牙拔除术患者并发晕厥38例的原因分析及防治措施

目的回顾分析我科2006年1月—2008年12月牙拔除术患者并发晕厥的原因及采取的防治措施。方法采取详细询问调查的方法,了解患者牙拔除术前的精神状况、心理状态、既往拔牙史及全身情况等,手术中仔细观察患者,做好全面记录。结果晕厥的发生与患者的年龄有关,20-40岁是牙拔除术并发晕厥的高危人群,初次拔牙、拔牙前的心理准备不充分、紧张恐惧及惧怕疼痛对晕厥反应的发生影响较大。结论牙拔除术前详细询问病史,严格掌握牙拔除术适应证,认真做好诊前3min交流,安慰疏导患者,消除患者紧张恐惧心理;牙拔除术中密切观察患者,发现异常情况,医护紧密配合采取相应的处理措施,对预防晕厥发生、保障患者安全及手术顺利进行至关重要。     

其他

利用中国数字化可视人体图像建立牙齿及牙列的三维实体和有限元模型；大学生中牙科恐惧症与人格焦虑症的相关性研究；基于逆向工程技术的嵌体计算机辅助设计；口腔门诊患者“知情选择”状况调查分析；口腔门诊治疗并发晕厥106例回顾分析；非参数检验方法概述；……[编者按]     

口腔门诊成人患者牙科焦虑症调查及相关因素分析

目的:研究口腔门诊成人患者牙科焦虑症的发生情况,探讨与患者焦虑可能相关的因素,为牙科焦虑症的防治提供临床依据.方法: 采用牙科畏惧量表(dental fear scale, DFS)对330 例到口腔门诊接受牙科治疗的18 岁以上患者进行牙科焦虑症的调查及相关因素分析.结果: DFS平均分值为39.21±13.97.40 岁以下、未婚女性、低经济收入、有过直接或间接的牙科经历、口腔保健意识较差的群体有较高的DFS分值(P<0.05).民族、文化程度和就诊情况与DFS分值差异无统计学意义.结论: 牙科焦虑症是一种多因素疾病,牙科焦虑症患者多见于40 岁以下未婚女性、低收入、有过直接或间接的牙科经历、口腔保健意识较差的人群.     

240例儿童牙科畏惧症的临床初步分析

目的：调查儿童患者牙科畏惧症的发生情况及影响因素。方法：采用改良的儿童畏惧调查量表-牙科分量表（CFSS-DS）和行为分级法对240例儿童牙病患者进行调查及统计分析,比较不同分组因素下儿童患者畏惧水平。结果：CFSS-DS平均评分值为15.78±3.90。240例患儿的术前评分值在年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生这几方面有显著性差异（P〈0.05）,性别和精神状态无显著性差异。患儿的畏惧率为75.83%,术中行为分级受患儿年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生和精神状态这五方面有显著性差异（P〈0.05）。结论：了解不同因素下患儿术前和术中的畏惧情况,以期将儿童DF降到最低程度,提高诊疗质量,更好地维护儿童的口腔状况。     

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。     

口腔外科门诊突发医疗紧急事件的回顾研究

目的:分析口腔外科门诊出现突发医疗紧急事件的种类、原因,探讨口腔医护人员对口腔科突发医疗紧急事件的预防。方法:对2003～2010年间于第四军医大学口腔医学院口腔外科门诊出现突发医疗紧急事件的病例进行回顾研究。结果:在口腔外科门诊进行治疗的患者、患者陪人和医护人员中共有63例出现突发医疗紧急事件;其中心血管疾病(44.44%)和肾上腺素反应(15.87%)最为常见;突发医疗紧急事件易于在患有全身系统疾病的患者(71.43%)和高龄患者(58.73%)的治疗过程中发生。结论:突发医疗紧急事件的发生与多种因素有关,患者自身系统疾病的存在是最主要的内在因素,治疗过程中患者情绪紧张、疼痛、麻药注射等刺激是最常见的诱因,口腔医护人员必须做好对口腔科突发医疗紧急事件的预防。     

心理指导对牙科畏惧症患儿的影响

目的观察心理指导对牙科畏惧症患儿的影响，为探寻治疗牙科畏惧症患儿的策略提供依据。方法牙科畏惧症患儿317例，随机分为试验组177例和对照组140例，试验组在口腔治疗前、中、后进行心理指导，对照组不进行心理指导，口腔治疗结束后应用Frank临床行为分级评定量表判断其畏惧程度。结果试验组在心理指导前后Frankl行为分级变化情况有统计学意义（P〈0．01）。结论心理指导对改善牙科畏惧症患儿在口腔治疗中的畏惧程度有良好的效果。     

口腔内科老年患者的心理状态分析和护理

两年来对182例口腔内科老年患者观察,发现患者的心理变化与治疗疗效有关。 患者的心理反应可分为畏惧、紧张(198人次中占111人次)、焦虑、消极(占74人次)、怀疑(占8人次)。平静(占5人次)。(由于部分病例存在多种心理,心理反应之和为198人次。) 治疗及护理时就应针对心理反应实施,才能提高疗效。由于患者的社会经历、地位、文化修养等个体间差异较大,故其反应程度与疾病的严重程度并不成正比,但有一定规律:年龄越高,体质越弱的患者,心理反应越严重。不良的心理反应不仅可以降低患者的耐痛程度,还影响治疗的顺利完成,     

儿童牙科畏惧症调查分析

目的 探讨儿童牙科畏惧症(dental fear,DF)的发生情况及产生原因.方法 采用临床焦虑及合作行为级别评定量表对300例儿童牙病患者进行调查及统计分析.治疗前问卷式调查、填表,治疗后由经治医师记录患儿DF发生情况.结果 300例儿童牙病患者中DF患者245例,发生率为81.67%,不同性别儿童DF发生率无统计学差异,年龄不同、牙科经历不同、口腔卫生状况不同的儿童DF发生率有统计学差异.结论 儿童DF发病率较高,与患儿年龄、不良的牙科经历、口腔卫生状况等因素有关.儿童DF直接影响儿童牙病的防治工作.     

280例口腔修复科患者牙科畏惧症的初步探讨

２８０例口腔修复科患者牙科畏惧症的初步探讨苏州口腔医院口腔修复科洪炯牙科畏惧症（ＤｅｎｔａｌＦｅａｒ，ＤＦ或ＤｅｎｔａｌＡｎｘｉｅｔｙ，ＤＡ）是指对牙科所持有的忧虑、紧张或害伯的心理状态，以及在行为上表现为敏感性增高，耐受力降低，甚至躲避治疗的现象。...     

Predicting anxiety during dental treatment using patients'self-reports: less is more

BACKGROUND: Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment. METHODS: One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales. RESULTS: Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment. CONCLUSIONS: Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.     

The impact of childhood sexual abuse on dental fear

OBJECTIVE: Dental fear is a risk factor for poor oral health. Thus, treatment of dental fear is a challenge to dentists. The consequences of childhood sexual abuse (CSA) may include dental fear. A history of CSA complicates dental fear treatment, and it is often a secret. The aim of this study was to explore differences in subjective evaluations of use of dental services, experiences of dental treatment situations, dental appearance and dental problems in women who report both CSA and dental fear, and women who report dental fear only. METHODS: In an anonymous survey, 58 women with dental fear and a history of CSA were compared with 25 women with dental fear without CSA. Twenty-five women without dental fear acted as a control group. RESULTS: No differences between dental fear patients with and without a history of CSA were found in subjective evaluations of use of dental services, dental appearance and dental problems, or in the scores on the Dental Fear Scale (DFS). Women who reported a history of CSA and dental fear had statistically significant higher scores on the Dental Belief Scale (DBS). CONCLUSION: The results suggest that women who report dental fear and a history of CSA assess interpersonal factors concerning communication, trust, fear of negative information and lack of control as more fear evoking than women who report dental fear without a history of CSA.     

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.     

Methods Helping Dentists to Detect Dental Fear

ObjectivesDental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients’ self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed.MethodsA cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new “traffic light” colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants.ResultsOf the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF “traffic light” system. The association between dentists’ and participants’ estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen's kappa value = −0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS.ConclusionsColour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.     

Background data about the dental fear scores of Hungarian secondary school students

Free association (coupling) of 139 Hungarian secondary school students (90 females, 49 males, age between 14-18 yr.) about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: simple and traumatising dental treatments, etc.) were coupled by the participants in 36,7% of the cases. Functions and importance of the teeth and oral hygiene were described in 7,2% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 16,5% of the cases. No answer was found in 39,6% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Age had no influence on the sense of the association (coupling).     

Childhood fear and anxiety states in relation to dental treatment

Five years experience by the authors in organizing a dental psychology clinic has impressed on them that many excessively fearful child patients have a history of untoward dental and medical experiences which might have been prevented. A background to an understanding of fear and anxiety in children is presented, and two cases are described to illustrate straight-forward behavior modification techniques which can be used to help the fearful or excessively anxious child cope with dental treatment.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.     

Oral-health-related quality of life among children with and without dental fear

Objectives.  This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured.
Material and methods.  The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register ( n  = 51) and schoolchildren ( n  = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule–Dental Subscale and a single question. ORHQoL was measured with CPQ_11–14. Background variables were gender and the dental care experienced.
Results.  The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ_11–14 total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P  < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics.
Conclusion.  Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.