龋病防治的临床难度评估

龋病是发生于牙体硬组织的慢性感染性疾病,具有发病率高、治疗率低等特点,严重危害口腔和全身健康。加强和完善龋病的规范化治疗是全人群、全生命周期龋病管理面临的关键问题。因此,在龋病诊断和分类的基础上,建立龋病防治临床难度评估系统,主要包括龋病风险评估和龋病治疗难度评估,可为龋病管理提供有效的依据。本文围绕龋病防治难度评估系统,从龋病的诊断和分类、龋病风险评估和龋病治疗难度评估等龋病防治临床管理的重要组成部分进行归纳与阐述。     

龋病活跃性试验及龋危评估的研究进展

龋病活跃性检测试验是检测个体或人群对可能发生龋病的危险因素的敏感程度。笔者就近年来常用的龋活性试验的原理、用途及优、缺点进行综述，并介绍龋危预测评估系统（Cariogram）的基本原理和重要意义。     

儿童龋病的风险性评估

儿童龋风险评估是对儿童个体的年龄、生物学因素、保护性因素和临床检查结果进行综合性分析,评估个体的患龋风险,是口腔保健人员和口腔医生制定治疗计划的重要组成部分。本文从儿童龋病的危害、不同年龄阶段儿童龋风险评估的内容及作用等方面进行归纳。     

全口牙齿龋病程度的数字评估法

龋病程度的统一正确评估，有助于各调查资料结果的比较，有利于根据不同的龋病程度制定相应的预防保健措施和治疗处置方案，更能通过防治前后龋病程度的变化客观反应防治效果。因此制定一种统一标准的评估法是极为必要的。龋病程度的评估，根据评估对象可分为单个牙齿、全...     

体外人工龋模型的建立方法及检测新技术

体外人工龋模型在龋病的研究中有重要的地位,它在龋病病因、病理及预防治疗方面起着不可替代的作用。我们现有的对龋病过程中矿物盐变化的了解,有很大一部分来源于体外实验。人工龋模型使单纯了解某种因素对龋病进程的影响成为可能,也可用于评价干预措施的有效性。     

蛋白质组学在龋病研究中的应用

随着人类基因测序的完成和后基因组学时代的到来,蛋白质组学应运而生,现今蛋白质组学已经涉足于包括口腔疾病在内的众多领域。龋病是最常见的口腔疾病,用蛋白组学的方法研究龋病具体发生发展机制,有利于我们更深入地理解龋病的发生发展过程,进行更好的防治。本文就蛋白质组学在龋病研究中的应用做一综述。     

基于慢性疾病管理理念的重度低龄儿童龋管理方法

重度低龄儿童龋是威胁中国儿童口腔健康的主要疾病。目前中国龋病治疗的主要手段是充填修复,对重度低龄儿童龋患者,充填修复具有患儿难配合、新发龋多、经济及医疗负担重等局限之处。随着对龋病病因学和疾病过程的深入理解,学界提出了基于慢性疾病管理思路的龋病管理模式,通过对致龋因子和保护因子的干预来改善口腔环境,由单纯的去除龋坏组织转向控制龋病的疾病进程,由此来改善龋病的治疗效果。本文以龋病的慢性疾病管理方法及国外本专业学术组织发布的指南进行回顾综述,为中国重度低龄儿童龋防治提供参考。     

1052例上海市普陀区外来儿童龋病调查

目的 了解上海市普陀区外来儿童的龋病发病情况。方法 按全国口腔流行学调查标准，对1052名外来儿童的龋病进行调查。结果 乳牙患龋率85．8％，龋均4．61；恒牙患龋率6．45％，龋均1．4。结论 上海市普陀区外来儿童乳牙龋病患病率仍处较高水平，防治是关键。     

光纤透照在龋齿诊断中的应用研究进展

龋病是一种常见病、多发病,人们需要有效的龋齿诊断方法发现早期病变,进行早期治疗,同时可监测龋病发展,预防和控制龋病。放射线检查因其电离辐射和技术要求而受到限制。近年来,新型数字化光纤透照技术因其可无创、无辐射,多次检查并摄取检测图像,通过所获取的数据信息评估龋洞深度而受到人们关注。本文主要介绍数字化光纤透照技术的原理、发展及其在龋病诊断中的应用研究进展。     

北京市海淀区3岁儿童龋病患病状况及龋病活跃性检测的研究

目的 通过了解北京市2所大学附属幼教机构学龄前儿童的口腔健康状况、龋病活跃性,了解儿童患龋情况与龋病活跃性之间的关系,探讨龋病活跃性检测筛查龋易感儿童及反映龋活跃性检测试剂的灵敏性和特异性,评价其对患龋预测的有效性和可行性.方法 对3岁年龄组儿童进行连续1年的口腔检查和龋活跃性检测,分析儿童患龋情况的变化与龋病活跃性之间的关系.结果 3岁儿童的患龋率为44.80%,龋均dft为2.04,龋面均dfs为2.79,儿童龋活跃性检测结果的各个分值与儿童患龋程度呈高度正相关关系(P<0.001).1年后随访,龋高危组儿童的新龋发生率显著高于龋低危组,经统计学检验其差异具有显著性意义(P<0.001).Cariostat法进行龋活跃性检测的敏感度可达95.1%,特异度达50.2%.结论 龋活跃性检测能够准确的反映儿童龋患现状,预测儿童患龋的趋势,为儿童制定个性化的预防保健计划.     

儿童龋病管理

龋病是临床上最为常见的儿童口腔疾病,儿童龋病在我国具有患病率高、治疗率低的特点。近年来,随着对龋病认识的日趋深化以及材料和技术的不断进步,儿童口腔医学不仅仅关注儿童龋病的治疗,开始更多地强调对其进行早期预防、诊断和干预,微创理念亦贯穿儿童龋病预防和诊疗的全过程。文章从对龋病发生发展的再认识出发,就儿童龋病风险评估和管理以及如何治疗儿童龋损做一介绍。     

儿童龋病管理

 龋病是临床上最为常见的儿童口腔疾病，儿童龋病在我国具有患病率高、治疗率低的特点。近年来，随着对龋病认识的日趋深化以及材料和技术的不断进步，儿童口腔医学不仅仅关注儿童龋病的治疗，开始更多地强调对其进行早期预防、诊断和干预，微创理念亦贯穿儿童龋病预防和诊疗的全过程。文章从对龋病发生发展的再认识出发，就儿童龋病风险评估和管理以及如何治疗儿童龋损做一介绍。     

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。     

The Monitor Practice Programme: is non‐invasive management of dental caries in private practice cost‐effective?

Background: The objective of this research was to assess the efficacy and cost‐effectiveness of a non‐invasive approach to dental caries management in private dental practice. Methods: Private dental practices from a variety of locations in New South Wales were randomly allocated to either non‐invasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient‐level decision analytic model was constructed to assess the cost‐effectiveness of the intervention at two years, three years, and hypothetical lifetime. Results: Twenty‐two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non‐invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years). Conclusions: A joint preventive and non‐invasive therapeutic approach appears to be cost‐effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.     

儿童龋病分级管理

儿童龋病分级管理模式是指通过临床检查与问卷调查,将儿童分为不同的患龋风险等级,并进行相应的个性化、精细化管理,以期达到降低儿童龋病患病率的目的。近年来,尽管我国卫生行政部门在儿童龋病防治方面投入了大量的人力和物力,但收效甚微。根据第四次全国口腔健康流行病学调查结果显示,我国儿童龋病患龋率仍处于较高水平。目前,国内已有不少文献对儿童龋病的风险评估进行了研究,但对其后的管理模式尚未有文献探讨。而国外已有文献对儿童龋病的管理模式进行了讨论,并且有些地区已将龋病分级管理的部分步骤应用于实践。文章将对儿童龋病分级管理模式进行论述,以期为我国儿童龋病的管理提供借鉴。     

The Monitor Practice Program: implications for dentistry and dental education

The restorative model of care, known colloquially as drilling and filling, has been challenged on the basis of its inappropriateness. The Caries Management System protocol was developed as an evidence‐based strategy for non‐surgical treatment of caries lesions and the Monitor Practice Program was designed to test the hypothesis that use of the protocol would reduce risk of dental caries experience. After 7 years, patients attending intervention practices, compared with those attending control practices, needed: 30%–50% fewer restorative interventions; 55% fewer first time restorative interventions; 32% fewer repeat restorative interventions; and were only 23% as likely to be classified as high risk. The outcome was cost‐effective and patients attending intervention practices highly valued non‐invasive care, and intervention dentists derived professional satisfaction from non‐surgical caries management. The implications of the program are that the general public will likely embrace the benefits of non‐invasive caries management, as will many current and future dental practitioners. This calls for dental practice reform including: the establishment of a clinical discipline in cariology; cariology curriculum development; revised accreditation regulations for cariology programs in dental schools; advanced training in clinical cariology leading to a specialty; support from the dental profession; and public health advocacy.     

部分去龋法治疗恒磨牙深龋的疗效观察

目的:探讨部分去龋治疗恒磨牙深龋的临床疗效.方法:对102颗恒牙深龋进行部分去龋法结合树脂严密充填,随访6个月以上,评价其牙髓存留率及治疗主观感受.结果:随访到的97颗患牙中,90颗充填物完好,牙髓活力正常,治疗成功率为92.8％;79.9％的患者治疗感受为轻度不适或无反应.结论:部分去龋法治疗恒牙深龋,可以减少牙髓暴露的风险,减轻患者治疗时的不适,获得较好的充填治疗效果,值得临床推广.     

The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults

In the absence of effective caries preventive methods, operative care became established as the means for caries control in general practice. Water fluoridation resulted in a declining caries incidence which decreased further following the advent of fluoridated toothpaste. The challenge today is to develop a non-invasive model of practice that will sustain a low level of primary caries experience in the younger generation and reduce risk of caries experience in the older generations. The Caries Management System is a ten step non-invasive strategy to arrest and remineralize early lesions. The governing principle of this system is that caries management must include consideration of the patient at risk, the status of each lesion, patient management, clinical management and monitoring. Both dental caries risk and treatment are managed according to a set of protocols that are applied at various steps throughout patient consultation and treatment. The anticipated outcome of implementing the Caries Management System in general dental practice is reduction in caries incidence and increased patient satisfaction. Since the attainment and maintenance of oral health is determined mainly by controlling both caries and periodontal disease, the implementation of the Caries Management System in general practice will promote both outcomes.