浅谈心血管疾病患者的拔牙问题

心血管疾病是人群中的常见病 ,严重的心血管病可因精神刺激、手术应激或其他因素而随时发生意外 ,拔牙是口腔外科常见的手术 ,手术虽小 ,亦可造成明显的应激反应 ,对心血管患者可造成心肌梗塞、严重心律紊乱、心力衰竭甚至死亡。尤其是老年人 ,由于机体老化 ,全身器官功能及对付应激能力较差 ,对拔牙又常有恐惧心理 ,在手术应激状态下就可能发生各种并发症 ,增加了老年心血管病患者拔牙时发生意外的危险性。所以 ,尽管口腔科因麻醉拔牙发生死亡的情况很少见 ,但仍为国内外学者所重视。不少文献报告从不同的角度论述了拔牙对心血管疾病的影响…     

单侧咀嚼及其对口颌系统的影响

单侧咀嚼是咀嚼的一种运动形式,在人群中占有一定的比例,近年来的研究表明,单侧咀嚼是咬合紊乱的一种表现形式,长期单侧咀嚼是颞下颌关节紊乱症(TMD)的病因之一,并与TND的严重程度有很大的关联。本文对单侧咀嚼及其对口颌系统的影响进行综述。     

单侧咀及其对口颌系统的影响

单侧咀嚼是咀嚼的一种运动形式，在人群中占有一定的比例。近年来的研究表明，单侧咀嚼是咬合紊乱的一种表现形式。长期单侧咀嚼是颞下颌关节紊乱症（TMD）的病因之一，并与TMD的严重程度有很大的关联。本文对单侧咀嚼及其对口颌系统的影响进行综述。     

咀嚼运动的中枢调控

咀嚼是口腔重要的生理功能之一。咀嚼运动属于节律性运动，受复杂的中枢神经调控网络控制。三叉神经感觉核接受口面部的感觉传入，三叉神经运动核内的不同亚核控制着不同的咀嚼肌，脑干中的中枢型式发生器（CPG）可产生咀嚼的基本模式，大脑皮层的不同部位则对咀嚼的精细调节以及咀嚼的准备，起始和控制发挥重要作用。由于咀嚼运动的复杂性，目前对于其中枢调控的机制还远未阐明，本文就这方面的有关进展作一综述。     

嗜神经病毒示踪成年小鼠开颌反射神经环路的实验研究

目的 :通过病毒示踪技术,研究牙髓刺激相关开颌反射的大脑核团,尤其是间脑和边缘系统的神经核团。方法 :通过运用顺行跨多突触病毒及逆行跨多突触病毒示踪开口肌运动相关核团及牙髓感觉相关核团。结果:小鼠全脑范围均出现荧光标记的神经元细胞,两种病毒共标记脑区12个,分布在端脑、间脑、边缘系统、中脑及网状结构。结论:开颌反射由多个核团参与,涉及全脑多个脑区,包括位于间脑的旁丘脑底核、下丘脑旁底核后部、未定带和边缘系统的中央杏仁核外侧部、终纹床核外侧部中间区。     

健康人下颌运动速度,加速度的研究

利用Ｄ－ＳＧＧ下颌运动轨迹分析仪，测试２５名正常ｈｅ青年在边缘运动、习惯运动、功能运动中下颌珠运动速度及加速度值。根据结果，作者首次提出下颌运动的“功能速度“和“极限速度”的概念及其生理意义。本文还首次应用第二定律：Ｆ＝ｍａ，来解释下颌运动加速度值的生理及临床意义。并提出在咀嚼。运动中，机体在咀嚼速度之间的分配上，采取的是“速度优先”的原则来保证必须的咀嚼效率。     

单侧部分后牙反He者的咀嚼运动轨迹研究

目的：探讨单侧部分后牙反Ｈｅ对咀嚼运动轨迹的影响。方法：对１４名单侧部分后牙反Ｈｅ者，１２名正常Ｈｅ对照，Ｋ６－Ｉ型下颌运动轨迹描记仪，测试分别用左、右侧咀嚼口香糖时的运动轨迹和速度。结果：①对照组冠状面咀嚼运动呈规则的环形，反Ｈｅ组出现同出入型、对出对入型等异常咀嚼环及“８”字型、出入轨重合型、桃型、平顶型、紊乱型等异常Ｈｅ期轨迹；②反Ｈｅ组咀嚼时向后运动的幅度，咬合引导轨迹与水平面的夹角，咀嚼     

单侧部分后牙反(牙合)者的咀嚼运动轨迹研究

目的 :探讨单侧部分后牙反牙合对咀嚼运动轨迹的影响。方法 :14名单侧部分后牙反牙合者 ,12名正常牙合对照 ,K6 - I型下颌运动轨迹描记仪 ,测试分别用左、右侧咀嚼口香糖时的运动轨迹和速度。结果 :1对照组冠状面咀嚼运动呈规则的环形 ,反牙合组出现同出同入型、对出对入型等异常咀嚼环及“8”字型、出入轨重合型、桃型、平顶型、紊乱型等异常牙合期轨迹 ;2反牙合组咀嚼时向后运动的幅度 ,咬合引导轨迹与水平面的夹角 ,咀嚼终末平均速度明显增大。结论 :单侧部分后牙反牙合 ,可以对咀嚼运动的类型、方向和速度产生明显影响     

颞颌关节紊乱综合征的手术治疗(附23例报告)

<正> 颞颌关节紊乱综合征是口腔科的常见病之一。其主要症状为咀嚼及张口运动时关节区疼痛,张口受限及下颌运动时有弹响或摩擦音,或有绞锁症状。因其病因复杂,目前尚缺乏理想的治疗方法。多数病员经局封、理疗、热敷药罐及调(牙合)等保守疗法,配合服用镇静止痛剂,肌肉松弛剂等药物,能使症状缓解;但有少数病例虽经以上各种方法治疗,症状仍不能缓解。此种顽固的颞颌关节紊乱综合征的治疗,是多年来口腔科医生深感困难的问题。我科     

Angle各类错[牙合]及正常[牙合]冠状面咀嚼模式分析

目的阐明 Angle 各类错骀及正常骀冠状面咀嚼轨迹形态及特征。方法选取358名错(牙合)和22名正常(牙合)为研究对象。根据冠状面切牙点的咀嚼运动轨迹将咀嚼模式分为8种咀嚼型。错(牙合)患者分别按有无颞颌关节紊乱病,Angle 分类分组。每一个个体分别计算左右侧第四个咀嚼环后10个咀嚼环中不同咀嚼型的个数,左右侧的平均值代表单侧咀嚼。Mann-Whitney U检验比较错(牙合)组与正常(牙合)之间各种咀嚼型发生频率的差异。结果结果正常骀具有一个简单稳定的咀嚼模式。几乎所有错(牙合)组,正常咀嚼型发生频率明显小于正常(牙合)。关节紊乱病患者咀嚼型发生频率不同于无颞颌关节紊乱综合症患者,重叠咀嚼型相对易出现(p=0.005)。不同 Angle 分类,有各自特定咀嚼型分布。结论在分析错(牙合)畸形对咀嚼模式的影响时,颞颌关节紊乱病患者单独分开分析可能更合理。AngleⅢ类患者反向及反向交叉咀嚼型出现频率相对较高。ClassⅡ~1患者开口凹型咀嚼型发生率较高,可能与前牙台阶型拥挤患者比例较高有关。     

Diagnostic techniques in children with secondary deforming temporomandibular osteoarthrosis]

The article presents the results of examination 135 children aged 2-15 years with deformities of maxillofacial system. Original screening methods of diagnosis of congenital disorders of metabolism were used. The signs of dismetabolic processes and morphofunctional disorders in gastrointestinal organs were found. These may indicate congenital and acquired genesis of metabolism-disturbances, which promote deforming of maxillofacial region and skeleton.     

Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers

Health professionals are subject to higher levels of stress than the average worker. Little has been written on these subjects, specifically in oral and maxillofacial surgeons. Anecdotally, dentists have been singled out as the health care professionals more likely to be subjected to severe stress, burnout, failed marriages, depression, substance abuse, and commit suicide. However, with oral and maxillofacial surgery being a particularly high-stress specialty of dentistry, a study of the dental literature regarding stress may be relevant. This article explores the myths and realities of stress and burnout in oral and maxillofacial surgeons and the coping skills, both adaptive and maladaptive used by practitioners to deal with their stress. This article also offers some practical suggestions for improving both the mental and physical health of oral and maxillofacial surgeons.     

Characteristics of an oral and maxillofacial radiology department: Report of the ad hoc Department Characteristics Committee of the American Academy of Oral and Maxillofacial Radiology

Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants, trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.     

109例颞下颌关节紊乱病相关因素分析

目的:探讨颞下颌关节紊乱病的相关危险因素,为临床预防提供帮助.方法:将2016年1月-2016年6月就诊于深圳市第二人民医院口腔科,并被诊断为颞下颌关节紊乱病者109例纳入病例组,随机抽取109名正常人作为对照组,进行问卷调查.使用SPSS 22.0软件包中的逻辑回归分析模型对调查结果进行统计学分析.结果:病例组中女性患者占76.1％,20～29岁年龄组患者最多,占44％.病例组中有夜磨牙或紧咬牙习惯、偏侧咀嚼习惯、颌面部外伤史的人数比例显著高于对照组(P＜0.05);经常熬夜、工作生活压力大、咀嚼硬物、有正畸治疗史的人数比例在病例组与对照组间无显著差异(P＞0.05).结论:年轻女性为颞下颌关节紊乱病的高发人群;夜磨牙或紧咬牙习惯、偏侧咀嚼习惯、颌面部外伤史可能是颞下颌关节紊乱病的重要危险因素;未见经常熬夜、工作生活压力大、咀嚼硬物、正畸治疗史与颞下颌关节紊乱病明显相关.     

Hemicrania continua presenting as temporomandibular joint pain

Patients presenting with unilateral facial pain present a unique diagnostic challenge for dental practitioners. As dentists, we routinely look for maxillofacial pathology, temporomandibular disorders, or odontogenic abscesses as the etiology of pain in these patients. However, several types of the chronic daily headaches may also produce signs and symptoms similar to dental or maxillofacial pathology. One such headache, hemicrania continua, is typically characterized by a continuous, throbbing, unilateral headache and is completely responsive to treatment with indomethacin. In this article we present 2 cases in which initial symptoms suggested temporomandibular disorders but the patients were ultimately diagnosed with hemicrania continua. A brief review of hemicrania continua and its treatment is included. Thoroughly understanding this entity and realizing that it may present as temporomandibular pain will allow us to more readily diagnose the condition and implement effective treatment.     

Disturbances of growth and development of the maxillofacial skeleton

Due to many developments in oral and maxillofacial surgery, the contribution of oral and maxillofacial surgeons in the diagnostics and treatment of growth and development disorders of the craniomandibulo-maxillofacial skeleton has become more and more important. Many disorders are treated by multidisciplinary teams including orthodontists and prosthodontists. Arbitrarily, 3 categories of growth and developmental disorders can be distinguished: dento-alveolar, dento-maxillofacial, and dento-maxillo-craniofacial disorders. In addition to classic bony reconstruction methods, new methodologies have been developed, such as distraction osteogenesis and simultaneous skin and soft tissue corrections. For many decades, the treatment of growth and development disorders has been a frequent subject of doctoral dissertations in The Netherlands. Attention is currently being paid to developing methods for three-dimensional planning and correction of these disorders, and methods which are minimally invasive.     

计算机辅助设计颌面缺损修复技术的开发应用研究

目的　开发建立颌面缺损修复计算机辅助设计 (CAD)技术。方法　通过对一例耳廓缺损和一例眼缺损患者修复的实例 ,详细介绍应用镜像技术、布尔运算及FreeForm软件等图像处理方法与相关软件 ,建立的颌面缺损修复CAD技术。结果　建立了颌面修复CAD技术。成功地完成了眼、耳缺损修复的CAD过程 ,方便而快速地获得了缺损区耳廓、眼的三维图像与数据 ,为进一步实现计算机辅助制作 (CAM)打下基础。获得的图像对称性好 ,修复体与组织面良好贴和。结论　本项研究建立的颌面缺损修复CAD技术 ,能基本解决颌面部常见缺损 ,具有较高的应用价值 ,可以在临床推广应用。     

Oral and maxillofacial surgery in The Netherlands: from Esser until today

In 2006, it was 50 years ago that the oral and maxillofacial surgery was officially recognized as a dental speciality in The Netherlands. During those five decades, oral and maxillofacial surgery significantly evolved, which is nicely reflected by the changes in the name of the scientific society supporting the speciality. Originally its name was The Netherlands Society for Oral Surgery and Surgical Prosthodontics, but in 1975 its name was changed into The Netherlands Society for Oral Medicine and Oral Surgery, and in 2006 into The Netherlands Society for Oral Medicine and Oral and Maxillofacial Surgery. Esser is considered to be the first oral and maxillofacial surgeon in The Netherlands. In The Netherlands, 2 schools of oral and maxillofacial surgery are recognized: the Utrecht School with Tjebbes as its founder and the Groningen School with Hut as its founder. Because of the 50th anniversary of the speciality, a thematic issue of the Dutch Journal of Dentistry offers a review of the current status of and expected future developments in oral medicine, head and neck oncology, maxillofacial traumatology, growth and development disorders of the maxillofacial skeleton, temporomandibular joint disorders and reconstructive surgery in The Netherlands.     

颌面部触觉及热刺激痛时大脑皮层激活区定位方法的初步探讨

目的:探讨将功能性磁共振成像(fMRI)技术运用于颌面部触觉及痛觉的大脑皮层定位研究的可行性。方法:选取右利手正常志愿者1名,分别采用触觉、热痛刺激颌面部及组块设计方法,采集全脑fMRI扫描数据,并用SPM99软件包进行结果的数据分析获得脑功能成像。结果:触觉刺激任务引起左侧顶叶中央后回(BA3)、右侧顶叶中央后回(BA1)、左额叶中央前回、右侧颞上回激活。热刺激痛任务可见右侧顶叶中央后回、右额叶中央前回、左侧额叶中央前回、左额上回、左前扣带回、左边缘叶前扣带回激活。结论:fMRI技术在合适的刺激条件下,可用于探讨颌面部触觉、疼痛与脑功能关系的研究,其脑激活区还有待于进一步实验结果。     

The role of cathepsin K in oral and maxillofacial disorders

Cathepsin K (CTSK) was thought to be a collagenase, specifically expressed by osteoclasts, and played an important role in bone resorption. However, more and more research found that CTSK was expressed in more extensive cells, tissues, and organs. It may not only participate in regulating human physiological activity, but also be closely related to a variety of disease. In this review, we highlight the relationship between CTSK and oral and maxillofacial disorders on the following three aspects: oral and maxillofacial abnormities in patients with pycnodysostosis caused by CTSK mutations, oral and maxillofacial abnormities in Ctsk^?/? mice, and the role of CTSK in oral and maxillofacial diseases, including periodontitis, peri‐implantitis, tooth movement, oral and maxillofacial tumor, root resorption, and periapical disease.