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口腔疾病患病率和发病率特别高,是主要的公共卫生问题之一。特别在社会低收入人群中,口腔疾病已经成为主要的疾病负担之一。本文就我国口腔流行病学资料,对我国目前口腔疾病的现状、改变的趋势、发展及对策做一论述和探讨。     

Mucosal disease series. Number VI. Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1 β ; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.     

口腔种植患者的口腔护理行为调查分析

目的：了解口腔种植患者的口腔护理行为,为口腔种植患者的口腔护理健康教育提供依据。方法：对在福建省级机关医院口腔科完成口腔种植义齿修复半年以上的患者进行问卷调查。结果：3.2%患者每天刷牙3次;34.8%患者刷牙时间大于3分钟;50.2%左右患者经常使用牙线和牙缝刷;30.3%患者经常使用冲牙器;仅6.7%患者做到戒烟;49.4%患者不按医嘱定期复查;65.2%患者未能进行牙周洁治。结论：口腔种植患者在口腔专业维护方面存在偏差,应加强健康教育,同时应特别注意文化程度较低的人群。     

Oral submucous fibrosis. Case report and review of the literature

A case history and brief literature review of oral submucous fibrosis is presented. This condition is most frequently found in the Indian subcontinent and only rarely encountered elsewhere. The aetiology is considered to be related to dietary habits and customs found in the population. The condition has a known malignant potential. With increasing migration to Australia from the Indian subcontinent the condition should be known and recognized by clinicians.     

Relation between social drug use/abuse and dental disease in California, U.S.A.

ABSTRACT This study has explored the social drug use/abuse patterns associated with dental disease. Seventy-seven subjects from the Berkeley Free Clinic were given questionnaires on their drug-use habits and then were examined for both DMF-T and OHI-S scores. Ninety-seven percent of the subjects indicated that they used one or more of the eight drugs being surveyed. The mean DMF-T of the subjects was 13.2 and the OHI-S was 2.61. The study indicated that persons who used barbiturates, miscellaneous hallucinogens and heroin have poorer oral hygiene than those in other categories. An unexpected finding was that subjects who used four or five of the surveyed drugs had lower DMF-T and OHI-S scores than those who used a lesser or a greater number of these drugs. The significance of these findings for an individual's oral health is not yet clear, but it is interesting that the oral hygiene index and DMF-T index did not increase with the increasing number of drugs used, although the specific use of barbiturates, miscellaneous hallucinogens and heroin were related to higher OHI-S scores. The lower OHI and DMF scores probably can be explained by the frequency of toothbrushing. Ninety-five percent of the 4–5 drug-use group brushed one or more times per day.     

A review and guide to drug‐associated oral adverse effects—Oral mucosal and lichenoid reactions. Part 2

Dental practitioners and other health professionals commonly encounter and manage adverse medicine effects that manifest in the orofacial region. Numerous medicines are associated with a variety of oral adverse effects. However, due to lack of awareness and training, these side effects are not always associated with medicine use and are underreported to pharmacovigilance agencies by dentists and other health professionals. This article aims to inform health professionals about the various oral adverse effects that can occur and the most commonly implicated drugs to improve the management, recognition and reporting of adverse drug effects. This article follows on from Part 1; however, the focus here is on lichenoid reactions and oral mucosal disorders including oral aphthous‐like ulceration, mucositis and bullous disorders such as drug‐induced pemphigus, pemphigoid, Stevens‐Johnson syndrome and toxic epidermal necrolysis.     

Oral health status in relation to socioeconomic and ethnic characteristics of urban adults in the U.S.A.

Nearly 1,300 adult members of a prepaid medical group plan in New York City were screened through automated multiphasic health testing in a series of test stations including a dental station, during 1971-1973. Oral status indicators were developed including a number of missing teeth, scores to measure levels of gingival and periodontal disease, Simplified Oral Hygiene Index scores, and ratios of decayed teeth. Ratios of filled teeth were calculated to measure levels of restorative care. The present paper examines the interrelationships of economic status, education and ethnic origin with each of the above oral status measures. It was found that variations in ratios of decayed and of filled teeth were primarily due to economic status while variations in a number of missing teeth, oral hygiene levels and levels of gingival and periodontal diseases were primarily due to screenees' educational level. Ethnic group differences could be explained in part by differences among these groups in economic and and educational levels. There were no consistent ethnic patterns, however, and while some differences could be explained by controlling for education and economic status, others persisted.     

武汉市东西湖区5岁儿童口腔健康行为调查

目的:了解东西湖区5岁儿童的基本口腔健康行为及其家长的儿童口腔卫生知识水平,为东西湖区儿童口腔卫生保健工作提供信息支持。方法:按照第三次全国口腔健康流行病学调查方案设计的5岁儿童家长问卷,对东西湖区8所幼儿园529名5岁儿童家长进行问卷调查,了解儿童饮食行为,口腔卫生行为、利用口腔医疗行为,家长口腔保健知识知晓情况。结果:30%的儿童经常有睡前进食甜食的习惯。5%的儿童在3岁前开始刷牙,每日刷牙2次者仅占10%。有5%的儿童使用含氟牙膏刷牙。在过去1年中,90%的儿童没看过牙医。结论:东西湖区5岁儿童口腔健康行为低于全国平均水平,儿童口腔健康行为尚不完善,有必要加强父母的口腔健康教育,建立正确的儿童口腔健康行为。     

Membrane locus and pH sensitivity of paraben inhibition of alkali production by oral streptococci

Parabens were found to be potent inhibitors of alkali production from arginine by oral streptococci such as Streptococcus rattus, Streptococcus sanguis and Streptococcus gordonii. For example, 2 mumol butylparaben per ml completely and irreversibly inhibited arginolysis by intact cells of S. rattus FA-1 and was lethal for the organism. In contrast, butylparaben was not a very effective inhibitor of ureolysis by intact cells of Streptococcus salivarius 57.I, although it did kill the cells. Butylparaben irreversibly inhibited the cytoplasmic enzymes arginine deiminase, carbamate kinase and urease in permeabilized cells or isolated form. However, inhibition of arginolysis by intact cells appeared to be due primarily to irreversible inhibition of transport systems for arginine uptake, because butylparaben added to intact cells did not reduce levels of arginine deiminase when the cells were subsequently permeabilized after washing. The insensitivity of ureolysis by intact cells to butylparaben can be related to the known high permeability of cell membranes to urea and the cytoplasmic location of urease. The potency of butylparaben as an inhibitior of arginolysis or glycolysis and as a lethal agent was found to be greater at acid pH that at neutral or alkaline pH.     

High incidence of autoantibodies in Taiwanese patients with oral submucous fibrosis.

BACKGROUND: Previous study has shown a high incidence of autoantibodies including antinuclear (ANA), antismooth muscle (SMA), antigastric parietal cell (GPCA), antithyroid microsomal (TMA), and antireticulin antibodies in a small group of 26 patients with oral submucous fibrosis (OSF). The reasons why some of the OSF patients have high titers of autoantibodies in serum have not been completely explained and no further study on autoantibodies in OSF patients has been done in a large group of patients. METHODS: In this study, we determined the serum levels of ANA, SMA, GPCA, and TMA in a large group of 109 male Taiwanese patients with OSF by an indirect immunofluorescence technique (for ANA, SMA, and GPCA), and by a semiquantitative microtiter particle agglutination test (for TMA). The presence of serum autoantibodies in OSF patients was further correlated with patients' oral habits and the severity of OSF measured by maximum mouth opening (MMO) and sites of involvement. RESULTS: We found that the frequencies of presence of serum ANA (23.9%), SMA (23.9%), and GPCA (14.7%) in OSF patients were significantly higher than those (9.2, 7.3, and 5.5%, respectively) in healthy control subjects (P < 0.01, P < 0.005, and P < 0.05, respectively). Although the frequency of presence of TMA (5.5%) in OSF patients was also greater than that (2.8%) in healthy control subjects, the difference was not significant (P > 0.05). The presence of serum GPCA in OSF patients was significantly associated with daily areca quid (AQ) consumption (P < 0.05). The presence of serum ANA in OSF patients associated with daily AQ consumption was of borderline statistical significance (P = 0.066). However, no significant correlations were demonstrated between the presence of serum autoantibodies in OSF patients and other variables of oral habits, MMO, and sites of involvement. CONCLUSION: In this study, all the 109 OSF patients had AQ chewing habit and 73.4% of the OSF patients swallowed the 'juice' of AQ during the chewing process. The presence of serum GPCA and ANA in OSF patients was associated with daily consumption of AQs. AQ chewing caused mucosal microtrauma, and ulcerations facilitated the diffusion of genotoxic and cytotoxic AQ ingredients into the oral and gastric tissues. Altered autoantigens released from AQ ingredients-damaged cells may induce autoantibody production. Higher frequencies of specific HLA-DR antigens in OSF patients may also help autoantibody production. Therefore, we conclude that the high incidence of autoantibodies in OSF patients may be due to AQ chewing habit, toxic AQ ingredients, and genetic susceptibility of the OSF patients.     

Sarcoidosis – a clinically orientated review

Sarcoidosis is a multisystem disease of unknown cause. Sarcoidosis can affect all individuals with any race, sex, or age but commonly affects young‐ and middle‐aged adults and usually presents with bilateral hilar lymphadenopathy, pulmonary infiltration, skin and ocular lesions. Other organs can also be affected. Diagnosis is established when clinical and radiological findings are supported by the presence of non‐caseating epithelioid cell granulomas, however, local sarcoid reactions and granulomas of known cause should be excluded. The optimal management has not been well defined yet, although corticosteroids remain the mainstay of treatment, there is little evidence on which to base the indications for treatment including dosage and duration of therapy. Certain clinical features are helpful in the prognosis of the condition that can vary from a self‐limiting course to progressive life‐threatening fibrosis of the vital organs.     

Oral cytology revisited

During the last decade, oral cytology has once again become the focus of scientific research. This new interest is due to the introduction of a cytobrush for cell collection as well as a computer-assisted analysis (Oral CDx^®). Although promising, the sensitivity and specificity of conventional oral brush cytology remains limited. To circumvent the problems and improve the accuracy, various adjunctive analytical methods have been attempted. DNA analysis, immunocytochemical and molecular analysis are suggested methodological cytology approaches to improve the validity of oral brush cytology. An increase in sensitivity (up to 100%) and specificity (up to 100%) of oral brush biopsy has been reported on localized pre-malignant and malignant lesions. Oral brush biopsy probably will not replace histopathology in the definitive diagnosis of oral cancer, but it might be valuable for the prevention of misdiagnosis of clinically doubtful oral lesions and for the monitoring of lesions that might proceed on to oral cancer.     

Oral health status and dental care for individuals with visual impairment. A narrative review

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals’ skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.     

Long‐term effects of using oral care aides at a nursing home for elderly dependent residents—a pilot study

The oral health status of elderly dependent residents is reported to be poor, as well as difficult to describe. Analysis of oral microbial flora has been suggested as a suitable measurement method. Oral care aides have been shown to have a positive influence on oral health care in nursing. The outcome of an intervention with oral care aides was followed during a two‐year period by recording: (a) the proportion of opportunistic microorganisms and bacteria associated with caries (b) whether oral hygiene assistance were given to the residents or not, and (c) individual experiences concerning oral health care among the staff involved. The oral flora and the amount of oral hygiene assistance improved throughout the entire study period, but staff interviews revealed that it took two years for good cooperation and prophylactic routines to be established. An unexpected finding was the positive correlation (p = .0005) between a high proportion of the opportunistic microorganisms and death within one year.     

口腔卫生师的职业与职责

口腔卫生师(hygienist)是口腔医疗卫生保健的特殊职业,是口腔卫生保健的专业人才,是口腔疾病预防的主力,作为口腔医学的重要组成部分,组成了口腔医疗的基本结构单元.口腔卫生师有明确的职业特征和社会属性,在大众的口腔医疗卫生保健中发挥独特的重要作用.口腔卫生师通过口腔卫生宣教,提高大众的口腔健康素质和修养;通过口腔照...     

Tunnel restorations in general practice. Influence of some clinical variables on the success rate

Using bitewing radiographs and clinical inspection, the success rate for tunnel restorations was assessed in a population with low caries activity. The material consisted of 242 tunnel restorations in permanent premolars and molars in 142 individuals (mean age = 18.8 years). The median DFSappr value (decayed and filled approximal surfaces) at the time of restoration was 4.0. The mean follow-up time was 25 months. Bivariate associations between the outcome variable (success/failure of the tunnel restoration) and conceivable explanatory variables were investigated. In a multivariate logistic regression analysis, the independent variables tooth type (premolars vs molars), surface site (mesial vs distal), radiographic stage of approximal carious progression and age of patient at the time of restoration (9-15 years vs &gt;15 years) were used to estimate the effect on the dependant variable success/failure. Using the life table method, the estimated cumulative proportion of successful restorations was 81% after 2 years and 64% after 3.5 years. The success rate was not related to caries activity and did not differ between the two types of tunnel preparation techniques nor between different follow-up periods. In the multivariate regression analysis, tooth type (molars vs premolars) was the only factor significantly associated with failure. Thus, a failure occurred about 5 times as often in molars as in premolars. Of the failures, half were due to caries; either radiographically observed adjacent to the restoration or progressing enamel caries on the outer proximal surface. Marginal ridge fractures constituted 26% of the failures. From the present results it can be concluded that in a population with low caries activity, the tunnel restoration technique can be recommended for premolars.     

Chlorhexidine with an Anti Discoloration System. A comparative study

Abstract  Correct oral hygiene is believed to be the basis of primary and secondary prevention. Sometimes, using a toothbrush or other mechanical instruments for oral hygiene may be difficult and it may become necessary to use an antiseptic. Chlorhexidine is an essential component in many available preparations on sale, because of its marked antiseptic qualities. One of the most frequent side-effects is the appearance of stains on the teeth and mucous membranes, which particularly disturbs the patient. A new mouthwash containing chlorhexidine has recently become available, besides maintaining its antiseptic qualities, also avoids the side-effect of staining. Objectives: The aim of this study was to check the capacity of the new mouthwash, which contains chlorhexidine and Anti Discoloration System (ADS), not only to prevent plaque formation like the other mouthwashes containing chlorhexidine but also to avoid staining that is one of the most frequent side-effects. Study design: The comparative study was carried out on a sample of 15 patients treated with two mouthwashes both containing 0.2% chlorhexidine, but different in that the first does not contain ADS, which is instead present in the second, a new product. The results obtained show that in the 15 patients treated, there is no statistically significant difference in the ability of the mouthwash to prevent bacterial plaque, however evidence of the stain was much less with the new mouthwash.     

Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer

BACKGROUND: The development of endosseous implants and free vascularized bone grafting has permitted increased possibilities of oromandibular reconstruction in patients with oral cancer. In this study, a concept combining surgical and prosthodontic treatments for mandibular fibula free flap reconstruction after tumor surgery was made based on a classification of bone defects. A follow-up study was performed to evaluate the treatment concept for oral rehabilitation in order to identify possible factors which may influence the functional result. MATERIAL AND METHODS: A follow-up examination included 28 patients who underwent the ablative tumor surgery and mandibular reconstruction during a 4-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The timing of the study was set to allow for a minimum 2-year follow-up (mean 45 months). RESULTS AND CONCLUSION: At the time of examination, prosthesis-based oral rehabilitation was completed in six patients (21%), and the prosthodontic work was still unfinished in four other patients. The other 18 had no dental prosthetic rehabilitation. Thirteen patients received a total of 37 oral implants, and 23 implants were functionally loaded. No implant loss was recorded. Oral functions such as speech, diet tolerance and oral competence were not directly affected by the presence of dentures. A decisive factor affecting the oral function was the extent of soft-tissue loss. According to the classification described here, the extent of the mandibular defect did not correlate with oral functions. The application of oral implants seemed to be advantageous for the oral rehabilitation of patients who had undergone intraoral resections.     

Self-awareness of premalignant oral lesions among veterans attending six U.S. Veterans Affairs Medical Centers

Early identification is key to reducing the morbidity and mortality of oropharyngeal cancer. This study identified factors associated with self-awareness among patients newly diagnosed with a premalignant oral lesion. Data describing sociodemographics, medical/dental histories, tobacco/alcohol use and oral health were obtained by questionnaire and clinical examination of 73 veterans at six U.S. Veterans Affairs Medical Centers. Lesion types included homogenous and non-homogenous leukoplakia, smokeless tobacco lesion (STL), papilloma, lichen planus and erythroplakia. Prior to diagnosis, 29 subjects (39.7%) were unaware of their lesion. In bivariate analyses, lesion self-awareness was associated with anatomic location, multifocal/generalized appearance, pain, oral sores, and cigar use (p<0.05). Awareness varied with lesion diagnosis and was more likely with STL and less likely with homogenous leukoplakia (p<0.05). In multivariate analyses, awareness was predicted by the presence of a lesion on easily visible mucosa (adjusted odds ratio, OR=11.2) and a history of mouth sores (OR=11.2). These findings identified marked variations in patient self-awareness of oral premalignant conditions.