重度骨量不足种植牙患者牙科焦虑症分析及心理护理

目的：调查重度骨量不足种植牙患者牙科焦虑症（DA）的流行情况和焦虑程度,从而提出相应的心理护理。方法：100例重度骨量不足种植牙患者,随机分为实验组和对照组。采用改良的牙科焦虑量表（DAS）对两组患者就诊时的牙科焦虑状况进行调查;实验组采用心理护理,对照组采用常规护理;手术完成时采用视觉模拟标尺评估术中焦虑及疼痛程度。结果：100例重度骨量不足种植牙患者DAS的平均分值为13．5±2．6,属较高畏惧;两组患者DAS平均分值无差异（P〉0．05）;手术完成时试验组患者的焦虑状态指数及疼痛指数小于对照组,差异有统计学意义（P〈0．05）。结论：重度骨量不足患者在接受口腔种植手术所产生的牙科焦虑是显著的,心理护理能有效缓解焦虑状态,提高其诊疗依从性。     

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目的    探讨心理行为诱导对牙科畏惧症（dental anxiety, DA）患儿的临床疗效。方法    对2009年2月至2010年7月在济南市口腔医院门诊就诊的398例3～12 岁口腔疾患儿童,采用儿童焦虑调查表-牙科分量表（children’s fear survey schedule-dental subscale, CFSS-DS ）进行分析比较,并将筛选出的316例DA 患儿随机分为试验组和对照组。试验组在进行常规口腔治疗的同时,采用心理行为诱导;对照组仅进行常规口腔治疗。结果      试验组治疗后,DA 程度明显下降（P＜0.01）,男孩DA 程度的下降较女孩更显著（P＜0.05）。结论    心理行为诱导治疗DA患儿效果明显,有利于提高临床治疗效率与治疗质量。     

牙科焦虑症对孕妇口腔健康状况的影响

目的：探讨牙科焦虑症对孕妇口腔健康状况的影响。方法：采用改良的牙科焦虑量表（MDAS）对安徽医科大学第一附属医院产科住院生产的542名孕妇进行调查,分析牙科焦虑症对其口腔健康状况的影响。结果：542名孕妇中,牙科焦虑程度较高者（MDAS≥15分）168例,牙科焦虑程度较低者（MDAS＜15分）374例,两组间患龋率差异无统计学意义（P＞0．05）;但牙科焦虑程度较高组的龋失补牙数（DMFT）和社区牙周指数（CPI）均高于牙科焦虑程度较低组,组间差异均有统计学意义（P＜0．01）。结论：牙科焦虑症可能对孕妇的口腔健康产生有害影响。     

社区与门诊老年人牙科焦虑症及其相关因素的研究

目的:调查社区和牙科门诊老年人牙科焦虑症的发生情况及其相关的因素. 方法:使用汉化Coarh's牙科焦虑量表(Dental Anxiety Scale,DAS)评定来自社区和口腔门诊的各700名老年人的牙科焦虑症(DA)情况,通过自行设计的一般情况表,收集可能与老年人DA发生有关的变量,采用多因素Logistic回归方法分析与社区、口腔门诊老年人DA发生有关因素.结果:DA的发生率在社区老人和口腔门诊老人中分别为23.86%、34.10%.Logistic回归分析显示,社区和口腔门诊老年人牙科焦虑症的共同影响因素包括性别、自我健康评价、亲友看牙经历、生活有焦虑;影响社区老年人牙科焦虑症的因素还包括看牙医的频率和既往就诊满意度. 结论:老年人DA的发生在社区和口腔门诊中均普遍存在,但影响因素有所不同. 减少DA对老年人口腔甚至身心健康的不良影响需要多方面共同努力.     

低龄儿童龋治疗时机的选择

目的：评价严重龋损乳磨牙治疗时机选择对儿童牙科畏惧程度和就诊行为的影响。方法：实验组为临床症状明显、主动初诊3～6岁患儿144例。对照组为口腔检查中发现无自觉症状乳磨牙龋病3～6岁患儿144例。用中文改良儿童牙科焦虑面部表情量表（MCDASf）评估患儿初次治疗前、治疗后及1周复诊时的主观畏惧状况;Venham 临床焦虑与合作行为评定量表评估初次就诊时与复诊时患儿临床就诊行为。对数据进行统计学分析。结果：实验组治疗后、复诊时 MCDASf 评分较治疗前均下降（P ＜0．05）。对照组治疗后、复诊时 MCDASf 评分较治疗前无明显变化（P ＞0．05）。实验组患儿治疗前后 MCDASf评分差值大于对照组（P ＜0．05）。复诊时2组患儿 Venham 评分级别一致（P ＞0．05）。实验组患儿就诊行为改善比对照组明显（P ＜0．05）。结论：对低龄儿童严重龋损非急性期患牙即时诊治可缓解牙科畏惧症。     

综合医院牙科门诊老年患者焦虑症及影响因素研究

目的：了解牙科门诊老年患者焦虑症流行情况及影响因素,为临床防治牙科焦虑症提供科学依据.方法：2012年2月-2013年2月,利用自制牙科焦虑症相关因素调查问卷和改良牙科焦虑量表（MDAS）,对352例牙科门诊老年患者进行问卷调查.对患者焦虑水平进行评分,并对其影响因素进行多因素logistic回归分析.结果：352例患者中,焦虑症的现患率为56.3％.多因素logistic回归分析结果显示,性别（OR--0.23,95％CI=0.18 ～ 1.07; P=0.0115）、既往躯体创伤史（OR=2.87,95％CI=2.85 ～4.00; P=0.0306）和是否初次就诊（OR =6.69,95％CI=5.03～ 7.64; P＜0.0001）与焦虑症的关系有统计学意义.结论：牙科焦虑症报告率较高,有必要通过针对性的干预措施来有效降低牙科焦虑症的发生及焦虑水平,以提高牙科诊治效果.     

高校社区少数民族老年患者牙科焦虑症的特点分析

目的：探讨高校社区少数民族老年患者牙科焦虑症的特点。方法：利用改良牙科焦虑量表（MDAS）对779例老年患者进行问卷调查,根据被调查者民族、性别、学历及牙科治疗史分组进行分析。结果：少数民族与汉族的老年患者牙科焦虑症的发生率无统计学意义（P〉0.05）,不同性别及学历的少数民族老年患者牙科焦虑症的发生率不同,具有统计学意义（P〈0.05）,少数民族女性老年患者牙科焦虑症的发生率高于男性,大专以下学历的少数民族老年患者牙科焦虑症的发生率高于大专以上组,既往有无牙科治疗史对牙科焦虑症的发生率无影响（P〉0.05）。结论：高校社区少数民族老年患者需要更多的心理辅导,临床医生应重视医学与心理学方法相结合预防牙科焦虑症的发生。     

中外儿童口腔治疗焦虑行为的对比

目的：比较美国佛罗里达大学口腔医学院（university of florida college of dentistry,UFCD）儿童牙科和中国解放军总医院（301医院）（301 general hospital of PLA China）儿童牙病科就诊儿童的恐惧心理,以改进管理儿童患者就诊行为的方法。方法：选取2006—09—2007—08在UFCD就诊儿童150例,2007—11—2008—03在解放军301医院儿童牙科就诊儿童270例,采用儿童畏惧调查表一牙科分量表（children＇s fear survey schedule—dental subscale,CFSS-DS）调查儿童牙科畏惧情况,所得数据进行统计学分析。结果：CFSS平均得分≥2．5者,UFCD为19．7％,301医院为27．2％;两地区6岁前儿童DF值均明显高于6岁后儿童（P〈0．05）;301医院女性DF值明显低于男性（P〈0．05）,UFCD则无显著差异;与治疗无关的恐惧,UFCD为32％,301医院为39％;两地区家长对治疗恐惧经历均明显影响患儿牙科畏惧症（DF）的发生（P〈0．05）。结论：父母不良的牙科经历是患儿DF发生的主要因素。年龄,性别也一定程度上影响儿童DF发生。     

深圳市成人牙科畏惧症患者的口腔健康相关生活质量研究

目的：研究牙科畏惧症（DF）患者的口腔健康相关生活质量。方法：选择在深圳市第五人民医院口腔科门诊就诊的358名18～75岁初诊患者,应用口腔焦虑量表（CDAS）和口腔健康影响程度量表（OHIP-14中文版）、人口统计学一般项目表进行调查。结果：DF患者的OHIP-14的分值中位数为21.25,明显高于一般就诊患者（中位数11.20）。且在生理性疼痛、心理不适和心理障碍等领域影响最大。CDAS与OHIP-14分值间的相关系数为0.255。结论：在牙科畏惧症患者中,牙科畏惧程度与口腔健康影响程度之间存在相关性,焦虑程度越高的患者口腔健康相关生活质量越差。对牙科畏惧症患者进行有效的心理干预可以提高其相关生活质量。     

儿童牙科畏惧症的预防治疗及其研究进展

牙科畏惧症（Dental Fear，DF），又名牙科恐惧症（Dental Phobia）、口腔焦虑症（Dental Anxiety，DA），是患者对口腔科治疗怀有紧张不安、焦虑害怕甚至恐惧心理，出现尖叫、抗拒或逃避行为的综合症状群。各国的流行病学调查中发生率在5％到80％都有报告，儿童的发生率更高。其发生与以下因素有关：儿童期不良牙科经历、周围人群特别是母亲对牙科治疗的态度、年龄、性别、受教育程度、儿童期受性虐待史等。症状包括：①行为表现，如焦虑不安、恐惧表情、反抗或拒诊行为；②生理反应，如面色苍白、肌肉紧张、出汗、呼吸急促、心率加快、血压上升、胃肠不适甚至呼吸困难。随着新的医学模式观念的普及，儿童DF的防治需要越来越迫切。现就其预防与治疗方法及研究进展综述如下。     

Understanding the adolescent patient: the gateway to oral health promotion

Although the adolescent years may be difficult emotionally and contributory to a variety of risk-taking behaviors, this period of progressive transformation of the child into an adult also offers a unique gateway for dental practitioners to promote the development of positive health behaviors as the foundational basis for the future oral and general health and well-being of our current adolescent dental patients.     

Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions?

Polk DE, Weyant RJ, Manz MC. Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions? Community Dent Oral Epidemiol 2010; 38: 1–9. © 2009 John Wiley & Sons A/S Abstract – Objectives: To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. Methods: A cross‐sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). Results: Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. Conclusions: There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES‐associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES‐associated disparities occur.     

Behaviors of children with and without attention deficit hyperactivity disorder during a dental recall visit

Many children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), but the impact of this on behavior at a dental visit has not been examined. This study compared the behaviors of children with and without ADHD during a dental recall visit. Forty-two children with and forty-two without ADHD (fifty-six boys and twenty-eight girls, ages 6.0 through 10.6 years of age) were selected from a chart review at a hospital dental clinic. Every child was observed in the dental chair before and during the dental visit. Tell-show-do was utilized with every patient. Each child was evaluated for compliance or resistance and was rated using the Frankl behavior rating scale. Behavior ratings of children with and without ADHD were not statistically different. This could indicate that children with and without ADHD behave similarly in the dental setting. Use of Tell-show-do and presence of a pediatric dentist trained in child psychology could have contributed to this similarity.     

Effect of fear on dental utilization behaviors and oral health outcome

OBJECTIVES: This paper assesses the effect of fear on a number of dental utilization behaviors and oral heath outcome in a sample of adult Floridians. METHODS: A telephone survey was conducted in 2004 among 504 adult Floridians. Data collected included sociodemographic factors, specific fear of dental pain (FDP), global FDP, global dental fear, three measures of dental utilization behaviors, and one measure of oral health outcome. Chi-squared tests and logistic regression analyses were conducted to quantify the individual and multivariate associations between fear factors and four behavior and outcome measures. RESULTS: Global FDP was significantly associated with putting off making a dental appointment and approach to dental treatment. Global dental fear showed an independent negative impact on all four behavior and outcome measures; reports regarding specific fear of painful dental events were not significantly associated with four behavior and outcome measures. CONCLUSIONS: Our findings suggest that: (i) dental fear and FDP have independent negative effects on dental utilization behaviors and oral health outcome after controlling for other sociodemographic and general health factors; and (ii) global dental fear encompasses broader components than FDP.     

口腔门诊治疗并发晕厥106例回顾分析

目的：通过对1983年以来，孝感市中心医院口腔中心门诊治疗并发晕厥106例的回顾性分析，探讨口腔门诊治疗并发单纯性晕厥的原因及一些相关因素，增强医患双方的防治意识，安全顺利的进行口腔门诊治疗。方法：对106例单纯性晕厥反应，采取现场询问式调查的方法，对其一般情况，口腔门诊治疗经历，治疗时的心态，口腔门诊治疗的了解，以及不同口腔治疗晕厥发生情况等进行调查、归纳、分析。结果：1)晕厥的发生与患者的年龄有关，12～40岁口腔门诊治疗经历欠缺的患者是口腔门诊治疗并发晕厥的高危人群。2)口腔患者进行治疗前心理准备充足与否对并发晕厥反应的影响较大。3)晕厥在口腔门诊某些治疗中发生率较高，拔牙术最多，其次为脓肿切排。86％(92例)属因畏惧疼痛导致紧张而诱发的血管抑制性晕厥。4)晕厥多发生于治疗初期(93：13)。结论：口腔门诊治疗并发晕厥临床表现多不严重，但对患者就诊和医师的治疗影响明显，切实做好口腔治疗错误信息，消除和减轻他们的疑虑和畏惧的紧张心情，对保障口腔门诊治疗安全尤为重要。     

Epidemiology of dental caries among adolescents in Tamil Nadu,India

Objective: Economic and dietary changes in the Indian state of Tamil Nadu have led to compromised oral health status of the adolescent population. Adequate epidemiological data are not available to address the prevention or treatment needs in this region of India. The aim of this study was to measure the prevalence and severity of dental caries among adolescents of Tamil Nadu, a southern state of India. Methods: The study sample included 974 adolescent school students (12–15 years of age) from both rural and urban areas of Tamil Nadu, India. The decayed, missing and filled teeth (DMFT) index of these students was measured using the World Health Organization oral health survey method, in a quantitative cross-sectional study. Results: The oral health survey indicated that the prevalence of dental caries among adolescents in rural and urban areas of Tamil Nadu was 61.4%, with an average DMFT score of 2.03. Multiple regression analyses indicated factors such as gender, mother’s education, type of school and caste as significant predictors of dental caries. Conclusion: Female gender, Scheduled Caste and Tribes attending public schools in rural areas were identified as the more vulnerable populations to be affected by dental caries. Oral health policies should be targeted to these adolescent populations in the Tamil Nadu region.Key words: Prevalence of dental caries, severity of dental caries, Thanjavur, Chennai, oral health survey     

Tooth Brushing, Flossing, and Preventive Dental Visits by Detroit-area Residents in Relation to Demographic and Socioeconomic Factors

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.     

Dental hygienists' career promotional behaviors and attitudes.

PURPOSE: The purpose of this study was to examine dental hygienists' career promotional behavior and factors which influence such behavior, including the image of dental hygiene, career and job satisfaction, the market demand for dental hygienists, and the influence of professional affiliation. Relationships between demographic items and promotional behaviors also were determined. METHODS: In fall 1990, a 48-item survey was mailed to a random sample of 600 dental hygienists living in Virginia. Responses were analyzed by Pearson correlation coefficient, t-test, and analysis of variance RESULTS: A 61.5% response rate was obtained (N=368). The majority of respondents (79%) promote dental hygiene as a desirable career with the career and job satisfaction factor having the highest correlation (r=.69, p<.001) with dental hygienists' promotional behaviors. Of the demographic variables, years in practice, age, and years since graduation were negatively correlated with dental hygienists' promotional behaviors. CONCLUSIONS: Dental hygiene practitioners hold the potential for promoting careers in dental hygiene as well as for promoting their profession. Dental hygienists who are satisfied with their career and job situation are more likely to promote dental hygiene as a desirable profession.     

Caries prevalence, oral health behavior, and attitudes in children residing in radiation-contaminated and -noncontaminated towns in Ukraine

INTRODUCTION: Several studies investigating the oral health status of children living in Ukraine after the Chernobyl catastrophe revealed an increase of caries in children residing in radionucleotide-contaminated areas. PURPOSE: (1) To compare prevalence of dental caries in contaminated and noncontaminated towns; and (2) to determine if there is a difference between dental behaviors and attitudes of children residing in contaminated and noncontaminated areas that may have contributed to differences in caries prevalence. METHODS: Children aged 13-14 were randomly selected in two towns of approximately the same population size (33 000): Ovruch (n = 119) from a contaminated area and Mirgorod (n = 100) from a noncontaminated area. Data on behaviors and attitudes were collected via a self-administered questionnaire having six domains: (i) family background; (ii) dental anxiety; (iii) dental utilization; (iv) oral hygiene; (v) use of fluoride toothpaste; and (vi) sugar consumption. Oral examinations included information on carious lesions, restorations, missing teeth, and soft tissue abnormalities. Caries prevalence was compared using a t-test. Regression analysis was conducted to determine the independent contribution of oral hygiene behaviors and dental utilization. RESULTS: There was a significant difference in caries prevalence in the contaminated town (mean DMFT = 9.1 +/- 3.5) versus the noncontaminated town (mean DMFT = 5.7 +/- 1.4; P < 0.000). Oral hygiene practices, age, and utilization of dental services were not found to be associated with differences in DMFT score between the two communities. CONCLUSION: There was a significantly higher caries prevalence in a radiation-contaminated town compared to a noncontaminated town of Ukraine. The difference was not explained by differences in oral health knowledge, attitudes or behaviors.     

Associations between occupational health behaviors and occupational dental erosion

OBJECTIVES: The aim of this study was to evaluate the associations between occupational health behaviors and occupational dental erosion. METHODS: Using data for 943 workers among 34 factories, selected by three-stage stratified cluster sampling from 888 factories using acids, two sets of modified case-control studies were performed. The cases were 242 workers with any dental erosion (G1-5) and 78 with severe dental erosion (G3-5); the controls were 701 workers with no erosion (GO) and 864 workers with no or mild erosion grades, GO-2, respectively. The main explanatory variables were behaviors such as wearing a respiratory mask and gargling at work. The results were adjusted for employment, age, sex, knowledge, and opinion about occupational health, attrition, and abrasion. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: The odds of overall occupational dental erosion (G1-5) was 0.63 (95% CI = 0.42, 0.94) for respiratory mask wearers compared to nonwearers; the odds of severe occupational dental erosion (G3-5) was not significantly less in respiratory mask wearers (OR = 0.94; 95% CI = 0.53, 1.67). Gargling did not show a significant association with occupational dental erosion in this study. CONCLUSIONS: Among occupational health behaviors, wearing personal protective respiratory masks in work was significantly associated with less overall occupational dental erosion.