Medical Emergencies in Dental Clinics: A Survey of 2013 Dentists in China

Objective To investigate the feature and frequency of medical emergencies in dental clinics in China and the Methods A survey study was conducted among 2408 dentists who attended continuing educational courses held by Society of Sedation and Analgesia of Chinese Stomatological Association in 18 cities from December 2015 to December 2018.Demographic information of the dentists and the characteristics of medical emergencies they encountered were collected and analyzed.The associated demographic features for dentist experiencing medical emergencies were analyzed by logistic regression model.Results A total of 2013 dentists provided valid responses and reported 2923 events of medical emergencies in dental clinics.Among them,85.0%reported that they had encountered medical emergencies,and 35.5%had encountered at least twice.Syncope(35.9%)and hypoglycemia(30.3%)were the most common reported medical emergencies.Medical emergencies were most likely to occur during local anesthesia(49.9%),out-patient oral surgery(25.9%),and root canal treatment(11.3%).There were 6 patients(0.2%)died in emergencies.84.0%dentists reported that they had never received training courses about medical emergency management in dentistry other than Basic Life Support.Longer practicing time(10-15 years)(OR=0.59,95%CI:0.41-0.85,P=0.004),working in private dental facilities(OR=1.69,95%CI:1.20-2.38,P=0.003)were associated with an increased risk of experiencing medical emergencies.Conclusion More efforts are needed in prevention,early identification,and timely management of medical emergencies in dental clinics in order to prevent fatal outcomes.The results of this survey are useful information for re-designing emergency training courses for Chinese dentists.

To explore and develop a model to maintain and build upon a dental clinic open for all in developing regions, with a primary focus on India

AIM: To study a service model that enables a clinic to be open to all members of the community, irrespective of their ability to pay.METHODS: Sampling methodology was used to gather information in two phases, with the city of Indore as the target region. In the first phase, dental professionals were surveyed to gather the cost of the facility, land and equipment and the cost of sustaining the practice. In the second phase, the residents of Indore were surveyed to collect information regarding their oral health problems and their expenditure for the same. Assessing the current situation, the questions to answer are related to the issues of dental health care access problems and the resources required, human and financial.RESULTS:(1) People younger than 20 years of age form a large proportion(43%) of the population of the city and also a large proportion(54%) of people who visit dental clinics;(2) Dental caries are commonlyfound in the population younger than 20 years of age and mobile teeth in those older than 50 years of age;(3) Dental caries and mobile teeth are almost equally found in people of the age group 20-50 years old;(4) A significantly large proportion of those older than 50 years old have had all their teeth extracted; and(5) A significantly large proportion of the 20-30 years of age group has had no teeth extracted.CONCLUSION: The model which we propose works well for low income patients; however, it places a lot of extra burden on the higher income group. A lot of effort can be put into generating revenue from other sources, including events and donations.

The Dental Absces: Epidemiological, Clinical and Therapeutic Aspects at the Dental Office of the Prefectoral Hospital of Siguiri in 2021 in the Republic of Guinea

Introduction: A dental abscess is a collection of pus located in the tissues surrounding the tooth roots. The aim of this work is to describe the epidemiological, clinical and therapeutic aspects of dental abscess in order to contribute to the management of patients suffering from this pathology at the dental office of the Siguiri Prefectural Hospital. Methods: This was a retrospective descriptive study lasting 2 months carried out on the registers of patients received between October 2017 and October 2020 at the dental office of the Siguiri prefectural hospital. Results: 4690 patient files were identified during the study, of which 546 met our selection criteria, i.e. a frequency of 11.64%. During our study, we found 51.83% female compared to 48.17% male, i.e. a sex ratio of 1.07. 54.21% of our patients resided in rural communes compared to 45.76% for the urban commune. The age group most affected was that of 16 - 25 years old or 33.69%. Swelling, pain and functional discomfort were the reasons for consultation in all patients followed by other associated reasons in 41.21%. The premolar-molar group was the most represented, i.e. 86.70%. 80.04% of our patients presented an acute abscess compared to 19.96% of chronic cases. Antibiotic, analgesic, and mouthwash were prescribed in all patients during the study followed by 96.37% of cases prescription of steroidal anti-inflammatory drugs. 93.04% of causal teeth were extracted followed by 6.78% of cases of conservative treatment in our study. In our study, 80.95% of our patients had a good post-therapeutic outcome. Conclusion: This study highlights the need for prevention and early management of dental abscesses.

Stress Sensitivity and Signs of Anxiety or Depression among First Year Clinical Dental and Medical Students

Background: Negative stress symptoms are reported in the literature among clinical dental and medical students and can include signs of anxiety or depression. However, very little has been researched about existing psychological preconditions of these students that could make them more vulnerable to negative stress symptoms. Objective: The aims were to explore first year clinical dental and medical students’ experiences of stress intensity, stress sensitivity and signs of anxiety or depression. Gender was also explored as a possible predictor of these psychosocial phenomena. Methods: First year clinical students at Aarhus University dental (n = 49) and medical schools (n = 59) were recruited to fill out a 45-item questionnaire that comprised demographics and three scales: Cohens Perceived Personal Stress (PPS-10), Stress Sensitivity Inventory (SSI) and Depression Anxiety & Stress Scale (DASS-21). Groups and genders were compared by frequency and using association statistics, bivariate odds ratios, nominal logistic regression and ANOVA. Results: Stress intensity perceptions were moderate to high for many. Dental students scored higher than medical students on all mean test scores. In general, women showed higher levels of stress than men. Dental students scored significantly higher than medical students on Depression, Anxiety and Chronic Stress with ANOVA tests. However, when gender, age and medical or dental student status were added into a logistic regression analysis in which high stress sensitivity was the main dependent variable, only high scores in perceived stress intensity and signs of depression and anxiety showed significant main effects. Conclusion: Present study confirmed the literature that reports high degrees of stress among dental and medical students. But more importantly, Stress Sensitivity Inventory appeared to be a reliable and excellent predictor of high perceived stress and signs of depression and anxiety. It can be useful to detect and prevent student psychosocial dysfunction in clinical learning environments. An important challenge for medical and dental educational institutions is to provide specific student emotional support as early as needed as well as to consider appropriate stress prevention curriculum reforms.

临床路径教学法在牙体牙髓科本科生临床教学中的应用

目的探讨临床路径教学法在牙体牙髓科本科生临床教学中的应用效果。方法选取2021年1月-2022年12月在首都医科大学口腔医学院牙体牙髓科进行临床实习的103名本科生作为研究对象,分为对照组(51名)和观察组(52名),对照组予以问题为基础的教学法(problem-basedlearning,PBL),观察组予以临床路径教学法(clinical pathway teaching method,CPTM),出科时进行理论、实践操作考核和问卷调查评价。结果观察组学生的理论、临床实践操作考核成绩分别为(92.30±3.00)分和(91.70±3.00)分,均优于对照组,差异有统计学意义(P<0.001);观察组学生对“培养临床思维能力”和“病例汇报和分析能力”的满意度高于对照组,2组学生在提高学习主观能动性、理论知识与实践紧密结合、文献查阅和总结能力、达到预期实习目标的满意度均高于96%,但2组差异均无统计学意义(P>0.05)。结论CPTM适用于牙体牙髓专业本科生的临床实习教学,对夯实医学生的基础理论和基本操作技能、提高临床教学质量有重要作用。

引导骨再生术在前牙区种植中的应用及对美学效果和临床疗效的影响

目的:探讨前牙区种植联合引导骨再生术的临床应用价值。方法:选取2022年1月-2022年10月笔者医院接受前牙区种植的142例患者,采用随机数字法将患者分为对照组(n=70)和观察组(n=72)。对照组单纯进行牙种植,观察组在牙种植基础上联合引导骨再生术治疗。通过临床资料收集比较两组治疗前和治疗6个月后的牙槽骨密度、植骨厚度和成骨厚度、牙周探诊深度(Periodontal depth,PD)、临床附着丧失(Clinical attachment loss,CAL)、牙龈退缩(Gingival recession,GR)、红色美学指数(Pink esthetic scores,PES)、临床疗效和并发症。结果:术后6个月,两组牙槽骨密度、植骨厚度和成骨厚度均高于术前,且观察组高于对照组(均P<0.05);术后6个月,两组PD、CAL及GR均低于术前,且观察组PD、CA及GR均低于对照组(P<0.05);术后6个月,两组PES指标评分均高于术前,且观察组高于对照组(P<0.05)。观察组总有效率95.83%,高于对照组的91.43%(P<0.05);观察组并发症发生率1.39%,低于对照组的8.57%(P<0.05)。结论:前牙区种植联合引导骨再生术美学效果好、PES评分高,临床总有效率高且并发症发生率低,具有较高的临床应用价值。

口腔修复门诊实施院内感染清单式管理的效果分析

目的分析口腔修复门诊实施院内感染清单式管理的效果。方法针对院内感染监测发现的问题,于2021年8月—2022年12月在医院口腔修复门诊实施包括诊室空气质量、医疗器械、口腔印模、医护人员手卫生的清单式管理。经过3次诊室空气培养,器械表面、印模表面及医护人员手部采样和细菌学检测,详细记录监测结果,对比实施前后口腔修复门诊院内感染控制质量监测数据的差异,分析实施效果。结果清单式管理实施后,口腔科门诊空气菌落计数较清单式管理实施前下降(P<0.01);医护人员手部、口腔印模表面、医疗器械表面菌落计数较清单式管理实施前下降(P<0.01);口腔科门诊空气、医护人员手部、托盘消毒储存监测合格率较清单式管理实施前提升(P<0.01);患者院内感染发生率较实施前下降(P<0.01)。结论口腔修复门诊实施院内感染清单式管理可有效减少诊室空气粉尘、器械表面、印模表面、医护人员手部的细菌学检出率,降低院内感染风险。

口腔临床诊疗中数字牙片影像技术的应用价值

目的探讨口腔临床诊疗中数字牙片影像技术的应用价值。方法选择2022年1月至2023年5月期间在本院口腔科就诊且需要拔牙治疗的50例正畸患者作为研究对象。患者在治疗前,完成数字化牙片摄影和传统牙片摄影。记录投照上、下颌牙齿X线倾斜的垂直平均角度,并统计牙齿根尖片的曝光时间,对比两种摄影技术对牙齿长度的测量结果。结果传统牙片摄影时,上颌和下颌切牙位、单尖牙、双尖牙位、第一磨牙位、第二及三磨牙位(足侧倾斜)选择投射角度低于数字化牙片摄影(P<0.05)。数字化牙片摄影投照上颌和下颌切牙位、单尖牙位、双尖牙位、第三磨牙位及第一、二磨牙位牙齿根尖片的曝光时间低于传统牙片摄影(P<0.05)。数字化牙片摄影对待拔除牙齿单根、双根颊和双根腭测量结果与游标卡尺测量结果相比,差异无统计学意义(P>0.05);传统牙片摄影对待拔除牙齿单根、双根颊和双根腭测量结果低于游标卡尺测量结果,差异具有统计学意义(P<0.05);以游标卡尺测量结果为依据,数字化牙片摄影和传统牙片摄影对待拔除牙齿单根、双根颊和双根腭测量结果相比,差异具有统计学意义(P<0.05)。结论数字牙片影像技术投照条件宽容度相对较大,投射时曝光时间短,对牙齿根尖的测量准确度较高,便于细致观察牙齿,应用于口腔临床诊疗的价值较高。

FOCUS-PDCA模式在口腔门诊院感质控管理中的应用

目的探讨FOCUS-PDCA模式在口腔门诊院感质控管理中的应用效果。方法运用FOCUS-PDCA程序对现存的院感质控管理问题进行分析,并制定实施流程,将计划、实施与实际工作有机地联系起来,检测该模式在口腔门诊院感质控管理中的实际效果。结果FOCUS-PDCA实施后,诊室环境样本的检测总合格率、医护人员手卫生依从率和洗手方法正确率高于实施前,科室医师院感知识考核平均分高于实施前,差异有统计学意义(P<0.05)。结论在口腔门诊应用FOCUS-PDCA模式进行院感质控管理,能有效提升诊室环境检测合格率,有效促进医务人员手卫生依从率和洗手正确率,有利于促进科室感染防控工作的规范化。

Effectiveness of air cleaner on mitigating the transmission of respiratory disease in a dental clinic environment

In dental clinics with an open floor plan,the risk of patient-to-patient transmission of respiratory disease is a concern.During dental procedures large amounts of bioaerosol are produced and patients cannot wear personal protective equipment.This paper examines how to effectively deploy air cleaner to reduce the infection risk in dental clinics with an open floor plan.Various locations of air cleaners at various clean air delivery rates(CADRs)were investigated.The dispersion of bioaerosol was studied through numerical simulations,and risk assessment was performed by a dose-response method.The findings indicated that dental patients downstream of the background ventilation have a higher infection risk than those to the left and right of an infected patient(i.e.,the source).The lowest infection risks for the adjacent patients were found when the air cleaner was place opposite to the dentists,i.e.,on the floor at low CADR levels of 2.2 m^(3)/min or on the bench at CADR levels of 4.4 m^(3)/min or greater.The results of this study indicated that air cleaner can mitigate the risk of patient-to-patient transmission of SARS-CoV-2 in dental clinics with an open floor plan.Background CADR levels determine the optimal placement of air cleaners.

7S精细化管理模式在口腔门诊诊区中的应用及对院内感染发生率的影响

目的 探究7S精细化管理模式在口腔门诊诊区中的应用及对院内感染发生率的影响。方法 选取2022年4月至2024年3月于我院口腔门诊诊区接受洁牙、补牙、拔牙治疗的患者60例,按随机数字表法分为对照组(30例,予常规管理)和观察组(30例,行7S精细化管理)。对比两组院内感染发生率、院内感染防控相关指标管理质量、各监测点菌落计数值、患者自护能力、患者对就诊管理满意度情况。结果 管理后,观察组医疗废物处理、手卫生情况、无菌器械管理、空气卫生质量评分高于对照组(P <0.05)。观察组医疗器械表面、医护人员手部、口腔科门诊空气菌落计数值低于对照组(P <0.05)。观察组患者自护能力高于对照组(P <0.05)。观察组院内感染发生率低于对照组(P <0.05)。观察组患者对管理满意度高于对照组(P <0.05)。结论 7S精细化管理模式在口腔门诊诊区中的应用具有较佳的临床效果,院内感染防控相关指标管理质量明显提升,各监测点菌落计数值减少,患者自护能力提升,院内感染发生率降低,患者对就诊管理具有更高的满意度。

口腔科门诊院内感染因素加强防护管理的应用效果分析

目的分析加强口腔科门诊院内感染因素防护管理的应用效果。方法随机选取2022年7月—2023年6月菏泽市单县中心医院口腔科门诊12名医护人员做为研究对象,研究期间医护人员无变动,按照不同的管理方式分为两组,于2022年7月—2022年12月实施常规管理,设为对照组(n=12),于2023年1月—2023年6月实施加强防护管理,设为研究组(n=12)。比较两组管理模式下院内感染防护效果。结果加强防护管理模式后,研究组的院内感染理论知识考核得分高于对照组,医疗器械不良事件发生率低于对照组,差异有统计学意义(P均<0.05);两组操作台表面、诊室空气菌落总数均符合医院消毒卫生标准,与对照组相比,研究组的操作台表面、诊室空气样本菌落总数降低,差异有统计学意义(P均<0.05)。结论加强口腔科门诊院内感染因素防护管理,可显著提高医护人员院内感染防护意识,降低口腔门诊院内感染不良事件发生,提升院内感染防护质量。

全瓷预成冠修复法治疗儿童乳磨牙大面积牙体缺损的临床效果

目的探讨全瓷预成冠修复法治疗儿童乳磨牙大面积牙体缺损的临床效果。方法选择2021年1月至2022年1月在杭州青意口腔诊所有限公司收治的148例乳磨牙大面积牙体缺损患儿为研究对象,其中接受全瓷预成冠修复法治疗74例,为观察组;接受直接复合树脂充填修复法治疗74例,为对照组。比较两组患儿修复后6个月疗效,修复体完整、邻接关系优和边缘密合的比例以及美学修复满意评分[采用白色美学指数(WES)和粉红色美学指数(PES)进行评估],修复前与修复后6个月牙龈指数和菌斑指数及咀嚼功能变化。结果观察组修复后6个月总有效率,修复体完整、邻接关系优和边缘密合的比例,以及WES评分和PES评分均明显高于对照组(均P<0.05)。两组患儿修复前牙龈指数、菌斑指数和咀嚼稳固度和咀嚼食物评分比较,差异均无统计学意义(均P>0.05);修复后6个月牙龈指数和菌斑指数均明显低于修复前(均P<0.05),咀嚼稳固度和咀嚼食物评分均明显高于修复前(均P<0.05),且观察组均明显优于对照组(均P<0.05)。结论全瓷预成冠修复法治疗儿童乳磨牙大面积牙体缺损的临床效果明显,能改善患儿的咀嚼功能。

数字化实时评估系统在前牙牙体预备教学中的应用效果分析

目的 对比分析数字化实时评估系统与传统教学在前牙牙体预备教学中的应用效果。方法 选取2021年9月—2021年1月沈阳医学院40名2018级的五年制临床口腔本科大四下学期在读的学生为研究对象。以随机数字表法将学生分为观察组和对照组,各20名。对照组学生采用传统教学方式,观察组学生采用迪凯尔数字化实时评估系统的教学方式。比较两组的牙体预备质量等级评分以及提问次数。结果 观察组切端预备量、唇面预备量、舌面预备量、轴面光滑度的优良率均高于对照组学生,差异有统计学意义(P <0.05)。结论 在前牙牙体预备教学中的应用数字化实时评估系统可以明显提高临床前学生牙体预备的教学效果,加快学生对牙体预备的掌握速度。

实习期口腔医学生叙事医学实践的初步探索

目的:探讨叙事医学教学实践对实习期口腔实习生叙事能力和共情能力的提升效果,并尝试以此为参考,建立一套有效的叙事医学教学实践方法。方法:选择2022年6月—2023年5月参加临床实习的口腔医学本科生34名,分为实验组(14名)和对照组(20名)。对照组按规范开展临床实习活动,实验组在对照组基础上开展叙事医学实践,包括理论授课、细读、平行病历、讨论会等实践内容。采用人际反应指数量表(Interpersonal Reactivity Index,IRI)评估2组学生的共情力,并对实验组进行叙事医学实践情况问卷调查。采用SPSS 12.0软件包对数据进行统计学分析。结果:实验组共情力量表的总分和各模块得分在实习后较实习前无明显变化,而对照组在“个人忧伤”模块的得分在实习后显著下降(P<0.05),说明没有接受叙事教育的对照组学生经过学习后共情有所降低。调查问卷结果和平行病历内容,也反映出实习生经过叙事医学实践后,叙事能力有所增强,对于医患双方心理社会因素的理解也更深刻。结论:叙事医学实践有助于提升叙事能力和共情能力,培养职业素养,缓和医患关系,应在口腔医学本科教学和医生职业生涯中持续推广。

口腔医学毕业临床技能OSCE考核方案的应用与效果分析

目的:探讨临床技能客观结构化临床考试(Objective structured clinical examination,OSCE)考核方案对学生临床思维和技能水平的考核效果。方法:对61名2018级本科生毕业考核实施OSCE考核方案,分析其成绩及对教学的满意度。结果:61名学生“7站”的考核成绩较好,其中“第6站——临床思辨”的考核成绩偏低,学生整体满意度较高。结论:OSCE考核方案可更全面、真实地考核学生临床思维和技能水平。

铈及铈基材料在口腔疾病领域中的应用

背景:铈(cerium,Ce)是含量最丰富的镧系元素,主要以氧化铈的形式存在。Ce^(3+)和Ce^(4+)两种价态之间快速转化使铈兼具氧化剂和还原剂的作用,具有抗菌、抗炎、促进组织再生和抗肿瘤等多种生物学活性,在口腔医学领域具有广泛的应用。目的:概述铈在抗菌、抗炎、促进组织再生及抗肿瘤中的作用和机制,综述近年来铈和铈基材料在口腔材料改性和口腔疾病诊疗中的研究现状和应用前景。方法:以“cerium,ceria,prosthodontics,prosthesis,restorative dentistry,denture,dental implant,caries,endodontics,pulpitis,periodontitis,periodontal diseases,oral cancer”为英文检索词,以“铈,氧化铈,修复,种植,龋齿,龋病,牙髓,牙周炎,牙周疾病,口腔癌”为中文检索词,分别在Web of Science、PubMed、中国知网及万方数据库进行文献检索,检索时限为各数据库建库至2023年。通过分析和阅读文献进行筛选,按照排除筛选标准纳入文献,最终纳入73篇文献进行综述。结果与结论:①铈主要通过直接接触细菌、氧化应激和破坏细菌生物膜发挥抗菌作用,同时依赖氧化还原酶模拟活性清除活性氧而发挥抗炎功能,铈的成骨和成血管活性涉及ERK和Wnt等一系列信号通路。②铈的抗菌、抗炎、成骨和成血管活性使其在治疗口腔感染性疾病和促进口腔软硬组织再生中具有广阔的应用前景,但铈的抗肿瘤特性在口腔领域的应用仍存在一定空白。③作为口腔陶瓷材料,氧化铈稳定的氧化锆具有优异的机械物理性能,但透光性较低,适用于制作基底瓷、义齿支架和种植体。④依托铈的生物学活性,铈基材料能够有效促进种植体骨和软组织整合,抑制牙齿脱矿和致龋菌生长,促进牙本质牙髓复合体再生,减轻牙周炎炎症反应并促进牙周组织再生,在种植体表面改性、龋病预防、牙髓炎、牙周疾病和口腔癌的诊疗中均有较大的应用潜力。⑤铈在高浓度和长时间给药的情况下存在潜在的毒性,为进一步扩大铈在口腔临床实际中的应用,铈的生物安全性以及铈基材料适应口腔环境的优化在未来仍需更详尽的研究。

16层螺旋CT syngo Dental成像技术的临床应用

目的:探讨16层螺旋CT syngo Dental成像技术临床应用及价值。方法:对48例患者颌部行16层螺旋CTDental扫描,利用syngo Dental应用程序进行全景曲面和剖面重建,对颌部疾病进行诊断分析。结果:syngo Dental成像技术方便快捷,能清楚显示颌部齿列及上、下颌骨病变,做出准确的影像诊断。结论:16层螺旋CT syngoDental成像技术对颌部疾病的影像诊断具有较高的临床应用价值。

O-AMAS有效教学模型结合椅旁教学法在口腔牙体牙髓科护理带教中的应用

目的:研究O-AMAS有效教学模型结合椅旁教学在口腔牙体牙髓科护理带教中的应用效果。方法:选取口腔牙体牙髓科的轮转护士80人,随机分为对照组40人和试验组40人,分别应用传统椅旁教学法和O-AMAS有效教学模型结合椅旁教学法。比较两组轮转护士的各项考核成绩并讨论差异。结果:试验组的口腔护理基础知识、基础技能、四手操作、根管治疗护理操作的考核评分均高于对照组(P<0.05)。结论:O-AMAS有效教学模型结合椅旁教学法可以有效提高轮转护士专业知识和技能水平,在口腔牙体牙髓科护理带教中具有较高的适应性和有效性。

根管治疗在牙体牙髓病治疗中的临床应用研究

研究根管治疗在牙体牙髓病临床治疗中的应用效果。选择2020年1月—2021年6月沧州渤海新区中捷医院收治的60例牙体牙髓病患者,按照随机数字表法将患者分为对照组和观察组,两组患者采取不同方法进行治疗,比较两组患者疼痛情况、菌斑指数、牙周探诊深度、治疗总有效率、生活质量评分、咀嚼功能评分,炎性因子水平。结果显示,治疗前,两组患者的疼痛评分、菌斑指数、牙周探诊深度、生活质量评分、咀嚼功能评分、炎性因子水平比较无明显差异(P>0.05);治疗后,观察组患者的疼痛评分、菌斑指数、牙周探诊深度、生活质量评分、咀嚼功能评分、炎性因子水平均优于对照组(P<0.05)。观察组患者的治疗总有效率高于对照组,但差异无统计学意义(P>0.05)。研究发现,牙体牙髓病患者治疗中实施根管治疗,可改善患者的疼痛、生活质量以及咀嚼功能,有效消除炎性因子,应用价值高,值得推广。