一种新型防喷溅面罩降低口腔诊室内气溶胶效果评价

目的:评价一种新型防喷溅面罩在口腔临床治疗中降低诊室内气溶胶浓度的效果。方法:首先分析不同类型口腔喷溅操作下(高速涡轮机下的窝洞制备、牙体预备、邻面去釉及超声治疗仪下的龈下刮治)气溶胶的分布特征;之后在仿真头模上模拟进行离体牙牙体预备,根据是否使用防喷溅面罩分为实验组与对照组,分别于喷溅操作治疗前、中、后多个时间点对室内气溶胶浓度进行采样,并记录及统计数据,评估使用新型防喷溅面罩降低口腔诊室内气溶胶效果。结果:不同类型口腔喷溅操作后诊室内气溶胶浓度均升高(P<0.05);其中,牙体预备喷溅操作后诊室内气溶胶浓度升高最明显(P<0.05)。因此,在仿真头模上模拟进行离体牙牙体预备,比较使用防喷溅面罩前后诊室内气溶胶的变化,结果显示使用面罩后诊室内气溶胶减少明显(P<0.05)。结论:不同类型的口腔喷溅操作均会产生高浓度气溶胶;使用这种新型患者佩戴的防喷溅面罩能有效降低口腔临床喷溅操作治疗过程中诊室环境内的气溶胶浓度,对于防止呼吸道传染病传播具有现实意义。     

PDCA循环联合PBL教学方法在口腔本科实习教学中的应用

目的 评价PDCA循环管理模式联合PBL教学方法在口腔本科实习中的教学效果。方法 选择新疆医科大学口腔医学院2010~2011级本科生,随机分为PDCA循环联合PBL教学试验组和传统教学对照组,各30人,比较2组实习生的理论知识、临床操作及诊疗技能有无差异。结果 在基础理论方面,试验组（86.325.13）分,对照组（82.726.49）分,成绩有统计学差异（P < 0.05）,在临床操作及诊疗技能方面,试验组表现良好及优秀为63.3%,而对照组仅为36.7%,且差异有统计学意义（P < 0.05）。结论 相对于传统教学方法,PDCA循环结合PBL教学能提高口腔本科实习生的理论知识掌握、临床操作及诊疗技能,值得推广和应用。     

品管圈对促进牙科诊疗器械消毒环节规范化管理的作用

目的 探析品管圈对促进口腔科诊疗器械消毒环节规范化管理的作用。方法 选取2016年7月～ 2017年6月我院口腔综合科使用的800件诊疗器械作为研究对象,其中2016年7月～ 2016年12月实施常规消毒管理; 2017年1月～ 2017年6月应用品管圈。对比品管圈应用前后诊疗器械消毒合格率和菌群浓度。结果 品管圈应用后根管治疗器械、车针、超声波洁牙机工作尖、牙周治疗器械和拔牙器械的消毒合格率分别为96.30%、95.65%、100%、93.75%和100%,均较应用前的92.59%、91.30%、89.47%、87.50%和93.33%明显提升（P < 0.05）。品管圈应用后诊疗器械中金黄色葡萄球菌、绿脓杆菌、念珠菌、A型溶血链球菌以及曲霉菌菌群浓度均较应用前明显下降（P < 0.05）。结论 在口腔诊疗器械消毒管理中运用品管圈能够进一步提高消毒管理效果,降低菌群浓度,可作为优选管理方案推广使用。     

气溶胶传播风险与口腔诊疗综合防控策略

口腔喷溅操作产生喷溅物、飞沫与气溶胶,当感染因子存在时,主要通过接触和飞沫传播。本文通过空气传播疾病风险模型分析,阐明预防气溶胶传播的重点为感染源管理、加大通风、减少暴露时间和正确使用防护口罩。通过对气溶胶产生和污染的分析,提出应加强水气路管理和喷溅行为控制,进行有效的空气和物表消毒、加强人员防护。基于感染链分析,阐述标准预防和附加预防措施在切断传染性疾病传播中的作用,提出口腔诊疗的感染防控需体现系统性、全面性和循证性。     

CBCT介导的渐进式教学在口腔专科生根管治疗术实习中的初步探讨

目的 探讨CBCT在口腔专科生根管治疗术实习过程中结合渐进式教学的效果。方法 选择62名口腔专科实习生,随机分为试验组（CBCT）和对照组（根尖片组）,实习初期和实习中期进行理论学习和观摩根管治疗流程,实习后期进行根管治疗术临床实践,对患者上颌中切牙、上颌第一前磨牙和下颌第一磨牙进行根管治疗,对比两组实习生读片准确性和根管治疗操作合格率,比较两组操作时间和治疗后疼痛。结果 两组学生对上颌中切牙读片、根管治疗操作合格率、操作时间和治疗后疼痛未见统计学差异（P>0.05）;而对上颌第一前磨牙和下颌第一磨牙,2组学生在所有评估指标上都存在差异（P<0.05）。结论 对于较复杂根管系统的牙位进行根管治疗时,CBCT可有效提高口腔专科生读片准确率和治疗成功率,缩短治疗操作时间,减轻治疗后疼痛。     

口腔诊疗中喷溅物污染来源的可视化模拟研究

目的 通过荧光素示踪法探索口腔诊疗中喷溅物的颗粒物特性和污染来源。方法 设置水路组和唾液模拟组,分别将荧光素钠溶液加入自供清洁水瓶中和经过导管导入口中,通过沉降结果的对比明确喷溅物的特性以及病原体的来源。结果 水路组检测到的荧光素点数量较唾液模拟组更多（P<0.01）,且水路组的荧光素点粒径均大于100μm。使用强负压吸引器干预后,荧光素点的数量显著减少（P<0.01）。使用弱负压吸引器干预后,粒径小于100μm的荧光素点占比下降。在模拟不同区段牙齿治疗时牙齿越靠近口腔前部,其喷溅物范围越发散,且数量越多。结论 在采取适当的防控措施时,口腔喷溅治疗造成疾病传播的潜在风险可能是可控的。     

口腔材料力学性能虚拟实验教学软件的设计与开发

目的 随着数字化教学模式的发展,虚拟实验教学逐渐应用于口腔医学领域,然而在口腔材料的实验教学中应用较少。为提高学生自学能力、分析和解决问题能力及创新能力,本研究设计并开发一种口腔材料学力学性能虚拟实验教学软件。方法 基于口腔材料学实验教学大纲,利用Flash软件实现将实验教学视频、电子教材及动画等数字化资源有机整合,开发虚拟实验软件。结果 设计开发的口腔材料虚拟实验教学软件简单易行,可脱机使用,主要包含实验原理、实验操作演示、自主实验操作平台、电子实验报告及知识拓展等模块,可通过实验操作录像及自主实验操作平台动画演示,规范实验操作方法并加深学生对实验原理的理解。结论 虚拟实验教学软件有望激发学生的学习兴趣,提高口腔材料力学性能实验教学效果,提升学生自主创新能力,更好地为口腔临床实践和科学研究奠定坚实基础。     

康复新液治疗口腔鳞癌患者平阳霉素诱导化疗后口腔黏膜炎的疗效分析

目的 观察康复新液治疗口腔鳞癌患者平阳霉素诱导化疗后口腔黏膜炎的疗效。方法 将106例经平阳霉素诱导化疗后出现口腔黏膜炎的口腔鳞癌患者随机分为试验组（53例）和对照组（53例）,试验组给予康复新液含服,对照组给予口服维生素B₂和维生素C。根据口腔黏膜炎分级和疼痛程度对两组患者疗效进行对比。结果 试验组治疗口腔鳞癌患者平阳霉素诱导化疗导致的口腔黏膜炎疗效优于对照组（P<0.05）。结论 当口腔鳞癌患者经平阳霉素诱导化疗后出现口腔黏膜炎时,康复新液可有效降低其炎症程度的分级,缓解疼痛,值得推广。     

口腔修复用金属三维打印件中夹杂物和孔隙率问题分析

目的 探讨口腔修复用金属三维打印件中夹杂物和孔隙率不合格原因，为三维打印口腔金属修复体的加工制作过程控制提供参考。方法 选择44批次钴铬合金和钛合金激光选区熔化（SLM）修复体3D打印件，在金相显微镜下放大100倍测定夹杂物和孔隙的面积分数，分析打印件的孔隙特征和产生不合格的原因。结果 夹杂物和孔隙的面积分数>2.8%的有16批次，不合格率为36.4%。44批次检测样品中未见明显夹杂，不合格均由孔隙面积分数超过2.8%导致。结论 目前口腔修复体加工制作行业对数字化3D打印技术的掌握尚不成熟，加工工艺技术有待进一步提高。     

牙科修复用CuO掺杂纳米二氧化钛的制备与表征

目的 通过氧化铜掺杂，制备改性氧化铜纳米二氧化钛光催化剂，检测氧化铜掺杂对CuO/TiO₂复合光催化剂吸收光谱的影响，为研制口腔临床修复功能性材料提供依据。方法 采用共沉淀法制备CuO/TiO₂（CuO掺杂纳米二氧化钛），通过X射线衍射仪（XRD）、扫描电镜（SEM）和紫外-可见光吸收光谱（UV-vis谱）对其形态、结构、组成和性质进行表征。结果 成功制备了CuO/TiO₂复合光催化剂，不同CuO掺杂比的TiO₂的形貌基本不变，CuO掺杂使CuO/TiO₂吸收光谱发生红移，增加了可见光的吸收边界，提高可见光响应。结论 掺杂CuO后的光催化剂有效地提高其可见光响应能力，减少了空穴和电子复合，提高了可见光响应的性能。本研究对解决口腔临床修复对抗菌抑菌自洁特性材料的需求具有参考意义。     

口腔急诊医务工作者应对新型冠状病毒感染的防控管理规范

2019冠状病毒病(corona virus disease 2019,COVID-19)疫情期间,口腔医务人员因其诊疗操作的特殊性存在较大交叉感染的风险。目前多数地区的医院仅保留口腔急诊通道。本文依托本单位急性创伤急救中心,结合临床急救经验,从新型冠状病毒的流行病学特点、口腔科急诊诊疗感染的特点、医务人员的个人防护及诊室环境的防控管理等多个方面提出口腔急诊医务工作者的应急管理和防控规范,供口腔急诊医务人员参考。     

The clinical impact of direct-acting antiviral treatment on patients affected by hepatitis C virus-related oral lichen planus: a cohort study

Objectives

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease. Literature supports an association between OLP and Hepatitis C virus (HCV) infection. The current treatment for HCV infection with direct-acting antivirals (DAAs) is highly effective and safe. The aim of this study is to evaluate the clinical impact of viral eradication with DAAs in patients with HCV and OLP.

Materials and methods

For this cohort observational study, 18 patients with HCV and OLP were recruited; all patients received DAAs. Nineteen patients with OLP without HCV were recruited as controls. Both groups received an oral clinical examination, taking photographs of the oral mucosa, at three time points. Size and type of lesions, clinical and efficacy scores, were evaluated at each time point with ImageJ software. Changes were assessed by a general linear model repeated measures analysis. Kruskal–Wallis H and Mann–Whitney U tests were used to evaluate the differences between subgroups.

Results

All patients of the study group reached a sustained virological response. The study group showed a correlation between viral load and clinical status (p?<?0.05), higher clinical scores at baseline (p?=?0.001) and higher efficacy index than controls (p?<?0.001), improving over time (p?<?0.001); controls did not show significant changes (p?=?0.196). One patient of the experimental group developed oral squamous cell carcinoma (OSCC) of the tongue during the DAAs treatment.

Conclusions

In this study, patients with HCV and OLP showed a worst clinical oral status than controls at baseline. However, treatment for virus eradication can improve the oral lichen planus clinical course.

Clinical relevance

HCV eradication can improve the clinical course of patients with HCV-related OLP.

     

Oral health in the indigenous Sámi population in Norway – the dental health in the North study

Abstract

Objective: This study aims at presenting the feasibility of using the public oral health clinics in indigenous Sámi communities, as arena for a comprehensive data collection for population-based epidemiological oral health research among adults (age, 18–75 years) in a multi-ethnic setting.

Material and methods: The study design was cross-sectional. The data collection was incorporated into the clinical procedure at six public dental clinics situated in the Administrative Area for the Sámi Language in Finnmark County, Northern Norway, during 2013–2014. Both clinical- and questionnaire-data were collected. The quality of clinical data was thoroughly calibrated and validated.

Results: Altogether, 2235 people participated in the study gave a crude response rate at 88.7%. In the final data sample (n?=?2034), 56.9% were female. We constructed three ethnic groups (Sámi, Mixed Sámi/Norwegian and Norwegian). Altogether, 67.7% reported Sámi or mixed Sámi ethnicity. The internal validity of the clinical data was found to be satisfactory when assessed by comprehensive quality procedure, calibration and reliability assessments.

Conclusion: This study design and method assessments provide solid documentation that public dental clinics are suitable as arenas for data collection in epidemiological oral health studies in the Sámi population in this region.     

Evidence-based dental management in the new era of sickle cell disease: A scoping review

BackgroundSickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD.Types of Studies ReviewedUsing a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations.ResultsSystemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care.Practical ImplicationsIn SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.     

Paediatric dental care during and post-COVID-19 era: Changes and challenges ahead

BackgroundCOVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus is transmitted through respiratory droplets and by physical contact from contaminated surfaces to the mucosa. Its route of transmission has caused a significant challenge in medical and dental healthcare.ObjectiveThis article aims to review the literature and information available on the provision of paediatric dental treatment during and post-pandemic and to provide specific recommendations on the safe provision of paediatric dental care.ResultsChildren infected by SARS-CoV-2 have no or milder COVID-19 symptoms and are potential vectors in spreading the disease. Routine dental treatment is suspended in many countries because of the increased risk of cross-infection in dental practices. Only emergency dental care is provided for urgent conditions. It is necessary to gradually reinstate regular dental care to paediatric patients and maintain their good oral health. To control the disease transmission and maintain the oral health of the population, minimally intervention techniques that minimise or eliminate aerosol generation, plus comprehensive oral health preventive measures should be practised to safeguard safety at dental practices in this unprecedented time.ConclusionsRobust infection control guidelines should be implemented in dental clinics to minimise the risk of infection and to ensure the safety of patients and staff during the pandemic. Three levels of preventive care should be practised to prevent oral diseases and improve children's oral health in this COVID-19 era. Treatment should be prioritized to patients in urgent needs and aerosol-generating procedures should be minimized.     

Human papillomavirus infections in the oral mucosa

BackgroundPublic awareness of human papillomavirus (HPV) as the causal agent of cervical cancer and of the availability of HPV vaccines has increased. As a result, more patients are asking their dentists about oral HPV infection and its prevention by means of vaccination. Parents of pediatric dental patients also may be concerned when their children have HPV-associated oral lesions, because HPV infection still often is considered a purely sexually transmitted disease. In this review, the authors provide the latest information for dental professionals about HPV infection in the oral mucosa and in general.Types of Studies ReviewedThe authors searched PubMed for all studies regarding HPV infection in the oral mucosa, and they reviewed relevant publications focusing exclusively on HPV infections of the oral cavity. In selecting studies for review, the authors made a clear distinction between studies regarding HPV infections in the mouth and those regarding HPV infection in the oropharynx or in other head and neck sites.ResultsHPV can infect oral mucosa. A subgroup of oral cancer clearly is associated with HPV. Oral HPV infection is transmitted sexually but also can be transmitted from mouth to mouth and vertically from an infected mother during delivery.Conclusions and Clinical ImplicationsPersistent HPV infection in the oral mucosa might increase the risk of developing oral cancer. Regular and meticulous clinical examination is the dentist's most important tool in detecting HPV-associated changes in the oral mucosae. HPV-associated oral cancer may affect a population younger than that typically affected by HPV-independent oral cancer. Alcohol and tobacco use increase the risk of developing oral cancer, so good practice includes encouraging patients to avoid these habits. The availabel HPV vaccines cover the HPV genotypes found most commonly in the oral mucosa, but their protective effect against oral cancer remains to be elucidated.     

The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study

Objectives

The study aimed to investigate the timeline association with specific dental therapy and osteoradionecrosis (ORN) in oral cancer patients.

Materials and methods

A total of 7394 oral cancer patients, including 198 ORN subjects, were retrieved from a Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan and were analyzed with the Cox proportional hazard regression to compare the ORN risk of individual dental treatments under different dental treatments.

Results

The initial dental treatment time significantly impacted on the risk of ORN in oral cancer patients (P<0.05). Pre-radiotherapy endodontic treatment and post-radiotherapy scaling or subgingival curettage increased ORN prevalence (hazard ratio [HR], 2.28 and 1.77, respectively). Endodontic treatment within 2 weeks to 1 month prior to radiotherapy increased the ORN risk by 5.83-fold. Dental scaling or subgingival curettage initialized from three to 6 months post-radiotherapy raised the ORN prevalence by 2.2-fold. Exodontia initialized within 2 weeks before radiotherapy (HR=1.49) or 1 to 3 months after radiotherapy (HR=2.63) greatly increased ORN prevalence. To perform oral surgery from 3 months pre-radiotherapy to 6 months after radiotherapy increased the 1.85-fold ORN risk. The chemotherapy combined oral surgery increased the ORN prevalence by 2.55-fold.

Conclusions

Timing of dental treatment, including pre-radiotherapy endodontic treatment, post-radiotherapy scaling or subgingival curettage, and oral surgery or exodontia before and after radiotherapy, could closely relate to ORN development in oral cancer patients.

Clinical relevance

Choosing right time to perform appropriate dental treatment could effectively reduce oral infection and ORN risk.

     

Impact of the Coronavirus on Providing Oral Health Care in the Netherlands

ObjectiveTransmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands.MethodsA cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands.ResultsOf the 1700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing at that time. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0%–87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status, and occupation.ConclusionsThe pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations.Key words: SARS-CoV-2, COVID-19, Dental infection control, Dental care, Dental practice management, Dentists     

The use of propolis in dentistry,oral health,and medicine: A review

BackgroundPropolis is a resinous product that is collected from plants by bees to cover holes and crevices in their hives. Propolis has potent antibacterial, antiviral, anti-inflammatory, wound healing, and anticancer properties. Propolis has been used therapeutically by humans for centuries, including the treatment of dental caries and mouth infections.HighlightThis review article attempts to analyze the potential use of propolis in general dentistry and oral health management.ConclusionPropolis is potentially useful in dentistry and oral health management based on available in vitro, in vivo, and ex vivo studies, as well as human clinical trials.     

Characteristics of the early stages of intravenous bisphosphonate-related osteonecrosis of the jaw in patients with breast cancer

Objective. The clinical features of the early stages of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with breast cancer remain unclear. A retrospective cohort study was conducted of patients with breast cancer who received intravenous bisphosphonate (BP) treatment in a single center in order to clarify the status of the early stages of BRONJ. Materials and methods. A BRONJ oral monitoring program was established in 247 breast cancer patients given intravenous BP treatment at the institution. The differences in age, BP treatment period, number of remaining teeth, oral hygiene status, presence of regular oral monitoring and the existence of suspected BRONJ (stage 0) among eight BRONJ and 36 non-BRONJ subjects who completed oral examinations were then compared. Results. BRONJ was observed in 0.4% of subjects on the first visit to the oral surgery clinic and in 3.2% of subjects during the follow-up period. Logistic regression analysis revealed that the odds ratio for identifying patients with BRONJ during follow-up by the presence of stage 0 at first visit was 24.0 (95% confidence interval [CI] = 3.6–161.7). The area under the receiver operating characteristic curve for identifying subjects with BRONJ by the presence of stage 0 was 0.82 (95% CI = 0.63–1.00). Conclusion. The results suggest that patients with stage 0 BRONJ on the first visit may progress to advanced BRONJ during the follow-up period. The oral monitoring program may contribute to the early detection of BRONJ.