Maryland dental hygienists' knowledge and opinions of oral cancer risk factors and diagnostic procedures

OBJECTIVES: To examine Maryland dental hygienists' (DHs) knowledge of oral cancer risk factors and diagnostic procedures, as well as opinions about the currency and adequacy of their oral cancer knowledge, educational preparation, interest in, and preferred types of, continuing education courses. METHODS: Seven hundred DHs were randomly selected from a registry of 2677 Maryland licensed dental hygienists. A mailed survey instrument provided baseline data on 331 (RR = 60%) DHs. Stratified tabular and logistic analytical techniques were employed (alpha level < or =0.05). RESULTS: Most correctly identified tobacco use (99.7%) and alcohol use (89%) as risk factors; however, 31% incorrectly identified poor oral hygiene as a risk factor. 64% of DHs correctly identified older age as a risk factor, yet only 16% identified that the majority of oral cancers are diagnosed in the 60+ year old age group. Nearly 91% correctly identified the examination procedures of the tongue for oral cancer detection; while only 16% of DHs correctly identified erythroplakia and leukoplakia as the conditions most likely associated with oral cancer. CONCLUSIONS: Gaps in knowledge exist and strongly suggest the need for continuing education courses to clarify risk factors and diagnostic procedures associated with earlier oral cancer detection and prevention.     

National Survey of Korean Dentists' Knowledge and Opinions: Dental Caries Etiology and Prevention

Objectives : Dentists have the potential to influence what their patients know and do regarding dental caries prevention. The practices of dentists and what they tell their patients are influenced, in part, by their own knowledge and opinions. The purposes of this study were to determine the level of knowledge and opinions about caries etiology and prevention among Korean dentists and to describe related factors. Methods : A pretested, 27-item questionnaire was mailed to 2,047 dentists, selected by a stratified random sampling allocated proportionately. A postcard reminder was sent to all dentists after one week. Nonrespondents were sent additional complete mailings after three, seven, and nine weeks. The response rate was 83 percent (n=1,700 dentists). Results : Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that recent graduates and dentists who worked in public health centers were likely to be more knowledgeable about caries etiology and prevention than their counterparts (P<.05). In regression analysis of perceived effectiveness of caries-preventive procedures for children, recent graduates, males, and dentists who worked in public health centers tended to rate caries-preventive procedures more effective than other dentists (P<.05). Dentists who had experience with school-based preventive programs and dentists in rural areas were likely to rate caries-preventive procedures for adults more effective than other dentists (P<.05). Conclusion : Overall, results of this study suggest that the majority of dentists do not know current information concerning etiology and prevention of dental caries, mechanisms of action of fluoride, and effectiveness of preventive procedures for children and adults. Efforts to enhance the level of knowledge and practices of Korean dentists about caries prevention should focus on strategies to educate older graduates and female dentists, especially those in private practice.     

Conceptions of Finnish people about the etiology and prevention of dental caries and periodontal disorders

Conceptions among the general public in Finland regarding the etiology and prevention of dental caries and periodontal disorders were surveyed in two interviews in 1971 and 1972. Both population samples interviewed comprised about 1,000 people aged 15 years and over. Inadequate oral hygiene was the most common (65%) possible cause chosen by the subjects among the causes of dental caries. Only 44% of the interviewees considered sugar to be a cause of cariers. Thorough cleaning of the teeth (83%) and dentist's check-ups twice a year (67%) were the factors most frequently chosen in caries prevention. Avoidance of sugar (56%) ranked as the third in frequency. As regards symptoms of periodontal disorders, tender gingiva, gingival bleeding, and loosening of the teeth were correctly suggested as symptoms by 62, 61 and 45%, respectively. Poor oral hygiene (77%) was the cause of gingivitis most commonly chosen by the interviewees, while simultaneous systemic disease (37%) was considered more important than, for example, dental calculus (31%). As regards treatment of periodontal disorders, careful toothcleaning (73%) received most support. However, this factor was closely followed by misconceptions regarding the supposed advantageous value of drug and rinses (50%), chewing of fibrous foods (45%), and vitamin therapy (38%).     

系统观在龋病病因研究中的体现

龋病病因是口腔医学爱们多年来的探索重点之一,20世纪．60,70年代提出的“四联因素”学说已被逐步证实,并逐渐得到公认,因为它是在系统观点的指导下形成的,本文就龋病病因学理论中的系统观点进行了较为详细的分析与阐释。     

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近十多年来,由于分子生物学技术的引入,对致龋菌的研究已深入到分子水平,从而对龋病发病机制给予了深层次诠释,同时开拓了对龋病防治的新视野。从龋病是细菌感染性疾病的观点出发,本文着重介绍关于龋病病因学中起重要作用的细菌因素方面的研究,附带介绍饮食因素和宿主因素方面的研究概况。     

龋病微生物因素研究进展

龋病是发病率最高的口腔慢性感染性疾病,以变异链球菌为代表的一系列细菌曾被认为是龋病的单一致病菌。然而,近几十年来,基于传统致病菌的防治手段未能有效降低龋病的发病率,人们逐渐认识到单一致病菌理论并不能全面反映疾病与微生物的关系。龋病病因学的微生物研究逐步从传统致病菌理论过渡至微生态失衡理论。目前,随着检测手段的不断发展,大量龋病微生物群落研究陆续开展,龋病“核心微生物组”的概念得以提出,即在龋病发生发展中起到关键作用的一组微生物,这将是未来龋病微生物因素研究的方向。     

A review of systemic and topical fluorides for the prevention of dental caries

ABSTRACT Because community fluoridation constitutes nearly an ideal public health method, it should be the cornerstone of all national programs of dental caries prevention. Where fluoridation is not possible for technical or political reasons, some alternative methods of providing benefits from systemic fluorides are available, including school water fluoridation, dietary supplements of fluoride and the fluoridation of salt. Dietary supplements of fluoride are not recommended for pregnant women for caries protection in their offspring. In areas with low fluoride levels in drinking water, solutions of 2 % sodium fluoride, 8% stannous fluoride and acidulated phosphate-fluoride (APF) (1.2% F ion) and the same concentration of an APF gel applied professionally can prevent dental caries. APF is currently the choice for these applications. Fluoride prophylaxis pastes should be used, particularly when a topical fluoride application is not scheduled to follow the prophylaxis. Effective unsupervised topical fluoride applications occur with use of fluoride containing dentifrices. Supervised self-applications of fluoride for public health programs overcome the inefficiencies of individual professional applications. Many studies continue to be reported on mouth-rinsing with fluoride solutions, toothbrushing with fluoride solutions and gels, toothbrushing with fluoride prophylaxis pastes and the application of fluoride gels in mouthpieces. Fluoride mouth-rinsing has several advantages. Self-application of fluorides will undoubtedly become the method of choice for delivering topical fluorides.     

氟化物在儿童和青少年龋病防治中的应用

氟是人体所需的微量元素之一,适量的氟可预防龋病.氟化物的防龋机制体现在降低釉质溶解度,促进釉质再矿化,抑制细菌代谢和菌斑形成,影响牙体形态等方面.氟在龋病预防中的应用主要有氟的全身应用和局部应用.前者包括饮水氟化:将饮水中的F-调整到适宜质量浓度,使其能预防龋病,又不会导致并发症;食盐氟化:以食盐为载体加入氟化物;牛奶氟化:将适量氟化物添加到牛奶中以预防龋病;氟片和氟滴剂:兼有局部和全身的双重作用,以全身作用为主.全身用氟有优点有缺点,需根据不同国家和不同地区的实际情况选择性应用.后者包括个人用氟:使用含氟牙膏、含氟漱口水、含氟牙线和茶叶水漱口等多种方式;专业用氟:氟溶液涂布、含氟涂料、含氟凝胶、含氟泡沫、含氟材料和缓释氟材料等.局部用氟在临床及家庭预防中较为普遍,防龋效果较佳.     

"摩梭人"龋病流行状况及口腔保健知识的调查

目的 :本调查旨在了解“摩梭人”龋患情况及对龋病相关知识的认识。方法 :选择“摩梭人”886人 ,男 389人 ,女 4 97人。口腔专业人员进行问卷和口腔内检查 ,用WHO(1997)口腔健康调查表 ,记录每户家庭内受检者的龋、失、补牙数 (DMFT)以及对龋病相关知识的认识。采用龋均 (XDMFT)和患龋率 (cariesprevalencerate)来描述受检人群龋病的严重程度。结果 :调查发现龋病常在家族中流行 ,该人群的龋患率为 4 8% ,龋均为 4 .9。其中女性的患龋率明显高于男性 (P <0 .0 0 1)。女性龋均为 6 .95± 0 .5 ,患龋率 86 .9% ;男性龋均为 1.6 5± 0 .3,患龋率为 11.4 % ,男女之间每天刷牙及饮食习惯无明显差异。调查群体大部分缺乏对龋病病因及如何预防等知识的认识。结论 :“摩梭人”口腔卫生状况很差 ,龋患情况较严重 ,龋病的发生有明显的性别特征。在该地区应积极开展防龋工作 ,重视口腔卫生保健知识宣传教育工作 ,提高“摩梭人”的口腔自我保健意识。     

Impact of dental treatment on the incidence of dental caries in children and adults

Abstract A review of the literature on the impact of dental care on the incidence of dental caries in children and adults suggests that the effect is small. Dental services were relatively unimportant in explaining the recent decline in caries in 5- and 12-year-olds. An important contribution of the dental services to the decline in caries was a change in the diagnostic and treatment criteria. The role of dentistry in reducing dental caries may lie mainly in the non-personal health services. Knowledge of the life history and patterns of caries attack rates within populations and individuals could be used as a benchmark against which interventions can be assessed. Different teeth and tooth sites are affected differentially at different levels of dental caries. This truism may appear obvious but it is not used to evaluate the effectiveness and quality of dental treatment. A working rule is that “As caries prevalence falls, the least susceptible sites (proximal and smooth surfaces) reduce by the greatest proportion, while the most susceptible sites (occlusal) reduce by the smallest proportion.” There is a specific relationship between the mean DMFT and mean DMFS, and the percentage of caries-free subjects and the frequency distribution of subjects with different levels of caries. Furthermore, the best predictor of caries at older ages is DMFT at a younger age. Caries levels follow trend lines for each level of caries. As the mean DMFT declines so post-eruptive time increases for initiation of caries and the progression rates of caries through enamel decreases. This is true regardless of the presence of fluoride.     

Allocation of dental caries prevention in Swedish teenagers

Abstract – In this study, the hypothesis that teenagers with high caries activity on proximal surfaces receive more preventive care in the Swedish Public Denial Health Service than those with lower caries activity on these surfaces, was tested in an audit study. Dental records and bitewing radiographs from 1987 and 1991 were used to assess caries progression in 406 teenagers from the age of 13 to the age of 17. The time allocated to prevention during the period was also registered. Caries progression as a measure of disease activity was tested. The results showed that the hypothesis could not be verified. The Odds ratio was 1.35. indicating that the chance to gel more than 15 min preventive time during 4 yr was only 1.35 times higher if you were highly caries active than if you were less caries active. Although the reproducibility of the method to use caries progression as a measure of disease activity was not high, it was considered a better indicator of active disease than the number of DMF surfaces.     

龋病病因学与发病机制研究的回顾龋病学研究百年回顾与展望之五

本文扼要介绍白Miller提出化学细菌学说以来有关龋病病因的研究和论点。对龋病的病变机制和引发龋病的细菌特异性问题也作了回顾。     

龋病病因学研究与临床诊疗新进展

龋病是发生于牙体硬组织的慢性感染性疾病,是加重或诱发全身疾病的主要口腔疾病之一。近年来随着高通量多组学技术、疾病动物模型与临床队列研究的进步,以及新型口腔材料与数字化、微创技术的发展,龋病的病因学研究与临床诊疗等方面均取得了较快的发展,全生命周期龋病管理理念更将龋病纳入全身慢性病防治体系,为不同年龄段龋病的群体管理和不同风险因素的个体化防治指明了方向。应进一步加强龋病的基础与临床研究,加快龋病防治新技术、新材料和新器械的临床验证,为龋病的早期诊断、综合预防以及功能与美学并重的微创诊疗提供有力手段,推动我国龋病研究水平的整体提升。     

变异链球菌噬菌体在龋病防治中的研究进展

变异链球菌作为主要致龋病原菌之一,其在牙菌斑生物膜中的过度增殖,是龋病发生发展的重要原因。细菌病毒——噬菌体可特异性感染细菌并有效降解细菌生物膜,因此变异链球菌噬菌体可能用于防治龋病。基于噬菌体的疗法已在多个领域进行临床应用,但变异链球菌噬菌体在龋病中的应用仍处于探索阶段。本文对变异链球菌噬菌体在龋病防治方面的应用进行综述,旨在为龋病的临床预防工作提供新的思路。文献复习结果表明,活噬菌体制剂具有特异性强、亲和力高以及安全性良好的优点,但由于其结构较不稳定,可以通过冻干、喷雾干燥、添加稳定性增强剂等方式,或将噬菌体并入软膏、可生物降解聚合物基质或微粒中加工成较稳定的制剂,在一定程度上提高稳定性;噬菌体产生的裂解酶可以消化细菌细胞壁,从而释放组装好的噬菌体颗粒,其在裂解生物膜中也同样表现优异;通过噬菌体展示技术筛选出针对致龋病原体的抗原结合片段库,利用抗原结合片段的被动免疫也可达到防治龋病的目的。然而,噬菌体的宿主范围狭窄,因此在临床龋病防治工作中可以通过噬菌体联合传统治疗或其他药物使用,或使用多种噬菌体的鸡尾酒治疗。     

The limitations of a 'high-risk' approach for the prevention of dental caries

The decline in the prevalence of caries has lead several authors to advocate the adoption of a 'high-risk' approach for caries preventive strategies. This paper analyses such an approach. It argues that the distribution of caries within a population follows certain laws: first, the mean caries score is a function of the prevalence; second, the variance is a function of the mean; and third, for a particular mean score, the distribution within the population is predetermined. Using data from the National Preventive Dentistry Demonstration Programme (NPDDP) in the US and the British Association for the Study of Community Dentistry (BASCD) epidemiological programmes in the UK the functions determining the distribution of caries within the population are examined. The findings indicate the changes in caries experience observed occurred throughout populations and are not confined to subgroups. Strategies limited to individuals 'at risk' would fail to deal with the majority of new lesions. The main emphasis should be centred on a population approach.     

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龋病是人类最常见的疾病之一,目前仍严重威胁着人群的口腔健康,是造成人类失牙的主要原因。根据我国2002年全国口腔健康流行病学调查,城镇成人患龋率接近50%,儿童患龋率接近80%。     

Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient

The prevalence of dental anxiety in the general population seems to be fairly stable, and the incidence is not reduced in spite of more modern treatment methods. Intensive fear often leads to avoidance of care and consequences like poor oral health, psychosocial problems and reduced quality of life. The aetiology of dental anxiety is complex, but is often associated with direct traumatic dental experiences during childhood. These negative experiences are reported as painful/unpleasant and are influenced by the patient's perception of lack of coping and control. The theory of latent inhibition indicates that several positive dental appointments before any invasive or painful treatment sessions may act as a barrier to these perceptions of lack of coping. This paper is presenting a short overview of behavioural science in dentistry and discussing the role of the dental hygienists as potential key personnel in prevention and treatment of dental anxiety.