口腔科门诊儿童牙病护理配合体会

目的探讨如何利用有限人力资源做好儿童牙病治疗过程中的护理配合工作,使儿童在相对平稳的心理状态下安全快捷地接受治疗,提高医生的工作效率。方法对386例2~12岁患儿进行相应的心理诱导后,根据其配合程度进行临床分型,针对不同患儿采用不同术中护理配合。结果 2~4岁患儿52.44%属于心理诱导不合作型,需要采用固定法护理配合。5~6岁患儿中51.45%属于基本合作型,50.72%采用四手操作护理配合。7~12岁患儿中53.61%属于合作型,59.04%采用巡回护理配合。结论巡回护理配合更适合7~12岁患儿。2~4岁患儿多需要固定法护理配合。四手操作适合各个年龄段,尤其是5-6岁的学龄前患儿。     

正畸治疗中影响儿童配戴活动矫治器的心理分析附210例调查

在正畸治疗中由干部分患儿不同程度的存在心理障碍，不能按医嘱要求配戴矫治器，致使矫治时间拖的很长，门诊病人大量积压，再则矫治器不能妥善保管而造成损坏和丢失，给矫治工作带来一定的困难。为了更好地配合临床工作，提高矫治效果；我们对主要影响患儿配戴矫治器的心理因素进行了调查。     

儿童患者在牙病诊治中的心理特点及护理

通过临床随机调查的503例牙病患儿在就诊过程中表现出的心理状态,将患儿分为配合型、依赖型、恐惧型、拒绝型,提出家长的言行举止、患儿年龄大小以及生活环境的不同将影响患儿在就诊中的配合程度。并总结出相应的护理措施:适合儿童就诊的环境布置,候诊患儿的宣传教育,接诊患儿言行举止要热情、亲切、和蔼,诊疗中什对患儿不同心理特征采用诱导、表扬、对比等方法,引导患儿配合治疗。     

386例婴幼儿舌系带过短矫正术的临床分析

目的：了解舌系带过短对患儿造成的不良影响,探讨舌系带过短小儿手术治疗的理想时期。方法：收集2002～2008年在福建省宁德市闽东医院口腔科接受舌系带过短手术的患儿386例（年龄为出生后3天至8岁）,根据年龄不同将患儿分成五组,比较各组患儿在舌系带肥厚率、术中缝合率、术中配合程度及术中出血量的区别,并且评估每组的手术安全性及术后护理的难易程度。结果：3～6个月年龄组的肥厚率、术中缝合率、术中出血量均较低,手术配合程度较佳,而手术安全性相对较高,术后护理较为容易。结论：小儿舌系带过短手术是安全有效的,手术最佳时期为出生后3～6个月。     

认知行为疗法对学龄前牙科焦虑症患儿就诊合作程度的干预评估

目的：评估认知行为疗法应用于学龄前牙科焦虑症患儿口腔治疗的效果。方法收集3～6岁牙科焦虑症患儿86例，随机分为试验组和对照组。试验组采用认知行为疗法进行行为管理，对照组采用Tell-Show-Do技术进行行为管理。通过比较2组患儿的配合程度和Frankl治疗依从性评分来评估该方法对学龄前牙科焦虑症儿童就诊行为的干预效果。结果试验组中，38例能配合治疗，5例不能配合，对照组中24例配合，19例不配合，试验组配合程度优于对照组（χ2=11.328，P＜0.01）；Frankl治疗依从性评分结果，试验组为（2.61±0.82）分，对照组为（1.93±0.96）分，试验组优于对照组（F=1.956，P＜0.01）。结论应用认知行为疗法对学龄前牙科焦虑症患儿治疗时，首先进行必要的情绪干预，而后再行无痛治疗，可纠正患儿的恐惧心理。     

水合氯醛在幼儿牙体治疗中的应用

幼儿牙体治疗时不能配合一直是儿童牙科工作者所面临的问题。我们以往采用强制的方法进行治疗，往往加深了患儿对牙体治疗的恐惧感，加剧了患儿的对抗行为，治疗时容易出现意外，治疗时间仓促使治疗效果不易得到保证。     

全身麻醉在儿童口腔疾病治疗中的应用

目的：评价全身麻醉在不配合儿童口腔疾病治疗中的临床疗效。方法：收集4—12岁患口腔疾病需治疗病例59例,分别对捆绑强制性多次复诊完成治疗和全麻一次性完成口腔疾病治疗进行临床效果对比评估。结果：全麻下对不配合儿童进行口腔治疗能缩短疗程、提高医疗质量,改善口腔整体卫生水平,减少继发龋、充填物脱落率（P＜0.05）,减轻治疗过程给患儿带来的恐惧、焦虑等负面情绪,有效提高患者的依从性（P<0.05）。结论：对于不配合治疗儿童进行全麻一次性治疗耗时短、疗效高,可降低心理恐惧和焦虑,保护患儿的心理健康,提高患儿的依从性。     

提高护理水平 预防儿童牙科畏惧症

目的探讨有效的护理措施在儿童配合牙科治疗中的作用。方法采用牙科畏惧症(DF)的评价标准进行分级,针对患儿的具体情况,采用一些护理措施。结果577例患儿有575例得到了不同程度的治疗,配合率达到99.6%。结论有效的护理措施能提高患儿在牙科中的配合率及治疗效果。     

医务人员着装和行为对唇腭裂住院患儿心理的影响

本文从唇腭裂住院患儿的心理特点出发,分析其病程、病情、年龄、住院环境、社会家庭因素对唇腭裂患儿的心理影响,探讨医务人员如何通过着装和行为来减轻唇腭裂住院患儿的心理压力.研究显示,通过塑造医务人员良好的仪容、仪表和行为规范,加强环境营造,体现人文关怀,可以使唇腭裂住院患儿减轻心理压力,由本能的反抗过渡到配合治疗.因此,医务人员针对唇腭裂患儿的特殊病情和心理特点采取有效的措施,可逐步解除患儿的心理问题,使他们能以最佳的心理状态积极配合治疗和护理.     

家长陪伴的麻醉诱导在儿童口腔颌面手术中应用效果评价

目的:探讨家长陪伴能否提高口腔颌面外科手术患儿麻醉诱导期的安全性。方法:采用随机对照研究,入选120例2~6岁口腔颌面外科手术患儿,随机分为2组,每组各60例。2组家长均进行术前宣教,试验组（P组）患儿家长在麻醉诱导期陪伴患儿,对照组（N组）患儿则无家长陪伴。在麻醉诱导时记录并比较2组患儿的血压、心率、氧饱和度,以及诱导时的配合度。采用SPSS 17.0软件包进行数据分析。结果:有家长陪伴的患儿与无家长陪伴的患儿相比,在麻醉诱导期心率及氧饱和度明显平稳,配合度也较好。结论:麻醉诱导期家长陪伴能有效提高口腔颌面外科手术患儿围术期麻醉安全性,是一项值得开展及推广的医患合作新途径。     

Long-term effects of two different treatments for dental fear and avoidance

Follow-up clinical studies of treatment for dental fear and avoidance behavior are infrequent in the literature. The present investigation reports follow-up results over more than two years from 84 out of 99 patients treated for dental fear in a Swedish community-based dental fear clinic. Broad-based behavioral therapy (BT) or general anesthesia (GA), both in combination with adjusted conventional dental treatment, were used. The frequency of patients' attendance for regular dental care after two years was unchanged or even somewhat increased and was significantly higher in those who had received the BT therapy. Most patients stated that they had no problems after leaving the dental fear clinic. Among patients reporting such problems, the change of dentist was most frequently reported. The level of dental anxiety as measured by Corah's DAS was still at a low level, in spite of a slight increase over the two years since initial therapy.     

基于环境听觉管理的舒适化治疗策略在儿童牙科畏惧症中的应用效果研究

摘要：目的    探讨基于环境听觉管理的舒适化治疗策略在儿童牙科畏惧症中的应用效果。方法    选择2021年7—8月于武汉大学口腔医院儿童口腔科就诊需行口腔治疗的3 ~ 10岁牙科畏惧症患儿60例，随机分为试验组和对照组，每组各30例。对照组仅进行行为管理，试验组在行为管理基础上采用环境听觉管理（佩戴无线智能耳机聆听音乐或音乐故事）。采用儿童畏惧调查-牙科分量表（CFSS-DS）和Venham临床焦虑与合作行为级别评定量表（以下简称“Venham量表”）评估两组患儿治疗前后的焦虑畏惧水平和临床合作情况。结果    在治疗后，两组患儿CFSS-DS评分较治疗前均显著下降，且试验组患儿CFSS-DS评分和Venham量表评级均显著低于对照组，差异均有统计学意义（均P < 0.05）。此外，试验组患儿的临床合作率显著高于对照组，差异有统计学意义（P < 0.05）。结论    基于环境听觉管理的舒适化治疗策略能够有效缓解儿童的牙科畏惧症状和焦虑水平，提高就诊的依从性和配合度，有望为开展儿童口腔舒适化治疗提供新的思路和参考。     

Machine learning methods applied on dental fear and behavior management problems in children.

The etiologies of dental fear and dental behavior management problems in children were investigated in a database of information on 2,257 Swedish children 4-6 and 9-11 years old. The analyses were performed using computerized inductive techniques within the field of artificial intelligence. The database held information regarding dental fear levels and behavior management problems, which were defined as outcomes, i.e. dependent variables. The attributes, i.e. independent variables, included data on dental health and dental treatments, information about parental dental fear, general anxiety, socioeconomic variables, etc. The data contained both numerical and discrete variables. The analyses were performed using an inductive analysis program (XpertRule Analyser, Attar Software Ltd, Lancashire, UK) that presents the results in a hierarchic diagram called a knowledge tree. The importance of the different attributes is represented by their position in this diagram. The results show that inductive methods are well suited for analyzing multifactorial and complex relationships in large data sets, and are thus a useful complement to multivariate statistical techniques. The knowledge trees for the two outcomes, dental fear and behavior management problems, were very different from each other, suggesting that the two phenomena are not equivalent. Dental fear was found to be more related to non-dental variables, whereas dental behavior management problems seemed connected to dental variables.     

Maximizing beneficence and autonomy. Ethical support for the use of nonpharmacological methods for managing dental anxiety

This article examines advantages associated with nonpharmacological behavioral management techniques and suggests that there are benefits to their use (such as achieving a more lasting solution to the problem of dental anxiety) that are not realized with medication-based interventions. Analyses that use Kantian and existential viewpoints for exploring the use of medication versus behavioral interventions for managing life problems yield parallel conclusions: there are advantages gained by using behavioral interventions that are not always associated with medication-based interventions. These analyses, taken together with an understanding of the psychology of dental anxiety management, suggest that using nonpharmacological techniques for the management of dental anxiety can maximize adherence to the ethical principles of beneficence and patient autonomy. The authors discuss the barriers that make nonpharmacological interventions for anxiety management difficult for dentists to routinely use, and suggest that additional training in these methods and increased collaboration with mental health professionals are needed for dentists.     

Dental hygiene fear: gender and age differences

Studies aimed at examining gender and age differences as they relate to dental anxiety have begun to appear in the literature. The purpose of this investigation was to explore fear and anxiety in a dental hygiene setting and evaluate gender and age differences among four sub-scales of dental hygiene fear. The Dental Hygiene Fear Survey (DHFS) was developed to address patient reaction to dental hygiene treatment. The University of Washington Dental Fears Model was the theoretical model used for it identifies four domains of dental fear: fear of specific stimuli, generalized anxiety, fear of catastrophe, and distrust. Males and females respond differently to dental hygiene treatment with women reporting significantly (p<.05) greater fear overall than males. Examination of the four dental hygiene fear sub-scales show that females report greater fear (p<.05) in relation to specific fear and generalized anxiety. There were no significant differences across age categories on total fear scores or within any of the sub-scales. Characterization of the dental hygiene fear patient along with knowledge of procedures that elicit anxiety can assist the practitioner in recognizing dental hygiene-related fear. With this foundation, the practitioner can then develop management strategies specific to this phenomenon.     

How can child life specialists help address dental fear and anxiety in children?: A review

BackgroundPainful pokes, buzzing drills, uncomfortable pressure, foreign tastes, and disturbing noises are all events that a child can experience in a single dental appointment. Each event has the potential to trigger dental fear and anxiety in pediatric patients. Dental fear and anxiety are common for children and can lead to the neglect of dental care into adulthood. Many behavioral interventions currently in practice focus on immediate behavior changes rather than long-term psychosocial well-being of children.ObjectiveThe purpose of this paper was to review the literature of pediatric dental fear and anxiety and provide reasoning for child life specialist intervention in the pediatric dental clinic.ResultsRooted in developmental theory, child life specialists advocate for the psychosocial care of children in various healthcare environments, including dental clinics. Child life specialists work to minimize pediatric fear and anxiety using various strategies, including psychological preparation. Psychological preparation is accomplished by the provision of developmentally appropriate education, therapeutic or medical play, and preparation books.ConclusionsFurther research is needed to establish the effectiveness of child life specialist intervention, such as psychological preparation, in pediatric dentistry at reducing pediatric dental fear and anxiety.     

Dental fear treatment: comparison of a video training procedure and clinical rehearsals

Abstract – Two types of fear desensitization, video training, and clinical rehearsals, were evaluated using psychometric tests, behavioral measures, and interviews for a group of 68 dental fear patients with high and low general trait anxiety. After treatment, a visual analogue scale (VAS) also tested the degree of perceived anxiety before going off to an unknown dentist. Results indicated no significant differences in dental fear reduction effects of the two types of desensitization. However, both treatments showed significant and meaningful effects when compared with a group of 75 dental fear patients on a waiting list who were also tested once at the beginning of the waiting period and again after 6 months. Only high general anxiety subjects resisted desensitization and failed standardized dental treatment tests. Exit interviews revealed that both groups named securing/accepting personnel, conversations about their fears and relaxation, in that order, as the most important factors in their dental fear reduction. Psychometric trust scores confirmed this. VAS scores showed a significant increase in fear level about the next dentist, also indicating trust as a major factor in reducing dental fear. Suggestions are made about which patient conditions can affect the choice of either of these training methods.     

Dental fear treatment: comparison of a video training procedure and clinical rehearsals.

Two types of fear desensitization, video training, and clinical rehearsals, were evaluated using psychometric tests, behavioral measures, and interviews for a group of 68 dental fear patients with high and low general trait anxiety. After treatment, a visual analogue scale (VAS) also tested the degree of perceived anxiety before going off to an unknown dentist. Results indicated no significant differences in dental fear reduction effects of the two types of desensitization. However, both treatments showed significant and meaningful effects when compared with a group of 75 dental fear patients on a waiting list who were also tested once at the beginning of the waiting period and again after 6 months. Only high general anxiety subjects resisted desensitization and failed standardized dental treatment tests. Exit interviews revealed that both groups named securing/accepting personnel, conversations about their fears and relaxation, in that order, as the most important factors in their dental fear reduction. Psychometric trust scores confirmed this. VAS scores showed a significant increase in fear level about the next dentist, also indicating trust as a major factor in reducing dental fear. Suggestions are made about which patient conditions can affect the choice of either of these training methods.     

Dental fear in adults: a meta-analysis of behavioral interventions

OBJECTIVES: The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia. METHODS: Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis. RESULTS: The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4). CONCLUSIONS: Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance ( >4 years after treatment) is 77%.     

Dental anxiety: differentiation, identification and behavioral management.

Dental anxiety has always been and still is a major impediment to regular dental care for a significant proportion of the general public. In years past, dental professionals could afford, by and large, to ignore this problem. Practices could flourish based on their technical virtuosity, and fearful or anxious patients might be considered a burden rather than a concern. Today, however, the laws of supply and demand are causing dentists to pay increased attention to aspects of the profession that extend beyond the science of clinical technique. A successful practice now depends on interpersonal as well as technical skills, particularly the ability to manage dental anxiety. Despite this, most dentists admit to a surprising lack of confidence when it comes to understanding the nature of anxiety and the modern methods advocated for its everyday management, which generally rely on behavioral modes of intervention. This paper is designed to familiarize practitioners with some of the basic elements of dental fear and anxiety, and their day to day management.