口腔正畸与患者社会心理因素的关系

正畸治疗过程的不适及美观上的不足会对患者的社交活动及心理造成影响,从而影响患者寻求正畸治疗的积极性、治疗过程中的依从性以及治疗完成后的满意度.本文对正畸治疗前、中、后患者的心理及其相应的影响因素作一扼要综述.     

舌腭弓等正畸焊接技巧

舌弓、腭弓 ,Ｎａｎｃｅ弓等是正畸矫治中常用的增强支抗的方法 ,焊接成功与否直接关系到矫治的效果 ,它们可以通过带舌腭侧的舌面管与带环相连接 ,但临床上更常用的是将其与带环直接连接在一起。临床上通常的做法为 :首先将带环从口内翻到石膏模型上然后弯制舌腭弓 ,然后固定 ,用银焊焊接舌腭弓。常用的固定方法为 :蜡固定后用石膏包埋。我们认为整个过程中有 5个关键会严重影响焊接效果 ,现将体会和经验环节介绍如下 :1　取印模　　取印模前需先将带环焊接面打磨成粗糙面以利焊接。取模时带环有时没被直接翻入阴模中 ,从口内取出放回阴模…     

正畸患者对矫治结果满意度的回顾性分析

目的 探讨错He畸形矫治结果与矫治前预测目标的协调性。方法 对1998年以来收治的138例错He畸形患者矫治后满意度进行回顾性分析。结果 本组138例中112例对矫治后面容满意，26例对矫治后面部美观效果不满意。结论 矫治前对矫治结果的预测和与患者的沟通十分重要。     

口腔正畸患者就诊原因和满意度调查分析

目的 研究正畸患者就诊的目的、动机和就诊满意度,促进正畸科口腔医疗服务质量的提高.方法 随机抽取口腔正畸科门诊咨询及治疗患者1065人进行问卷调查,对结果进行描述分析.结果 研究发现正畸治疗的主要原因是影响容貌美观及个人形象;儿童主要是应父母的要求前来就诊,而成人病人主要是为了社交、工作及恋爱、婚姻的需要;患者最为关心的问题主要包括医生技术水平、治疗效果,疗程长短及收费的高低.90％以上的复诊患者对接诊医生服务态度与医疗质量,护士及导医的服务态度及质量,诊疗环境满意或基本满意.结论 最大程度获得颜面部及牙齿的美观是正畸患者就诊的主要原因;患者对西安交通大学口腔医院正畸医疗服务整体满意率相对较高,对等候或排队时间满意率低.     

老年患者活动义齿修复椅旁护理沟通技巧的探讨

目的探讨口腔修复门诊老年患者的椅旁护理沟通技巧及作用。方法收集2007～2009年在广东省口腔医院番禺分院行活动义齿修复的老年患者116例,对其进行术前心理疏导、修复过程心理护理、义齿佩戴注意事项的指导。结果性格固执、任性的男、女性患者分别占45.45%（20/44）和23.61%（17/72）,男性高于女性,两者差异有统计学意义（χ^2=5.04,P〈0.05）。男、女性患者对修复效果的不满意率分别为6.82%（3/44）和4.17%（3/72）,男性略高于女性,两者差异无统计学意义（χ^2=0.04,P〉0.05）。116例老年患者在诊治各阶段经过椅旁护理的充分沟通,基本消除顾虑和恐惧心理,积极配合治疗。对修复效果不满意者经反复多次的椅旁沟通后均顺利完成整个修复治疗过程。修复过程中护理配合熟练,所有患者对治疗修复效果都满意。结论充分的椅旁护理沟通可给予老年患者精神与心理上的支持和鼓舞,增加患者对医生的信任,增加治疗信心,配合诊治,提高义齿修复的满意度。     

嵴上纤维环切辅助正畸压低牙周炎患牙的研究进展

随着人们对口腔健康及美观意识的提高,成年正畸患者逐渐增多,成年人的牙周状况较差,常有牙根暴露、附着丧失、松动度增加、前牙扇形移位等临床表现。近年来有研究报道,嵴上纤维环切术联合正畸治疗可以增加牙周炎患牙骨内根长、减少附着丧失、改善牙周炎患者的牙周状况和美观。本文就嵴上纤维环切术辅助牙周炎患牙正畸压低的背景、临床操作及效果作一综述。     

Peplau人际关系理论在口腔正畸治疗中的护理应用

目的探讨Peplau人际关系理论在口腔正畸治疗的护理过程中护士与患者及家属建立良好护患关系、提高患者治疗依丛性的实践效果。方法对286例错胎畸形患者在口腔正畸治疗时采用Peplau人际关系理论指导临床。开展相关护理。结果整个护理过程护患沟通良好．患者对护理服务质量满意率逐年上升,2012年患者的满意率为95．2％、依从性为93．8％,2013年满意率为97．3％、依丛性为95．6％,2014年满意率为99．5％、依丛性为98．5％。结论Peplau人际关系理论应用在口腔正畸治疗中可促进护患关系的良好互动与沟通．提高患者的治疗依从性。     

口腔正畸医生诊疗行为与患者治疗满意度的相关性研究

目的:探讨口腔正畸医生诊疗行为与患者治疗满意度两者之间的相互关系。方法:选取门诊410名口腔正畸患者,采用“口腔医生行为评价量表”,口腔治疗满意度量表进行问卷调查,并分别按照性别、年龄和疗程进行分组比较。对获得的数据使用SPSS18.0软件进行相关分析、逐步回归和秩和检验等统计分析。结果:口腔正畸医生诊疗行为与患者治疗满意度之间的相关系数R=0.750,有明显的统计学差异(P<0.05)。在24种口腔正畸医生诊疗行为中,有6种与患者治疗满意度产生明显的正相关(P<0.05)。女性较男性对治疗的满意程度更高(P<0.05)。青少年与成人之间以及在不同疗程间的满意度无显著性差异。结论:口腔正畸医生要规范自己的诊疗行为,加强与患者的沟通交流,提高患者治疗满意度。     

正畸医生行为与患者满意度和医患关系的影响

目的：探讨正畸医生诊疗行为与患者满意度和医患关系的影响。方法：随机抽取正畸治疗复诊患者400名进行问卷调查，年龄12～38岁，其中男133名，女267名。结果：①正畸医生的24种行为与患者满意度及医患关系均有显著相关性（P〈0．0001），三者均与年龄性别无关。②正畸医生有6种行为明显影响患者满意程度（R^2=0．518），正畸医生5种行为明显影响医患关系（R^2=0．448）。结论：正畸医生的诊疗行为与患者满意度及医患关系密切相关。     

口腔正畸临床摄影常见问题及技巧探讨(二):口内摄影

口内像是口腔正畸的重要资料,拍摄的好坏会影响病例的展示水平,直接妨碍论文的发表。在已发表的各类论文的临床图片中经常会发现这样那样的错误,我们将针对这些问题进行探讨。     

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隐形矫治器要求患者有较好的合作性。由于矫治器本身的特性,患者的临床牙冠不应过短。根据该矫治器对牙齿的控制程度,可将矫治病例分为低、中、高矫治难度。矫治难度越低,控制程度越好。     

The effect of undergraduate education in communication skills: a randomised controlled clinical trial

Purpose: To determine whether students improve their communication skills as a result of supervised patient care and whether a newly implemented communication course could further improve these skills. Method: We conducted a randomised, controlled trial including all participants of the first clinical treatment course (n = 26) between October 2006 and February 2007. Randomisation was balanced by gender and basic communication skills. The test group practised dentist‐patient communication skills in small groups with role‐plays and videotaped real patient interviews, whereas the control group learned in problem‐based workshops both on a weekly basis. Before and after the interventions (two group pre‐ and post‐design) all students conducted two interviews with simulated patients. The encounters were rated using a 10‐item checklist derived from the Calgary–Cambridge Observation Guide I. Results: Repeated measures ANOVA (α = 0.05) showed a significant difference of the sum scores of the ratings between test and control group (P = 0.004). The participants educated in communication skills improved significantly (Δ = +14.9; P = 0.004), whereas in the control group no accretion of practical communication competence was observed (Δ = ?3.9; P = 0.23). Conclusion: It could be demonstrated that solely interacting with patients during a clinical treatment course did not inevitably improve professional communication skills. In contrast, implementation of a course in communication skills improved the practical competence in dentist‐patient interaction.     

无托槽隐形矫治患者与固定矫治患者龈沟液中白细胞介素变化的对比研究

目的 对比无托槽隐形矫治患者与固定矫治患者治疗后龈沟液中白细胞介素（IL）-1β、IL-6、IL-8、IL-10、IL-16和IL-18的表达水平差异。方法 选取接受无托槽隐形矫治的67例患者作为观察组,接受固定矫治的40例患者作为对照组,分别检测患者接受矫治前与接受矫治后24 h、12个月龈沟液中IL-1β、IL-6、IL-8、IL-10、IL-16和IL-18的表达水平。结果 接受正畸治疗前2组龈沟液中各IL的表达水平差异无统计学意义（P>0.05）;正畸治疗24 h后2组龈沟液中的IL-1β、IL-6、IL-8、IL-10和IL-18表达水平均升高,但2组间所有IL因子表达水平差异无统计学意义（P>0.05）;正畸治疗12个月后观察组龈沟液中的IL-1β、IL-6、IL-8、IL-10和IL-18表达水平低于对照组（P<0.05）,IL-16表达水平2组间差异无统计学意义（P>0.05）。结论与固定矫治相比,无托槽隐形矫治患者的口腔炎症反应较弱,更有利于口腔微环境的恢复。     

Assessing communication skills for medical interviews in a postgraduate clinical training course at Hiroshima University Dental Hospital

The study was conducted to investigate and clarify the effectiveness of our method of teaching communication and interview skills for medical interviews. Subjects were 18 first-year residents, enrolled in a postgraduate clinical training course at Hiroshima University Dental Hospital. Subjects underwent two objective structured clinical examinations (OSCEs), and the results of instructor and resident assessments of various elements dealing with necessary communication skills for conducting medical interviews were analysed. A statistically significant correlation between assessments of instructors and residents was observed in one element: confirming patient identity and introducing self (r = 0.812, p < 0.001) in the first interview. However, a statistically significant correlation between assessments of instructors and residents was observed in four elements in the second interview: greeting the patient (r = 0.548, p < 0.05), maintaining physical distance (r = 0.582, p < 0.05), showing empathy (r = 0.601, p < 0.05), summarizing and reconfirming patient complaints (r = 0.628, p < 0.01). Total scores given by instructors in the second OSCE were higher than those in the first OSCE (p < 0.001). The correlation coefficients of the total score in the first and second interviews were r = 0.020 and 0.679 (p < 0.01), respectively. These results may suggest the educational effectiveness of OSCE on the acquisition of communication skills for medical interviews. However, the results of resident self-assessments reveal that OSCE should be performed at least twice in order for residents to acquire the necessary communication skills for medical interviews.     

Meta-analysis in evidence-based orthodontics

Author – Papadopoulos MA Objective – In the last 10 years, health sciences literature has seen a significant increase in papers that report findings of meta‐analyses. Meta‐analysis overcomes the weakness of conventional narrative literature review. Moreover, it has established itself as a significant tool in clinical research and evidence‐based medicine. But despite its station in the field, it is not without controversy. The aim of this paper is to present the main controversies that surround meta‐analyses and to discuss the most important issues of conduct and reporting of results derived from these studies. Results – Controversial issues include the ability of the investigators to combine studies that differ in important aspects; such as study populations, experimental designs and quality controls, and the like. It has been argued that selection bias could exist. Thus, it is common for the results of meta‐analyses to be contradictory. As any other statistical procedure or analytical approach, meta‐analyses too can be misused or abused. Misleading results could be avoided if certain basic principles are followed in the conduct of a meta‐analysis. In particular, attention should be given to: (a) the methods of literature search for the studies to be included in the analysis, (b) the measures taken to reduce or eliminate bias, (c) the inclusion and exclusion criteria of the individual studies from the analysis, (d) how the data will be extracted from the literature, and (e) how the data will be analyzed statistically. Conclusion – Reports of meta‐analytical studies carried out with the above parameters in mind yield a more objective appraisal of the evidence, and a more precise estimate of the treatment effect.     

数字化正畸中前牙转矩设计的比较

正畸治疗过程中,前牙转矩不仅会影响前牙区的美观,也会影响后牙咬合关系,因此前牙转矩的控制具有重要意义.如何通过数字化技术控制前牙转矩是目前正畸临床应用的热点问题,而前牙转矩控制的方案设计是许多正畸医生临床操作的疑难和困惑所在.笔者通过文献复习,结合临床病例的研究结果,对个性化唇侧矫治器、个性化舌侧矫治器和透明矫治器3种...     

The role of orthodontics in temporomandibular disorders

Summary Temporomandibular Disorder (TMD) is the main cause of pain of non‐dental origin in the oro‐facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD‐related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.     

数字化三维诊疗技术在口腔正畸学中的应用

数字化三维诊疗技术有利于三维诊断、医患沟通、远程诊疗、辅助治疗,有助于提升正畸治疗的精确性、有效性和安全性。本文将从三维颜面成像、三维数字化牙颌模型、三维头影测量、锥形束计算机断层扫描三维重建、数字化三维手术模拟、颞下颌关节的三维诊断和评估等方面的研究进展作一综述。     

正畸临床中融合牙的治疗体会

目的：探讨正畸治疗中融合牙的临床处理方法,以期获得有效的治疗方法。方法：收集近3年来临床中伴有融合牙的错耠畸形病例7例（男3例,女4例）,根据面型的突度及患者的就诊要求,经Bolton分析确定治疗方案,采用拔牙或不拔牙治疗,同时结合邻面去釉。结果：采用不同的矫治设计方案,以Bolton指数来指导拔牙或不拔牙、结合邻面去釉,所有患者均获得满意的临床矫治效果。结论：对于融合牙引起的牙量骨量不调及Bolton指数不调,可根据临床症状选择拔牙或不拔牙,结合邻面去釉的治疗方案,两者均可取得良好的临床疗效。