中国成年人牙科焦虑症患病率的Meta分析

目的 系统评价中国成年人牙科焦虑症的患病率,为口腔保健的干预决策提供依据。 方法 计算机检索PubMed、Web of Science、Ebsco、Embase、The Cochrane Library、中国知网、万方数据库和维普数据库有关中国成年人牙科焦虑症的横断面研究,检索时限均从建库到2022年9月30日。筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R 4.0.4软件进行Meta分析。 结果 共纳入39个研究,包括24 309例研究对象。Meta分析结果显示,中国成年人牙科焦虑症患病率为35.39%［95%CI（31.31%,40.01%）］。亚组分析结果显示,男、女性患病率分别为32.92%和44.78%;16~39岁、40~59岁、≥60岁的成年人患病率分别为49.37%、47.13%、37.41%;轻度、中度和重度患者患病率分别为13.81%、15.15%、9.24%;小学及以下、中学、大学及以上文化程度的成年人患病率分别为33.81%、35.84%、36.24%;有牙科治疗史和无牙科治疗史成年人患病率分别为39.45%、45.90%;在口腔门诊接受调查和非口腔门诊接受调查的成年人患病率分别为27.10%、39.31%。 结论 我国成年人牙科焦虑症的患病率较高,以中度焦虑为主,女性、青年、无牙科治疗史的群体更易发生。建议对成年人牙科焦虑症进行早期干预,提高其口腔保健意识和治疗依从性,从而促进我国成年人的口腔健康水平。     

507例放射性颌骨坏死回顾性分析及临床新分期的建立：单一中心20年经验

目的通过回顾性分析放射性颌骨坏死（ORNJ）的临床表现,探讨建立一种可更好地指导临床治疗和预后风险评估的新分期。 方法选择中山大学附属口腔医院1993年3月至2014年10月ORNJ手术病例共507例,根据软组织和骨组织破坏程度,结合长期的临床经验以及对国内外ORNJ分期的总结,提出基于软组织（T）和骨组织（B）破坏程度的"TB"临床新分期,进一步分析不同新分期病损与患者手术情况、手术效果及预后的关系。 结果按"TB"新分期,Ⅰ期55例（10.85%）、Ⅱ期174例（34.32%）、Ⅲ期180例（35.50%）、Ⅳ期98例（19.33%）。Ⅰ、Ⅱ期病例主要采取死骨刮治术、扩大摘除或颌骨方块切除术,Ⅲ、Ⅳ期患者主要采用颌骨节段性切除,部分病例予同期组织瓣包括游离血管化腓骨肌皮瓣转移修复术。不同分期患者手术治疗后均获得较好效果。术后最常见的并发症为手术部位感染（19.92%）和伤口裂开（13.41%）。极少数出现皮瓣坏死、吸入性肺炎甚至死亡等严重并发症。按新分期划分,越严重的患者预后越差,围手术期并发症发生率越高,Ⅰ~Ⅳ期病例围手术期并发症的发生率分别为9.09%、25.86%、30.00%和53.06%。 结论成功建立了一种基于软硬组织破坏程度的"TB"新分期,该分期可更好地用于指导ORNJ临床治疗和预后风险评估。     

食物嵌塞双轴分类法及序列诊疗方案的临床效果观察

目的 探究食物嵌塞双轴分类法及序列诊疗方案的临床应用效果。方法 采用食物嵌塞双轴分类法对272例食物嵌塞患者进行分类,并按序列诊疗方案进行治疗。在治疗结束当天、1月、3月、6月和12月时,根据患者的主观感受进行疗效评价。结果 在治疗结束当天、1月、3月、6月和12月时,患者的主观感受评分分别为2.00、1.93、1.59、1.20、0.98,各时间点的患者主观感受评分均存在差异（P<0.05）;治疗有效率分别为87.17%、81.70%、73.21%、55.80%、44.59%。结论 食物嵌塞双轴分类法及序列诊疗方案可有效地指导食物嵌塞的治疗。     

Can dietary supplements improve a clinician’s well-being and health?

Many people use dietary supplements to improve their physical and mental well-being and their general health, but do not know if they really have any benefit. To our knowledge, little has been published on their use in the clinical environment, so we evaluated the evidence for their benefits in people whose work is physically and mentally challenging. Studies on nutrition and supplementation in athletes and military personnel have clearly shown that several compounds improve cognition, mental well-being, and physical performance. Based on this evidence, and with the many pressures faced by healthcare workers, as well as the need for concentration and endurance, some dietary supplements might be beneficial. Supplementation of a balanced diet with omega-3 fatty acids, vitamin B3, vitamin C and associated antioxidants, vitamin D, and protein, may improve a clinician’s physical and mental health and their performance at work. Specific research is, however, needed to evaluate this more fully.     

MAPK、MMP-2和MMP-9在唾液腺腺样囊性癌中的表达及临床意义

目的:研究人唾液腺腺样囊性癌组织中MAPK(p-ERK1/2、p-P38及p-JNK)、MMP-2和MMP-9的表达情况,探讨其与临床病理特征的关系.方法:应用免疫组织化学SP法检测27例腺样囊性癌组织标本(癌组)和15例正常唾液腺组织标本(对照组)中p-ERK1/2、P-P38、p-JNK、MMP-2和MMP-9的表达情况.采用SPSS17.0软件包对数据进行统计学分析.结果:p-ERK1/2、p-P38、p-JNK、MMP-2和MMP-9在腺样囊性癌组中的阳性表达率(分别为81.48%、88.89%、70.37%、81.49%和77.78%)均显著高于在正常唾液腺对照组中的阳性表达率(分别为20%、26.67%、26.67%、26.67%和26.67%),差异有统计学意义(分别为P<0,01、P<0.01、P<0.05、P<0.01和P<0.01).腺样囊性癌组织中p-ERK1/2、p-P38、MMP-2和MMP-9在Ⅲ～Ⅳ期组的阳性表达率(分别为88.89%、100%、94.44%和94.44%)显著高于Ⅰ一Ⅱ期组(分别为44.44%、66.67%、55.56%和44.44%),差异有统计学意义(分别为P<0.01、P<0.01、P<0.01和P<0.05),但p-JNK的表达与临床分期无统计学关系(P>0.05);p-ERK1/2、p-P38、p-JNK、MMP-2和MMP-9的表达与患者的性别、年龄、原发肿瘤部位、病理分型以及有无神经侵袭、复发和转移亦均无相关性(均为P>0.05);p-ERK1/2、P-P38、p-JNK与MMP-2和MMP-9的表达分别呈显著正相关(分别为r=0.786,P<0.001;r=0.796,P<0.001;r=0.824,P<0.001和r=0.768,P<0.001;r=0.581,P<0.01;r=0.604,P<0.01).结论:P-ERK1/2、p-P38、p-JNK、MMP-2和MMP-9的高表达与腺样囊性癌的临床分期及进展密切相关.MAPK/MMPs通路可能参与腺样囊性癌的发生、发展、侵袭及转移过程.     

Study of Orthophosphate,Pyrophosphate, and Pyrophosphatase in Saliva With Reference to Calculus Formation and Inhibition

Background: A large amount of calculus may hamper the efficacy of daily oral hygiene and thereby accelerate plaque formation. Salivary concentrations of orthophosphate and pyrophosphate are important in preventing calculus formation. Activity of orthophosphate, pyrophosphate, and pyrophosphatase was studied in whole saliva in calculus‐forming groups and plaque‐forming groups. Methods: The material for this study consists of 60 healthy individuals (age range: 15 to 30 years; mean age: 22 years). Depending on calculus index score, individuals were divided into four groups, each of 15 patients: Group 1, calculus index score 0 to 0.6; Group 2, calculus index score 0.7 to 1.8; Group 3, calculus index score 1.9 to 3; and Group 4, plaque group where index varied from 0 to 3. The saliva was collected and biochemically analyzed for concentration of orthophosphate, pyrophosphate, and pyrophosphatase. Results: The mean values of orthophosphate in Groups 1, 2, 3, and 4 were 0.2559, 1.3639, 1.7311, and 0.1868 mM, respectively. The mean values of pyrophosphate in Groups 1, 2, 3, and 4 were 0.3258, 0.1091, 0.0314, and 0.3860 mM, respectively. The mean values of pyrophosphatase in Groups 1, 2, 3, and 4 were 10.7937, 15.4249, 27.2900, and 7.5427 units/ml, respectively. Conclusions: A holistic approach toward the control of periodontal disease should include antiplaque and anticalculus agents. The results are conclusive that the components orthophosphate, pyrophosphate, and pyrophosphatase present in saliva have a very significant role to play in formation and inhibition of calculus. This study reinforces the idea of using pyrophosphate and newer bisphosphonates as potential anticalculus agents.     

Review of clinical EMG studies related to muscle and occlusal factors in healthy and TMD subjects

Several electronic instruments have been developed as adjuncts to objectively record the dysfunctional features of temporomandibular disorders and to study the effectiveness of various treatment interventions. The aim of this review was to assess the value and contribution of clinical electromyographic research in the understanding of asymptomatic and dysfunctional muscle function and the therapeutic effects of interocclusal appliances. For this purpose MedLine and PubMed searches were conducted with the following main keywords alone and in various combinations: electromyography, muscles of mastication, masseter, temporalis, temporomandibular, TMD, utility, validity, repeatability, rest, postural, vertical dimension, occlusal, splint, treatment. The review includes critical evaluation, discussion and conclusions regarding electromyographic studies in asymptomatic and dysfunctional muscles, rest position, occlusal parameters and interocclusal appliances, as well as a critical summary and proposals for further research. Much of earlier critique of many electromyographic studies still applies regarding comparative sample selections, research designs, analyses and conclusions. The areas not well-understood include normal biological variation, capacity for adaptation, fluctuations regarding the clinical course and multidimensional features of temporomandibular disorders and long-term follow-up data, especially in studies that evaluate the effectiveness of therapeutic measures. Considering the required improvements in technical and research designs features and critical appraisal electromyographic research could have value as an adjunct research tool to study features of craniofacial muscle-related dysfunction. Until electromyographic measures are correlated with other multidimensional, especially subjective and pain-related methods, the clinical use of this method for diagnostic purposes of temporomandibular disorders remains in doubt, and is not at present recommended.     

Expression profile of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs in mature human odontoblasts and pulp tissue

Previous studies have demonstrated that (at least) matrix metalloproteinase (MMP)-2, -8, -9, -14 and -20 are expressed by human odontoblasts. Here, we analysed the expression of 19 MMPs and their specific tissue inhibitors (TIMP)-1, -2 and -3) -1, -2 and -3 in mature human odontoblasts and pulp tissue. Since MMP-20 is almost exclusively expressed by the dentin-pulp complex cells, we further analysed the effect of transforming growth factor (TGF)-beta1 and bone morphogenetic protein (BMPs)-2 on its expression. Matrix metalloproteinase-9 served as a positive control for growth factor responsiveness. It was found that MMP-1, -2, -9, -10, -11, -13, -14, -15, -16, -17, -19, -20 and -23, in addition to TIMP-1, -2 and -3 were expressed by both odontoblasts and pulp tissue. Neither MMP-3 nor MMP-12 were expressed in odontoblasts or pulp tissue, and MMP-7, -8, -24 and -25 were expressed only in the odontoblasts; MMP-2, -10, -11, -14 and -20 were expressed more abundantly by odontoblasts, whereas pulp tissue expressed more MMP-13 and MMP-17. Transforming growth factor-beta1 (1 ng ml(-1)) and BMP-2 (100 ng ml(-1)) did not markedly affect MMP-20 mRNA expression. In contrast, TGF-beta1 alone and with BMP-2 significantly upregulated MMP-9 mRNA by 2.4-fold and by 2.6-fold, respectively, in odontoblasts, while in pulp tissue no effects could be detected. The wide-scale expression of MMPs and TIMPs by mature human odontoblasts and pulp tissue suggests that they may participate in dentin matrix organization prior to mineralization, and that growth factors may further control dentin matrix modeling by differentially regulating individual MMPs.     

口腔颌面部手术术后谵妄危险因素的Meta分析

目的分析口腔颌面部手术术后谵妄（POD）的相关危险因素,为临床有效预防POD提供依据。 方法检索Web of Science、PubMed、Cochrane Library、EMbase数据库,时间为数据库建库至2018年7月1日,查找关于口腔颌面部手术POD的相关文献,按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于POD相关因素的数据,采用RevMan 5.3、StataSE 12.0软件进行统计学分析。 结果共纳入11篇口腔颌面部手术POD的相关研究,涉及口腔颌面部手术2429例患者,其中发生POD共415例（发生率17.1%）。研究结果显示,年龄、男性、独居、精神状态、高血压、术前血红蛋白、总蛋白、术中麻醉时间、手术时间、失血量、气管切开术、术后疼痛为口腔颌面部手术POD的危险因素（P<0.05）,而吸烟、酗酒、美国麻醉医师学会（ASA）分级、糖尿病、心脏病、术前血清钠、术前白蛋白、输液量、颈淋巴清扫术、皮瓣转移修复术与POD无明显相关性（P>0.05）。 结论临床上口腔颌面外科医生在术前应密切关注患者的年龄、性别、精神状态、高血压及相关实验室结果（术前血红蛋白、总蛋白）;术中应密切控制麻醉时间和手术时间,减少出血,维持良好通气;术后做好镇痛管理,能有效预防POD发生。     

金刚砂车针清洗消毒及灭菌方法的研究现状

金刚砂车针因其结构复杂、直接与患者口腔接触及需要重复使用的特点,因此关于该车针的清洗消毒灭菌方法一直受到人们的关注。常用的金刚砂车针清洗、消毒、灭菌的方法主要有人工清洗法、酶清洗法、超声震荡法、化学液浸泡法、干热灭菌法和湿热灭菌法。上述方法均存在优点和不足,本文综述了上述方法的适用范围和优缺点以及最新的研究进展。     

Nutrition and health: guidelines for dental practitioners

Good nutrition is vital to overall health, and poor diet and a sedentary lifestyle are major causes of morbidity and mortality worldwide. Nutritional factors are implicated in many oral and systemic diseases and conditions, including obesity, hypertension, dyslipidemia, type II diabetes, cardiovascular disease, osteoporosis, dental caries and some cancers including oral cancers. This review focuses on the evidence for the relations between key nutritional factors and health. Energy intake is related to body weight and obesity, highlighting the importance of lower-energy diets and regular physical activity for body weight maintenance and for preventing obesity. Evidence is presented for the health benefits of high quality carbohydrates, such as whole grain products, and fruits and vegetables, in reducing the risk of cardiovascular disease and cancer. The adverse effects of sugar, sweetened beverages, and trans and saturated fats on several diseases including caries, diabetes and cardiovascular disease are described. The health benefits of unsaturated fats, antioxidants, B vitamins and vitamin D in cardiovascular disease, periodontitis, cancer, and other conditions are documented. Both benefits and harmful effects of dairy product intake on health are discussed. Based on the evidence, nutritional guidelines are provided, as well as key recommendations for preventing obesity. Dentists can play a critical role in motivating and enabling healthy food choices.     

成人口腔多灶性朗格汉斯细胞组织细胞增生症1例

朗格汉斯细胞组织细胞增生症(Langerhans cell histiocytosis,LCH)是一种朗格汉斯细胞异常增殖和浸润性疾病,通常累及全身骨骼、皮肤、垂体,亦可累及肝脏、脾、血液系统、肺、淋巴结及中枢神经系统.成年人罕见.LCH缺乏公认的治疗方案,最常见的治疗方法包括手术、局部注射类固醇药物、化疗、放疗或联合...     

舌系带过短及其诊治方法的研究进展

舌系带过短是一种先天性发育异常,表现为舌系带短粗,与舌腹或口底黏膜的附着点前移,使得舌的运动受限.舌系带过短不同程度地影响了舌的运动,从而可能影响母乳喂养和舌体的吞咽、语音、口腔自洁功能,以及导致开牙合、下中切牙间缝隙等错牙合畸形.其中,舌系带过短对婴幼儿母乳喂养及语音功能的影响,是诊治过程中备受关注、争议较多的热点....     

治疗性义齿对无牙颌患者义齿空间的影响及临床效果评估

目的探究治疗性义齿对无牙颌患者义齿空间变化的影响,并对其临床疗效进行系统性评估。方法对20例接受治疗性义齿治疗的患者进行治疗前后满意度问卷调查,填写口腔健康影响程度量表(oral health impact profile,OHIP?14),收集义齿空间、义齿组织面、咬合印迹、哥特式弓描记图像、黏膜状态、偏侧咬合状态、咬合力、固位稳定、患者咀嚼能力、义齿满意度及OHIP?14评分等数据进行统计分析。结果本研究中受试者通过治疗性义齿的治疗,义齿空间得到改善,义齿的组织面的组织调理剂逐渐分布均匀,咬合印迹逐渐对称、均匀,哥特式弓描记图像显示关节、神经和肌肉逐渐稳定,口腔黏膜转变为健康状态,偏侧咬合情况有所改善,咬合力、固位稳定性和主、客观咀嚼能力也较治疗前有显著提高,在治疗前后的患者满意度及OHIP?14评分均有明显改善,差异有统计学意义(P<0.05)。客观咀嚼能力与义齿的固位稳定性、主观咀嚼能力和义齿满意度呈正相关;而与OHIP?14评分呈负相关。结论治疗性义齿有助于恢复理想的无牙颌义齿的空间,并且能改善患者的口腔健康状况,提高义齿的固位与稳定和咀嚼能力,从而提高患者的满意度,有临床应用的价值与推广的潜力。     

凹面畸形诊断、分类与生长趋势预判

根据面部特征、牙槽相对基骨代偿程度、咬合关系及颌骨形态等要素,凹面畸形可分为牙槽性、颌位性、骨源性（包括上颌源型、下颌源型及上、下源型）3大类。在头颅侧位片,牙槽性、颌位性及骨源性上颌源型,其下颌形态均呈扁长方形,而骨源性下颌源型及上、下源型均呈厚重三角形。从生长发育高峰初始期直至停止期,牙槽性、颌位性及骨源性上颌源型的生长型发展比较稳定,正畸矫形疗效较可靠;而骨源性下颌源型及上、下源型,其生长型严重程度呈增加趋势,而且下颌厚重三角形正中联合凹势越深,预后越差, 表明即使在早期经过正畸矫形治疗,将来畸形复发或仍需要手术干预的可能性较大。     

Biodegradation of differently cross-linked collagen membranes: an experimental study in the rat

The aim of the present study was to compare the biodegradation of differently cross-linked collagen membranes in rats. Five commercially available and three experimental membranes (VN) were included: (1) BioGide (BG) (non-cross-linked porcine type I and III collagens), (2) BioMend (BM), (3) BioMendExtend (BME) (glutaraldehyde cross-linked bovine type I collagen), (4) Ossix (OS) (enzymatic-cross-linked bovine type I collagen), (5) TutoDent (TD) (non-cross-linked bovine type I collagen, and (6-8) VN(1-3) (chemical cross-linked porcine type I and III collagens). Specimens were randomly allocated in unconnected subcutaneous pouches separated surgically on the back of 40 wistar rats, which were divided into five groups (2, 4, 8, 16, and 24 weeks), including eight animals each. After 2, 4, 8, 16, and 24 weeks of healing, the rats were sacrificed and explanted specimens were prepared for histologic and histometric analysis. The following parameters were evaluated: biodegradation over time, vascularization, tissue integration, and foreign body reaction. Highest vascularization and tissue integration was noted for BG followed by BM, BME, and VN(1); TD, VN(2), and VN(3) showed prolongated, while OS exhibited no vascularization. Subsequently, biodegradation of BG, BM, BME and VN(1) was faster than TD, VN(2), and VN(3). OS showed only a minute amount of superficial biodegradation 24 weeks following implantation. Biodegradation of TD, BM, BME, VN(2), and VN(3) was associated with the presence of inflammatory cells. Within the limits of the present study, it was concluded that cross-linking of bovine and porcine-derived collagen types I and III was associated with (i) prolonged biodegradation, (ii) decreased tissue integration and vascularization, and (iii) in case of TD, BM, BME, VN(2), and VN(3) foreign body reactions.     

Management of patients with ocular manifestations in vesiculobullous disorders affecting the mouth

Pemphigoid and pemphigus diseases as well as Stevens–Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon, eyelid malposition, ocular surface scarring and severe visual loss. In addition to diagnostic assessments, ophthalmologists must treat the dry eye and meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants. Topical anti‐inflammatory therapy is used to treat acute inflammatory exacerbations of the ocular surface, but it cannot prevent scarring alone. Intralesional antimetabolite therapy can cause regression of conjunctival pathology in selected cases. Hence, patients with vesiculobullous disorders should be managed by a multidisciplinary team representing ophthalmology, dermatology, otolaryngology, oral medicine and pathology, internal medicine and intensive care. Systemic treatments including corticosteroids, azathioprine, cyclophosphamide, cyclosporine and mycophenolate mofetil help control inflammation. Intravenous immunoglobulins, plasmapheresis and targeted antibody therapy can be used in selected, severe and treatment‐resistant cases. Local surgical management may include debridement of pseudomembranes, lysis of symblepharon, amniotic and mucous membrane grafting as well as reconstructive procedures. Prospective, multicentre, international studies are recommended to further support evidence‐based practice.     

Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 39: 276–288. © 2010 John Wiley & Sons A/S Abstract – Objective: To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. Methods: Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing‐stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community‐dwelling elderly aged 65–95. Results: Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta‐blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. Conclusions: In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.