口腔预防医学：绪论

1、口腔预防医学Preventive dentistry一、口腔预防医学的定义 口腔预防医学（preventive dentidtry)是通过预防或减少疾病的发生和发展， 达到促进良好口腔健康和功能。Preventive DentistryDental Public HealthCommunity DentistryPreventive DentistryPrevent and reduce dental diseasesPromote good dental health and functionPhysical modelDental Public HealthPrevent and cont

2、rol dental diseasesPromote dental health through organized community effortPhysical-mental-social modelWider contents (e.g. dental service, manpower)Dental Public HealthDental Public health is the science and art of preventing and controlling dental diseases and promoting dental health through organ

3、ized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual.It is concerned with dental health education of the public, with applied dental research, and with the administration of group dental care programs, as well as the prevention

4、 and control of dental diseases on a community basis. (American Dental Association, 1976)Community DentistryDefine dental problems of communitiesResolve dental problems of communitiesPhysical-mental-social model口腔流行病学简介Introduction of oral epidemiologyAims of oral epidemiologyto study the distributi

5、on of oral health and diseases in populationsto study the factors which affect the distributionto study oral preventive methods and evaluate the effectsto monitor the change of oral health and diseasesto provide information for formulating oral public health strategiesObjective of epidemiological st

6、udyDecisionMake clearWrite downTerms used in oral epidemiologyprevalence (active disease; experience)incidence (person or tissue)mortality (person or tooth)流行病学研究方法分类描述性分析性实验性一次研究横断面研究（现况研究）纵向研究常规资料分析病例报告等病例-对照研究群组研究（队列研究）临床实验现场试验社区干预试验二次研究：系统分析、Meta分析等等观察法实验法Epidemiological study methodsdescriptive

7、 epidemiology cross-sectional study longitudinal study study analyzing available routine data-sets case reportanalytic epidemiology case-control study cohort studyexperimental epidemiology clinical trial field trial community trial流行病学研究方法分类（逆向）指研究对象接触过某种待研究的物质或具有某种研究的特征或行为。是本研究需要探讨的因素。 流行病学研究方法描述性研

8、究 概念：利用已有的资料或专门调查获得的资料，描述研究群体的疾病或健康状态分布并寻找分析其差异及原因，以确定高危人群，形成病因假设，为探讨疾病的病因及防治措施制定等研究提供线索特点:属于观察法，设计上不设专门的对照组，时间上以横断面研究为主，也有前瞻与回顾特点用途例子横断面研究时序上是横断面研究描述分布，寻找病因线索某地区人群的患龋率纵向研究可反映变量的时间变化研究疾病的发生和发展，可作病因分析，估计预后某地区人群的龋病发病率历史资料分析对已有资料做分析或总结根据病史记录、疾病监测描述分布以及变化趋势统计一个医院拔牙的主要原因：龋病、牙周病、外伤描述性研究横断面研究概念：是在特定时间对某一人群

9、或人群样本的患病或健康情况及其主要影响因素所进行的调查特点：1、时序上是横断面研究2、不能得出因果关系的结论3、一般不用于病程短的疾病的研究4、患病率低的疾病不适用本研究5、研究设计不设对照组用途：1、了解群体疾病或健康相关事件 分布情况2、评价防治措施效果3、发现线索探讨疾病的病因4、发现早期患者和高危人群 流行病学研究方法分析性研究分类特点用途例子病例对照研究时间上是回顾性的由果及因可为因果联系提供基础或方向广泛探索、分析某疾病的 影响因素深入检验某个或某几个病 因假说（设）研究健康状态等事发生的 影响因素疾病预后因素的研究临床疗效影响因素的研究药物不良反应相关因素的研究调查幼儿猖獗龋的危

10、险因素：将400名患猖獗龋幼儿作为病例组，400名患非猖獗龋幼儿作为对照组。调查采用发问卷方式，内容包括婴幼儿期喂养方式、日常饮食队列研究时间上是前瞻性的研究对象按暴露与否进行分组 由因到果，能确证暴露和结局之间的因果关系检验病因假设（通常一个） 评价预防效果 研究疾病的自然史调查婴幼儿喂养方式与猖獗龋的关系：喂养方式分两种（喂奶时加糖、喂奶时不加糖），400名喂奶时加糖的幼儿为暴露组，400名喂奶时不加糖的幼儿为非暴露组，连续追踪数年后，观察两组猖獗龋的患病情况。概念：对所假设的病因或流行因素进一步在选择的人群中探索疾病发生的条件和规律，以确定疾病的发生是否与某暴露因子有关，验证病因假设。流

11、行病学研究方法实验性研究特点:1前瞻 为一种前瞻性研究2干预 必须施加一种或多种干预处理3随机 采取严格的随机分配原则4对照 必须有平行的实验组和对照组特点用途例子临床试验以病人为实验对象最理想的条件评价一种或多种临床疗法对疾病转归的影响，研究一种产品的作用及副作用比较两种树脂充填的效果现场试验在现场环境下进行常用来评价疾病预防措施的效果研究氟化泡沫对学生龋病预防的效果社区干预试验社区为单位，对受试社区随机分组，不对社区的个人随机分组常用于评价不易落实到个体的干预措施的效果氟化饮用水对龋病发生的影响RCT (randomized controlled trial)Randomized samp

12、lingControl groupParallel (gender, severity)BlindMulti-centerQuasi-experimentStudy populationstudy populationreference populationVariablecategorical: nominal, ordinal continuous: interval, ratioenumeration data measurement dataindependent & dependent variableReliability Reliability - measurement Chi

13、-square test, t-test, correlation analysis, Kappa test duplicate examination calibration Intra-examiner/inter-examinerValidity Early study of water fluoridation in North America (1ppm）ReporterPlace Age Time DMFT Drop （%）Dean Grand Rapids 1214 1945 9.6 1214 1959 4.356Blayney Evanston 1214 1946 9.0 12

14、14 1959 4.748Hutton Sarnia(control) 1214 1959 7.5 Brantford(Canada) 1214 1959 3.257AstKingston(control) 1314 1960 12.5 Newburgh 1314 1960 3.770Basic oral health survey（2013）Key age group5 yr12 yr15 yr35-44 yr65-74 yrDiseasesDentition status （包括龋病）Gingival bleeding scoresPocket scoresLoss of attachme

15、ntEnamel fluorosisDental erosionTraumatic dental injuriesOral mucosal lesionsDenture statusIntervention urgencyCaries Epidemiology DMF indexfirst described by Klein et al. in 1938-tooth or surface indicesrecord current active caries and past experiencediagnosis made at cavitation level, thus it is e

16、ssentially irreversible but components can changeDMF indexD for active decay in dentineM for missing due to cariesF for filled due to cariesDMF/dmfT/SDMFT,DMFS,dmft,dmfsdmf index in primary dentitiononly missing teeth that cannot be explained by natural exfoliation is included in the m componenttend

17、 to increase with age up to around 6 years and then decrease with age due to natural exfoliationdmf index in primary dentitiondmf适宜用于换牙前儿童龋病的检查 对于混合牙列, 常见的是使用def或df这两个指数都不记录因龋失牙，因为在替牙期常常很难区分脱落的牙齿是因龋失牙还是正常的换牙所致在def指数(Gruebbel ,1944)中，e代表因龋需要拔除的乳牙。df指数则不计因龋失牙def和df在数值上是相等的，def将龋齿分为两种程度来记录龋病检查器械为什么不用尖探

18、针？WHO tooth status assessment-examine 32 teeth for permanent dentition- a tooth is considered present when any part of it is visible-preference is given to recording permanent teeth-status of the crown and the root recorded separately 牙冠状况冠龋诊断标准牙冠有明显的龋洞 或明显的釉质下破坏 或明确的可探及软化洞底或洞壁的病损 记为冠龋龋无龋已充填无龋已充填有龋-

19、不区分原发还是继发Converting WHO codes to DMFT scores-include both crown and root statusbased on 32 teeth-3 situation defined as DTDT include codes 1 and 2 only-MT include code 4 only for subjects under age 30 years-MT include codes 4 and 5 for subjects aged 30 years and above-FT include code 3 only患龋率（Preva

20、lence rate of caries）- Number of examinee with caries (DMF0)/Number of examinee X 100%Root caries诊断标准：色、形、质改变WHO标准与全国流调标准的差异！衡量根面龋指标- 根龋患病率- 平均每人患根龋牙数或牙面数- Root caries index (RCI指数) Surfaces of root with caries (DF)/ surfaces of root opened X 100%龋病流行特征与有关因素Distribution of Caries- Current theory is

21、that the burden of the disease is concentrated in 20-25% of each age group WHO caries level evaluation standard(12-year-olds）0.01.11.22.62.74.44.56.5 6.5 very low low moderate high very highDMFTDistribution of Caries- Dental caries has declined both in established market economies over the past deca

22、des - but still remains a major public health problem- Dental caries is increasing in some developing countries（Established Market Economies）Changes in Caries Levels - 12 year olds DMFTReduction in Dental Caries due to:- Water fluoridation- Use of fluoride toothpaste and mouthrinses- School based fl

23、uoride mouthrinse schemes- Use of fluoride gels and varnishes- Fissure sealing- Dietary changes? dmft(5 yrs) DMFT (12 Yr)1995 4.5 1.02005 3.5 0.5Change of caries level in ChinaDmft/DMFTSource: National Oral Health Survey 2005YearsMean caries experience in ChinaA disease of childhoodorA lifelong chal

24、lengeAge and cariesPrimary 6 months eruption - caries top - 57 year-old drop until 0Permanent 56 years eruption caries increase along with ageAge and caries- Sugar (economy)-Oral hygiene- Use of preventing dental services Location (urban/rural) Primary teeth: 5 Yr：3.54（M） 3.46（F） Permanent teeth: 12 Yr：0.45（M） 0.62（F） 35-44 Yr：3.79（M） 5.23（F） 65-74Yr：13.99（M） 15.32（F）Gender and cariesCaries and FluorideCa2+Ca2+Ca2+Ca2+SugarH+H+bacteriab