口腔医生对门诊突发医疗事件及处理认知水平的调查

目的了解北京地区口腔医生对门诊突发医疗事件及处理的认知水平,探讨提高口腔医生急救处理能力的方式。方法采用自行设计调查问卷,对北京696名口腔医生进行常见门诊突发医疗事件及紧急处理能力的调查,对数据进行描述和统计分析。结果口腔医生门诊常遇到的13项突发医疗事件中,晕厥、低血糖、轻度过敏反应、体位性低血压发生频率位居前4位,分别为65.92%、51.27%、34.53%、21.08%。不足30%的口腔医生充分了解基础生命支持-心肺复苏(BLS-CPR)的相关知识。非营利性、二或三级医疗机构的口腔医生急救能力高于在营利性、规模小的医疗机构的口腔医生。结论应提高口腔医生应对突发医疗事件的认识和预防意识,加强基本急救能力的培养,口腔医学院应开展急救实践操作训练以提高口腔医生综合执业能力。     

A survey on the cognition of emergency and treatment during outpatient service among dentists

目的 了解北京地区口腔医生对门诊突发医疗事件及处理的认知水平,探讨提高口腔医生急救处理能力的方式.方法 采用自行设计调查问卷,对北京696名口腔医生进行常见门诊突发医疗事件及紧急处理能力的调查,对数据进行描述和统计分析.结果 口腔医生门诊常遇到的13项突发医疗事件中,晕厥、低血糖、轻度过敏反应、体位性低血压发生频率位居前4位,分别为65.92%、51.27%、34.53%、21.08%.不足30%的口腔医生充分了解基础生命支持-心肺复苏(BLS-CPR)的相关知识.非营利性、二或三级医疗机构的口腔医生急救能力高于在营利性、规模小的医疗机构的口腔医生.结论 应提高口腔医生应对突发医疗事件的认识和预防意识,加强基本急救能力的培养,口腔医学院应开展急救实践操作训练以提高口腔医生综合执业能力.     

伴有全身系统性疾病的牙槽外科治疗的评估与处理

牙及牙槽外科学是口腔医师执业所必须掌握的基本理论,随着医学的发展及人民群众对健康的日渐重视,在牙及牙槽外科门诊就诊的复合有全身各系统疾病患者数量日益增加,对牙及牙槽外科的医疗服务提出新的要求;微创外科、舒适化医疗的发展迅猛,对医师的知识结构要求更高。本文通过对临床常见复合机体各系统疾病的牙槽外科治疗的评估与处理要点进行分析,以期对该类患者的牙槽外科医疗决策发挥作用,规避医疗风险,提高医疗的安全性。     

ASA分级系统在口腔外科门诊治疗中的应用

目的:探讨ASA(American society of anesthesiologists)分级系统在口腔外科门诊患者中应用的重要性。方法:回顾2003-04～2011-03期间在第四军医大学口腔医院口腔外科门诊出现突发事件的病例,分析并对比ASA分级系统的应用及预防应对措施采取前后口腔外科门诊突发事件的种类及发生率。结果:使用ASA分级系统并根据不同患者的分级情况采取相应的预防应对措施后,在口腔外科门诊突发事件的种类减少,发生率明显降低。结论:ASA分级系统可帮助医生预测患者的治疗风险,提前采取对应防治措施,有助于减少口腔外科门诊突发事件的种类并降低其发生率。     

口腔科诊疗中内科急症的治疗和预防

口腔科诊疗中内科急症的治疗和预防丁小蓉在口腔科诊疗中，因为操作复杂、诊疗时间长、眼前操作的紧张恐惧、以及张口劳累等，常会遇到意外的内科急症患者。我们对某综合性医院口腔科５０２８８例门诊就诊患者出现的内科急症进行了讨论分析。１９８４～１９８９，门诊口腔...     

口腔医师应加强对门诊医疗突发事件的认知和处理能力

近年来,大型专科口腔医院口腔颌面外科门诊的就诊量在逐年增多,相应的医疗风险也随之增加,其中包括可能危及患者生命的医疗突发事件。最常见的突发事件有晕厥,其次是过度换气、药物过量、肾上腺素反应以及高血压等。突发事件主要发生在治疗结束未离开口腔诊室前、局部麻醉过程中或紧随局部麻醉后以及治疗过程中。牙齿拔除相关的突发事件最多,其次是局部麻醉相关。强烈提示口腔医师应该重视门诊临床突发事件的处理,进行相关知识和技能的培训,提高应对突发事件的能力。     

口腔颌面外科手术后疑似急性肺栓塞病例的临床分析

目的:分析口腔颌面外科手术后疑似急性肺栓塞病例发作的临床特点,总结治疗和急救经验,加强对口腔颌面外科患者围术期突发急性肺栓塞的预防。方法:回顾性分析2008-03—2011-05在我院颌面外科住院手术后5例突发疑似急性肺栓塞病例的临床表现、辅助检查和治疗方法等情况。结果:5例患者均以突发呼吸困难为主要临床表现,发病后血清D-二聚体显著升高,早期积极抗凝治疗有效。结论:口腔颌面外科术后出现呼吸困难应警惕肺栓塞的可能性,D-二聚体可作为诊断参考指标之一,及时进行抗凝治疗是治疗成功、改善预后的关键。     

口腔颌面外科医疗纠纷的原因分析及对策

目的:探讨口腔颌面外科医疗纠纷发生的原因,提供预防和解决医疗纠纷的对策。方法:统计78例口腔颌面外科门诊和住院发生医疗纠纷的病例,将发生原因、发生后果、解决途径进行分类和分析。结果:病房发生医疗纠纷的概率大于门诊,病房以并发症型和疗效型为主,门诊以其他类型为主;Ⅰ、Ⅱ级医疗纠纷发生比Ⅲ、Ⅳ级纠纷发生多;医疗纠纷的解决方式以化解和协商为主。结论:医疗纠纷是一个复杂多因素引起的医患权益之争,并有逐年上升的趋势,医疗质量控制是预防医疗纠纷发生的根本措施。     

口腔科门诊的临床口腔健康教育

医院口腔科门诊虽然是以“治疗”为主要任务,但是同样需要重视“预防”工作,门诊医护人员可利用患者候诊时间、诊疗间隙,向患者或陪伴人宣传有关口腔卫生保健知识,开展临床口腔健康教育。 一、教育方法 1.集体教育 集体教育是利用患者在候诊时,事先有计划地选择适当内容进行教育,常用方法有电视录音、墙报,演讲等。主要内容:如口腔保健为什么非常重要?牙齿牙周组织有哪些结构?口腔和牙齿有哪些功能?     

尿样HIV抗体检测用于口腔科门诊的问卷调查

目的 了解口腔科医护人员及口腔专科门诊患者对HIV检测方法的认知和对尿样检测HIV抗体的接受程度.方法 对广州市2所口腔医院和5个口腔科的牙科医师、牙科助理109人及患者90人进行血液和尿样检测HIV的问卷调查.结果 牙科医师、牙科助理、患者选择尿样HIV抗体检测的比例分别占95%、 83%、96%;牙科医师、牙科助理、患者认为门诊侵入性治疗前患者有必要接受HIV抗体尿样检测的比例分别占其所调查对象总数的74%、 73%、 73%.结论 大多数牙科医师、牙科助理和患者愿意选择尿样检测HIV抗体,且认为口腔科门诊侵入性治疗术前进行HIV抗体尿样检测是必要的.     

Medical emergencies: the experience of staff of a UK dental teaching hospital

OBJECTIVE: To assess the frequency of faints and other medical emergencies experienced by staff of a UK dental hospital. To investigate the training they had received in the management of medical emergencies, their perception of readiness to deal with emergencies and future training needs. SUBJECTS: All 193 clinical staff (dentists, hygienists, nurses and radiographers) of the University Dental Hospital of Manchester. DESIGN: Structured questionnaire with covering letter, reminders sent to non-responders. RESULTS: There was an 82% response. Fainting was the commonest event: other medical emergency events were experienced with an average frequency of 1.8 events per year, with the highest frequency reported by staff in oral surgery. Most expressed a need for further training: only 3% felt no need. CONCLUSIONS: Medical emergencies occur in dental hospital practice more frequently but in similar proportions to that found in general dental practice. There is a perceived need for further training among dental hospital staff in the management of medical emergencies.     

Cardiac sarcoidosis: an overview of management for the patient requiring oral and maxillofacial surgery.

PURPOSE: The study goal was to present a current definition of sarcoidosis and an overview of cardiac involvement and implications in perioperative management of cardiac sarcoidosis. MATERIALS AND METHODS: Materials included a retrospective review of 4 patients with cardiac sarcoidosis who underwent minor oral surgery. Laboratory data, medical data, and data obtained through monitoring the patient's general condition related to the surgery were critically analyzed. RESULTS: Preoperative understanding of cardiac pathophysiology, evaluation of the patient's general condition, laboratory data, medical records, and physician correspondence were important, as was precise treatment planning against cardiac emergencies that could occur in surgical treatments. It was essential to monitor vital signs, any electrocardiographic changes, blood pressure, and heart rate, starting from the pretreatment period and continuing through the oral and maxillofacial surgery into the post-treatment period. Glucocorticosteroid coverage and prevention of endocarditis were also considered during oral and maxillofacial surgery planning. CONCLUSIONS: Critical issues were identified in the performance of oral and maxillofacial surgery for patients with cardiac sarcoidosis.     

2018例口腔颌面外科日间手术临床分析

目的:总结中南大学湘雅医院口腔颌面外科开展日间手术的临床经验,探讨日间手术在口腔颌面外科的应用效果与安全性。方法:回顾分析2014年7月—2019年6月在中南大学湘雅医院日间手术中心进行治疗的所有口腔颌面外科患者的临床资料,包括患者年龄、性别、疾病名称、麻醉与手术方式或取消原因、住院时间、延期出院原因、术后并发症发生情况及医疗费用等。选取其中手术量最多的8种疾病,以普通住院病房为对照,比较同类型疾病平均住院时间与医疗费用的差异。采用SPSS 23.0软件包对数据进行统计学分析。结果:在纳入研究期间的5年内,中南大学湘雅医院共完成口腔颌面外科日间手术2018例,疾病类型以口腔颌面部软组织肿物、牙及颌骨病变、唾液腺疾病为主。患者年龄2~77岁,平均34.45岁,男女比例为6:4。手术取消率1.13%,术后并发症发生率0.64%,平均住院时间0.89 d,延迟出院率0.40%。与普通病房相比,同类型疾病住院时间与医疗费用均显著降低(P<0.05)。结论:口腔颌面外科能够实施日间手术的疾病类型多,患者依从性好,住院时间短,医疗资源利用率高。在规范管理的前提下,安全可行,值得进一步推广应用。     

Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists

Background: Medical emergencies in dental offices are considered a problem in most countries owing to dentists’ concerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medical emergencies in dental offices and dentists’ preparedness have been analysed in several countries but have never been studied in Poland. Aim: To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists’ preparedness and attitudes towards medical emergencies. Methods: An 18-item questionnaire was completed by 419 dentists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equipment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard deviation. Pearson’s linear correlation coefficient was used to determine correlation strength. Results: The most common medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5–10 for 0.48% and more than 10 for 0%. As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing seizures. Conclusion: The prevalence of medical emergencies in dental offices in Poland is comparable with that in other countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergraduate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency medical equipment in the dental office.Key words: Dentist, medical emergency, cardiopulmonary resuscitation, dental education     

Aetiological factors for oral manifestations of HIV

OBJECTIVES: Describe the oral diseases in HIV-infected individuals in London, UK and identify social and medical factors related to the presence of specific oral diseases.
DESIGN: Cross-sectional analytic study.
SETTING: Dental clinics.
SUBJECTS: Consecutive sample of 456 patients with HIV infection.
METHODS: Social and medical history and clinical examinations. Univariate and logistic regression analysis.
OUTCOMES: Presence of HIV-associated oral disease.
RESULTS: 80% of patients with AIDS and 50% of patients with HIV had a specific oral disease. The most common diseases were hairy leukoplakia (30%), erythematous candidiasis (24%), pseudomembranous candidiasis (14%), angular chielitis (6%), necrotising periodontal disease (8%) and non-recurrent ulceration (6%).
CONCLUSIONS: The presence of erythematous candidiasis was not related to advanced HIV disease. Pseudomembranous candidiasis, hairy leukoplakia and mucosal ulceration were significantly associated with advanced HIV disease. Smoking was also identified as a strong aetiological factor in oral diseases. Longitudinal studies are required to further explore the prognostic significance of oral diseases in HIV infection.     

Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago

OBJECTIVES: To describe the type and frequency of oral and dental conditions presenting to medical practitioners in Trinidad and Tobago, type of management, and interest in continuing education in oral diseases. METHOD: Cross sectional survey of registered medical practitioners in Trinidad. 20-item self-reported questionnaire. RESULTS: 103 medical practitioners participated in the study (response rate 69%). Mean age 33 years. Mean years since qualifying was 8 years and 72% worked mainly in hospital service or private practice (19%); 67% had seen patients with a dental problems, with 69% of those at least as frequently as once a month. Most frequently seen problems were dental abscess (72.5%) and toothache (59.4%). In the case of dental abscess and oral mucosal infection 31.9% and 63.8% respectively, diagnosed and treated before referring. 84% cent expressed interest in receiving continuing education in oral diseases. CONCLUSIONS: In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.     

Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated.     

重大突发公共卫生事件一级响应下口腔疾病临床研究工作指导建议

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情发展迅速,各地相继启动突发公共卫生事件一级响应。新型冠状病毒肺炎的爆发,对包括口腔疾病在内的临床研究的开展带来了巨大挑战。鉴于口腔疾病专业特点与诊疗操作的特殊性,保障临床研究受试者和相关从业人员的健康与权益、规范临床研究的实施尤为必要。结合国家卫生健康委员会颁发的相关规范标准,并参考部分临床研究相关组织发布的临床试验管理共识和中华口腔医学会制定的疫情期间口腔疾病治疗规范,特制订口腔疾病临床研究工作指导建议,为重大突发公共卫生事件一级响应下口腔疾病临床研究的开展提供参考。     

56例合并系统性疾病的口腔癌患者的治疗效果评价

目的: 总结56例合并系统性疾病的口腔癌患者的诊疗经验。方法: 回顾56例口腔癌患者的临床资料,根据口腔癌的特征,分析和制订局部及全身治疗方案,评价治疗效果。结果: 56例患者分别接受手术、放化疗、免疫治疗等。对34例（60.71%）合并高血压患者、11例（19.64%）合并冠心病患者、1例（1.79%）合并严重心律失常的患者提出心血管治疗意见;对23例（41.07%）糖尿病患者提供了合理化控制血糖的方案;对19例（33.93%）合并呼吸系统疾病的患者提出了相应的肺功能检测及术后并发症的治疗方案。结论: 多学科协作对合并系统性疾病的口腔癌患者的诊疗合理、有效,值得完善和推广。     

Dental management of patients with cardiovascular disease

Authors present the management of patients affected by cardiovascular disease undergoing oral surgical treatment. Oral surgery may influence the health of these patients because of three factors: psychological stress, anesthesia and daily pharmacological therapy. Dentists have to know and apply preventive rules to avoid the risks of medical complications during surgical treatment, they also have to be able to manage cardiological emergencies wherever they occur.