children for their dental visit until the child is more than one year of age. 2. A majority of Indiana dental practitioners see children with nursing caries or rampant caries on a monthly basis. 3. The majority of Indiana dental practitioners refer children with nursing caries to pediatric dentists for treatment. 4. Although the full treatment plan may undergo some modification based on various parental concerns, a majority of practitioners do not experience difficulty in obtaining treatment plan acceptance for nursing or rampant caries cases.