载银纳米二氧化钛在口腔材料中抗菌性的研究

复杂的口腔微生态环境中存在多种致病性细菌、真菌等,可引起一系列口腔感染性疾病,如釉质脱矿、龋病、义齿性口炎和种植体周围炎等。传统抗菌方法大多未能达到预期的抗菌效果。载银纳米二氧化钛是一种新型复合型纳米无机抗菌剂,可有效杀灭口腔细菌并分解细菌内毒素,无明显耐药性,被广泛应用于口腔材料的抗菌性能研究中。本文就载银纳米二氧化钛的抗菌机制、生物相容性及安全性、在口腔材料中抗菌性能的研究现状进行综述。     

牙周疾病与流行病学指数的进展

口腔流行病学研究人群中口腔疾患和口腔健康状况的分布以及影响分布因素，以探讨口腔疾病的病因，制定并评价口腔疾病防治和提高口腔健康水平的策略和措施。开展牙周病流行病学调查研究，对推动牙周病的病因研究，改进其防治策略，提高防治效果，具有重大意义。1流行病学指数记分法在牙周疾病中的地位人类在征服口腔中最主要疾病──龋病中取得的成就，其中就包含着口腔流行病学的贡献。牙周病研究比龋病复杂，它涉及到软硬两种组织，病变隐若，对牙周病不容易作客观量度，例如，牙周的病理学症状如软组织的颜色改变、肿胀、出血和牙槽骨的…     

中等卫生学校学生龋病牙周病六年观察分析

龋病、牙周病是口腔常见病,其患病情况在国内已有较多报道,但中等卫生学校学生的龋病、牙周病患病情况.尚未见报道.作者于1990年和1996年对成都第二卫校15～20岁的1020名学生进行了龋病、牙周病患病情况调查;分析其患病情况和发展趋势,为中等专业学校学生口腔常见病的防治工作提供依据.     

口腔细菌对动脉粥样硬化发生发展作用的研究进展

口腔细菌是口腔微生物的重要组成部分,口腔细菌不仅在龋病和牙周病等口腔疾病中发挥重要作用,还与糖尿病和动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease,ACVD）等全身系统性疾病关系密切。文章就口腔细菌与动脉粥样硬化（atherosclerosis,AS）的关联证据及口腔细菌在其中的可能致病机制进行分析和总结,旨在为AS的预防、早期诊断及治疗提供新思路。     

龋病与牙髓病的临床管理

针对现实临床工作越来越重视"术",分科越来越细,看病越来越复杂,而疾病控制特别是对口腔常见病龋病牙周病的控制明显不足的现状,作者提出:回归口腔医疗的初衷,以提高口腔健康、保存健康牙齿寿命为出发点,以疾病控制为考核点,加强龋病与牙髓病的临床管理,将预防与疾病风险评估的理念、疾病预防措施和个性化整体治疗设计融为一体,纳入到口腔医疗临床的各项工作中,达到提高疗效、提高效率的目标。1.龋病的临床管理:需要充分认识龋病发病机制的复杂性和多因素性,充分认识龋病的治疗不是简单的补洞,充分认识多项口腔治疗过程可能增加患龋的风险性,为此,必须建立全面系统的龋病管理体系,包括:(1)建立以龋病与牙周病监控为重点的患者口腔健康档案。(2)对初诊患者口腔健康状况进行综合评估与分析。(3)将龋病牙周病风险控制措施纳入口腔其他疾病治疗计划中。(4)制定符合具体患者的龋病牙周病控制方案。(5)实施合格的牙体修复。(6)口腔医疗机构应该常规使用氟化物控制龋齿。2.牙髓病治疗技术的临床管理:微生物感染是导致牙髓病的主要病原,因此,牙髓病治疗的成功依赖于对微生物感染的有效清除与控制,也依赖于患者自身免疫功能的维持。目前,根管治疗术仍是主要的治疗牙髓病的技术。要通过术前、术中和术后的有效管理,减少创伤、缩短治疗时间、提高疗效、提高效率。根管治疗技术管理的内容包括:(1)治疗前的诊断和病因分析。(2)治疗计划中包括牙体修复和疾病(龋、牙周病等)控制。(3)认识到牙髓病是感染性疾病的大前提,治疗过程和治疗技术要围绕去除感染源、防止感染扩散的原则而展开。(4)认识到为了获得良好的治疗效果,目前的牙髓病治疗技术与所有外科技术一样,实施的是有创操作。但是所有治疗过程需要有充分的保护措施,避免和减少对正常组织的损伤。(5)需要做好术前的准备工作,尽可能减少术中时间,提高工作效率。(6)要严格执行行业的"技术指南"。(7)建立有效的疗效回访和患者口腔健康评估与再评估制度。患者多因"病症"缠身而求医,但医生治病不应只是单纯的治"病症",还要认识导致病症的原发因素,如龋病和牙周病。也要认识到,口腔治疗中的干预措施常常改变口腔的微生态环境,增加患龋病和牙周病的风险,而新发的龋和牙周病常常导致复杂的口腔治疗功亏一篑。要把防范龋病牙周病的措施作为常规性措施纳入口腔治疗中,加强疾病的管理和治疗的追踪。     

可摘局部义齿与口腔微生态平衡

微生态学是研究正常微生物群与宿主的相互关系、生态疗法、生态调整等的科学。戴用可摘局部义齿引起口腔微生态环境失调和促进菌斑的沉积,导致龋病和牙周病发病率增加,以及防治口腔疾病的生态防治法和药物控释系统,本文作了介绍。     

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。     

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口腔内已知细菌种类多达700余种,多种微生物属于益生菌(probiotics)。近年研究发现,益生菌能够竞争性抑制口腔致病菌黏附和定植、中和致病毒素,还可能通过调节机体免疫反应维持口腔中的菌落平衡,从而对龋病、牙周病等的防治发挥积极的作用。特别是益生菌对龋病预防作用取得了更多证据支持,同时口腔益生菌也得到一定商业化开发应用。本文就口腔益生菌的防龋作用与应用做一回顾和展望。     

纳米载银义齿基托生物安全性的研究现状

聚甲基丙烯酸甲酯（polymethyl methacrylate, PMMA）是目前临床中广泛使用的义齿基托材料,它具有良好的生物相容性、化学稳定性和美观性等诸多优点。但PMMA的抗菌性能欠佳,它的较大表面积和高孔隙率易打破口腔内微生物和宿主之间的动态平衡,在使用过程中常发生黏膜发红、溃疡,甚至义齿性口炎的情况。近年来在PMMA中添加纳米载银无机抗菌剂以提高其抗菌性能的研究十分常见,这种新型材料的抗菌性能已被证实。但纳米载银粒子（Ag-loaded nanoparticles, AgNPs）的潜在毒性和口腔材料的特殊性导致其具有一定的应用风险,可能与不同浓度、尺寸、粒径及载体的AgNPs有关。本文综述了近些年关于AgNPs的潜在毒性研究,以及不同纳米载银义齿基托的生物安全性的研究现状,旨在为其临床应用提供参考。     

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.     

Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.     

The role of the dental hygienist in the public health sector; an Australian perspective

A review of the literature on dental hygienists and their utilisation in the dental workforce is presented. Dental hygienists are employed as part of a dental team in the prevention and management of the two most common and costly oral diseases; dental caries and periodontal disease. The potential scope for dental hygienists in the public health sector in Australia is examined in the light of broader issues relating to changing disease patterns, service delivery and the treatment of patients with special needs. Prevention and treatment of oral disease by the dental hygienist in schools, institutions, nursing homes, hospitals and residential facilities is discussed, with emphasis on such issues as legislation, productivity and quality assurance. Implications for the future training of dental hygienists are presented and recommendations made for increasing their utilisation in the public sector.     

大学新生口腔健康知识和健康行为抽样调查报告

目的　调查大学新生口腔健康知识和健康行为。方法　采用全国口腔健康流行病学调查方案统一问卷, 对四川大学1 035名大学新生进行口腔健康知识和健康行为问卷调查。结果　(1)口腔疾病就医行为:1 035名大 学新生中仅13·1%的学生定期接受口腔健康检查;(2)口腔卫生措施:每天刷牙两次的占74·4%,刷牙时间达到 3 min以上的仅7·7%,坚持使用含氟牙膏的16·6%,使用过牙线的人仅6%;(3)饮食习惯:51·9%的学生不常吃零 食,94·7%的学生不吸烟;(4)龋齿与牙周疾病的防治知识及口腔保健知识测试结果普遍较差。结论　大学新生对 口腔卫生知识认识有限,采取的口腔卫生措施不够认真彻底。     

Xylitol in the prevention of oral diseases

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function tor these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root‐surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct tor the prevention of oral diseases tor special needs patients.     

脉冲式冲牙器的研究进展及应用

口腔微生物可附着在牙齿表面形成牙菌斑生物膜,是龋病、牙周病的重要始动因子。有效清除牙菌斑,维护口腔卫生是预防和控制常见口腔疾病的关键措施。脉冲式冲牙器作为清洁口腔的重要辅助工具,应用日益广泛,其潜在价值也日益凸显。本文从脉冲式冲牙器的作用机制、冲洗效果、临床应用以及安全性等方面作一综述。     

正畸治疗中早期龋的防治

错畸形是仅次于龋病和牙周疾病的第三高发口腔疾病,随着文化和社会经济水平的不断提高,人们对正畸治疗的需求逐年增加。正畸固定矫治最常见的并发症——早期龋,已经严重挑战龋病预防和正畸治疗的美学效果,值得医患双方高度重视并采取有效的防治措施。     

Behavioural and socioeconomic factors associated with the simultaneous occurrence of periodontal disease and dental caries

Abstract

Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases.

Materials and methods: The study population consisted of 5255 dentate persons aged ≥30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established.

Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries.

Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.     

农村社区儿童口腔健康状况的调查研究

目的　调查农村地区儿童与青少年口腔健康状况 ,为开展农村社区口腔保健项目制订相应对策。方法　采用随机分层、整群抽样的方法 ,抽取两个省的二个乡镇社区 1～ 12岁儿童及 15岁、18岁青少年共计 2 793名。采用WHO的基本调查方法进行龋病与牙周病患病状况的调查 ,分析学龄前无龋儿童与高龋儿童 (龋均 >3)的分布状况 ,以及调查青少年的牙周健康状况 ,评价疾病的分布范围与严重程度 ,以便确定干预的重点。结果　学龄前儿童乳牙患龋水平很高 ,6岁儿童患龋率为 72 .9% ,龋均 3.6 4 ;其中无龋儿童为 2 7.15 % ,高龋儿童 5 2 .2 % ,97%的龋未经治疗。 7～ 12岁儿童乳牙患龋率随年龄增长逐年下降 ,至 12岁仍有乳牙龋残留。恒牙患龋水平很低 ,12岁患龋率 2 1% ,龋均 0 .38,95 %未经治疗。青少年软垢指数为中等水平 ,口腔卫生状况普遍较差 ,牙龈炎与牙石严重 ,浅牙周袋很少 ,无深牙周袋 ,未发现牙周炎问题。结论　农村儿童乳牙龋患严重 ,恒牙龋水平很低 ,大多数龋未经治疗。口腔卫生状况较差 ,牙龈炎、牙石严重。发展农村社区保健项目 ,初级口腔卫生保健应是重点。     

Self-reported health behavior and dental knowledge of a migrant worker population

In conjunction with operation of a summer school-based dental program in Michigan, 101 children from migrant families, primarily Mexican-American, completed questionnaires relating demographic background, past dental experience, and knowledge of caries preventive methods. A smaller number of available mothers were asked these questions plus others relating to family dental problems, diet and knowledge of periodontal disease. Adults and children reported similar demographic backgrounds. Most children (68.7%) listed brushing as the best way to prevent cavities as did 60% of the mothers. Less than 2% of the children considered use of fluoride in any form as the best way to prevent cavities and only two of 20 mothers mentioned fluoride in this context. Members of this selected population were weak in their knowledge of the relation between a sweet diet and caries, the relation between oral hygiene and periodontal health, and the role of fluorides in caries prevention.