西安市1002名家长对儿童牙科全身麻醉技术认知及接受度调查

目的：了解家长对儿童牙科全身麻醉技术（dental general anesthesia,DGA）的认知和接受程度并分析其可能的影响因素。方法：向2011年11月．2012年3月间前来第四军医大学121腔医学院儿童口腔科就诊的1002名初、复诊患儿家长解释DGA后由家长完成调查问卷,数据采用SPSSll．0软件行统计学分析。家长对DGA的接受度采用相对数形式统计,利用X^2检验明确不同因素是否影响家长对DGA的接受。结果：儿童口腔治疗常见的行为诱导方法中,家长对DGA的熟悉程度较低,仅有6．69％的家长听说并对其有所了解。在医生提出建议时,20．76％的家长会接受该技术,61．98％的家长担心麻醉药物的副作用,同时分别有超过33．33％的家长认为全麻技术会对患儿大脑及身体发育产生影响。经统计学分析,家长对DGA的接受度与家庭月收入,家长最高学历及地域因素有关P〈0．05）。结论：DGA在国内儿童口腔医学领域是一种新兴牙科行为诱导技术,患儿家长对其了解较少,接受度普遍偏低。医生在选择该方法时应做好解释工作并获得家长的知情同意。     

我国儿童口腔科医师临床诊疗工作调查分析

目的 进行我国儿童口腔科医师临床诊疗工作情况的调查研究，为今后学科发展改善基础及继续教育提供依据。方法 对参加第五届全国儿童口腔医学会议的医生进行问卷调查，并分析139份有效回卷。结果 无痛治疗（27．3％）、冠髓切断术（21．6％）、橡皮障的应用（1．4％）、氟化物的使用、咬合诱导等工作开展情况还有待加强。而根管治疗、窝沟封闭的应用情况比较好。结论 目前在我国儿童口腔医学临床中已开展了各项必要的诊疗工作，但还有必要加强基础及继续教育以使整体水平更上一层楼。     

儿童行为管理技术研究进展

在儿童牙病的治疗过程中,患儿不合作是口腔科医生经常面临的问题.合理使用行为管理技术能帮助我们更有效地管理儿童行为,以助于提高治疗效率,缓解工作压力.本文主要从基础行为管理技术和高级行为管理技术两方面对儿童口腔行为管理技术的研究进展进行简要综述.     

牙科急诊患儿的行为特点和临床分析

目的：分析影响牙科急诊患儿治疗时与医生合作行为的因素，并探讨这些因素与患儿合作的关系，总结出使患儿合作的经验。方法：观察255例急诊患儿在治疗过程中的表现，并调查可能影响患儿行为的因素。结果：牙科急诊患儿合作程度在不同年龄、性别、陪伴者间有显著性差异，而不同病因的患儿合作程度无显著性差异。结论：影响儿童治疗时与医生合作的行为因素多种多样，在儿童牙科急诊中掌握患儿的心理状态非常重要。     

虚拟现实技术应用于儿童口腔治疗非药物行为引导的进展

儿童由于其年龄、认知等因素影响，是牙科焦虑/畏惧症的高发人群，难以配合医生完成治疗。由于常规的行为管理效果欠佳，且采用药物对儿童进行行为管理的方式家属又表示担忧，从而延误了病情治疗。虚拟现实技术拥有的特性比较适合于儿童口腔治疗中的行为管理。文章通过阐述虚拟现实技术在减轻疼痛、缓解焦虑中的作用，从而介绍儿童口腔治疗非药物行为管理的进展。     

牙科临床儿童患者的行为学探讨

作者在用几种不同的方法接待儿童牙病患者的基础上，对儿童口腔门诊患儿的行为进行分析，探讨了口腔门诊患儿就诊行为的影响因素及适合儿童行为心理的处理方法，供从事儿童牙病的临床医护人员参考。材料和方法1．病例选择和分组从我院儿童门诊中随机调查502例患儿，其中男性279例，女性223例，年龄1～15岁。患者按城乡。初复诊、年龄、成份及父母学历进行分组登记，其中第一次接受牙病治疗者为初诊，凡第二次以上接受牙病治疗者为复诊。按年龄分为1－3岁组（包括3岁）、4～6岁组（包括6岁）、7～14岁（包括14岁）［1］。2．按患儿就诊时的行…     

儿童口腔科中的行为管理

儿童口腔科临床的行为管理(Behavior management)问题在我国儿童口腔科领域是一个尚未得到应有关注的专题，在专业教材中也还未将此专题独立成章。另一方面儿童口腔科是与孩子打交道的专业，行为管理渗透于日常临床工作的很多环节，在临床实践中如何处理孩子的不合作行为是医生们经常要面临的一个挑战。目前虽然不少临床工作者在实践中赁直觉和经验应用了某些科学的行为管理方法，但就本文作者所知对该专题国内还没有科学系统的研究，     

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。     

牙髓切断术与牙髓摘除术在无症状深龋露髓乳牙治疗中的现状调查

目的：对无症状深龋机械性露髓乳磨牙的牙髓治疗的选择进行调查并分析。方法：2014年10月－2015年2月向不同地区452位口腔全科及儿童口腔专科医生发放问卷,进行调查。数据采用SPSS18．0软件进行统计学分析。利用χ2检验明确不同因素对医生选择治疗方法的影响。结果：343名样本人群中,深龋机械性露髓患牙治疗时仅有131名（38．19%）医生选择牙髓切断术,212名（61．81%）选择牙髓摘除术。医生的选择与其从事儿童口腔诊疗工作的时间及所在城市的经济因素有关（P<0．05）。选择牙髓切断术的医生中,87．78%的人认为牙髓切断术可以保存部分活髓,进而维持乳牙牙根的正常吸收,对继承恒牙的影响较小;选择牙髓摘除术的医生中,有172人（81．13%）认为该类患牙的牙髓状态不易判断,进行牙髓切断术后失败率较高。结论：由于主客观条件的限制,国内口腔医生对于深龋机械性露髓乳牙的治疗普遍采用牙髓摘除术,牙髓切断术的普及率较低。     

青少年心理行为与牙科焦虑症的相关性研究

目的：调查研究口腔门诊青少年患者心理行为与牙科焦虑症（DA）的相关性。方法：利用改良牙科焦虑量表以及自制青少年心理行为问卷表对400例口腔门诊青少年患者进行问卷调查,对被调查者性别、是否有牙科治疗史以及3种不同的心理行为分组进行分析。结果：回收有效问卷379份,有效率94．75％;不同性别和对DA的发生差异极有统计学意义（P〈0．01）,Pearson列联系数r=0．27;是否有既往口腔科治疗史对DA的发生差异有统计学意义（P〈0．05）,r=0．11;紧张与焦虑行为和自我控制力行为与DA有关（P％0．05）,r分别为0．55和0．35;而内向和羞怯行为与DA无明显关联。结论：DA在青少年患者中常见,性别、既往口腔科科治疗史以及部分心理行为对DA有影响．     

Principles and application of learning theory in child patient management.

General dentists, as well as pediatric dentists, treat many children. Behavior management for children is an integral component of pediatric dental practice. Behavior management techniques have been developed based on empirical evidence indicating the importance of social learning theory to change both the causes and consequences of negative behaviors. This paper addresses the theoretical basis of current approaches in guiding children's behavior during dental settings. The relevance of the theoretical areas to the day-to-day treatment of the patient is emphasized.     

Increasing general dentists' provision of care to child patients through changes in the undergraduate pediatric dentistry program

Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998-99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded, fifteen from each of the three surveyed classes. Dentists who graduated after the changes to the program (2000, 2002) reported that they performed a greater number of complex pediatric dentistry procedures and treated more toddler and preschool children than the group that graduated before the changes (1993). Referrals to pediatric dentistry specialists were higher in the 1993 group than in the 2000 and 2002 groups. In conclusion, an adequate pool of pediatric patients is critical to provide dental students with sufficient learning experiences. The dentists who graduated from the program after the changes were implemented are providing more comprehensive treatment to younger children.     

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近年来,无痛镇静治疗日益受到口腔医生和患者的关注,在儿童口腔医学临床中也是如此,但对此存在某些错误认识,集中表现在过分夸大药物的作用,而忽视了一些基本而有效的技术。本文总结国内外相关研究并结合我们自己临床工作经验,为大家梳理了无痛镇静治疗的必要性、相关概念和常用方法,希望能对临床口腔医学工作者,尤其是儿童口腔科医生的工作有所裨益。     

Child-management techniques. Are there differences in the way female and male pediatric dentists in Israel practice?

The purpose of this study was to assess differences in the management techniques used by Israeli female and male pediatric dentists. All 112 participants of the meeting of the Israeli Society of Dentistry for Children that was held in February 1999 received a questionnaire which sought information regarding age, sex, behavioral and pharmacological methods used to treat children, having a course in nitrous oxide, general anesthesia, and feelings towards pediatric patients. No differences between female and male dentists were found regarding most management techniques. The majority of dentists used tell-show-do, and gave presents at the end of the appointments. Hypnosis was the least used technique. Papoose board was more prevalent among male dentists than among female dentists. Most dentists reported having the parents present during treatment, and more male dentists used their assistance when restraint was needed. General anesthesia was significantly more prevalent among males than among females (p = 0.01). One-third of the dentists reported feeling aggression toward the pediatric patient. Although not statistically significant, more female dentists reported about feeling aggression than male dentists. Most dentists felt authority towards the pediatric patient. Our findings imply that female and male dentists use similar management techniques when treating children.     

Necessity and relevance of qualitative research in pediatric dentistry. A literature review

ObjectivesThis review aims to understand the essence and relevance of qualitative research in pediatric dentistry and summarizes the most important information needed for a pediatric dentist before conducting a qualitative study.MethodsAn electronic search was conducted on studies published from December 2019 until December 2021 using PubMed, Scopus, and King Abdulaziz University Digital library. Several keywords were used to identify the studies for this review.ResultsThirty-three studies involving qualitative methods in pediatric dentistry have been conducted on parents and dentists. Qualitative studies in pediatric dentistry are used to explore the perceptions of mothers and their children and to understand their behavior in different areas related to pediatric dentistry. Barriers to conducting qualitative studies with children include credibility, the influence of others on children’s opinions, and differences that influence children’s behavior while conducting the study.ConclusionQualitative methods in pediatric dentistry have been conducted on parents and dentists; however, little is known about the credibility and trustworthiness of conducting qualitative research with children. Future studies are needed to investigate effective interview techniques with children and more research should be conducted to evaluate the credibility and trustfulness of using children as a source to collect data in qualitative research.     

General dentists' referral of children younger than age 3 to pediatric dentists

PURPOSE: The purpose of this study was to assess which variables are associated with Iowa general dentists' referral of children younger than age 3 to pediatric dentists. METHODS: A survey was mailed to all Iowa general dentists (N=1,089). Respondents were asked how likely (never, sometimes, often, always) they were to refer children younger than age 3 to pediatric dentists in the past 12 months. Associations between referral patterns with practice, dentists,' and patients' characteristics were determined. RESULTS: The adjusted response rate was 65%. Nearly 50% of all dentists reported often or always referring children younger than age 3. Dentists who referred were more likely to be males and to have been in practice longer. Dentists who perceived that they had not received adequate exposure to preschool children younger than age 3 in dental school were more likely to refer. Dentists with smaller percentages of children within their practices were more likely to refer. Dentists most often referred children who were uncooperative, had severe decay, or had special needs. CONCLUSIONS: About one half of Iowa's general dentists refer children younger than age 3 to a pediatric dentist. Initiatives need to be undertaken to address dentists' reluctance to care for young children.     

Challenges and dilemmas in behaviour guidance of the pediatric dental patient

In addition to the pressures of providing a high quality of dental care for children, dentists practising pediatric dentistry are faced with some legal and ethical concerns regarding the use of behaviour management techniques. The following article will discuss some of the pressures and ethical dilemmas facing dentists treating children. Strategies for making the dental appointment more humane for child, parent and dentist are suggested. The most perplexing issues in pediatric dentistry today are related to the management of patients. In addition to questions regarding clinical management, dentists treating children have to make careful judgements concerning management of patient's behaviour. The following scenarios are a few examples of the situations that often arise during the dental treatment of child and adolescent patients: "I really had to raise my voice to Jamie today and use a lot of physical restraint to administer the local anesthetic. I was not happy about being so aggressive, but it was important to get that filling done. I wonder, though, how he is going to feel about going to the dentist now?" "I feel frustrated that I did not get any work done on that four-year-old today, but I did not want to use undue force. Maybe I should have been more forceful; hand-over-mouth-exercise might have worked, but I always feel uncertain about using that technique and I wonder what the parents will think if I use it."     

The pediatric dental workforce in 2016 and beyond

BackgroundChildhood caries is a major oral and general health problem, particularly in certain populations. In this study, the authors aimed to evaluate the adequacy of the supply of pediatric dentists.MethodsThe authors collected baseline practice information from 2,546 pediatric dentists through an online survey (39.1% response rate) in 2017. The authors used a workforce simulation model by using data from the survey and other sources to produce estimates under several scenarios to anticipate future supply and demand for pediatric dentists.ResultsIf production of new pediatric dentists and use and delivery of oral health care continue at current rates, the pediatric dentist supply will increase by 4,030 full-time equivalent (FTE) dentists by 2030, whereas demand will increase by 140 FTE dentists by 2030. Supply growth was higher under hypothetical scenarios with an increased number of graduates (4,690 FTEs) and delayed retirement (4,320 FTEs). If children who are underserved experience greater access to care or if pediatric dentists provide a larger portion of services for children, demand could grow by 2,100 FTE dentists or by 10,470 FTE dentists, respectively.ConclusionsThe study results suggest that the supply of pediatric dentists is growing more rapidly than is the demand. Growth in demand could increase if pediatric dentists captured a larger share of pediatric dental services or if children who are underserved had oral health care use patterns similar to those of the population with fewer access barriers.Practical ImplicationsIt is important to encourage policy changes to reduce barriers to accessing oral health care, to continue pediatric dentists’ participation with Medicaid programs, and to urge early dental services for children.     

Swedish dentists' perceptions of their patients.

Swedish dentists' perceptions of patient behavior problems, levels of stress experienced by the dentists in relation to such behavior, and general problem areas in their occupational situation were investigated by means of a self-administered questionnaire mailed to a sample of 485 Swedish dentists. The questionnaire assessed 16 different patient behavior problems and an additional number of other occupationally related problem areas. A total of 342 replies (71.4%) were analyzed. The relationship between the occurrence of behavior problems and the resulting level of stress was inversely proportional. This implies that Swedish dentists feel confident in dealing with behavior problems in their patients. Furthermore, this study shows that most dentists (93%) feel positive about their work and believe that their work is highly appreciated by their patients (96%) and colleagues (84%).