口腔全科住院医师培训2段式轮转模式的思考和探讨

<正>自2017年开始,浙江大学医学院附属口腔医院住院医师规范化培训采用2段式轮转模式,即第1段（第一年,12个月）轮转口腔颌面外科门诊、口腔修复科、牙体牙髓科和牙周科四个科室各3个月,第2段为第2、3年轮转口腔颌面外科、口腔修复科、牙体牙髓科、牙周科、儿童口腔科、口腔急诊、口腔黏膜科、口腔正畸科、口腔预防科、口腔颌面影像科,共计33个月,前后轮转顺序不固定。颌面外科、修复科、牙体牙髓科和牙周科四个科室每个科室轮转6个月,但分为2次进科,每次3个月。     

1720名孕妇牙体牙周健康状况的调查分析

目的：调查分析武汉市孕妇牙体牙周健康状况,为孕前孕期妇女口腔疾病防治提供依据。方法：按照世界卫生组织制定的口腔健康调查基本方法,对5160名孕妇通过随机抽样,采用口腔健康数据库管理系统记录1720名孕妇牙体牙周健康状况。结果：孕妇总患龋率为58．6％,龋均为1．54,龋面均为2．43。牙龈炎患病率72．1％,结石检出率为53．6％。随着孕周的增加龋患率没有明显差异,牙龈炎的发生明显加重,有统计学意义。结论：孕期妇女牙体牙周健康状况较差,提示应加强孕妇口腔卫生宣传指导,采取措施积极治疗口腔疾病。     

《中华老年口腔医学杂志》稿约

1.本刊为老年口腔医学专业学术期刊,季刊,国内外公开发行,现为中国科技论文统计源期刊。杂志涵盖老年口腔医学及相关学科的内容,包括:老年口腔解剖生理、老年人龋病、老年人牙髓及根尖周病、老年人非龋性牙体硬组织病、老年牙周疾病、老年口腔黏膜病、老年人口腔修复、老年人种植修复、老年人颞下颌关节病、老年口腔颌面感染、老年口腔颌面创伤、老年口腔颌面肿瘤、老年人口腔用药、老年口腔病的预防、老年口腔病的护理等。辟有临床与基础研究论著、专题报告、述评、文献综述、讲座、短篇报道、个案报道、学术交流、会议总结、论文摘要、国…     

《中华老年口腔医学杂志》稿约

1.本刊为老年口腔医学专业学术期刊,季刊,面向国内外公开发行。杂志涵盖老年口腔医学及相关学科的内容,包括:老年口腔解剖生理、老年人龋病、老年人牙髓及根尖周病、老年人非龋性牙体硬组织病、老年牙周疾病、老年口腔黏膜病、老年人口腔修复、老年人种植修复、老年人颞下颌关节病、老年口腔颌面感染、老年口腔颌面创伤、老年口腔颌面肿瘤、老年人口腔用药、老年口腔病的预防、老年口腔病的护理等。辟有临床与基础研究论著、专题报告、述评、文献综述、讲座、短篇报道、个案报道、学术交流、会议总结、论文摘要、国内外学术动态、国际国内会…     

以口腔表征为首发的血液系统疾病500例临床分析

目的： 探讨以口腔表征为首发症状的血液系统疾病的临床特点,为早期诊断,防止漏诊误诊提供依据。方法： 回顾近5年因口腔症状首诊于上海交通大学医学院附属第九人民医院口腔相关科室（口腔黏膜病科、牙周病科、牙体牙髓病科和口腔颌面-头颈肿瘤科）的500例血液系统疾病患者的临床资料,分析其口腔表征的多样性及分布情况。结果： 500例首诊于口腔各科的血液系统疾病患者的口腔表征有口腔黏膜和牙龈出血、牙龈增生、口腔黏膜溃疡、口腔黏膜感染及口腔颌面部肿块。其中以口腔颌面部肿块症状首诊者数量居首,占19.8%。血常规、凝血机制和口腔病理活检对血液系统疾病的初步筛查与确诊至关重要。结论： 多种血液系统疾病都可能在疾病初期就出现口腔表征,正确认识血液系统疾病多样性的口腔表征,结合血常规和凝血机制检查以初步筛选血液系统疾病;对表现为口腔颌面部肿块的患者进行肿块活检,可在临床上更早地对血液系统疾病进行诊断和鉴别诊断,从而避免误诊和漏诊。口腔表征的治疗以针对血液系统疾病为主,口腔局部对症治疗为辅。     

《中华老年口腔医学杂志》稿约

1.本刊为老年口腔医学专业学术期刊,季刊,面向国内外公开发行,每季首月20日出版。现为中国科技论文统计源期刊(中国科技核心期刊)。杂志涵盖老年口腔医学及相关学科的内容,包括:老年口腔解剖生理、老年人龋病、老年人牙髓及根尖周病、老年人非龋性牙体硬组织病、老年牙周疾病、老年口腔黏膜病、老年人口腔修复、老年人种植修复、老年人颞下颌关节病、老年口腔颌面感染、老年口腔颌面创伤、老年口腔颌面肿瘤、老年人口腔用药、老年口腔病的预防、老年口腔病的护理等。辟有临床与基础研究论著、专题报告、述评、文献综述、讲座、短篇报道、个案报道、学术交流、会议总结、论文摘要、国内外学术动态、国际国内会议报道等栏目。欢迎广大作者踊跃投稿。     

58例老年人牙周牙髓联合病治疗初探

牙周牙髓联合病变是老年人常见的一种口腔疾患,患牙常呈现松动,牙龈反复红肿、溢脓及疼痛等症状.治疗一般均待急性炎症控制后拔除患牙,从而导致牙列缺损,影响咀嚼功能,降低老年人的生活质量.为尽量保留牙齿,本文对58例老年患者采用了牙周-牙髓联合治疗,取得较满意效果.     

全军继续医学教育一类项目 牙周病、口腔黏膜病新理论新技术学习班

20 0 4年 9月 8～ 11日 ,第四军医大学口腔医学院将举办全军继续医学教育一类项目———“牙周病和口腔黏膜病学新理论新技术进展”学习班。内容包括 :牙周病检查诊断技术的进展 ;牙周病新分类法介绍 ;牙周基础治疗意义及疗效评估 ;创伤性牙合的调牙合原则和方法 ;牙髓牙周联合     

咬合创伤对口颌系统及全身的影响与矫治

咬合是口颌系统的重要功能结构 ,是完成口腔功能的重要组成部分 ,对保证口腔及全身健康很重要。咬合创伤是口腔的常见疾病之一 ,以往认为咬合创伤是由于功能性或非功能性的力量超过了牙周的适应和修复能力而引起的牙周创伤 ,表现为牙周组织的病损 ,然而咬合创伤无论与牙体、牙髓、牙周肌肉、颞下颌关节均有密切的关系[1 6 ] ;与口腔颌面的各组织结构以及与全身各部位甚至中枢神经等各系统也密切相关 ,与口腔医学中的各个学科均有联系。咬合创伤既作为一种口腔常见病 ,又是引起许多口颌面疾病的原因。咬合创伤对口颌面及其他器官的影响甚至对…     

全军继续教育一类项目牙周病、口腔黏膜病新理论新技术学习班

20 0 4年 9月 8-11日 ,第四军医大学口腔医学院将举办继续医学教育一类项目—“牙周病和口腔黏膜病学新理论新技术进展”学习班。内容包括 :牙周病检查诊断技术的进展 ;牙周病新分类法介绍 ;牙周基础治疗意义及疗效评估 ;创伤性牙合的调牙合原则和方法 ;牙髓牙周联合病变的诊断     

The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women

BACKGROUND: Our objective was to describe the oral health of pregnant women, to determine oral health changes during pregnancy, and to determine factors associated with maternal periodontal health or disease. MATERIALS AND METHODS: Between December 1997 and July 2001, 1,224 pregnant women at < 26 weeks' gestation were enrolled in the study and oral health examinations were performed at enrollment and within 48 hours of delivery. Demographic, medical, and health behavior data were determined by chart abstraction and questionnaire. Comparisons between oral health at enrollment and delivery were made by student t test or Fisher's exact test. Ordinal logistic regression analysis was used to identify risk factors for maternal periodontal disease. RESULTS: Among 903 women, there was a significant increase in those with health/periodontal disease absence between enrollment and delivery (P < 0.001). However, we also observed a significant increase in women with four or more sites with attachment loss > or = 2 mm or > or = 3 mm (P < 0.05, 0.001). Race, smoking, and insurance status were significantly associated with maternal periodontal disease. Black women were more likely than white women to have periodontal disease at enrollment (adj. odds ratio 2.9, 95% confidence interval 2.2 to 3.9) and delivery (adj. odds ratio 3.1, 95% confidence interval 2.2 to 4.2), and experience incident disease (adj. odds ratio 2.3, 95% confidence interval 1.6 to 3.4). CONCLUSIONS: Oral health examinations were well accepted by pregnant women. An increase in attachment loss may represent active periodontal infection accelerated by pregnancy. Further study on racial disparity in oral health among pregnant women is needed. Continued efforts to evaluate and establish appropriate definitions of oral disease in pregnancy are warranted.     

Survey of medical doctors' attitudes and knowledge of the association between oral health and pregnancy outcomes

Abstract: Objectives: The study was designed to assess the views and knowledge of healthcare providers in general medicine and other specialties on the association between oral health and pregnancy outcomes. Material and Methods: Two hundred and fifty physicians practicing in northern Jordan hospitals and healthcare centers were asked to complete a questionnaire. Completed questionnaires with the answers were returned completed by 197 participants (response rate was 79%). Results: The majority of the physicians (81%) agreed that pregnancy increases the tendency to have gingival inflammation. However, 88% of doctors advised delay dental treatment until after pregnancy. Only half (54%) thought that tooth and gums problem can affect the outcomes of pregnancy. Moreover, approximately 50% agreed with the possible association between oral health and pregnancy outcomes. Altogether, 52% agreed with the statement ‘a tooth for a baby’ and 57% believed that calcium will be drawn by the developing baby. If asked to advise patient to visit dentist during pregnancy, 50% said they would do so. Moreover, the majority (68%) did not advise women planning to become pregnant to include a periodontal evaluation as part of their prenatal care. About 32% felt that periodontal disease can be treated safely during pregnancy with a procedure called scaling and root planning. Reading the information in a book, magazine or pamphlet was useful and reliable information about preterm births and periodontal disease. Physicians do not routinely advise their patient to seek dental care during pregnancy. General practitioners were less informed about oral health practices on pregnant women. Issues on training need to be addressed. A public health campaign is required to educate healthcare providers to encourage pregnant women on the need for a regular dental check‐up during and prior to attempting pregnancy. Conclusion: There is a need to educate healthcare personnel further about oral health and pregnancy outcomes.     

Choosing the left fork: Steven Offenbacher and understanding maternal periodontal disease and adverse pregnancy outcomes

Steven Offenbacher was one of the first researchers to identify periodontal disease as a risk factor for various adverse pregnancy outcomes. Cohort and case-controlled studies of pregnant women have demonstrated periodontal disease as a risk factor for preterm birth, preeclampsia, and fetal growth restriction. Periodontal therapy during the second trimester improves maternal oral health but fails to reduce the risk of preterm birth. A possible association between periodontal disease and gestational diabetes has also been reported. In one model, periodontal bacteria gain access to the systemic circulation, and thereby the placenta, resulting in local inflammation, placental dysfunction, and, consequently, adverse pregnancy outcomes. It is crucial to increase awareness of the links between maternal periodontal and adverse pregnancy outcomes and to promote oral health prophylaxis during pregnancy.     

孕妇牙周病与胎膜早破的相关性研究

目的:本研究通过检查比较胎膜早破孕妇与正常孕妇牙周健康状况,分析牙周健康状况与胎膜早破的关系,为胎膜早破的病因提供一定的临床依据。方法:选择早产胎膜早破(PPROM)孕妇18例、足月胎膜早破(PROM)孕妇20例作为实验组,足月正常孕妇(Non-PROM)28例作为对照组。检查牙周状况记录菌斑指数(PLI)、探诊深度(PD)和龈沟出血指数(SBI)。结果:胎膜早破组牙龈炎症明显,牙周状况差,PLI、SBI均高于正常对照组,差异有统计学意义(P<0.05)。各组间探诊深度无明显差别,无统计学意义。结论:牙周病可能是导致胎膜早破的原因之一。孕期及孕前的口腔保健及口腔健康教育,是预防和减少不良妊娠结局发生的有效措施。     

上海妊娠期女性牙周健康状况的多因素分析

目的:了解上海市妊娠期女性的牙周健康状况,探讨妊娠期女性牙周健康的影响因素,为以后进行有针对性的口腔健康教育、制订公共卫生策略提供依据。方法:采用横断面研究, 随机抽取各区县妇幼保健院建卡的妊娠期女性(0~40周)进行调查。调查方法包括问卷调查和临床牙周检查, 牙周检查项目包括可视菌斑指数、探诊出血指数、牙周袋深度、临床附着丧失。采用SPSS18.0软件包对数据进行χ2检验和logistic多因素回归分析。结果:共调查561名妊娠期女性,平均年龄(27.5±4.0)岁,孕周5~40周,平均孕周(18.9±8.1)周。牙周病患病率49.6%,其中牙周炎患病率为6.8%,牙龈炎为42.8%。Logistic回归分析显示,处于妊娠中、晚期的女性比妊娠早期更容易患牙周病;居住在郊区的妊娠期女性比居住在市区者患牙周病的危险性高。结论:上海市妊娠期女性牙周病的患病率与妊娠周期、居住地有关,应该加强对相应高危人群的口腔健康教育。     

武汉市1009名孕妇牙周状况调查

目的:了解武汉市孕妇的牙周状况及其影响因素。方法:采用横断面研究的方法,按照纳入标准抽取2006-05—12在省妇幼保健院进行孕检或生产的已作婚姻登记的妇女1009名。调查方法包括问卷调查和临床牙周检查。运用卡方检验及Logistic回归分析的统计学方法对数据进行分析。结果:受检孕妇的牙龈炎和牙周炎患病率分别为74.8%和37.2%。大于30岁者患牙周炎的危险度比值(oddsratio,OR)为1.6;学历较低者患牙龈炎的OR为1.4;月收入为中或低水平的孕妇患牙周疾病的几率较大,牙龈炎OR分别为1.5和2.1,牙周炎OR分别为1.1和1.7;孕前近1年内没有口腔就诊行为的孕妇,患牙龈炎和牙周炎的OR分别为2.3和2.1;孕前或孕期患有全身性疾病的孕妇,患牙龈炎和牙周炎的OR分别为1.8和2.2;孕期有过吸烟和饮酒行为的孕妇患牙周炎的OR分别为3.8和1.6。结论:牙周疾病较易发生于年龄较大、学历和月收入较低、口腔健康行为较差、孕前或孕期患有全身性疾病及有吸烟或饮酒行为的孕妇,应加强对这部分孕妇的口腔健康教育。     

Female sex hormones and periodontal health-awareness among gynecologists – A questionnaire survey

Sex hormones play an important role in periodontal health and disease. For example, puberty, menses, pregnancy, menopause, and oral contraceptive use influence a woman’s periodontal health. Periodontal infection has also been associated with adverse pregnancy outcomes. Subsequently, it is important that gynecologists are educated about hormonal effects on women’s oral health. The current study assessed gynecologist’s awareness regarding the effect of female sex hormones on periodontal health, preterm delivery, and maternal periodontal disease.MethodsGynecologists from the Bagalkot district of the Karnataka state, India, completed a questionnaire regarding female hormonal and periodontal health. Respondents were divided into two groups: Group A (doctors that practiced at a medical college or hospital) and Group B (doctors that practiced at private hospitals). Out of 73 gynecologists, 62 (85%) completed the survey, with 19 (30.6%) participants in Group A and 43 (69.4%) participants in Group B. Survey responses were collected in the presence of the investigator, and data between the groups were statistically compared.ResultsOur findings showed that most gynecologists were aware and concerned about female patient’s oral health during various hormonal phases. However, gynecologists practicing at medical colleges and hospitals (Group A) had significantly greater health awareness than doctors practicing at private hospitals (Group B).ConclusionWomen have special periodontal health care considerations, and there is a need for better oral health education among caregivers. Our results suggest that increasing dental health awareness among gynecologists would significantly improve women’s health and pregnancy outcomes.     

Periodontal disease early in pregnancy is associated with maternal systemic inflammation among African American women

BACKGROUND: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. This study determined whether maternal periodontal disease in early pregnancy is associated with elevated serum C-reactive protein (CRP) levels and whether maternal race influences the relationship between maternal periodontal disease and systemic inflammatory responses. METHODS: A secondary analysis of prospectively collected data from the Oral Conditions and Pregnancy study was conducted. Healthy women at <26 weeks of gestation underwent an oral health examination and had blood collected. Periodontal disease was categorized by clinical criteria, and maternal serum was analyzed for CRP levels using highly sensitive enzyme-linked immunosorbent assay kits. An elevated CRP level was defined as >75th percentile. Demographic and medical data were obtained from the women's charts. Chi-square and multivariable logistic regression models were used to determine maternal factors associated with an elevated CRP. An adjusted odds ratio (OR) for elevated CRP levels was calculated and stratified by race and periodontal disease category. RESULTS: The median (interquartile) CRP level was 4.8 (0.6 to 15.7) microg/ml, and an elevated CRP level (>75th percentile) was 15.7 microg/ml. African American race and moderate/severe periodontal disease were significantly associated with elevated CRP levels. When stratified by race, moderate/severe periodontal disease remained associated with an elevated CRP level among African American women (adjusted OR: 4.0; 95% confidence interval [CI]: 1.2 to 8.5) but not among white women (adjusted OR: 0.9; 95% CI: 0.2 to 3.6) after adjusting for age, smoking, parity, marital status, insurance status, and weight. CONCLUSION: Among African American women, moderate/severe periodontal disease is associated with elevated CRP levels early in pregnancy.     

Plasma 25‐Hydroxyvitamin D Concentrations and Periodontal Disease in Postmenopausal Women

Background: Vitamin D has anti‐inflammatory and antimicrobial properties that, together with its influence on bone health, may confer periodontal benefit. Methods: Cross‐sectional associations (years 1997‐2000) between plasma 25‐hydroxyvitamin D concentration [25(OH)D] and periodontal measure were investigated among 920 postmenopausal women. Measures of chronic disease were defined based on: 1) alveolar crestal height (ACH) measures from intraoral radiographs and tooth loss and 2) Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) criteria using measures of clinical attachment level and probing depth (PD). Acute oral inflammation was assessed by the percentage of gingival sites that bled upon assessment with a probe. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for periodontal disease among participants with adequate [25(OH)D ≥50 nmol/L] compared with deficient/inadequate [25(OH)D <50 nmol/L] vitamin D status adjusted for age, dental visit frequency, and body mass index. Results: No association was observed between vitamin D status and periodontal disease defined by ACH and tooth loss (adjusted OR = 0.96, 95% CI = 0.68 to 1.35). In contrast, women with adequate compared with deficient/inadequate vitamin D status had 33% lower odds (95% CI = 5% to 53%) of periodontal disease according to the CDC/AAP definition and 42% lower odds (95% CI = 21% to 58%) of having ≥50% of gingival sites that bled. Conclusions: Vitamin D status was inversely associated with gingival bleeding, an acute measure of oral health and inflammation, and inversely associated with clinical categories of chronic periodontal disease that incorporated PD, an indicator of oral inflammation. However, vitamin D was not associated with chronic periodontal disease based on measures of ACH in combination with tooth loss.     

Pregnancy,parity and periodontal disease

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post‐partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.