416例老年人根面龋的诊治体会

牙根面龋是老年人常见的龋病,由于病损的发生随年龄的增加而上升,因此该病的发生与年龄有较为密切的关系。近年来我们共治疗老年人根龋416例,现报告如下: 1 临床资料     

He面尚未成洞龋早期诊断方法的进展

近20年来，由于预防工作的广泛展开，特别是氟化物的广泛应用，龋病的发病率明显下降。但He面龋所占比例却有所增加，常表现为在表面正常的牙釉质下向深层发展。因此，如何对尚未成洞龋作出早期正确诊断已成为口腔医生日益关注的问题，传统的视诊、探诊法已远远不能满足要求，迫切需要开发新型、有效的龋病诊断技术。本文介绍几种He面尚未成洞龋的诊断方法。     

对中老年人牙根面龋的观察和治疗

牙根面龋是中老年人的常见病,近年来引起国内外学者的关注,对其病因、临床表现和治疗进行了多方面的研究。我们从117名患者中,调查分析了1580个牙,治疗了500个患牙,经过随访观察总结如下: 1 一般资料 本组为随意抽样的门诊就诊患者117名,男女比例约3:2,年龄45～85岁。对1580个牙的分析:按病变破坏程度分为浅、中、深龋,按龋坏部位分为单面洞、双面洞和环形洞。其中单面洞占50％,双面洞和环形洞占50％。治疗500个患牙中,病程发展到中、深龋者占66％。     

无龋根面和牙骨质龋菌斑菌丛的研究

本实验选择门诊患者28人,分为无龋恨面组和牙骨质龋组进行了细菌学研究。结果提示:轻链菌、粘放菌和内氏放线菌是参与菌斑组成的基本成员;变链菌在牙骨质龋组中显著多于正常无龋根面组达10倍以上,在统计学上有极显著差异,提示变链菌为根龋的主要致病菌;而韦荣氏菌是基础牙菌斑微生物群落成员之一。     

根面龋研究进展

恨面龋是中老年人常见的口腔疾病,随着人口老龄化,患龋率逐年上升,直接危害中老年人的口腔健康。笔者对根面龋的定义、临床特点、病因、好发部位、流行情况及防治方法进行综述。     

两种材料治疗老年人根面龋的疗效观察

老年人由于牙龈萎缩和长期佩戴假牙压迫牙龈组织等原因,易造成根面龋损,根面龋是中老年人常见的口腔疾患之一,根据调查:老年人根面龋患病率在35%左右,随着年龄的增长发病率升高.给老年患者造成进食和生活上的困难,降低了生活质量.笔者将近几年临床诊断为老年人根面龋的牙齿,分别采用两种材料进行临床充填治疗,并对其近期疗效进行观察,现报道如下.     

两种方法治疗中老年人根面龋近期疗效观察

根面龋是中老年人常见的口腔疾患之一，随着年龄的增长发病率升高。本组对155例60岁以上的中老年人共268个临床诊断为根面龋的牙齿，分别采用两种方法进行治疗，并对其近期疗效进行观察，现报道如下。     

He面可疑龋诊断不同方法比较

目的：比较临床检查（ＣＥ）,常规Ｘ线片（ＣＲ）,Ｈｅ翼片（ＢＷ）和牙科Ｘ线影像诊断系统（ＲＶＧ）诊断可疑Ｈｅ面龋的精确性。方法：４４个可疑Ｈｅ面龋的离体牙作为研究对象,以病理组织学检查为标准,测定计算真、假阳性率（ＴＰ,ＦＰ）和预测值（ＴＰ／ＦＰ）。结果：ＴＰ和ＦＰ是：ＣＥ＝０．６３和１．９１,ＣＲ＝０．５９Ｔ和０．８８,ＢＷ＝０．３９和０．５８,ＲＶＧ＝０．６８和１．８５。ＴＰ／ＦＰ是：ＣＥ＝１     

根面龋细菌学初步分析

目的 :通过对根面龋菌斑微生物的定量分析 ,进一步了解根面龋的致龋机制。方法 :19例根面龋患者 ,根据临床表现分为活动性和非活动性龋 ,对其根面龋的菌斑微生物进行菌落计数。结果 :无论活动性还是非活动性根面龋 ,厌氧菌都有较高的检出率 ,活动性根面龋检出率更高 ,活动性根面龋中链球菌总菌、变链菌、放线菌和乳杆菌检查率稍高 ,在非活动性根面龋中韦永氏菌和新月单胞菌的检出率稍高。梭杆菌及类杆菌 (包括紫质单胞菌、普氏菌、脆弱类杆菌 )检出率二者相似。活动性根面龋的各菌菌落计数均多于非活动性根面龋 ,差别最明显的是变形链球菌和放线菌。结论 :变形链球菌 ,放线菌是根面龋由非活动性到活动性转变的优势菌     

牙合面尚未成洞龋早期诊断方法的进展

近20年来,由于预防工作的广泛展开,特别是氟化物的广泛应用,龋病的发病率明显下降.但牙合面龋所占比例却有所增加,常表现为在表面正常的牙釉质下向深层发展.因此,如何对尚未成洞龋作出早期正确诊断已成为口腔医生日益关注的问题,传统的视诊、探诊法已远远不能满足要求,迫切需要开发新型、有效的龋病诊断技术.本文介绍几种牙合面尚未成洞龋的诊断方法.     

(牙合)面可疑龋诊断不同方法比较

目的:比较临床检查(CE),常规X线片(CR),(牙合)翼片(BW)和牙科X线影像诊断系统(RVG)诊断可疑(牙合)面龋的精确性.方法:44个可疑面龋的离体牙作为研究对象,以病理组织学检查为标准,测定计算真、假阳性率(TP,FP)和预测值(TP/FP).结果:TP和FP是:CE=0.63和1.91,CR=0.59T和0.88,BW=0.39和0.58,RVG=0.68和1.85.TP/FP是:CE=1.91,CR=0.88,BW=0.58,RVG=2.06.RVG与CE及CR无显著性差异(P>0.05).结论:RVG可期望增加诊断效果,并可减少X线剂量和产生即刻影像.     

Effect of contact media on the diagnostic quality of electrical resistance measurements for occlusal caries

BACKGROUND: Electrical resistance measurements have been used for the diagnosis of occlusal caries. Both site and surface-specific techniques have been described, the latter more suited to clinical trials or epidemiological surveys. For surface-specific measurements the tooth is dried and a contact medium drawn along the fissure pattern to provide an electrical contact between a probe tip and the tooth surface. OBJECTIVES: Different contact media have been used and it was the aim of this study to investigate whether different contact media could influence the diagnostic accuracy and repeatability of surface-specific electrical resistance measurements. METHODS: Electrical resistance readings were taken on 99 molar teeth using saline, KY jelly, toothpaste or dental prophylaxis paste. Readings were repeated on 44 randomly selected teeth. The teeth were serially sectioned and visually examined to establish the deepest lesion if present. RESULTS: The Student t-test showed that there were statistically significant differences between readings taken with different contact media, with the exception of toothpaste and prophylaxis paste, where no difference was found. The strongest relationship between histology and resistance reading was achieved with KY jelly (r = 0.559). The optimum sensitivity and specificity achieved was 0.59 and 0.86, respectively (resistance cut-off 0.1 M(Omega)). ROC analysis showed that the diagnostic performance of saline was significantly inferior to the other contact media (P < 0.05). Limits of agreement were used to assess repeatability which were acceptable for all media except toothpaste. CONCLUSIONS: Differences were found between electronic resistance readings taken with different contact media. KY jelly was found to produce the best overall diagnostic performance and should be the standard material used for surface-specific measurements.     

Performance of diagnostic systems in occlusal caries detection compared

Abstract – Many investigations have been conducted to evaluate existing and new diagnostic systems in the detection of occlusal carious lesions. The performances of these systems are difficult to compare with each other, because of the disadvantages associated with the widely used validity parameters sensitivity and specificity. In this study a meta-analysis was performed to facilitate a comparison between the performances of diagnostic systems which are currently in use in occlusal caries diagnosis. Nine in vitro studies and one in vivo study complied with the selected criteria for inclusion in the analysis. The sensitivity and specificity values obtained from these studies were converted into normal deviate values, and plotted on linearly scaled normal-deviate axes. D_z values, which quantify the performance above chance of a diagnostic test in one single value, were calculated. Averaged D_z values of the diagnostic systems were subsequently compared to each other. The results indicate that electrical resistance measurements and fiber-optic transillumination had a comparatively good, and visual inspection and xeroradiography a poor, performance in occlusal caries diagnosis. All the other radiographic image modalities had intermediate performances.     

Value of bitewing radiographs in detection of occlusal caries

A system of diagnosing occlusal caries from bitewing radiographs was developed in an attempt to overcome the problems of clinical diagnosis found in other studies. Standardised bitewing radiographs for 1172 Berkshire schoolchildren aged 11-13 years who were participating in a toothpaste trial, were assessed for occlusal caries under uniform magnification and illumination. The radiographic scores were then compared with the clinical records for these subjects. The radiographic technique proved to be acceptably reproducible at 82.6%. However, only 33.2% of the lesions present were detected on the radiographs. It is concluded that bitewing radiographs for the detection of occlusal caries are of little value in epidemiological studies.     

The prevalence of questionable occlusal caries: Findings from The Dental Practice-Based Research Network

BackgroundQuestionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this studyMethodsA total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices.ResultsOverall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively).ConclusionsTo the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions.Clinical ImplicationsQOC is common in routine practice and warrants further investigation regarding how best to manage it.     

Electronic diagnosis of occlusal caries in vitro: adaptation of the technique for epidemiological purposes

Abstract Most studies on electronic diagnosis of occlusal caries have involved taking site-specific conductance measurements. Airflow around the electronic caries monitor probe removes superficial moisture and the conductance measurement reflects the caries status of that part of the fissure beneath the probe tip. This is an appropriate technique for a clinician to use to monitor caries status, and it could be adapted for use in epidemiological studies and clinical trials. The present work investigated an alternative technique using a jelly as a contact medium over the entire fissure system so that the probe might record the overall caries status of the tooth reflecting the worst affected site. Readings were taken on 96 extracted teeth with dye-coloured jelly acting as a contact medium. Readings were repeated on 32 teeth. Histological validation of caries status was carried out by visual examination of serial sections through each tooth to note the deepest lesion. The sensitivity and specificity of the overall electronic caries monitor readings were calculated for all lesions and dentine lesions only using selected resistance cut-off points and presented as a series of Receiver Operating Characteristic (ROC) curves. The optimum sensitivity and specificity values were, for all lesions: 61% and 86%, and for dentine lesions: 76% and 76% respectively. The reproducibility of the readings was acceptable (Kappa values for all lesions= 0.76, for dentine lesions=0.55). The technique warrants further study as an overall reading may be more appropriate for epidemiological and clinical trial use.     

Clinical and radiographic judgement of occlusal caries in adolescents

In this study, the clinical and radiographic material of two groups of 17- and 20-yr-old adolescents, born either in 1970 or in 1976, was compared to study changes in the prevalence of occlusal dentine caries and to determine the additional value of the bitewing radiographs. The first and second molars of 478 participants were included. Clinical data were derived from an epidemiological project. Two examiners judged the bitewing radiographs, of which about 10% was examined by both. The overall Cohen's kappa for interexaminer agreement was 0.87. The prevalence of occlusal caries had not changed for the two age groups; after clinical and radiographic examination, around 33% of the occlusal surfaces of the 17 yr olds and around 25% of the 20 yr olds exhibited dentine caries. The clinical prevalence of occlusal caries in first and second molars was highly underestimated when compared with the radiographs. In the 1976 group, more sealants were recorded during the clinical examination. On the bitewing radiographs, radiolucencies were found underneath one-half of the sealants of the 17 yr olds and underneath one quarter of the sealants present in the 20 yr olds.     

光学相干断层成像技术在龋病诊断中的研究进展

早期诊断龋病能够及时干预病变,终止或逆转龋病进程,降低治疗成本。现有的临床及影像学检查手段对龋病诊断的敏感性较低。光学相干断层成像作为一种无创、无辐射的高敏感性和特异性的检测手段,在龋病的诊断中有着良好的应用前景。本文就光学相干断层成像检查原理以及其在平滑面龋、窝沟龋、邻面龋和继发龋诊断中的研究进展作一综述。     

Clinical performance of a laser fluorescence device for detection of occlusal caries lesions

Children and adolescents must be examined often for occlusal caries. Diagnosis of fissure caries is difficult especially when the tooth surface appears seemingly intact. It has been shown that using traditional clinical methods, as little as 20% of teeth with fissure caries under intact surfaces were correctly recognised as such. Therefore, new methods for increasing the accuracy of diagnosis have been sought for years. Recently, a new device, based on fluorescence measurements, was introduced. The purpose of this study was to test the device under in vivo conditions in order to provide recommendations for its use in the dental office. Seven general dental practitioners examined a total of 332 occlusal surfaces in 240 patients. Caries extent was determined for each site after operative intervention (='gold standard'). Clinical inspection and analysis of bitewing radiographs exhibited statistically significant lower sensitivities (31-63%) than did the DIAGNOdent device (sensitivity > or = 92%). It is recommended that the laser device is used in the decision-making process in relation to the diagnosis of occlusal caries as a second opinion in cases of doubt after visual inspection.