62例残障儿童及青少年在全身麻醉下牙齿治疗的回顾性研究

Retrospective study of dental treatment under general anesthesia of 62 disabled children and adolescents

目的:对在全身麻醉(general anesthesia,GA)下牙齿治疗的残障儿童及正常儿童的口腔患病状况、治疗内容及复查情况进行回顾性分析。方法:收集2008年8月至2015年9月北京大学口腔医院儿童口腔科在全身麻醉下接受牙齿治疗的残障儿童和正常儿童的资料,追踪随访1年,记录性别、出生日期、治疗日期、年龄、残障类型、治疗前口腔患病状况、治疗内容及复查情况,比较不同年龄组之间与不同残障类型之间的差异。结果:共纳入62名残障患者,平均年龄(9.38±5.22)岁,正常对照57名,平均年龄(3.00±1.41)岁。残障患者平均患牙数(11.79±4.98)颗,正常患者平均患牙数(12.40±4.11)颗,人均集中在10~15颗。龋齿、牙髓炎、根尖周炎、牙外伤和牙齿发育异常在残障儿童中所占百分比分别为67.56%、13.54%、15.15%、1.07%和2.68%,DMFT/dmft指数(decay,missing,filled tooth)为11.55±5.56,且学龄组患儿(8.35±4.69)低于其他3个年龄组;在正常儿童中分别为65.35%、19.09%、14.14%、0和1.41%,DMFT/dmft指数为12.23±4.42。树脂充填、窝沟封闭、预防性树脂充填(preventive resin restoration,PRR)、牙髓切断术、根管治疗/牙髓摘除术、牙拔除术、预成冠修复术在残障儿童中所占百分比分别为52.71%、7.24%、8.56%、0.72%、17.13%、10.01%和3.62%;在正常儿童中分别为56.31%、1.27%、0.13%、2.29%、19.87%、7.90%和12.23%。残障患者一年内复查率56.45%,正常患儿为75.44%。残障患者与正常患者一年内出现问题牙齿的数目均较半年内增长一倍,充填体脱落/折断好发于乳前牙,继发龋/再发龋及牙髓炎/根尖周炎好发于乳磨牙。结论:残障儿童及青少年的口腔卫生状况差,全身麻醉下牙齿治疗能为其改善口腔状况提供有效的治疗方法,定期复查、家庭维护和特殊的预防政策对保持患者的口腔卫生起着不可或缺的作用。

Objective:To retrospectively figure out the oral health status,treatment and follow-ups after dental treatment under general anesthesia(DGA)of disabled children or adolescents.Methods:Clinical data of disabled children or adolescents and normal children as control received DGA in the Department of Pediatric Dentistry,Peking University School and Hospital of Stomatology from August 2008 to September 2015 were recorded,including:gender,birth date,treatment date,disability type,oral health status before treatment,treatment content and follow-ups(in 1 year).Differences among ages and disabilities were analyzed statistically.Results:Sixty-two disabled patients and fifty-seven controls were recruited,mean aged(9.38±5.22)years and(3.00±1.41)years.Most patients had 10 to 15 problem teeth with which the mean number of the disabled children and adolescents was(11.79±4.98)while that of the normal controls was(12.40±4.11).Caries,pulpitis,periapical periodontitis,dental trauma and developmental tooth anomalies of the disabled patients accounted for 67.56%,13.54%,15.15%,1.07%,and 2.68%,respectively and the DMFT/dmft index was 11.55±5.56 while in the control group those were at 65.35%,19.09%,14.14%,0,1.41%and 12.23±4.42.The DMFT/dmft index of the disabled patients in the group 6-12 years(8.35±4.69)was significantly less than that of the other three groups(P<0.01)while no differences were found in disabilities(P=0.239).Resin restoration,pit and fissure sealant,preventive resin restoration,pulpotomy,pulpectomy/RCT,extraction and crown of the disabled patients were performed as 52.71%,7.24%,8.56%,0.72%,17.13%,10.01%and 3.62%respectively whereas those made up as 56.31%,1.27%,0.13%,2.29%,19.87%,7.90%and 12.23%in the control group.Thirty-five(56.45%)disabled patients and fortythree(75.44%)controls recalled.Problem teeth within one year after operation in diabled patients and controls were both nearly twice as much as the number within half a year.Restoration loss/fractured mainly occurred in anterior primary teeth while secondary/recurrent caries and pulpitis/perapical periodontitis mostly occurred in primary molars.Conclusion:Oral health status in our disabled children and adolescents is poor.Though dental treatment under GA is an effective way to improve the oral health of disabled children and adolescents,periodic follow-ups and family oral health care are equal important for oral health maintenance.