合理情绪疗法与Er激光治疗对青少年正畸开窗患者牙科焦虑的影响

Effects of Rational Emotional Therapy and Er Laser Therapy on Dental Anxiety of Teenagers with Orthodontic Window Opening

目的:探讨使青少年正畸开窗患者治疗中出现牙科焦虑症(Dental anxiety,DA)的情况得以减少的方法。方法:采用2χ2析因设计随机对照试验,设计方案为开窗术(A因素,包括在碧兰麻醉下行开窗术A1、Er激光下行开窗术A2)×合理情绪疗法(B因素,包括有B1、无B2),通过治疗方法不同将200例正畸开窗患者分为4组。A组:在碧兰麻醉下行开窗术;B组:Er激光下行开窗术;C组:先对患者进行合理情绪疗法,再在碧兰麻下对患者实施开窗术;D组:进行合理情绪疗法后在Er激光治疗下行开窗术。A组和C组均通过症状自评量表调查、认知情绪调节问卷(中文版)调查。通过经过优化后的牙科焦虑量表(Modified dental anxiety scale,MDAS)对四组患者不同时期的DA水平的变化进行观测,再将开窗术前后的数据进行统计分析。结果:就正畸患者SCL-90评分中的五个因子(躯体化、抑郁、焦虑、敌对、人际敏感)而言,C组青少年的评分明显低于A组(均P<0.05);C组积极应对得分较高,消极应对得分较低,二者均高于和低于A组(均P<0.05)。在四组患者进行复诊时发现,他们的DA值整体呈下降趋势,且四组中D组下降数值最高,B、C二组次之。即使是同一组别,患者治疗前后的效果也存在很大差别(P<0.05)。结论:使得青少年正畸开窗患者治疗的牙科恐惧降低,需要采用合理情绪疗法和Er激光治疗,并将二者结合以此达到最优效果。

Objective:To explore the methods of reducing dental anxiety(DA)in adolescent orthodontic window-opening patients.Methods:200 patients with orthodontic fenestration were analyzed retrospectively randomly,and divided into 4 groups according to the different treatment methods.Group A:fenestration under Cymbidium anesthesia;Group B:fenestration under Er laser;Group C:reasonable emotional therapy was given to the patients before fenestration under Cymbidium anesthesia;Group D:fenestration under Er laser therapy after rational emotional therapy.Group A was investigated by symptom checklist 90(self rating scale),and group C was investigated by Cognitive Emotion Regulation Questionnaire(Chinese version).Modified dental anxiety scale(MDAS)was used to observe the changes of DA level in the four groups at different stages.The data before and after window opening were compared and analyzed statistically.Results:In terms of five factors(somatization,depression,anxiety,hostility and interpersonal sensitivity)in SCL-90 scores of orthodontic patients,the scores of adolescents in group C were significantly lower than those in group A(all P<0.05).the scores of positive coping and negative coping in group C were higher and lower than those in group A(all P<0.05).During the follow-up visit,the DA values of the four groups showed a downward trend as a whole,and among the four groups,group D had the highest downward trend,followed by group B and group C.Even in the same group,the effect of treatment is also very different(P<0.05).Conclusions:In order to reduce the dental fear of adolescent orthodontic fenestration patients,rational emotional therapy and Er laser therapy should be used,and the combination of them can achieve the best results.